Excerpted from Homebirth Making it Happen by Anne Sommers and Abbi Perets
Despite the many terms you may hear, there are basically only two kinds of midwives: lay midwives and certified nurse midwives. The difference between the two is their training.
Lay midwives (also referred to as traditional midwives, empirical midwives, or direct-entry midwives) are not nurses; rather, they're women who have had direct training in midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program that is separate from the field of nursing. Lay midwives are trained to provide the Midwifery Model of Care to healthy women and newborns throughout the childbearing cycle, primarily in non-hospital settings. Some lay midwives become certified professional midwives (CPMs) or licensed midwives (LMs).
CPMs are independent practitioners who meet the certification standards set by the North American Registry of Midwives (NARM). The NARM certification process verifies a midwife’s knowledge and skills through written examinations and skills assessments, all of which includes training in out-of-hospital births.
A licensed midwife is sanctioned by her state after she passes a test administered by the state’s medical board licensing division. Licensing requirements differ among states; some, like Oregon, do not require licensing at all. Lay midwives in eight states – Indiana, Iowa, Kentucky , Maryland, Missouri, North Carolina, Virginia, and Wyoming – and in the District of Columbia legally are not able to become licensed midwives. So while you may be able to have a legal homebirth in those states, a lay midwife could risk arrest by attending.
Certified nurse-midwives (CNMs) first train as nurses and usually work as nurses in hospitals for several years while they attend a program accredited by the American College of Nurse Midwives Certification Council. Once they complete their midwifery studies, they must pass an examination to be licensed in the individual states in which they practice. CNMs typically work in hospitals and birth centers.
Of course, the groups overlap somewhat. Each midwife is also a unique individual, and you should consider much more than the letters after her name.