If you're considering a home birth, you'll likely meet midwives with different credentials. Understanding what a CPM had to do to earn that title helps you evaluate whether their training matches what you need for your birth.
What education does a CPM need before taking the certification exam?
The North American Registry of Midwives (NARM) requires CPM candidates to complete specific educational benchmarks before sitting for the exam. They must document at least 1,873 hours of didactic education covering anatomy, physiology, prenatal care, labor management, newborn care, and complications.
Candidates complete this education through one of three pathways: accredited midwifery schools, portfolio evaluation programs (structured self-study with preceptors), or MEAC-accredited distance learning programs. All three routes require the same clinical experience and exam, but the timeline varies from 2 to 5 years depending on the pathway.
The didactic requirement increased from 1,350 hours to 1,873 hours in 2012. This puts CPM education roughly equivalent to an associate degree in terms of classroom hours, though the content focuses exclusively on physiologic birth and midwifery skills.
How much hands-on birth experience must a CPM have?
NARM requires candidates to attend at least 75 births total before certification. Of those, they must serve as primary midwife for at least 50 births, meaning they were the lead clinician responsible for care during labor and delivery.
The 75 births break down into specific categories: at least 50 as primary under supervision, at least 20 continuity of care experiences (where the student followed the client from prenatal through postpartum), and documented experience with variations like twins, breech, or water birth. Candidates must also attend at least 20 prenatal exams, 20 newborn exams, and 20 postpartum visits.
For comparison, Certified Nurse Midwives (CNMs) attend a minimum of 40 births during their graduate program, though many attend more. The CPM pathway requires more births but all occur in out-of-hospital settings, while CNM students typically train primarily in hospitals.
- How many births had you attended when you took your CPM exam?
- What percentage of your training births were home births versus birth center births?
What does the CPM certification exam test?
The NARM Written Examination covers prenatal care, intrapartum care, newborn care, postpartum care, well-woman gynecology, and complications management. The exam contains 350 multiple-choice questions administered over two 3-hour sessions.
Candidates must score at least 70% to pass the written exam. The pass rate for first-time test-takers averaged 84% between 2015 and 2020. Those who pass the written exam then complete a Skills Assessment, where they demonstrate hands-on competencies like suturing, newborn resuscitation, and physical exam skills.
NARM updates the exam every few years based on a job analysis study of practicing midwives. The most recent update in 2020 added more questions about informed consent, shared decision-making, and recognition of complications.
Does a CPM need to maintain their certification?
CPMs must recertify every three years through NARM's renewal process. Recertification requires 30 continuing education contact hours, proof of current CPR certification, and documentation of active midwifery practice or an alternative pathway for those not currently practicing.
The continuing education must include at least 2 hours on cultural competency, 2 hours on communication and ethics, and specific clinical topics that change each cycle. CPMs must also submit peer review documentation showing other midwives have evaluated their clinical skills and outcomes.
CPMs who let their certification lapse can reinstate within 5 years by completing additional continuing education and paying reinstatement fees. After 5 years, they must retake the full certification exam.
- When does your current CPM certification expire?
- What continuing education have you completed in the past year?
How does CPM training differ from CNM training?
Certified Nurse Midwives (CNMs) must first become registered nurses, then complete a master's or doctoral degree in nurse-midwifery accredited by the ACME. This takes 6 to 8 years total. CPMs enter midwifery training directly without nursing degrees, completing 2 to 5 years of midwifery-specific education.
CNM programs train students in hospitals and include managing epidurals, vacuum extraction, and medication administration. CPM training occurs in homes and birth centers and focuses on physiologic birth without routine interventions. CNMs can work in hospitals, birth centers, or homes. CPMs work only in out-of-hospital settings.
Both credentials require national certification exams and state licensure where applicable. CNMs hold licenses in all 50 states. CPMs hold licenses in 38 states as of 2024, though they practice legally in several others through different mechanisms.
What ongoing skills must CPMs maintain?
Beyond continuing education, CPMs must maintain current certification in neonatal resuscitation through an approved provider like the American Academy of Pediatrics NRP program. Most states that license CPMs also require adult CPR certification and training in recognizing medical emergencies.
Many CPMs maintain additional certifications in water birth, breech birth, or twin birth through organizations like the Academy of Vaginal Breech Birth. These advanced skills aren't required for the CPM credential but allow midwives to attend births outside standard low-risk parameters if permitted by their state.
Some states require CPMs to carry specific emergency medications like oxytocin, methergine, and IV fluids. The CPM certification doesn't include prescriptive authority, so midwives work with collaborating physicians or follow state protocols for carrying these medications.
- What emergency medications do you carry to births?
- Do you attend breech or twin births, and what additional training do you have for those situations?
How much does CPM certification cost to obtain and maintain?
The NARM application fee costs $75, and the written exam costs $550. The Skills Assessment costs an additional $250. Total NARM fees for initial certification run $875, not including the cost of the education program itself.
Midwifery education programs vary widely in cost. Accredited midwifery schools charge $15,000 to $50,000 for complete programs. Apprenticeship pathways cost less in tuition but require unpaid clinical hours that can span 3 to 5 years. Portfolio evaluation programs through organizations like MEAC charge $3,000 to $8,000 in administrative and preceptor fees.
Recertification every 3 years costs $175, plus the cost of continuing education courses which typically run $200 to $500 total depending on the format. Most CPMs also pay $200 to $400 annually for professional liability insurance and $100 to $500 annually for state licensing fees where applicable.
A CPM has completed at least 1,873 hours of education, attended 75 births including 50 as primary midwife, passed a national exam, and maintains certification through continuing education every 3 years. This training prepares them specifically for physiologic birth in homes and birth centers, not hospital-based care. When interviewing midwives, ask how long they've held their CPM, how many births they've attended since certification, and what additional training they've pursued beyond the baseline requirements.
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Sources
- North American Registry of MidwivesCPM candidates must complete at least 1,873 hours of didactic educationView source
- North American Registry of MidwivesCandidates must attend at least 75 births total, with 50 as primary midwifeView source
- North American Registry of MidwivesPass rate for first-time CPM exam takers averaged 84% between 2015 and 2020View source
- North American Registry of MidwivesCPMs must recertify every three years with 30 continuing education hoursView source
- National Association of Certified Professional MidwivesCPMs hold licenses in 38 states as of 2024View source
- North American Registry of MidwivesNARM certification fees total $875 for initial certificationView source