NACPM Statement on PEP

NACPM has been asked by members of our community to clarify our position in relationship to the Portfolio Evaluation Process (PEP).

NACPM, in collaboration with our fellow US MERA organizations (ACNM, AMCB, ACME, ICTC [now NAABB], MANA, MEAC, NARM), supports accredited education as a basis for licensure in new state/jurisdiction legislation to license CPMs. The Midwifery Bridge Certificate is an integral part of the CPM path to licensure and is designed to support the qualification for licensure for currently-credentialled CPMs who did not graduate from MEAC-accredited programs. These agreements, along with the Principles for Model U.S. Midwifery and Regulation were developed and endorsed by all the organizations in the US MERA collaboration, and are aligned with the International Confederation of Midwives Global Standards for Education and Regulation.

Importantly, NACPM values the Portfolio Evaluation Process (PEP) as an innovation ahead of its time, whose attributes of accessibility, affordability, and student-directed learning and pace are only now being acknowledged and reflected in the most cuttingedge innovations in higher education in the country – in particular in competency based, direct-assessment education. NACPM is committed to advancing midwifery education that reflects the innovations, affordability, accessibility and benefits to students that are embodied in the PEP process within accredited institutions and programs.

NACPM acknowledges the challenges and barriers experienced by people in our country who want to become CPMs. Midwifery students more often than not face significant challenges to being able to afford their education and to finding and working with preceptors in both the PEP and accredited-school routes to the credential. In addition, we acknowledge additional and profound barriers to becoming midwives and to legal recognition that exist for midwifery students of color, indigenous and native American students, and LGBTQIA2S+ students. We know that until the CPM workforce comes to represent the evolving racial and social makeup of the childbearing population, CPMs will be limited in their ability to play an essential role in eliminating unconscionable racial and social disparities and improving outcomes for the childbearing population. These racial and social barriers are systemic within our society’s structures and within our own profession of midwifery.

Although NACPM cannot on our own eliminate the barriers to education and legal recognition for CPMs students in general and those barriers that are particular to students of color and indigenous and LGBTQIA2S+ students, as the professional association specifically representing CPMs, we have an important accountability and role to play regarding access to education and legal recognition for all people who want to become CPMs. NACPM is committed to investing in a strong racially, ethnically and socially representative CPM workforce to meet the urgent needs of childbearing people and to supporting excellence and innovation in midwifery education.

The following are ways that NACPM is working now to address these critical issues for the profession and to breaking down barriers to education for all midwifery students. We need and invite your thoughts, ideas, comments and your participation in problemsolving. Please reach out to us at


  • is working with the current 116th Congress to secure federal funding for midwifery education applicable to all accredited schools and programs, regardless of credential, including specific support for midwifery students of color and indigenous midwifery students;
  • is developing a set of competencies for CPMs. Our Competencies Team has consulted with a direct assessment national expert to ensure that these competencies will support the development of direct assessment midwifery programs and accreditation standards;
  • has shared information about a foundation we have discovered that provides direct scholarships and loans for students to advance professionally in their careers – with MEAC, to share in turn with the schools and students; and with the National Indigenous Midwifery Association, the Changing Woman Initiative, and the National Association to Advance Black Birth (NAABB);
  • continues to search for funding to support the development of direct assessment midwifery training schools;
  • awards scholarships to students of color, and indigenous and LGBTQIA2S+ students to take the NARM examination, to retake the examination, and for state licensing fees through the Bigger Table Fund
  • is engaging respectfully with advocates as they explore state-specific mechanisms in licensing legislation to address the issues and needs of the range of birth attendants; • fully supports including exemption language in all state/jurisdiction CPM licensure legislation that acknowledges the inherent sovereignty and selfdetermination of Indigenous peoples;

In 2017, NACPM wrote and distributed a set of Briefing Papers: Midwifery Landscape and Future Directions that describes the momentum generated by the US MERA agreements in gaining legal recognition and access to midwifery care for more people, and the opportunities that are emerging as a result. After the first CPM credential was issued in 1994, within a few years several states passed laws to license direct-entry midwives based on the credential. This surge of success generated increasingly powerful and effective opposition by the American College of Obstetricians and Gynecologists (ACOG), resulting in a many-year drought in new states/jurisdictions licensing CPMs. The US MERA agreements have generated important and significant new momentum: seven states have passed new US MERAaligned laws to license CPMs since 2015, the year when US MERA reached its accords, and as of June 2019, a total of thirty-three states/jurisdictions now license CPMs. The NACPM Briefing Papers are designed to answer questions and engage midwives and students in further conversations about the future of the profession. One of the briefing papers Certification and a National Credential has recently been translated into Spanish and our goal is to have the remaining papers translated into Spanish as well.

As a member of the US MERA collaborative, NACPM helped draft and endorsed the US MERA Statement on Licensure of Certified Professional Midwives and the Principles for U.S. Model Midwifery Legislation and Regulation that support independent, selfgoverning midwifery – principles NACPM advocates for in all state legislation. Along with all US MERA organizations and ACOG, we endorse the NARM-issued Midwifery Bridge Certificate.

NACPM supports all CPMs. We provide robust professional development opportunities, especially through a program of clinical, policy and birth justice webinars, that are free to all, can be attended in-person or accessed on our website at any time, and have CEUs available for a small fee. A number of our clinical webinars qualify for the Midwifery Bridge Certificate. We advocate for CPMs at national policy tables and provide support to state/jurisdiction advocates for state/jurisdiction licensure and regulation for CPMs through in-person visits, conference calls for strategy development, in-person and virtual testimony to regulators, and technical assistance and toolkits . We have a team developing competencies specifically for CPMs and will launch a Practice Committee to provide much-requested clinical guidance later in 2019. Our NACPM Chapters are growing and thriving, creating a dynamic relationship between the national association and midwives in states and a professional identity and community for direct-entry midwifery in the U.S.

We invite you to explore and engage with us:

Printable Version: NACPM PEP STATEMENT 6.8.19