Midwives in the United States are extremely diverse. There are differences in educational levels, training, experience, and titles. There also exists a hodgepodge of state regulations, and vast differences among states in licensing, certification, registration and permit requirements. Some states have outright bans prohibiting the delivery of babies by direct-entry or lay midwives. Others permit deliveries, but don’t regulate the practice and offer no licensing or certification options. A midwife’s salary is based on her education, training, experience, and professional accreditation and affiliations.
Certified nurse midwives (CNMs) are among the most highly educated and trained of midwife professionals. CNMs enter midwifery training as registered nurses (RNs) with bachelor’s degrees. Certified midwives (CMs) also have four-year degrees, but their backgrounds can be in a variety of fields. The national education and practice standards that both CNMs and CMs must meet are identical and are established by the American College of Nurse Midwives (ACNM), which also is a credentialing body for educational institutions that provide midwifery training. Midwife candidates already enrolled in ACNM-approved coursework will be grandfathered, but applicants beginning in 2011 must have master’s degrees to apply. Those who complete midwifery education receive a master’s degree. According to a leading salary website, CNMs and CMs have a median income of about £59,150 (almost £4,940 a month), among the highest of any nursing profession. CMs and CNMs in the 90th percentile can make more than £65,000 a year. Even the bottom quarter of CMs and CNMs have median salaries over £50,050, or £4,170 per month.
Most midwives who aren’t CNMs or CMs are referred to as “direct-entry” or “lay” midwives. Many are CPMs (certified professional midwives) who are certified by the North American Registry of Midwives (NARM). Clinical skills and competency-based educations are NARM’s hallmarks, but not all states recognise their certification. Other lay midwives practice is some states under various titles, but they have no formal educational standards and their clinical experience is limited to observing other midwives during the birthing process. Some states have requirements for lay midwives, such as defining a minimum number of births that must be attended. Other states prohibit lay midwives from deliveries babies at all. Lay midwives earn about £22,750 to £26,000 per year, according to Salary Expert (roughly £1,950 to £2,145 monthly). Illinois is the highest-paying state for lay midwives (near £26,000), and Chicago and New York are the best-paying cities (about £26,000).
All states recognise the validity of CNMs and CMs to practice midwifery, although some states require further documentation, such as acquiring a permit or receiving state certification or licensing. Nine states—Alabama, Illinois, Indiana, Iowa, Kentucky, Maryland, North Carolina, Pennsylvania and South Dakota—and Washington, D.C., ban lay midwives from practicing. Connecticut, Nebraska, Ohio and West Virginia have no prohibitions on lay midwifery, but also don’t regulate the practice. In Georgia and Hawaii, lay midwifery is legal by statute but there is no licensing or certification required (which depresses lay midwife salaries through a public perception that they are not qualified). Licensed midwives (LMs) are lay midwives licensed in a particular state.
There are numerous professional midwife organisations and various credentialing institutions. Aside from the ACNM and NARM, the American Midwifery Certification Board (AMCB) is the national credentialing body for CMs and CNMs. The Citizens for Midwifery (CFM), the Midwifery Education Accreditation Council (MEAC) and the International Confederation of Midwives (ICM) all provide support for practicing midwives and promote standards and acceptance for the practice of midwifery.