CNMs Don’t Want to Play with CPMs

The ACNM has just posted a letter on their website which expresses the disdain that some in the organization have for homebirth midwives (specifically, CPMs). It cites the fact that many women who have passed the CPM credential have learned by apprenticeship. Not only have they learned by apprenticeship and don’t have a university degree but even their teachers have learned by apprenticeship and don’t have a degree. Oh dear, the sky is falling, the sky is falling. How is it possible that clean, tidy, smart nurse midwives with a degree might be lumped in with the unwashed self-taught midwife? We recognize the caste system as observers outside of India looking in but, what we can’t see is the caste system within obstetrics that is impervious to change. Based on beliefs, traditions, entrenched learning and old grudges, this caste system is self perpetuating and impenetrable. All the “Big Pushes” in the world won’t make a dent in this North American version of it.

It does not occur to the policy makers at the ACNM that the very education that they hold up as the gold standard is the education that has led to:

-nurse midwives who have never seen a normal birth (home birth without interference)
– CNMs who have a very high rate of cesarean section in their hospital based work

-CNMs who hide behind protocols even when they don’t make any common sense at all
e.g. “I don’t WANT to induce women at 41 weeks but my protocols. . . ”

-CNMs who have been doling out outrageous amount of antibiotics to childbearing women and their babies.

-CNMs who have fought for the right to mutilate the genitals of innocent boys

-CNMs who have turned a blind eye to the need for food programs and improved nutrition for pregnant women

-CNMs who have used ultrasound and dopplers on every pregnant client and never questioned the harm they are doing

The ACNM may think they have an elite training program but teaching new recruits the same misinformation that their professors have perpetrated for years is not an advancement for women.


The ACNM does not seem to realize that this is the computer age and information is readily available to practitioner and client alike.  Every time I have taken a nurse midwife, obstetrical nurse or doctor to a homebirth, they have come away in awe about how much they learned.  Of course, those individuals had the humility to be open to learning and that is sometimes missing in people with university degrees on their walls.

I don’t know how long that letter will be up on the ACNM site because someone may come along and realize that it makes nurse midwives look like arrogant idiots.  Read it quick so you can mark this place in history.

More about contortions in licensing midwives in this post “Living Exposed”

Gloria Lemay

9 thoughts on “CNMs Don’t Want to Play with CPMs

  1. I would rather have a midwife who was trained through apprenticeship, who understands and reveres the choices of a birthing woman and understand what Natural Childbirth is about, than a Registered midwife with a shiny degree (issued by the medical machine) that has no real knowledge or experience in TRUE natural childbirth!!!

  2. The sad fact is that most women would be better off having a chimpanzee attend a birth than ANY midwife or physician in N. America. That’s why there is a growing unassisted birth movement. Gloria

