To clarify what mwherbs said--the CPM certificate was created and is maintained by a national organization that is independent of any state gov't or licensing agency. NARM (north american registry of midwives) is responsible for creating CPM (certified prof. mw) standards, testing, and so forth. It is midwives and knowledgable midwifery supporters who created it, independently of med standards/dictates as well as of state gov'ts. So yes, a mw might be a CPM and still not be licensed by her state.
"all in all, if i had a whole lot of money to spend and if i was looking for medicalized midwifery care, and i was expecting a complicated pregnancy with possible doctor oversight, then yes, i would hire a cpm."
Again to underscore mwherbs, while NARM does require a particular set of basic skills and holds to basic standards of midwifery care, I would not call this generally 'medicalized' and there is a LOT of variation among CPMs because NARM leaves the setting of particular protocols to the mw to decide (such as carrying meds or only using herbs, gbs testing, doing breech, vbac, multiples...lots of individual choices). It could be that in her state or region, the CPMs have come together and self-chosen to adhere to certain things such as Dr. visit at 36wks, or that could be a state licensing requirement.
But even where CPMs are not licensed, and so are not specifically under any regs/restrictions, they are wanting to a) seem both professional and adherent to 'norms' in maternity care--and let's face it, however much one might disagree, medical maternity care is the 'norm' in the US....so a Dr visit might seem like a nod to that norm and a way to determine 'low risk' (by med standards). CPMs might also want to b) have each others' support, which may mean that some adopt protocols they don't personally agree with, but which aren't TOO much a compromise and do earn them that peer-group support. That can be so important to a mw! And really to her clients, too--because then you know she is in communication w/other mws, willing to hold herself accountable to something besides her own will, able to learn from/share with the others.
I know a mw who completely refuses any real comm or accountability to other mws...and she is scary in so many ways--taking unreasonable risks, refusing peer review ever, not keeping up with research and so forth....and her outcomes demonstrate this. We all want to think that our mw is following her own values and especially, is perceiving and assessing us totally on an individual basis. But in some ways it can be well worth to the greatest number of moms/babies, when a mw adopts some general rules she may not totally agree with, or ask moms to do something (like a Dr visit) that are clearly not needed, in part to remain in good standing with her peers.
Hopefully, any CPM is making use of Informed Consent/Refusal--in having waivers for families to sign if someone really does not want to follow some particular protocol of the mw.