In the US there are two pathways to midwifery, Certified Nurse Midwives 
(CNM)and Certified Professional Midwives (CPM), who are well trained but 
do not start out as nurses. Some States in the US allow only CNM's, 
others provide for licensing of CPMs as well.

In States that do not recognize CPM's, some women practice midwifery 
anyway, as a way to give women choice. All midwives generally have good 
outcomes, as word quickly gets around communities as to who is skillful.

Due to the complex political concerns here and power struggles between 
different health professionals, some women have far less access to 
midwives than they want and need. Lay midwives may step into that gap. 
They are usually well trained, and have apprenticed with more 
experienced midwives, and have formal classroom studies as well. Of 
course, there are problematic practitioners in any field. Many "lay" 
midwives are CPM's, a few are not.

You can learn more about this at The North American Registry of Midwives 
(NARM) website: <http://www.narm.org/htb.htm>

Catherine Watson Genna, IBCLC  NYC

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