System Failure: No Accountability, No Justice

Overview

The Certified Professional Midwife (CPM) model is not only clinically risky, it is structurally unaccountable. When something goes wrong, families often have no clear path to justice, and midwives face no meaningful oversight or professional discipline. Legislators have created licensure laws without enforcement mechanisms. Credentialing bodies prioritize protection over transparency.

The result is a system that fails everyone involved, including the midwives themselves.

Licensing Without Enforcement

• Many states license CPMs without requiring malpractice insurance, hospital privileges, or quality oversight.

• In most jurisdictions, no agency regularly reviews outcomes, audits cases, or investigates complaints.

• Licensing grants legal recognition without attaching enforceable professional standards such as what level of risk is legally acceptable to manage at home.

A license without accountability is not protection. It is permission without consequence.

Midwives Left Without Guardrails

Most CPMs:

• Work in isolation, without supervision or clinical review.

• Receive certification from NARM, which does not investigate complaints without full maternal consent, even in the event of death.

• Are not subject to standardized peer review or formal reporting requirements.

This lack of structure leaves midwives vulnerable to accusations, unprotected from legal risk, and without the systems needed to improve their practice.

Lawmakers and Prosecutors Face Gaps

• Statutes governing CPM scope of practice are often vague or absent.

• Prosecutors struggle to bring cases, even in fatal outcomes, due to unclear legal standards and limited authority.

• When laws are unclear, serious safety violations may result in no charges, no revocation, and no restitution for families.

Families Left With No Recourse

• Most CPMs do not carry malpractice insurance, so civil lawsuits often offer no compensation.

• Complaints to certifying bodies may be ignored or dismissed without explanation.

• Families may discover too late that their provider was not held to the same standards as other licensed professionals.

In many cases, no one is held accountable. No corrective action is taken. And the same risks persist for the next family.

Licensing Does Not Equal Protection

Creating a licensing pathway without guardrails does not protect the public. It creates a false sense of legitimacy, undermines trust in health systems, and leaves both midwives and families exposed to avoidable harm.

The solution is not more licensing. It is better oversight, clearer laws, and higher standards of accountability. If a profession cannot meet those minimum standards, it should not be licensed.