In some states, such as California, Florida and Washington, direct-entry midwives are licensed by the state with strict requirements for state-approved formal education or approved equivalency options. (These three states presently extend licensure reciprocity.) In several other states, direct-entry midwifery is licensed or otherwise regulated and educational requirements involve alternate routes and/or the demonstration of didactic and clinical competency. And in other states midwifery practice is either legal but unregulated or illegal. In these situations, midwifery training is typically obtained by a combination of preceptorship and independent or group study. The Nizhoni Institute of Midwifery combines the best of didactic education with preceptorship and is designed to meet the most stringent requirements for state midwifery licensure.
In California, midwives are licensed by the Medical Board of California to practice in every setting: birth centers, homes, hospitals, public health clinics, and physician and midwifery offices. California’s standards for midwifery education are among the highest in the nation and licensed midwives enjoy a broad scope of practice.
Certified Nurse-Midwife or Certified Midwife
A student who is a registered nurse may enter a program approved by the American Midwifery Certification Board (AMCB) of the American College of Nurse-Midwives to become a certified nurse-midwife or CNM. These programs are university-affiliated and require a baccalaureate degree as a prerequisite to application. A few programs allow non-nurses with a baccalaureate in another field to enter a three-year Master of Science program. During this time they study basic nursing, obtain a nursing degree and then complete a Master of Science in Nursing or a Master of Science in Midwifery. They are then allowed to take the examination for certification as a nurse-midwife. The majority of CNMs in the United States practice in hospitals or birthing centers, although about 1% attend homebirths. A few AMCB-approved programs in the United States offer a direct-entry, Certified Midwife credential to non-nurses. at present only a small number of states in the United States recognize the CM credential.
OB/GYN Physician Assistant
Another route to working with birth and women’s health care involves becoming a Certified Physician Assistant (PA-C) with a specialty in obstetrics and gynecology. Physician Assistants must have a supervising physician and are allowed to practice to the full extent of their training, although in most states they have less practice autonomy in comparison to advanced practice nurses. Physician assistant programs are university-based but the prerequisites, length of training, and degree earned varies.
Apprenticeship is a time-honored method of midwifery training but does have two significant weaknesses. First, many midwives do not actually teach needed didactic information to their apprentices. Second, apprentices tend to inherit and perpetuate a preceptor’s areas of knowledge deficit and may not have sufficient knowledge or experience to recognize their problem areas.