The history of National Midwifery Institute is intimately interwoven with the history of direct-entry midwifery credentialing in the United States and direct-entry midwifery licensure in California. Just as midwives are called to practice, so too midwives in the 1980s and 1990s stepped into additional roles as political activists, organizers and educators in order to practice as midwives as safely and competently as they could. In this way, the lives of NMI co-founders Shannon Anton and Elizabeth Davis are also part of the tapestry of US direct-entry midwifery as it is practiced today.

  • Midwifery practice is considered illegal in California: both lay midwives and nurse-midwives face arrest and prosecution for practicing medicine without a license if caught.



  • California Nurse Midwife Statute is passed, allowing nurse-midwives access to a licensure mechanism and legal practice in that state—with restrictions, including physician supervision. Lay midwifery is still interpreted as illegal; lay midwives continue to practice underground.

  • Elizabeth Davis completes her midwifery apprenticeship training with Tina Garzero and John Walsh.



  • Elizabeth Davis writes 1st edition of Heart & Hands text as a means to organize her thoughts and experience from her first few years as a practicing midwife in California.

  • Elizabeth Davis receives BA from Antioch University in Holistic Maternity Care.



  • First edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published as A Guide to Midwifery: Heart and Hands.

  • There are over 600 lay midwives already serving a well-established home birth community in California without the benefit of licensure. Lay midwives in California continue to be arrested and prosecuted for practicing without a license in that state.

  • Mothering magazine surveys consumers, state health agencies, and existing midwifery schools to gather more information on midwifery in the United States. The results, published in 1981, are the following: five states legally recognize lay midwifery practice (New Hampshire, New Mexico, South Carolina, Texas, Washington); four states recognize the legal practice of “granny” midwives if licensed before a certain time; seven states and the District of Columbia identify lay midwifery practice as illegal (Indiana, Louisiana, Maryland, New York, North Carolina, Ohio, Pennsylvania, West Virginia); eight states prohibit lay midwifery practice through judicial interpretation; eleven states have no legal recognition either for or against lay midwifery practice, and; eleven states consider lay midwifery practice legal but no further licenses are being issued.


  • Elizabeth Davis first offers the Heart & Hands Midwifery Intensives course in San Francisco, California. The course was developed at the request of a group of birth assistants seeking to acquire practical midwifery skills. Over the years and by demand, the course evolves to include basic introductory information and emphasis on the intuitive, interpersonal skills essential to effective midwifery care.

  • Elizabeth Davis is asked to serve on the initial board of the Midwives Alliance of North America (MANA) as regional representative for the Pacific states. Officially incorporated as a not-for-profit professional organization for all midwives in 1982, MANA was created out of a desire for a professional organization for all midwives regardless of their education, certification, or licensure status. Elizabeth serves on the MANA Board for the next 5 years, including instrumental participation in MANA’s work toward developing a national competency-based certification process.

Heart & Hands intensives students in class.

  • MANA creates the Credentialing Committee, which 1983 through 1985 works in conjunction with the MANA Standards and Practice Committee and MANA Education Committee to develop proposals for a voluntary registry for direct-entry midwives.



  • MANA establishes the Interim Registry Board (IRB) as a result of the work of the Credentialing Committee, Standards and Practice Committee and MANA Education Committees in 1983-1985. The IRB seeks to develop a test based on the MANA Core Competencies.


  • The California Association of Midwives is formed in 1987 as a professional association for midwives serving the home birth population in California. The original purpose of CAM was to assist California home birth midwives in communicating with each other in order to further their education, educate the public about home birth with midwives, and to change and maintain direct-entry midwives’ legal status in California. CAM also provided an unsanctioned, grassroots certification mechanism for California midwives prior to the advent of state-regulated California midwifery licensure during the late 1980s though the mid 1990s. Applicants were required to document minimum experience requirements signed for by precepting midwives, master a skills list, and pass a written exam. CAM hoped that CAM-certified midwives would be able to more easily obtain licensure in California when and if it became available. Elizabeth Davis is a founder of the CAM certification process.

  • Second edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published. The second edition is published again in 1988, 1990, 1992, 1994.


  • Aspiring midwife Shannon Anton takes her first midwifery class with senior midwife Ann Fuller in California.

  • Elizabeth Davis completes CAM certification.

  • Elizabeth Davis' book Energetic Pregnancy is published. A second printing is issued in 1990. Now out of print.


