What's the difference between a Certified Midwife and a Certified Nurse Midwife?
by Karen Jefferson CM
In the state of New York, you may encounter midwives with two different certifications - Certified Midwives (CM) and Certified Nurse Midwives (CNM), both of whom are called Licensed Midwives (LM). Both CMs and CNMs provide midwifery including women’s and transgender healthcare throughout the lifespan, and both attend births in hospitals, birth centers, and homes.
Certified Midwives and Certified Nurse Midwives may have a variety of backgrounds, for example: medicine, physical therapy, policy, advocacy, public health, lactation, social work, arts and sciences, and many others. CMs and CNMs differ in how they entered their midwifery educational programs, but they do not differ in how they left their programs, and how they leave is what is important for their practice.
CMs must take science and social science prerequisites, earn a graduate degree from a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass the American Midwifery Certification Board (AMCB) national examination to earn state licensure.
CNMs must graduate from a nursing school, after which they earn a graduate degree from a midwifery school accredited by the ACME and must pass the same AMCB national exam to earn state licensure.
CMs are educated side-by-side with CNMs in two midwifery education programs: State University of New York, Downstate and the Midwifery Institute at Thomas Jefferson University, where they earn graduate degrees in midwifery. All graduates are eligible for national certification by the AMCB. All graduates demonstrate midwifery practice that meets the ACNM core competencies.
Both CMs and CNMs have the identical ACNM defined scope of practice and follow American College of Nurse Midwives (ACNM) standards and code of ethics for midwifery.
CMs are licensed in NY, NJ, DE, RI and ME. Certified Midwives are able to practice independently to the full extent of their education and training, including prescriptive authority, in NY, RI and ME. In response to the need for more maternity care providers and better access to high quality, high value women's healthcare, additional states are pursuing CM licensure.
CNMs are licensed in all 50 states, and are able to practice independently (including the ability to prescribe) of any agreement with a physician in 25 states. Ninteen states require a written collaborative agreement with a physician, and in the last seven states midwives are able to practice independently with a written physician agreement only for prescribing.
In New York State both CMs and CNMs are independent providers and do not work "under" a physician, though all midwives work within a close network of obstetrical and primary care providers and have a collaborative relationship with a licensed obstetrician.
Licensed midwives are not supervised; they are independent practitioners. New York State law provides that licensed midwives shall have collaborative relationships with: a licensed physician who is board certified as an obstetrician-gynecologist by a national certifying body; or a licensed physician who practices obstetrics; or a hospital, that provides obstetrics through a licensed physician having obstetrical privileges at such institution, that provide for consultation, collaborative management and referral to address the health status and risks of his or her patients and that includes plans for emergency medical gynecological and/or obstetrical coverage. A midwife shall maintain documentation of such collaborative relationships and shall make this information available to his or her patients.