Nearly half of the pregnancies in the United States each year are unintended, and emergency contraceptive pills (ECPs) have emerged as an important method for the prevention of unintended pregnancy. Despite the potential benefits of ECPs, they remain underused. The primary purpose of this study was to learn about ECP knowledge, attitudes, and practice patterns among certified nurse-midwives (CNMs) in North Carolina. The secondary purposes were to describe characteristics of CNMs practicing in North Carolina, and the contraceptive methods other than ECPs that they discuss with and prescribe for their patients. The study was conducted using a cross-sectional, confidential, self-administered mail questionnaire completed by 139 CNMs (73% response rate) in clinical practice in North Carolina. The majority of the CNMs worked in private practice settings (67%) in urban areas (60%). The median number of women seen weekly for gynecologic care was 15 (range 0-80), and the discussion and provision of contraceptive methods by the CNMs was comprehensive. All of the CNMs reported being somewhat (49%) or very (51%) knowledgeable about ECPs. Accuracy of ECP knowledge, as determined by a seven-item index, was high among 59% of participants and low among 41%. A small percentage of CNMs thought that ECPs encourage irresponsible behavior (12%) and that women will rely on ECPs as a regular form of contraception (4%). Half (50%) of the CNMs thought ECPs should be available over-the-counter. The majority of the CNMs discussed and prescribed ECPs (92%) though many did so only when the client requested. Over half (53%) of the CNMs identified one or more limitations to discussing ECPs. Attitudes toward ECPs and the frequency of ECP discussion and prescription were associated with accuracy of ECP knowledge. The CNMs in this study frequently provided gynecologic care and offered a range of contraceptive options. Their ECP attitudes and practice patterns were associated with the accuracy of their ECP knowledge. The information gained from this study can be used to develop and evaluate an educational intervention to increase discussion and prescription of ECPs.