  • January: Shannon Anton joins the CAM board as a beginning midwifery student. She serves on the CAM board for the next seven years in a variety of roles including CAM Region 3 Rep, CAM Certification Administrator, CAM Legislative Committee Member and Treasurer, and CAM Representative to the NARM Task Force (origination of CPM credential).

  • June: The National Coalition of Midwifery Educators (NCME) forms as a result of a meeting of MANA midwifery educators. NCME included twenty-one individuals representing nine midwifery education programs: sixteen of the participants were state-licensed midwives (states or municipalities offering licensure at this time were Washington, Florida, and El Paso, TX). NCME functioned as a support group for MANA and later MEAC until the mid-1990s.

  • October: Shannon Anton co-organizes the 1990 CAM Conference in San Francisco, expanding the conference’s scope and pioneering the current three-day CAM Conference format.

  • Elizabeth Davis' book Women's Intuition is published (now out of print). A Spanish edition is released in 1991.


  • January-March: Shannon Anton attends Elizabeth Davis’ Heart & Hands Midwifery Intensives as a beginning midwifery student.

  • The National Coalition of Midwifery Educators creates the MANA Education Coalition (now known as MEAC). Elizabeth Davis is a co-founder. MEAC’s focus is to develop a national accreditation process for direct-entry midwifery education programs.

  • November: MANA administers the first Interim Registry Board Registry Examination to a small number of candidates across the country.

  • Interorganizational Workgroup on Midwifery Educaton (IWG) forms. Includes equal numbers of Certified Nurse-Midwives (CNMs) and direct-entry midwives as well as subject matter experts from the American College of Nurse-Midwives (ACNM) and MANA, and public members. A series of IWG meetings takes place, funded by a grant from the Carnagie Foundation. The outcome of these meetings is recognition of the need for direct-entry midwives to create their own accreditation and education credentialing mechanisms. The IWG members began compiling a list of direct-entry midwifery skills: this skills list and the idea of developing a process of certification were presented to the MANA Board.


  • Spring: Shannon Anton completes her apprenticeship training with Labor of Love Midwifery in the San Francisco Bay Area, and is certified by California Association of Midwives. Shannon maintaines a primary midwifery practice with apprentices summer 1992 through summer 1998.

  • After five years of planning for the national certification exam, drafting the exam itself in keeping with MANA Core Competencies, and field-testing the examination, the MANA Interim Registry Board incorporates as a non-profit organization separate from MANA called the North American Registry of Midwives (NARM).

  • August: Shannon Anton becomes a member of the CAM Legislative Committee; she serves in this capacity until 1998. As a member of the Legislative Committee, Shannon was intimately involved in legislative efforts that led to the passage of the California Licensed Midwifery Practice Act.

  • Second edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published in German.


  • After years of grassroots organizing and legislative effort, California passes the Licensed Midwifery Practice Act. Direct-entry midwives in California could now access midwifery licensure through a challenge mechanism provided by Seattle Midwifery School. Seattle Midwifery School’s challenge mechanism was the only approved route to licensure in California until the early 2000s. Midwives already licensed in Florida and Washington could become licensed in California during this time through a reciprocity agreement.

  • Elizabeth Davis becomes Registered Midwife through MANA Interim Registry Board.

  • June: Shannon Anton is nominated to the NARM Board of Directors. Shannon serves on the NARM Board 1993 to present.

  • August: The first in a series of five NARM Task Force meetings is held. Sponsored by NARM, MANA, and the MANA Education Coalition (now MEAC), the Task Force meetings took place 1993-1995 and were attended by more than 150 direct-entry midwives and nurse-midwives. The purpose of the meetings was to gather input from midwifery practitioners and educators to guide development of a certification process. It was decided that certification would require both education and certification: the educational portion included minimum clinical experience requirements and preceptor verification of proficiency in clinical skills. The certification portion would include a Written Examination on the essential skills and knowledge needed for competent and safe entry-level, out-of-hospital midwifery practice. Skills and knowledge included would be based on a Job Analysis survey. Elizabeth Davis and Shannon Anton both take part in the Task Force process.

  • August: Shannon Anton serves as CAM Representative to the newly-formed NARM Task Force (origination of CPM credential).


  • January: Shannon Anton becomes NARM Board Accountability Chairperson and Director of Accountability; continues to present.

  • CAM defers all certification activity to NARM; all CAM-certified midwives qualify for the NARM CPM.

