Critical questions confront the American College of Nurse-Midwives (ACNM). What is the ACNM's responsibility to the profession of midwifery in the United States? Who should set the standards of midwifery practice? Should the ACNM recognize other educational pathways to midwifery? What effect would the answers to these questions, either positive or negative, have on nurse-midwifery and on the ACNM? A comprehensive data base pertaining to the subject of any change in titling or education is given. Directions and choices are articulated.