Midwifery and Certified Nurse Midwives

Meet Our Midwives

What is a Midwife?

The name midwife means “with women” and midwives have been ushering women through the normal stages of life, from birth to puberty to pregnancy to menopause and beyond since before the time of modern medicine. Although considered primary healthcare providers in most countries around the world since ancient times, midwives have been continually gaining popularity in the United States since the 1900s and in 2005 midwives attended 11.2% of all vaginal births.

Today’s midwives must graduate from an accredited education program and pass a certification exam. Once certified, midwives attend continuing education programs in order to keep abreast of changes in obstetrics. Many midwives work as labor and delivery nurses before transitioning to the midwife role. Midwives collaborate with an obstetrician.

What are the different kinds of Midwives?

Today, most U.S. midwives are Certified Nurse-Midwives (CNMs), meaning they:

• have a masters degree or higher
• have completed training in both disciplines of nursing and midwifery
• are certified with the American College of Nurse Midwives
• are licensed in every state
• have ability to prescribe medications in every state
• may work with doctors.

Although trained to work in hospitals, birth centers, and in the home, about 96 percent of births performed by CNMs occur in hospitals.  
 
Not all midwives are CNMs. A Certified Midwife (CM) meets all the criteria of a CNM except he or she is not a registered nurse. Direct-entry midwives (DEM) may not have a college degree and may have been trained through apprenticeships or self-study and work exclusively in out-of-hospital settings. A Certified Professional Midwife (CPM) is also an expert in out-of-hospital births for low risk women and is certified by the North American Registry of Midwives after passing written exams and hands-on skill evaluations.

Choosing a Midwife

As with any healthcare provider, it is important to feel comfortable, have trust in, and share a mutual respect with your midwife. Ask about the midwife’s background and certifications, and ensure that the midwife’s philosophy and approach to health are in line with your own preferences.

Is a Midwife Right for You?

The reasons that a woman or couples choose midwifery care are varied and often stem from the documented research on the high quality, personalized care received and on excellent maternal and infant outcomes. Countless studies of groups of low risk women cared for with the midwifery model of care compared to the medical model of care have shown:

• 33% lower risk of neonatal mortality
• 31% lower risk of low birth weight babies
• 19% lower infant mortality
• Less use of medical interventions
• Lower C-section rates
• More likely to experience prenatal education focusing on health promotion and risk reduction
• More likely to receive support with psychological issues, nutrition and breastfeeding information, and newborn care
• High levels of patient satisfaction

Many women choose midwifery care because of their desire for natural childbirth, although pain medication and epidurals are available for women under a midwife’s care if they are in the hospital setting. Although it is not appropriate for midwives to independently care for high-risk pregnancies, nurse-midwives are trained to recognize high-risk pregnancies, multiple births, risk factors from prior pregnancy complications, and may care for them in collaboration with a physician. Midwives are not trained to perform Cesarean sections, but often may first assist in surgery and can perform basic first aid on a compromised newborn until a physician arrives.

Have a Back-Up Plan

Even in low-risk pregnancies, unexpected complications can arise. Especially if your midwife practices in out-of-hospital settings such as a birth center or your home, ask about what will be done in case of a complication, who their back-up physician is, what emergency equipment they have access to, where the nearest hospital is, and whether the midwife has reliable transportation.