By Jacque Shannon-McNulty


Midwifery is enjoying an explosion of popularity with moms-to-be. More and more women are choosing to give birth with midwives. The term “midwives” used to be a one size fits all label for a woman helping another woman give birth naturally. In the United States, however, there are now several classifications of midwives, making it finding the right midwife complicated for even the savvy mom-to-be.

Choosing the right kind of midwife is critical to assuring that you have the best birth experience possible. Every birth is unique and every mom-to-be has different needs in pregnancy and birth. Understanding the differences between different types of midwives will go a long way to helping you to choose the right midwife for your pregnancy and birth.

All midwives have a number of commonalities; these characteristics in general are what distinguish the care that midwives provide from a doctor’s care. Midwifery literally means “with woman” and is a holistic, woman-centered care philosophy. Midwives spend more time in prenatal appointments with their clients than most doctors do. Midwives are trained to prevent many common pregnancy complications through preventive care practices. Midwives spend time educating their clients about nutrition, exercise and stress reduction to help maintain healthy pregnancies. Midwives tend to be less interventive, relying less on technology and more on personal care to attend to the needs of their clients. Midwives also tend to provide more individualized care, offering more flexibility and open discussion of your personal preferences and your birth plan.

Certified Nurse-Midwives are nurses who continue on to complete an advance practice graduate degree program in midwifery. Certified Nurse-Midwives (CNMs) are trained in hospitals and generally practice within the medical system. CNMs attend just over 10% of births in the United States, according to the American College of Nurse-Midwives, and 96% of CNM attended births are in hospitals. Though most CNMs have never witnessed birth outside of a hospital, a small number of CNMs attend births at independent freestanding birth centers and a handful attend homebirths.

Certified Nurse-Midwives often work in teams with physicians and are required to have physician back up. This enables easy continuity of care should your pregnancy or birth develop problems. Conversely, it can add some extra restrictions for a CNM to practice under physician supervision. Due to medial malpractice insurance restrictions, hospital policy or rules laid down by supervising doctors, many CNMs are unable to attend VBAC births (Vaginal Birth After Cesarean), even healthy and uncomplicated VBACs. Most CNMs are unable to attend breech births or twin births in hospitals, though some are able to at birth centers and at home. In hospitals, some CNMs can even attend births where a mother chooses to use an epidural or other medication, though most CNMs prefer to practice with a focus on natural childbirth.

Certified Professional Midwives are apprentice-trained midwives (direct-entry midwives) who have completed the certification process through the North American Registry of Midwives. CPMs practice holistically outside of the medical system, they are not dually trained in the medical system and nurses and they usually practice independently, without physician supervision. This freedom from institutional restrictions enables many CPMs to provide individualized care without blanket risk-out protocols. Many CPMs attend healthy VBAC births and some very experienced and specially trained CPMs even attend healthy, uncomplicated twin births and breech births.

CPMs are experts in homebirth. The credentialing process for CPMs is the only educational route that requires homebirth experience to achieve certification; no CNM or MD program has this requirement, and the vast majority of CNMs and MDs have never even witnessed an out of hospital birth. With this extensive training and specialized experience in homebirth, CPMs are uniquely qualified to attend homebirth. CPMs tend to embrace waterbirth as a healthy birth option and support their clients who are interested birthing in the water. CPMs have a strong working knowledge of gentle, natural healing modalities like herbs and homeopathy. CPMs act as guardians of the natural process of pregnancy and birth. They are trained to detect problems before they occur and to manage emergencies during birth. When they can’t prevent a pregnancy or birth complication, they refer their high-risk clients to a physician.

Direct-Entry Midwives are apprentice-trained non-nurse midwives and receive their training from more experienced midwives. DEMs are midwives who have not undergone the certification process that CPMs have. They may be highly skilled and well-trained, or they may be less experienced. Because the term direct entry midwife encompasses such a wide array of midwives with very different types of training and experience, it is up to the mom-to-be to ask many questions, check referrals and carefully assess the individual training and experience of a DEM.

Direct-entry midwives and even Certified Professional Midwives are sometimes referred to in the media and by physician groups as “lay midwives.” This term is essentially pejorative, and is not a professional classification of a certain type of midwife. Other kinds of midwives, such as traditional midwives, granny midwives, traditional birth attendants or independent midwives also are types of direct-entry midwives.

Licensed Midwives are usually CPMs or other direct entry midwives who have passed a licensure exam and have received a license to practice midwifery in their state. While many states do license CPMs and DEMs, several still have not enacted licensure legislation. The qualifications for the LM credential vary from state to state.

While many midwives are deeply committed to the Midwives Model of Care, some midwives practice with more of a medically-inspired model of care. Do your research. Ask lots of specific questions. Check out referrals. Most importantly, trust your instincts. Only you can decide which midwife best suits your needs.

Whatever your birth plan entails, if you would like to experience your birth as a healthy, natural, joyful life transition, a midwife is a great choice to support and care for you through your pregnancy and birth.

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