CPM Midwife Requirements Training, Birth Attendance, Certification, and Licensing

The CPM credential is built around out-of-hospital birth. NARM describes it as the only national credential that requires knowledge and experience in out-of-hospital settings. ^[1] When you are hiring a midwife, the practical question is not only whether she earned the credential, but whether she is currently certified, legally able to practice in your state, and active enough to keep her emergency skills sharp.

The North American Registry of Midwives (NARM) validates midwifery education through one of four routes: completion of NARM's Portfolio Evaluation Process (PEP), graduation from a program accredited or pre-accredited by the Midwifery Education Accreditation Council (MEAC), certification by the AMCB as a CNM or CM, or legal recognition in a state or country NARM has already evaluated for educational equivalency. ^[1] In practice, NARM's application page also lists separate routes for US state-licensed midwives and UK Registered Midwives. ^[4]

MEAC is authorized by the US Department of Education to accredit midwifery education programs and institutions. ^[2] MEAC-accredited programs document didactic and clinical hours through their accreditation; PEP candidates document equivalent education through a portfolio reviewed by NARM Registered Preceptors.

Whatever the route, NARM requires that the clinical component of the educational process run at least two years and include a minimum of 55 births in three distinct categories. Apprenticeship-based training typically lasts three to five years. ^[1]

NARM's Entry-Level Portfolio Evaluation Process runs in four phases. Phase 1 requires at least 10 births attended in any setting and any capacity, including at least 2 planned hospital births. Phase 2 requires at least 20 births as an assistant under supervision, plus 25 prenatal visits (including 3 initial exams), 20 newborn exams, and 10 postpartum visits. Phase 3 requires at least 20 births as primary midwife under supervision, plus 75 prenatal exams (including 20 initial exams), 20 newborn exams, and 40 postpartum exams. Phase 4 adds 5 more births as primary under supervision. ^[1]

That comes to a minimum of 55 births before the exam and 25 births as primary midwife under supervision in total. Of the 20 Phase 3 primary births, 5 require full continuity of care (five prenatals spanning at least two trimesters, the birth, the newborn exam, and two postpartum exams), 10 more require at least one prenatal visit with the same client, and at least 10 must take place in homes or other out-of-hospital settings. ^[1]

CNM and CM training is structured differently. It is competency-based against the ACNM Core Competencies rather than built on a documented birth count, is delivered at the graduate level in ACME-accredited programs, and takes place mostly in hospitals. ^[2]

The NARM Examination is computer-based: 300 multiple-choice questions delivered in two three-hour sessions. Every application route requires passing it, and NARM notes the exam is required for state licensure in all states that license direct-entry midwives to attend births primarily in out-of-hospital settings. ^[1]

Question content comes from NARM's Written Test Specifications and Examination Reference List, which in turn are drawn from the MANA Core Competencies and NARM's periodic Job Analysis, a survey of how midwives across the country actually practice. Many midwifery schools build curriculum against those test specifications. ^[1]

Hands-on skills are handled separately from the exam. Entry-level midwifery skills are demonstrated to and signed off by NARM Registered Preceptors during clinical training, using NARM's Verification of Skills forms. ^[1]

CPMs recertify every three years. [1,2] Each cycle has a set of mandatory areas plus continuing education. The mandatory areas are 5 contact hours of peer review (participating in peer review or attending a peer review workshop), current CPR and neonatal resuscitation certification, a workshop, course, or module on cultural awareness completed within the last three years, an affirmation that the midwife currently uses Practice Guidelines, an Emergency Care Form, Informed Disclosure, and Informed Consent documents, and current demographic information. ^[5]

On top of the mandatory areas, a CPM chooses one of two options: 25 contact hours drawn from NARM's seven continuing education categories, or retaking the NARM Examination. That puts the usual total at 30 contact hours per three-year cycle. ^[5]

If certification lapses, there is a 90-day grace period to submit recertification requirements. After that the CPM is expired, and reactivating requires documented attendance at 5 births within 5 years of reapplying, 30 contact hours in the last 3 years including 5 hours of peer review, current CPR and NRP, and either retaking the NARM Examination or submitting a current state midwifery license or AMCB certification. ^[1]

CNMs hold a bachelor's degree and an RN license, then complete a graduate-level midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME), and are certified by the American Midwifery Certification Board (AMCB). CPM certification does not require an academic degree; it rests on documented competency in the areas NARM specifies. ^[2]

The training environments differ too. CNM programs are largely hospital-based, and more than half of clinical education must be supervised by a CNM or CM. CPM training centers on physiologic birth outside hospitals, and at least 10 of the 20 Phase 3 primary births must occur in homes or other out-of-hospital settings. [1,2]

Both credentials require a national exam and ongoing recertification: AMCB on a five-year cycle, NARM on a three-year cycle. Both certifying bodies are accredited by the National Commission for Certifying Agencies. On practice settings, CNMs and CMs work in hospitals, homes, birth centers, and offices, with the majority of their births in hospitals; CPMs work in homes, birth centers, and offices, with the majority of their births at home or in birth centers. ^[2]

On licensure, CNMs are licensed in all 50 states, DC, and the US territories. CPMs are licensed in 37 states and DC. [2,3] Massachusetts added a licensure pathway under Chapter 186 of the Acts of 2024, which created a Board of Registration in Midwifery inside the Department of Public Health and requires a valid NARM CPM credential for licensure. ^[6]

NARM requires current CPR and neonatal resuscitation certification for both certification and recertification. NRP Advanced has been the standard since March 1, 2023, though NARM continues to accept unexpired NRP Essentials plus BLS for Health Care Providers. Neonatal resuscitation courses must be approved by the American Academy of Pediatrics, the Canadian Paediatric Society, or NARM. Approved CPR providers include the American Heart Association, the Red Cross, ASHI Basic Life Support, and the Heart and Stroke Foundation of Canada. NARM accepts only courses with a hands-on skills component; online-only courses do not count. ^[7]

Some midwives pursue further training in breech birth, twin birth, or water birth through continuing-education providers. That training is not part of the CPM credential, and whether a midwife may attend those births at home depends on state law and her own practice guidelines.

CPMs do not hold prescriptive authority. In some states they may obtain and administer specific medications, such as those used for postpartum hemorrhage, under state rules. ^[2] Ask directly what a midwife carries and what her state permits.

NARM publishes a current fee schedule. For the Entry-Level PEP route, the phase application fees are $240 for Phase 1, $450 for Phase 2, $450 for Phase 3, and $135 for Phase 4, a total of $1,275, with the examination billed separately at $1,155. MEAC graduates pay $1,365 with the examination included; the CNM/CM route is $1,260, the UK Registered Midwife route $1,210, and the state-licensed midwife route $55 plus the $1,155 exam fee where applicable. An examination retake is $210. ^[8]

Recertification costs $216 when submitted before expiration, or $270 within 90 days after. Reactivating after expiration, including the required examination, is $790. ^[8] Verify current amounts before budgeting, since NARM updates the schedule.

Education costs sit on top of certification fees. MEAC-accredited programs generally charge in the tens of thousands for a complete program. Apprenticeship pathways cost less in tuition but require years of clinical hours that are often unpaid. Most state-licensed CPMs also pay state licensing fees and, where they carry it, professional liability insurance, whose availability and cost varies by state and credential.