Direct-entry midwife

[7] North Dakota, for instance, is one of many states that have no official laws regulating or prohibiting the practice of midwives without a CNM credential.

States can unintentionally encourage issues with midwifery by not providing standards or licensure opportunities to ensure the competency of midwives.

While Certified Professional Midwifery is legal in Hawaii, licensure has been deemed too expensive and is unavailable to most, according to the Midwives Alliance of North America.

[9] The fall can also be attributed to the movement toward universities teaching gynecology and surgery as well as advancements in technology such as anesthesia and forceps.

During this time period, organized medicine launched a campaign to convince the public that hospital births were the best option, while painting midwives as unintelligent, untrustworthy and criminal.

[10] The State of the World's Midwifery report supports the profession, urging governments to recognize it as vital to maternal and newborn health services.

[3] For instance, to qualify for licensure in California, a midwife must complete a three-year postsecondary midwifery education program and pass a licensing examination.

[3] In Minnesota, licensed midwives are required to screen potential clients, and only accept those who are expected to have a “normal” delivery.

Now, for states that regulate the profession, most of them require midwifery candidates to take the NARM exam and complete NARM certification before receiving a license from the state,[15] however certification and licensure is only recognized in states that legalize and recognize midwifery.” In order to be recognized as a CPM by NARM, a midwife must meet three criteria: meet all education requirements and pass a certification exam; meet minimum experience requirements; document proficiency in all midwifery skills (Stover, 2011, p. 325).