  • Shannon initiates Study Group in response to apprentice midwives in the San Francisco Bay Area who expressed a need for a midwife-facilitated group learning process. Students who attended the first eighteen months of Study Group virtually defined the curriculum. Focus remained on the context of experiential learning which moved the group from topic to topic.

  • November: Shannon Anton co-founds Bay Area Homebirth Collective, a group of independent midwifery practices dedicated to promoting midwifery care and home birth. The group is "committed to using the collective power of our diverse practice styles and geographic locations to provide families with resources such as classes, support groups, social gatherings, and informative talks and/or panels throughout the year." The Bay Area Homebirth Collective is loosely grouped into regional chapters.

  • December: The first NARM Certified Professional Midwife (CPM) Credential is issued.

  • Elizabeth Davis' book Women's Sexual Cycles: Understanding Your Moods and Desires at Every Stage of Life is published. The book has since been released in German, Hungarian, and Lithuanian editions.


  • As decided by the NARM Task Force, the 1995 NARM Job Analysis is initiated by NARM and the National Assessment Institute. An extensive survey, including every possible midwifery knowledge aspect and skill for out-of-hospital practice and taking an average of 12 hours to complete, was mailed to 3000 midwives practicing in primarily out-of-hospital settings across the country. The survey was returned by 850 midwives: two-thirds were direct-entry midwives, and one-third were Certified Nurse-Midwives. The survey results formed the basis for a new version of the NARM Written Examination.

  • Summer: Shannon Anton and Elizabeth Davis co-found National Midwifery Institute as Midwifery Institute of California. Enroll first student.

  • Summer: Midwifery Institute of California applies to be part of MEAC’s accredited midwifery school pilot program.

  • September: California Licensed Midwife LM #1 issued; LM #s 1-3 are Washington state-licensed LMs already, and receive their licenses through a reciprocity agreement.

  • September: Elizabeth Davis is issued the NARM CPM credential after passing the NARM Examination.

  • October: Shannon Anton is issued the NARM CPM credential after passing the NARM Examination.

  • November: Shannon Anton is licensed as CA LM #5 through the Seattle Midwifery School's challenge mechanism for California midwifery licensing: she is one of three California midwives to participate in the pilot of Seattle Midwifery School’s new challenge process.


  • Midwifery Institute of California is pre-accredited by MEAC.

  • MEAC completes Midwifery Institute of California’s first site visit.

  • NARM contracts with Schroeder Measurement Technologies (SMT) to oversee test development, test administration, and the portfolio evaluation process.

  • August: First NARM Written Examination Form D, developed by SMT, is administered.


  • Elizabeth Davis' book The Women's Wheel of Life: Thirteen Archetypes of Woman at Her Fullest Power, co-authored with Carol Leonard, is published. The book has since been released in Australian and Hungarian editions.

  • Elizabeth Davis receives Lifetime Achievement Award from the Midwives Association of Florida.

  • Third edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published. This edition is published again in 1997 and 1999.


  • Fall: The NARM Task Force meets for the final time at the National MANA Conference. All midwives in attendance were asked to give advice and direct the NARM Board on the certification process. Based on recommendations of the midwives in attendance, the Education portion of the NARM Certification Process was expanded. The educational portion could be completed in three ways: through graduation from a MEAC or AMCB (formerly the ACC) accredited program, through legal recognition from a state or province that has been evaluated for educational equivalency from NARM, or through the Portfolio Evaluation Process (PEP).


  • Shannon Anton serves as NARM Liaison to the MEAC Board (2000-present)

  • Spring: Midwifery Institute of California celebrates its first 3 graduates! Because Midwifery Institute of California is not yet an approved route to licensure in California, MIC's first graduates obtain California licensure through Seattle Midwifery School's challenge mechanism.

  • September: Due to substantive changes in the program –relocating the office to Vermont, and changing its name to National Midwifery Institute—Midwifery Institute of California relinquished pre-accreditation status.


  • NARM repeats the Job Analysis process.

  • Elizabeth Davis' book Women's Sexual Passages: Finding Pleasure and Intimacy at Every State of Life is published. A German edition is published in 2006.


  • March: National Midwifery Institute pre-accredited by MEAC.

  • October: National Midwifery Institute granted full MEAC accreditation.

  • First student graduates from National Midwifery Institute.


  • National Midwifery Institute is approved as a route to licensure for aspiring midwives in California, joining Seattle Midwifery School’s challenge and newly-approved 1-year residential challenge program and 3-year program both offered by Maternidad La Luz in Texas.

