Understanding the Different Types of Midwives
Not all midwives are the same. Knowing the difference helps you choose the right care provider for your birth experience and ask the right questions.
Two types of licensed midwives in Texas
Texas recognizes two distinct midwifery credentials: the Certified Nurse-Midwife (CNM) and the Licensed Midwife (LM). Both are licensed professionals with rigorous training, but their pathways, scopes of practice, and typical practice settings differ meaningfully.
Certified Nurse-Midwife
Regulated by the Texas Board of Nursing
Licensed Midwife
Regulated by the Texas Dept. of Licensing and Regulation (TDLR)
Licensed Midwife (LM) and the CPM credential
Families sometimes see both "LM" and "CPM" after a midwife's name and wonder what the difference is. Here is a plain-language explanation.
How the LM and CPM relate to each other
In Texas, the Licensed Midwife (LM) is the state license issued and regulated by TDLR. It is required to legally practice midwifery in Texas. The Certified Professional Midwife (CPM) is a national credential issued by the North American Registry of Midwives (NARM).
Because the Texas LM licensing pathway is built on NARM exam and skill specifications, all Licensed Midwives in Texas qualify to hold the national CPM credential. However, maintaining the CPM requires a separate application and ongoing renewal fees with NARM. The CPM is not required to practice legally in Texas. Some LMs choose to maintain both credentials; others practice only under their Texas state license.
Detailed comparison
The table below covers the key regulatory and practice differences between CNMs and Licensed Midwives in Texas.
| Category | Certified Nurse-Midwife (CNM) | Licensed Midwife (LM) |
|---|---|---|
| Regulating body | Texas Board of Nursing (BON) | Texas Dept. of Licensing and Regulation (TDLR) |
| License type | Advanced Practice Nurse (APN) authorized as CNM | Licensed Midwife; may also hold national CPM credential from NARM |
| Entry pathway | Registered nurse plus graduate-level nurse-midwifery program (ACME-accredited) | Direct entry; nursing background not required. TDLR-approved program, MEAC-accredited school, or NARM PEP pathway |
| Prescriptive authority | Yes, if delegated by a collaborating physician under BON requirements | No prescriptive authority; authorized to purchase and use oxygen and newborn eye ointment |
| Birth settings | Hospitals (most common), birth centers, homes | Homes and birth centers; community birth setting training is required for licensure |
| Medicaid recognition | Primary care provider for women; 92% physician rate | Provider in licensed birth centers only; 76% physician rate in that setting |
| Continuing education | Required per BON standards | Required for TDLR re-licensure every two years |
| Professional org (TX) | Consortium of Texas Certified Nurse Midwives (CTCNM) | Association of Texas Midwives (ATM) |
| Verify license | bon.texas.gov | tdlr.texas.gov |
Questions to ask when choosing a midwife
Whatever type of midwife you are considering, here are the most important questions to ask before committing to a care relationship.
Verify their license
Ask for their full name and license number. Check CNMs at bon.texas.gov and LMs at tdlr.texas.gov to confirm their license is current and in good standing.
Understand where they practice
Confirm they are authorized and experienced in the birth setting you prefer, whether that is a hospital, birth center, or home birth.
Ask about their certifications
Ask whether they hold a current CPR and NRP certification. These are required for LM licensure and reflect readiness for newborn emergencies.
Ask about consultations and transfers
Find out under what circumstances they consult a physician or transfer care to a hospital, and which hospital or provider they work with.
Ready to find a Texas midwife?
The Association of Texas Midwives connects families with qualified Licensed Midwives across the state.