The American College of Nurse - Midwives and the North American Registry of Midwives recommend that midwives should at minimum meet the standards of midwifery established by the International Confederation of Midwives (ICM), which include completion of a formal midwifery education
program, national certification, and licensure in the local jurisdiction of practice.32, 33 Certified professional midwives (CPMs) may achieve certification through
apprenticeship and portfolio evaluation without obtaining a formal midwifery degree; within CPM professional organizations efforts are under way to uniformly adopt ICM standards.33, 34 Oregon has followed this trend; in 2015 licensure became
mandatory for attendants at out - of - hospital births.