  • August 8: Julie Hunn, NMI Graduate, is licensed as California LM #156 through National Midwifery Institute: NMI’s first graduate to receive their license through NMI’s Certificate Program!

  • Shannon Anton becomes NARM Board Vice-Chairperson (2003-present)

  • Two students graduate from National Midwifery Institute.


  • June: Shannon Anton and Elizabeth Davis receive the California Association of Midwives Brazen Woman Award for their contributions to the advancement of midwifery.

  • Fourth edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published.

  • Two students graduate from National Midwifery Institute.


  • September: National Midwifery Institute accreditation renewed.

  • Four students graduate from National Midwifery Institute.


  • National Midwifery Institute Challenge process for California Midwifery Licensure is approved by the California Medical Board. Over fifty midwives completed the NMI Challenge Mechanism before the program was suspended in 2014 due to legislative changes.

  • Two students graduate from National Midwifery Institute.


  • Three students graduate from National Midwifery Institute.


  • Five students graduate from National Midwifery Institute.


  • September: National Midwifery Institute accreditation renewed.

  • NARM Job Analysis repeated.

  • Seven students graduate from National Midwifery Institute.


  • International Confederation of Midwives (ICM) issues global standards of midwifery. The ICM standards are essential pillars to strengthen midwifery worldwide by preparing fully qualified midwives to provide high quality, evidence-based health services for women, newborns, and childbearing families.

  • Elizabeth Davis' book Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth Experience is published. The book has since been published in French, Dutch, Greek, Korean, Hungarian, and Spanish.

  • Eight students graduate from National Midwifery Institute.


  • Twelve students graduate from National Midwifery Institute.



  • Fifth edition of Heart & Hands: A Midwife’s Guide to Pregnancy and Birth is published. The 5th edition has sold over 200,000 copies. A Portuguese edition is forthcoming.

  • Sixteen students graduate from National Midwifery Institute.

  • April: A joint meeting of seven organizations directly responsible for education, regulation and professional associations for the three US midwifery credentials - CPM, CNM and CM - is held in Warrington, Virginia. Named the United States Midwifery Education, Regulation and Association (US MERA) work group, the coalition's objectives were to:

    1. Strengthen the foundation for organizations responsible for midwifery education, regulation, and associations to work collaboratively to advance the midwifery profession in the US, and;

    2. Grow together as leaders creating the future of midwifery in the US.

US MERA was formed in direct response to the International Confederation of Midwives (ICM) Global Standards for Education, Regulation and Association issued in 2011 as complements to the ICM Definition of a Midwife and the ICM Essential Competencies for Basic Midwifery Practice. According to US MERA: "Our organizations’ understanding and endorsement of the ICM standards and the global vision for midwifery inspired us to come together to ensure the alignment of U.S. midwifery with these standards to strengthen midwifery in our country. Our ultimate goal is to ensure a highly qualified midwifery workforce that will increase access to midwifery care and improve the health of women, infants and families in our country."

The US MERA includes representatives from: Midwives Alliance of North America (MANA), National Association of Certified Professional Midwives (NACPM), North American Registry of Midwives (NARM), Midwifery Education Accreditation Council (MEAC), American College of Nurse-Midwives (ACNM), Accreditation Commission for Midwifery Education (ACME), and American Midwifery Certification Board (AMCB). In 2016, International Center for Traditional Childbearing (ICTC) joins the coalition. 

  • Ten students graduate from National Midwifery Institute.


  • Shannon Anton serves on MANA Conference Planning Committee for 2014 MANA Conference in St. Louis.

  • March: National Midwifery Institute accreditation renewed.

  • December: NMI Challenge Mechanism suspended due to changes to the California Licensed Midwifery Practice Act.

  • Shannon Anton attends US MERA meetings as NARM Board member.

  • Twenty-four students graduate from National Midwifery Institute.


  • Elizabeth Davis is honored with the Midwifery Today Lifetime Achievement Award at the 2015 Midwifery Today Conference.

  • April-present: Shannon Anton serves as NARM Board member of US MERA Equity Task Force.

  • April-present: Shannon Anton serves as member of US MERA Direct Assessment Education Task Force.

  • July: Shannon Anton attends US MERA Direct Assessment training with Charla Long.


  • Shannon Anton serves as Accreditation Review Committee member for MEAC.

  • Seven students graduate from National Midwifery Institute.



  • Eight students graduate from National Midwifery Institute.


  • Eleven students graduate from National Midwifery Institute.

To learn more, view the NMI Handbook.