Tuberculosis (TB) has reemerged as a major public health concern in the United States, with increasing impact upon women of childbearing and childrearing age. As a primary health care provider, the certified nurse-midwife (CNM) must be able to respond to a variety of client concerns and questions. This article reviews the natural history and changing epidemiology of TB. An in-depth focus on skin testing describes common errors in administration and interpretation, and how to clearly explain the meaning of a positive PPD result. Clinical presentations of active TB are summarized, with their implications for pregnancy and fertility. The final sections discuss the workup of latent TB to rule out active disease and outline standards for management and therapy. Combining a sound knowledge base with expertise in client education and counseling enables CNMs to make unique contributions to the broad effort to contain the new TB epidemic.