Traditionally, CNMs have provided care to underserved populations in rural areas or inner-city settings. As with many other professions, certified nurse midwives are regulated at two different levels. Licensure is a process that takes place at the state level in accordance with specific state laws. In contrast, certification is established through a national organization and requirements for minimal professional practice standards are consistent across all states. The current trend is moving toward requiring master's degree preparation and national certification.
National certification is required in some states for CNMs to be licensed to practice.