Educational background requirements and licensing requirements vary by state. By and large maintain autonomous practices outside of institutions. Not required to be nurses. Have met rigorous requirements and passed written exam and hands-on skills evaluation. Administered by the North American Registry of Midwives.
Legal status varies according to state.
Practice most often in homes and birth centers. Almost all of the states that license direct entry midwives are now using the written exam of the CPM process as their state licensing exam, and work is underway in many states for the CPM to be the basis of licensing these midwives. In Washington and Oregon having a CPM is a route to licensure. Must have at least a Bachelors Degree when training is complete. Are legal and can be licensed in all states.