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How are certified midwives and certified professional midwives recognized in the United States?

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Midwives assisting a birth while astrologers consult sky charts; woodcut relief print from Jakob Rueff's De conceptu et generatione hominis (1554; The Expert Midwife). — midwifery Midwives assisting a birth while astrologers consult sky charts; woodcut relief print from Jakob Rueff's *De conceptu et generatione hominis* (1554; *The Expert Midwife*).

In the United States, midwifery is practiced through two primary pathways: nursing and direct entry. It is important to clarify that Certified Midwives (CMs) and Certified Professional Midwives (CPMs) are distinct from lay midwives, who lack formal training and are not licensed.1

The recognition of these professionals is based on their specific certification and training:

Certified Midwives (CMs): These are direct-entry midwives who receive formal training and are certified by the American Midwifery Certification Board.
Certified Professional Midwives (CPMs): These are also direct-entry midwives who receive formal training and are certified by the North American Registry of Midwives.

Unlike Certified Nurse-Midwives (CNMs), who must first become nurses before completing postgraduate midwifery training, CMs and CPMs enter the healthcare profession directly as midwives. All these practitioners are considered skilled birth attendants, whereas lay midwives—who operate through informal apprenticeship models—are categorized by the World Health Organization as unskilled birth attendants due to their lack of formal training in emergency techniques.1