To become a midwife in the U.S., you must first be educated. Unlike nurse-midwifery, non-nurse midwives do not have legal protection in all 50 states. Student midwives must consider the law and rule of the state in which they will practice, because different states have different approved paths to a direct-midwifery. Non-nurse midwives can choose to be educated in one of three ways: a formal, post-secondary school, an apprenticeship or self-study.
The apprenticeship model is the traditional methodology for lay midwifery education in the U.S. While other countries have established, university-based direct-entry programs, U.S. midwifery education programs evolved into nurse-midwifery programs, which train the midwife first as a nurse and then as a midwife. A return to direct-entry midwifery began in the 1970s and has continued to today. The apprenticeship model pairs a seasoned, practicing midwife with a student who learns the craft of midwifery by working alongside the expert, taking on more responsibility as she is able.
In some states, particularly those where midwifery is legal and regulated, formal post-secondary schools provide midwifery education. These mostly free-standing institutions offer classes on campus, in a distance format or a combination of both. Programs of study include all aspects of the core competencies of midwifery care, as well as offering a clinical portion, through which student midwives practice hands-on midwifery care and skills.
Some student midwives choose to engage in self-study, usually under the auspices of a senior midwife. Some institutions offer a self-study curriculum, which guides the student midwife in educating herself in the art and science of midwifery. Self-study has its detractors, however, who claim that self-study results in an inferiorly trained midwife as compared to more formal programs. In states that do not restrict the type of education a direct-entry midwife must have, self-study might be a viable option for a determined and disciplined student midwife.
The Midwifery Education Accreditation Council, or MEAC, is a nationally recognized accrediting body that specializes in institutions of midwifery education. MEAC accredits schools that meet their baseline standards for midwifery education. While MEAC accreditation is not required for all states, a MEAC-accredited school is the current standard in direct-entry midwifery education in the U.S. and holds schools accountable for the quality of their educational offerings.
State licensure depends upon the state in which the midwife plans to practice. The graduate midwife should contact the department of health in their state for specifics. If the student midwife wishes to The North American Registry of Midwives (NARM) administers the national certification exam to be a certified professional midwife (CPM). The CPM credential, however, is not recognized by all states.
The legal status of midwives depends upon the state in which they practice. The regulation of midwives has been highly contested by medical boards, who cite safety concerns of direct-entry midwives. Practicing illegally in a state that regulates midwives might result in the midwife's arrest; while many midwives feel this is worth the risk, others feel that changing the system is a better way to address the problem in a legal manner. Consumer-based and professional organizations have sprouted up across the country to address the growing concerns of consumers and restriction of birth options in the U.S. Due to the differences in regulation and law among states, student midwives should be sure to verify the approved courses of study for their state.