Midwife Titles: What is a CNM, CPM, and LM?

Here is what you should know.

In the state of Texas there are three titles of midwifes that operate in the maternal health field. Each title stands as such: Certified Nurse Midwife, Certified Professional Midwife, and Licensed Midwife or Lay Midwife. While each title is guided by values that align with autonomous care and faith in the process of physiological birth, each title comes with different certifications, educational requirements, and scope of practices.

Certified Nurse Midwives are RNs that have continued their education to become an APRN in the field of midwifery. A CNM receives a master’s degree or higher in education from an ACME accredited program on top of an additional 850+ clinical hours in a birth center and hospital setting. CNMs are then required to pass a state licensing exam hosted by the Texas Board of Nursing and a national exam by the American Midwifery Certification Board. CNMs must demonstrate that they meet the Core Competencies for Basic Midwifery of the ACNM. The American College of Nurse Midwives are congruent and often exceed global standards of the International Confederation of Midwives. In addition, CNMs are required to re-certify through the AMCB every five years and must complete additional certification for specific medical procedures such as 3rd and 4th degree laceration repairs.

CNMs operate in hospital settings, in birth centers, in homes and their scope of practice includes gynecological health, family planning; independent prenatal, birth, and postpartum care; sexual and reproductive health, and preconception care. CNMs have the ability to prescribe medications, treat substance abuse disorders, admit, manage, and discharge patients according to the ACNM.

A CPM is a credential issued by North American Registry of Midwives to midwives who have passed NARM’s written exam to establish competency. The acronym CPM stands for, Certified Professional Midwife, a holder of this credential has to demonstrate knowledge, responsible care, and competency in out of hospital setting experiences. To achieve this credential through NARM standards a candidate must graduate from an accredited Midwifery Education Accreditation Council (MEAC) program or complete NARM’s Portfolio Evaluation Process where a midwife’s apprenticeship experience is evaluated to determine if they meet the criteria for certification. A CPM certification is usually an addition to state licensure or a requirement to be licensed, and often states will offer the option or require candidates to take NARM’s CPM exam right after passing state examination. CPMs are required to follow law, regulations and to operate within the scope of licensed midwifery allowed by the state they are licensed in. In the state of Texas a midwife can be licensed without being a CPM however a CPM must be licensed by the state.

NARM is an organization that strives for excellence in creating responsible and skillful midwives. In addition to having their program reviewed by independent researchers, NARM’s CPM program was accredited by the NCCA in 2002 and has been re-accredited every year since. It is important to note that NARM is not a regulatory organization, however they do review CPM credentials and receive complaints against midwives who hold a CPM credential.

For the next portion of this article, we will be discussing Licensed Midwives. A licensed midwife is someone who has completed all educational and clinical requirements in the state they are applying, in addition to passing a licensure examination given by the state. The educational requirements and scope of practice vary depending on which state a midwife is becoming licensed in. For example, the state of California requires candidates to complete a MEAC, accredited program approved by the Medical Board of California along with state examination, required 1350 clinical hours and other certifications.

The state of Texas offers multiple pathways for education which are: any MEAC program, two state approved courses that must have a minimum of 250 hours of course work guided by MANA Core Competencies with 1350 out of hospital clinical hours, or become a CPM through NARMs PEP, or apprenticeship pathway. These educational requirements are determined by TDLR, a professional licensing department in Texas.

Licensed midwives operate in out of hospital settings such as birth centers and home births. Generally, a LMs scope of practice includes prenatal, newborn and post-partum care within the boundaries of a normal low risk pregnancy. With few exceptions, licensed midwives are not permitted to administer pharmaceuticals or perform certain medical procedures as they do not have the clinical experience or education medically to safely perform these duties, an exception to this clause would be standing orders for pharmaceuticals from a physician that are renewed yearly.

The CNM, CPM, and LM roles play an important part in the maternal health professionals available to Texas mothers. It is important to understand the roles, education, and scope of practice within each title of midwifery to be able to make informed decisions about your maternal healthcare. With adequate knowledge available to patients, it is my belief that mothers can be empowered to act on that knowledge to make choices based on personalized health.