This was written by NACPM Board Member Sakina O’Uhuru, CNM, CPM, MS, for the NACPM August 2026 newsletter.
When we talk about workforce development in midwifery, I believe we have to ask a very basic question: Who actually has access to becoming a midwife, and what can we do collectively to make that pathway more accessible?
This is something I think about every day. I see incredibly committed aspiring midwives — particularly Black, Indigenous, and other students of color —who feel deeply called to serve their communities, but face barrier after barrier on the road to becoming credentialed midwives.
Important work is already happening across our profession to expand pathways into midwifery, strengthen preceptor networks, provide financial support, and increase representation. The question for me is: How do we build on that work and go even further?
Tuition is only one barrier. I hear from students about the difficulty of finding preceptors and clinical placements. Some have to travel long distances or temporarily relocate, paying for transportation, lodging, food, and other expenses while also taking time away from work and family.
And finding a preceptor is not always the same as finding a good preceptor.
Students need preceptors who genuinely want to teach and mentor them, and are committed to providing equitable learning environments. I continue to hear about students navigating racialized assumptions, cultural misunderstandings, bias, and sometimes different expectations based upon who they are. Increasing the number of preceptors matters, but we must also talk about the qualty and safety of those learning settings & relationships.
Then there is the journey toward credentialing and the NARM examination. There are examination fees, preparation expenses, and, for some, the cost of retesting. I also believe we should be willing to have thoughtful conversations about whether our assessments, grading structures, and weighting consistently reflect the knowledge and competencies expected of an entry-level midwife in real-world community practice. We can maintain rigorous standards while still examining whether the way we measure competency is realistic, equitable, and effective.
As our country continues to face a maternal mortality crisis — disproportionately impacting Black women and other marginalized communities — alongside critical maternity care shortages and expanding maternity care deserts, we simply cannot afford to lose capable future midwives along the way.
For me, workforce development also means asking how we more intentionally support Black-led, Indigenous-led, women-led, and BIPOC-led midwifery training programs that are already doing this work in their communities. Not just through words of support, but through acknowledgment, funding, scholarships, partnerships, preceptor networks, mentorship, clinical opportunities, and the sharing of institutional resources and power.
This responsibility belongs to all of us schools, preceptors, professional organizations, credentialing bodies, funders, and organizational leaders, etc.
Important work is already happening. And our opportunity now is to ask how we go further, together. How do we remove more barriers, strengthen the pathways that already exist, and make sure our investments reflect the diverse midwifery workforce we say we want and that our communities desperately need?
Sakina is the Founder and Executive Director of A Wombman’s Way Warrior Midwife Training Program.