Certified Professional Midwives in West Virginia
This Science and Technology Note explores access to maternal healthcare in West Virginia. It also explores the role certified professional midwives can play in obstetric care and their licensure.
Research Highlights
Half of all counties in West Virginia are considered to be maternal care deserts.
Certified professional midwives (CPMs) primarily work in rural homes and can offer pregnancy and obstetric support to women, however they are not licensed by the state.
Legislation has been proposed in West Virginia to grant licensure to CPMs.
Many states provide licensure to CPMs, though their policies regarding Medicaid reimbursement vary.
One major issue facing pregnant women in West Virginia is access to maternal care. Certified professional midwives (CPMs) are healthcare professionals that provide obstetric care and primarily work in rural areas in their patients homes to help deliver babies. This Science and Technology Note explores the role of CPMs in West Virginia, previous legislation that sought to provide state CPM licensure, and how other states regulate CPMs.
Access to Maternal Health in West Virginia
Access to care is a concern for a large number of pregnant women in West Virginia. Half (27) of all counties in West Virginia are considered maternity care deserts, meaning they have no obstetric providers and no hospitals or birthing centers offering obstetric care for pregnant women. This is higher than the national average of 33% of counties that are considered maternity care deserts. An additional 5 counties are considered to have moderate access, indicating there are fewer than 60 obstetric providers per 100,000 births and less than 2 birthing hospitals. Women in West Virginia are more than twice as likely than the US average to have to travel more than an hour to get to a birthing hospital. Increased travel time to access maternal care leads to greater risk of maternal morbidity, NICU admission, and stillbirth. Birthing hospital closures and medical provider shortages in the state have been cited as causes to maternity care deserts and long travel times to access care. These issues are likely to increase, especially in rural areas, due to the potential closure of up to 13 hospitals in the next several years.
Access to maternity care in West Virginia. Counties in blue are considered maternity care deserts and moderate access is available in green counties. People in grey counties have full access to care. Red dots indicate the 7 hospitals most at-risk of closure. Maternity care access data based on data from the March of Dimes and hospital closure data obtained from Sheps Center.
What are Midwives?
Midwives are healthcare practitioners that provide gynecological, obstetric, prenatal, and primary care. Midwives are divided into three tiers based on increasing education requirements and scope of practice: CPMs, certified midwives (CMs), and certified nurse midwives (CNMs). There were 8 CPMs registered with the North American Registry of Midwives (NARM) as of 2023 in West Virginia. As of May 2025, there were 0 CMs and 79 CNMs practicing in West Virginia. CPMs primarily provide care in homes or at birthing centers, making them a valuable resource in maternity care deserts and rural areas.
| Certified Professional Midwife | Certified Midwife | Certified Nurse Midwife | |
|---|---|---|---|
| Education Requirement | High school diploma and apprenticeship program | Bachelors degree and additional health and science courses and training | Bachelors degree and RN licensure |
| Scope of Care | Ongoing care throughout pregnancy and hands-on care during labor, birth, and post-partum period. Recognize abnormal and dangerous conditions and refer to proper providers. | Independent practice providing primary care throughout life. Provide pregnancy, childbirth, and postpartum care, gynecologic and sexual health. May conduct physical exams, diagnose, and treat conditions. | |
| Care Location | Primarily homes and birth centers | All settings, primarily hospitals and birthing centers | |
| Reimbursement | Medicaid reimbursement in some states, private insurance varies | Medicaid reimbursement in some states, most private insurance | Medicaid reimbursement required, most private insurance |
Comparison of CPMs, CMs, and CNMs. Table based on information from the American College of Nurse-Midwives
Certified Professional Midwives in West Virginia
Certified professional midwifery is a slowly growing profession in West Virginia. There were 3 CPMs registered by NARM as of 2005. In the same year, 0.1% of babies in West Virginia were delivered by CPMs and 0.2% of babies were born at home. By 2021, West Virginia had 8 registered CPMs. As more CPMs became available in the state, they delivered 0.9% of West Virginia babies in 2021 and 1.2% of babies born in the state were born at home. This trend suggests that as more CPMs become available in West Virginia, they will continue to provide care to pregnant women. Although it is likely that the majority of women that are giving birth at home or with CPMs in West Virginia are living in maternity care deserts, further analysis will need to be performed to confirm this. However, CPMs are generally known to serve a disproportionate number of low-income, rural, and uninsured people.
CPMs are allowed to practice in West Virginia. However, recent legislation sought to enact a state CPM licensure program. Both HB 5491 (2024) and SB 748 (2024) would have enacted a state licensure program for CPMs to be administered by the West Virginia Board of Registered Nurses, however, neither of these bills advanced out of committee. SB 482 (2025) sought the same as the two 2024 bills and passed the Senate with bipartisan support, however, it was not voted on in the House. These efforts were supported by multiple nursing professional groups including the Midwives Alliance of West Virginia and the West Virginia Nurses Association. Proponents of the bills said that state licensure for CPMs would provide families with a mechanism to verify their midwife’s training and skills, increase the number of licensed providers, help bridge the maternity care gap in West Virginia, and bring West Virginia in line with states that already offer licensure. In a 2008 statement, however, the executive director of the West Virginia Board of Registered Nurses argued that the public would be better served by CNMs, as opposed to CPMs. The executive director also argued that the small number of CPMs that may seek licensure in West Virginia would necessitate high licensure fees to offset their costs, which may be a barrier for entry. The Board did not provide a comment regarding the 2024 or 2025 pieces of legislation. A 2008 report seeking information of the potential to establish a state CPM licensure program by the West Virginia Legislative Auditor’s Performance Evaluation & Research Division (PERD) resulted in not recommending state licensure for CPMs. The PERD report found that there were too few CPM-assisted births from 2002-2006 (14 births/year), however rates have been increasing through 2021 (151 births). They also found that in 5 states, state licensure did not increase the number of midwives in the state in the years following establishment of a licensing program. PERD also stated that insurance providers will not reimburse CPMs because they are not licensed. They worry, however, that insurance reimbursement may not be a strong enough incentive for CPMs to seek state licensure.
CPM Regulations in Other States
CPMs are currently licensed in 38 states and Washington, DC. Governing bodies for administering licenses vary among states but generally require applicants to be certified by the NARM. Some states, including Texas and Idaho, offer licenses through a Midwifery Board. Other states administer their licenses through their State Board of Nursing (Maryland), Department of Health (New Mexico), Board of Medicine (Virginia), or Cabinet for Health and Family Services (Kentucky). If West Virginia were to approve state CPM licensure, other governing boards could be considered in addition to the West Virginia Board of Registered Nurses.
State Medicaid reimbursement for CPM services varies as well. Six state Medicaid programs (Washington, Oregon, Wisconsin, New Mexico, Virginia, and Illinois) reimburse CPMs at the same rate as physicians. An additional 16 state and Washington, DC Medicaid programs offer partial reimbursement and the other 17 states that offer licensure do not offer Medicaid reimbursement. If West Virginia were to approve a state licensure program for CPMs, offering Medicaid reimbursement for services is an option that could be explored.
This Science and Technology Note was prepared by Nathan G. Burns, PhD, West Virginia Science & Technology Policy Fellow on behalf of the West Virginia Science and Technology Policy (WV STeP) Initiative. The WV STeP Initiative provides nonpartisan research and information to members of the West Virginia Legislature. This Note is intended for informational purposes only and does not indicate support or opposition to a particular bill or policy approach. Please contact info@wvstep.org for more information.