A certified nurse-midwife is a registered nurse with graduate education in midwifery, licensed as an advanced practice registered nurse and certified by the American Midwifery Certification Board. Nurse-midwives attend close to one birth in ten in the United States, and the great majority of those births happen in hospitals rather than at home.
The role covers more than birth. A nurse-midwife provides prenatal and postpartum care, gynecological and contraceptive care, and primary care for women across the lifespan, and in many rural counties is the only clinician offering any of it.
The credentials are not interchangeable
Three American credentials use the word midwife and they are earned differently.
The certified nurse-midwife is a nurse first. Registered nurse licensure, then a graduate midwifery program, then national certification, then an advanced practice license from a state board of nursing. This is the role covered by levels of nursing as one of the four advanced practice roles.
The certified midwife holds the same national certification and the same graduate education but entered without a nursing background. Only a minority of states license the role at all.
The certified professional midwife is a separate credential, awarded by a different body, focused on out of hospital birth and not built on nursing education. Legal status varies enormously by state, from full licensure to prosecution.
Confusing the three is common in news coverage and in legislation, and the distinctions decide who may practice where.
Where it started
Midwifery in America was largely driven out of practice in the early twentieth century as birth moved into hospitals, and nurse midwifery was reintroduced deliberately.
Mary Breckinridge trained as a midwife in England because no American training existed, and in 1925 founded what became the Frontier Nursing Service in Leslie County, Kentucky. Her nurse-midwives rode circuits through a thousand square miles of mountain country from small district centers. The county's maternal death rate fell from the worst in the country to well below the national average, and the service's records became the first serious American evidence that midwife attended birth was safe.
The first American nurse midwifery school opened at the Maternity Center Association in New York in 1932, staffed by a graduate of Breckinridge's service. The Frontier Nursing Service opened its own school in 1939, and its successor, Frontier Nursing University, still trains nurse-midwives and nurse practitioners in Kentucky. The American College of Nurse-Midwives was founded in 1955.
Practice and regulation
Nurse-midwives are licensed in all fifty states, but the terms differ as much as they do for nurse practitioners. Some states grant full practice authority under the board of nursing alone. Others require a collaborative agreement with a physician, and in a few the agreement must be with an obstetrician specifically, which is a real constraint in counties that have none. See nurse practitioner practice authority and collaborative practice agreements.
Hospital privileges are a second gate. A nurse-midwife with an unrestricted state license still needs privileges from the hospital where they intend to attend births, granted through medical staff bylaws that the state does not control.
The Nurse Licensure Compact does not cover advanced practice roles, so a nurse-midwife working across a state line needs a license in each state.
Why the numbers matter now
The United States has the highest maternal mortality rate in the developed world, and rural obstetric units have been closing for two decades, leaving counties described as maternity care deserts where the nearest labor and delivery unit is an hour or more away. See rural and frontier nursing.
Nurse midwifery is one of the few available answers, which is why practice authority for the role has moved up the legislative agenda in states that had not touched it in years.
Related
- Levels of nursing
- Nurse practitioner practice authority
- Mary Breckinridge
- Rural and frontier nursing
- Nursing in Kentucky
Sources
- Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. U.S. Bureau of Labor Statistics, May 2025 data. Accessed September 8, 2026.
- Essential facts about midwives. American College of Nurse-Midwives, on credentials, birth share and practice settings. Accessed September 8, 2026.
- American Midwifery Certification Board. On the certified nurse-midwife and certified midwife credentials. Accessed September 8, 2026.
- Frontier Nursing University, history of the Frontier Nursing Service. Accessed September 8, 2026.