Kraus further points out that these clear definitions alleviate confusion that exists regarding the many terms used to describe this profession. A midwife does not have to be a nurse, however, midwifery education must require or grant a baccalaureate degree. A certified nurse-midwife (CNM) as one who is educated in both nursing and midwifery, and has evidence of certification according to the requirements of the American College of Nurse-Midwives.

Although the numbers of CNMs that attend hospital births in the U.S. has grown from 19,686 in 1975 to 196,977 in 1994, in Europe, midwives are the principal attendants for 75% of the births (Gabay & Wolfe, 1997, p. 386). The current need for more affordable maternity care by insurance providers and the public, has led to an increased demand for CNMs in the U.S. In response to this demand, the ACNM is committed to increasing the numbers of CNMs from 5,000 to 10,000; this would allow for CNMs to be present at 10% of U.S. births, by the year 2001 (Scoggin, 1996).

The ACNM initially certified only those candidates who were also nurses. The Midwives Alliance of north America (MANA) certified those who were not nurses (Draus, 1997, p. 44). Currently the Division of Accreditation (DOA) of the ACN

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