Understanding Midwifery Credentials: CNM, CPM, and Lay Midwives

Choosing an out-of-hospital birth is a powerful decision—one rooted in trust, physiological wisdom, and reclaiming birth as a sacred, family-centered event. But if you're new to this world, the different types of midwives and their credentials can be confusing. Let’s break it down, so you can make an informed choice for your birth team.

CNM – Certified Nurse Midwife
CNMs are registered nurses who go on to receive graduate-level training in nurse-midwifery, usually through hospital-based programs. Most CNMs work in hospitals or under physician oversight, and their practice is highly regulated. While this may sound like a safer option on paper, many CNMs have little to no exposure to natural, undisturbed birth. Their training is rooted in managing risk within a medical model—not in protecting normal birth. These are excellent providers for women with pre-existing conditions, high risk pregnancy, or in- hospital or birth center birth.

Because of strict state protocols and employer policies, CNMs often must follow timelines, require routine interventions, and are bound by hospital rules. Their ability to support true autonomy is limited, and they are often required to transfer care for even minor variations from textbook norms. CNM doesn’t always equal safe, especially for families seeking physiological, low-intervention birth outside of hospital walls.

CPM – Certified Professional Midwife
CPMs are credentialed through a national board that certifies competency in out-of-hospital birth. Their training focuses on home birth and birth center care, and includes an apprenticeship under an experienced midwife, along with academic study and skills testing. While this credential shows dedication and structure, it is still considered entry-level, and experience can vary widely.

CPMs are more likely than CNMs to be comfortable with normal birth and may attend a wider variety of labors without automatic intervention. However, they are still subject to state licensing restrictions in many places, which can limit their ability to provide care that is truly woman-led. They may also be influenced by the pressure to "legitimize" midwifery by aligning with medical systems. The licensure laws will effect their standards and behavior, and its vital that clients screen their midwifery prospects for integrity first, and a solid training background.

Lay Midwife, Community midwife – Traditional, Relationship-Based Care
Lay midwives—or traditional community midwives—are trained through mentorship, experience, and hands-on clinical work, often attending hundreds of births over many years. Their knowledge is deeply rooted in continuity of care, long-term client relationships, and respect for birth as a normal, God-designed process. While not state-licensed, they are skilled in everything from fetal heart monitoring to birth emergencies, hemorrhage management, resuscitations—on par with a seasoned labor and delivery nurse.

Lay or community midwives prioritize autonomy, informed consent, and trust. They are not beholden to hospital timelines or legal liability fears, allowing them to stay present during the birth process without rushing it. Their care is personal, often spiritual, and guided by discernment, not policy. This does not mean unsafe—it means intentional, customized, and deeply human care. Most community midwives have extensive training and run very professional clinical practices, with many supporters in the medical community.

So What’s Right for You?
If you’re looking for a hands-off, mother-led birth supported by someone who truly knows physiological labor—and trusts it—you may find that a lay or traditional midwife is the most aligned with your values. These midwives often have just as much clinical knowledge as a nurse, but carry something far more valuable: relational wisdom, emotional presence, and trust in God’s design.

Out-of-hospital birth is not about rejecting safety. It’s about redefining it.
Safety isn’t a title—it’s experience, discernment, and trust. At Cardinal Birth Midwifery, we honor the sacred work of stewarding birth with skilled hands, wise hearts, and a deep respect for the families we serve.