The Advantages of a Midwife

     A midwife is a health care professional who provides a wide range of health care services for women that can include your gynecological check-ups, menopause, family planning services, pre-conception, prenatal, postpartum care, and newborn care.1 In addition, midwives usually care for women with low-risk pregnancies throughout all phases of pregnancy and the postpartum period.2 If your pregnancy is a relatively low-risk pregnancy, you might prefer a nurse-midwife. In most parts of the world, obstetricians deliver babies only during emergencies, and midwives handle rest. That’s increasingly true in the United States, where nationwide about 10 percent of all pregnant women now choose midwives.3 

There are several different types of midwives, each with its own training requirements:

Certified nurse-midwives (CNMs) are registered nurses who are also trained in midwifery. They are licensed to practice throughout the United States and Canada.1 Certified nurse-midwives complete two years of graduate work in midwifery after nursing school and are certified by the ACNM (American College of Nurse-Midwives) Certification Council.4 Certified nurse-midwives don’t accept high-risk pregnancies, and they always have a physician on call. In general, certified nurse-midwives use fewer medical interventions than obstetricians. Several research studies in the United States have shown that healthy women with normal pregnancies who choose certified nurse-midwives are just as likely to have healthy births as those who choose obstetricians. Studies show that for low-risk pregnancies, deliveries by CNMs are as safe as those by physician.3 As long as your pregnancy and birth are uncomplicated, a certified nurse-midwife can care for you through pregnancy, labor, and birth.1 In some cases, he/she may provide continuing routine gynecological care, and sometimes, newborn care.5 

Certified midwives (CMs), while not nurses, are graduates of schools of midwifery, often part of university programs. Certified midwives must pass state or provincial licensing exams.1 Certified midwives demonstrate knowledge and skills equivalent to those of CNMs. They have completed an ACNM-accredited educational program and are certified by the ACNM Certification Council.4 Most CNMs or CMs often work in a practice with Ob/Gyn but sometimes can practice on their own.2 They also work in hospitals and birth centers and can deliver your baby at home.1 

Direct-entry midwives (DEMs) are midwives who are trained without first becoming nurses. They may have a college degree or may learn their trade through self-study, workshops, or other instructional programs. Most attend births in homes or birth centers. Those who are evaluated and certified through the North American Registry of Midwives (NARM) are called Certified Professional Midwives (CPM), but they are not required to have completed an accredited educational program.4, 5 Other direct-entry midwives known as lay midwives, are not certified. Lay midwives are midwives who are not professionally trained. They usually learn the skills of midwifery through apprenticeship. Many are trained in other countries where lay midwifery is common. It’s best to use a certified nurse-midwife or certified midwife, as they have met professional and licensing standards.1 Not all states recognize direct-entry midwives. 

     Often women seek care from a midwife when they want a healthcare provider consistent with their childbirth philosophy. US studies have shown that healthy women with straightforward pregnancies who chose midwifery care had very good outcomes with fewer interventions and lower cesarean rates.1 

     If you choose a CNM or a CM (about 9 percent of expectant mothers do), be sure to select one who is certified and licensed (all fifty states now license nurse-midwives).5 The majority of trained midwives in the United States are certified by the American College of Nurse-Midwives (ACNM), so when you’re choosing a midwife, look for the letters CNM, which stands for certified nurse-midwife, or CM, which stands for certified midwife.1 Most CNMs or CMs use a physician as a backup in case of complications; many practice with one or with a group that includes several obstetricians.5  However, even with strong evidence supporting midwifery as the standard of care for childbearing women, the United States has not fully accepted the professional midwife as an autonomous provider of care. Childbirth continues to be primarily a medical event, with 93% of births attended by physicians (most of whom are obstetricians) and 99% of births occurring in hospitals.4 Therefore, you may well find that your insurance plan covers the services of certified nurse-midwives. Find out about your midwife’s experience and training and what sort of medical backup he or she has in case of emergency.1 

Lylla Ngo, M.D

Thomas Hale, Ph.D.

References:

1. Stone J, Eddleman K. The pregnancy bible : your complete guide to pregnancy and early parenthood. 2nd ed. Buffalo, N.Y.: Firefly Books; 2008.

2. Blott M. The day-by-day pregnancy book. London: Dorling Kindersley; 2009.

3. Riley L. You & your baby pregnancy : your ultimate week-by-week pregnancy guide. 2nd ed. ed. Hoboken, N.J.: Wiley; 2012.

4. Walsh LV. Midwifery : community-based care during the childbearing year. Philadelphia, PA ; London: W.B. Saunders; 2001.

5. Murkoff HE, Eisenberg A, Hathaway SE. What to expect when you're expecting. 3rd ed. New York: Workman Pub.; 2002.