From the beginning of time, people have given birth and their births have been attended by those within their communities. Older women passed down knowledge to younger women and so the art of birth attendants was born. Early in the history of the Western world, before birth had been medicalized and moved into the hospital, midwives and other culturally trained birth attendants were guiding babies into the world and caring for women during their childbearing years. As the birth climate changed and birth began to be seen as a medical condition that necessitated management and intervention, midwives and traditional birth attendants became a small but mighty few, pushing back at the notion that birth was anything but a natural process that could largely progress without the need for medical treatment.


As the need arose for a way that midwives could combat the expectation for birth attendants to have medical training, nurse midwifery answered the call in the 1920s. The Frontier Nursing Service was created as a way for nurses to provide maternity care for the rural poor in Kentucky and expanded from there. Nurse midwives began to move into the hospital setting during the 1950s and helped improve hospital care for birthing families in many ways. Now, CNMs are trained as nurses and then obtain a Masters degree in Nurse Midwifery. Currently 95% of births attended by CNMs (Certified Nurse Midwives) are in the hospital setting.

In the 1960s, coinciding with the movement of women taking back their bodily autonomy, mostly white, middle class, educated women began to desire birth outside of the hospital with what was termed “lay midwives” or “direct-entry midwives”. These midwives did not have training in nursing but instead trained much like the birth attendants of history. Knowledge and skills were learned through apprenticeships and hands-on experience at the tutelage of an elder midwife. This push for other birth options was the beginning of the modern direct-entry midwifery movement.


At the Tyler Birth House, our providers are licensed CPMs (Certified Professional Midwives), a national licensure for direct entry midwives. CPMs are licensed through NARM, an organization that advocates for midwifery rights and sets the training standards for direct entry midwives. In order to take the NARM certifying exam, student midwives must apprentice under an experienced midwife in order to learn the skills and knowledge required to safely practice midwifery. A student must attend a number of births as an assistant and as a primary under the supervision of the midwife. They must demonstrate an understanding of over 500 topics and show proficiency in the related skills. Some students attend a midwifery program at a school or university and some choose to study independently. At the end of their training, which usually spans 3-4 years at minimum, students sit for the national certifying exam. If successful, the student must attend several more births under the supervision of their preceptor and are then allowed to practice independently.


In the state of Texas, midwives are licensed under the Texas Department of Licensing and Regulation and there are a few options to qualify for a license in Texas. All options meet or exceed the requirements for a CPM licensure. Midwives must be CPR trained and also be trained in Neonatal resuscitation in order to obtain licensure in Texas. All of our midwives are also licensed by the state of Texas.


Midwives are also required to attend continuing education courses to maintain their licenses in order to encourage continued education and growth of skills throughout their careers. CPMs must also peer-review their births with other midwives as a requirement of their certification.

The landscape of birth attendants has changed dramatically since our country’s early history but the heart of out of hospital birth is still the same: birth is a beautiful, natural and important time in a family’s life and it deserves to be treated with dignity, trust and respect. At the Tyler Birth House, we hope that we honor that sentiment and demonstrate it in everything that we do to care for you and your baby.



The History of Midwifery-BY JUDITH P. ROOKS, CNM, MPH, MS; May 22, 2014,women%20in%20the%20antebellum%20South.

Midwives. Required Training and Education; TDLR;

Entry Level (PEP) Applicants. NARM.