    p.s. here’s the letter from ACNM for those who don’t like to go to links

    July 15, 2009
    Special Alert to ACNM Members: Recent Developments Related to Attempts to
    Provide Federal Recognition to All CPMs
    As we enter into the critical next few weeks of federal health reform debate, ACNM continues to devote unprecedented resources to our legislative agenda: reimbursement equity for CNMs and CMs; recognition of CNMs and CMs as primary care providers; inclusion of maternity and newborn care as guaranteed minimum benefits; increased funding for graduate nursing education and loan repayment programs available to CNMs and CMs; funding for women’s medical home demonstration projects; and other exciting opportunities. We have made remarkable strides in gaining congressional support and we will need to maintain an aggressive presence to achieve victory on this ambitious agenda that will dramatically enhance access to midwifery care in the US. These are exciting times!
    In this whirlwind of legislative activity, ACNM also faces situations in which we must articulate the values and principles of our organization in ways we’ve not been called upon to do in the past. This week, ACNM expressed to members of Congress our opposition to federal recognition of certified professional midwives (CPMs) who have not successfully completed an accredited formal education program, as covered practitioners under the Social Security Act for the purpose of providing services under Medicare or Medicaid. We did so in response to the recent legislative activities of the Midwives and Mothers in Action (MAMA) Campaign (, a coalition working to gain federal recognition of all CPMs. ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support, and significant reflection by the ACNM Board of Directors regarding the mission ( and fundamental principles of our organization.
    Read ACNM’s letter to Congress on CPM legislation at
    ACNM’s Position
    ACNM’s official position is that recognition as a professional midwife in the US requires (1) successful completion of a formal education program accredited by an agency recognized by the US Department of Education; (2) national certification; and (3) licensure in the state in which services are provided. This position was explicitly articulated in ACNM’s January 2008 ACNM Issue Brief, “Midwifery Certification in the United States.” Through this statement, for the first time, ACNM recognized the value of the 8403 Colesville Road, Suite 1550, Silver Spring, MD 20910-6374
    phone: 240.485.1800 fax: 240.485.1818
    accredited education pathway and certification processes developed by the CPM community, while also clarifying that ACNM does not support apprentice pathways to certification. This position was re‐evaluated, slightly revised, and re‐issued as an official ACNM Position Statement in March 2009 ( A motion to further revise the position statement to soften ACNM’s position regarding the need for formal education was made at the second business meeting of the recent ACNM 54th Annual Meeting, but was defeated by a majority of the ACNM membership present.
    CNMs in the US have supported formal university‐based education for more than 80 years. ACNM’s intensive engagement this year in federal health care reform as well as our work with the multi‐disciplinary Coalition for Patient Rights ( has further reinforced our commitment to these principles. In fact, our current efforts to secure primary care status for CNMs and CMs in federal legislation have been hampered by a perceived lack of formal educational standards in the midwifery profession.
    Moreover, ACNM does not believe that lesser standards of education should apply for midwives who are attending home births. In fact, because home birth midwives are frequently working independently with reduced access to consultation with other health care professionals, we believe that they should be among the most highly trained maternity care providers.
    There is no precedent for extending federal recognition under the SSA to a class of health care providers who lack a formal education from an accredited health care program or institution. ACNM believes that doing so at this time would be inconsistent with the standards and oversight processes that are well established and provide a critical level of quality assurance in the health professions in the US.
    The Lack of Uniform Educational Standards in the CPM Credential
    While some CPMs have graduated from an academic program accredited by the Midwifery Education Accreditation Council (MEAC), others have completed apprentice programs with no minimum educational requirement or qualified faculty oversight. At least half of the 1400 current CPMs have been trained through apprentice routes, according to CPM leaders.
    The CPM credential is conferred by the North American Registry of Midwives (NARM). Like the vast majority of certifying bodies, including the American Midwifery Certification Board (AMCB), NARM is accredited by the National Organization for Competency Assurance’s National Commission for Certifying Agencies. Accreditation of the certifying body, however,is not the same as requiring graduation from a formal accredited educational program prior to taking the certification exam.
    Midwifery in the Global Context
    The value of formal, accredited education in the health professions is universally recognized. Just this year, the World Health Organization (WHO) issued new standards calling for initial education of midwives at the bachelor’s level from accredited institutions with qualified midwifery faculty. As a nation with a well‐developed health care infrastructure, the US should lead the way in professional standards—not accept a lesser standard for midwifery than any other health care profession.
    The WHO standards are located at
    In Closing
    ACNM sincerely applauds the progress that the CPM community has made in moving toward a framework of professional standards and processes for CPM education and credentialing. However, the lack of a uniform standard of accredited formal education remains a critical missing component. Until the CPM credential includes this uniform educational standard, ACNM must oppose federal recognition of CPMs without the above credentials.
    ACNM leaders appreciate that this is a challenging and even emotional issue for many ACNM members who value the passionate energy that CPMs have helped to generate for midwifery and out‐of‐hospital birth. We understand that many of our members work with CPMs directly or in other ways.
    We strongly support the right of women to have choices in childbirth and that the current maternity care system does not always meet their needs. In many venues on the federal and state level, ACNM works to support these choices and to improve the maternity care system and enhance the availability of high‐quality midwifery care to all women in all settings.
    ACNM looks forward to the day when there is one unified profession of midwifery, with unified standards for education and credentialing, working toward common goals. In the meantime, we continue to maintain our long‐held standards for academic preparation and clinical practice and we will continue our dialogue with our CPM colleagues in the interest of one day attaining that goal.
    Continue to look for news on ACNM legislative priorities in ACNM’s Quick e‐news and the ACNM web site in the coming weeks and months as Congressional leaders work to enact federal health care reform. ACNM has been and continues to be well represented in Washington and through our hard‐working Government Affairs Committee and federal lobbyist Patrick Cooney, who have worked tirelessly to build congressional support to enhance access to midwifery care.
    ACNM members wishing to express their views on this or other federal legislative issues are encouraged to contact ACNM at

  3. sounds to me like some have their panties in a twist because they paid out lots of money to be the ‘authorities’ on natural childbirth, yet here are these women, practicing without an expensive medical degree, doing better work than the others could ever imagine doing.

    maybe they need to be schooled about where midwifery came from in the first place. not from doctors and medical books and sitting in a classroom reading manuals….but from nature, from being present and watchful, observing the process in action and learning from it. why are people so afraid to let nature teach them?

  4. It’s true. I confess it’s all true. Certified Professional Midwives do not have to take O-chem. I took O-chem for fun as I thought it might help me with my home brewing, but as it turns out, O-Chem is not very helpful in the clinical practice of making beer at home. Perhaps being able to understand whether the central carbon atoms in the molecule labeled as pitocin are SP2 or SP3 hybridized is really, really important to the practice of nurse midwifery in the hospital setting. If so, I am sure that Melissa Avery, PhD, CNM, FACNM, FAAN wouldn’t mind taking a test in O-Chem to assure her understanding of the science remains adequate. I am thinking to entitle this test “Organic Chemistry for Practicing Nurse Midwives – Knowledge Retention Examination.” Of course I need to provide a release form so that I can publish the results in Midwifery Today….

    I will be shocked if she gets a single question correct.

    It is interesting. The CPMs are the only ones trained to do this work. The CPMs are the ones doing most of the work. The ACNM has had decades to get the job done, but has failed. We have women birthing at home unattended because they cannot find a midwife to attend them. We have women abandoning their birthing decisions because they cannot find a midwife to attend them. We have underwhelming outcomes at full retail prices. Nevertheless, the leadership of ACNM is fond of professional finery.

    I am struggling to understand why the folks who aren’t getting the job done are lobbing rocks at the ones who are. Perhaps this is just too complex a topic for me.

    Thanks for listening,


    p.s. I support and adore our nurse midwives. We need 10 times the number we have. Unfortunately, this little marshmallow is hurtful to women.

  5. Apparently, it has already been removed. I can’t find anything labeled “special alert” or any letter on this topic. Figures.
    Power. Control. Money.
    It always boils down to that.

  6. Thank you for posting this and reminding me why the ACNMs position is not a good one! I am trying very hard to be a protector of normal birth in the hospital but it is impossible. A CNM in my community has a 90% induction rate! Her midwifery education was a quick route to medical school!

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