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What Is a Midwife?

midwife, midwives, certified nurse midwife, nurse midwife, midwife definition, doula
A midwife checks a fetus' heart beat and movement.
Credit: ChameleonsEye / Shutterstock.com

A midwife is a trained professional who aids and supports women in their pregnancies. They support the women and help them keep healthy through the birth process and recover during the postpartum period. Many women with low-risk pregnancies prefer using a midwife. Using a midwife, women have more customized individual care, depending on their specific needs physically, emotionally and culturally. A midwife’s philosophy states that pregnancy and birth are normal and healthy events until proven otherwise, allowing nature to take its course.

In terms of international recognition, midwives must successfully complete a midwife education program based on the International Confederation of Midwives (ICM) Essential Competencies for Basic Midwifery Practice. A midwife must acquire the requisite qualifications to be registered and legally licensed to use the term midwife.

In the United States, there are roughly 15,000 practicing midwives. They can work in hospitals, or they may practice in birth centers, clinics and even private homes. Over 10 percent of all U.S. births are attended to by midwives, and that number sharply increases in other countries. Though the correlation has not been determined, the nations that fare best in terms of infant and maternal mortality are also the nations that utilize midwives as primary health care providers.

In the United States, there are several types of midwife credentials. Most popular are:

Certified midwives (CM): educated and certified in the discipline of midwifery. They are not registered nurses, and only some states recognize this certification as sufficient for licensing.

Certified nurse-midwives (CNM): educated in both nursing and midwifery, and are certified by the American College of Nurse-Midwives. They have at least a bachelor’s degree and may have advanced degrees as well, and often work in conjunction with doctors. These are the types of midwives who deliver most often in hospitals.

Certified professional midwives (CPM): have met the standards for certification by the North American Registry of Midwives. This is the only midwifery credential that requires knowledge about out-of-hospital birth settings, and CPMs generally practice in homes and birth centers.

Direct-entry midwives (DEM): independent practitioners that are educated through self-study, apprenticeship or college. They are trained to provide the Midwives Model of Care through the childbearing cycle outside of the hospital. Examples of DEMs include licensed midwives and registered midwives. Some states do not regulate DEMs or allow them to practice.

There are a number of unlicensed “midwives” who are typically referred to as traditional or community-based midwives. They choose to not be certified or licensed, due to personal, religious or philosophical reasons. Midwives are not to be confused with doulas, which are birth assistants who have no professional standing at hospitals. They are a source of support during the process, but not medically trained to attend to births on their own.  

Midwives partner with their patients, giving support and care (both psychologically and physically) during the pregnancy to ensure proper prenatal development. They conduct the births and provide postpartum care to the infant and mother, including any accessing of medical care or carrying out of emergency measures. Midwives provide health counseling and education for both the mother and the family, helping the parents prepare for parenthood and what happens after the birth.

The difference between physicians and midwives

How do midwives differ from doctors? They have different education and philosophies, though that can vary from person to person. CNMs may use medical intervention, like medications and drugs, as well as electronic fetal monitoring, depending on the mother. Other types of midwives are often not legally allowed to use these without the supervision of a doctor. Many birthing centers and homes are not equipped for these kinds of procedures, so midwives are generally associated with natural vaginal births.

If complications arise, such as the need for an emergency C-section, midwives cannot perform the surgery and complete the birth. An obstetrician must be present to perform the delivery. After the baby is born, midwives are trained in basic life support for newborns and in the case of sudden complications, can support the baby’s health until a neonatologist or pediatrician is present.

Only you can decide if a midwife is the right choice for you. Midwife-supervised births often have fewer medical interventions than average, plus a reduced need for epidurals, episiotomies or C-sections. For the most part, higher-risk pregnancies are not recommended for midwife supervision. The website Kids Health recommends discussing with your doctor if you are carrying twins or multiples, have had prior pregnancy complications, or other factors that can raise the risk to your pregnancy.

If you decide to move forward with a midwife, it’s a good idea to have an emergency back-up plan in case of complications. Find out how your midwife is licensed or trained to handle emergencies, and plan for transportation to the nearest hospital.

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