Finding a Midwife Who's Right for You
If you are considering a midwife, you should educate yourself on the different types, what they can and cannot do (this varies by state and is also based on level of training), and what you can expect. When finding a midwife who's right for you, ask detailed questions about how long they have been practicing, the outcomes, costs and payment, and more.
If you are considering a home birth, you may be wondering about your options for a care provider. Although who you choose will be a personal decision, you may want to consider a midwife. In a majority of cases, home births are attended by some type of midwife. So what is a midwife and why would you want one?
Midwives are care providers who specialize in assisting with childbirth. Similar to obstetricians in some ways, midwives can provide prenatal check-ups, attend labor and delivery, and provide postpartum care for the mothers and newborns.
Although healthcare providers and midwives may disagree on whether a home birth or hospital birth is safer, they both agree that if a woman chooses a home birth, the safety and health of herself and her baby are more protected if a trained and qualified midwife is present.
There are two types of midwives in the United States: certified nurse-midwife (CNM) and direct-entry midwife (DEM).
Let's start by looking at CNMs. These nurse-midwives are certified by the American College of Nurse-Midwives (ACNM). CNMs have to complete an accredited nursing program and be licensed as a registered nurse (RN). After becoming an RN, the next step is to complete a program in nurse-midwifery from an accredited institution. After completing this, they must be certified by the ACNM.
CNMs offer a number of services, such as prenatal, labor, birth, postpartum, and newborn care. Because they are also nurses, CNMs can provide a variety of care, including gynecological exams, family planning counseling, and health counseling, just to name a few examples.
Although their services are similar to those of an obstetrician, CNMs can provide more personalized care that focuses on the expectant mother's individual needs. In addition, insurance companies and Medicaid are required to reimburse the services provided by CNMs.
So what's the catch? Although it may seem like CNMs would be the best choice for a home birth, there are some legality issues. Although it is legal for CNMs to practice in all 50 U.S. states and in the District of Columbia, in some states, it is illegal for a CNM to assist in a home birth. In these cases, they are only allowed to serve clients at birthing centers and hospitals. State nursing boards regulate the licenses closely, so if a CNM assists in a home birth in a state where it is illegal, he or she could lose their license.
A large part of the CNM's training takes place at a hospital, so their approaches may not be as hands-off as other midwives. In some cases, CNMs who are practicing in a freestanding birthing center can offer a more natural approach to birth and tend to avoid many of the hospital methods (see What Are Freestanding Birth Centers?).
Direct-Entry Midwife (DEM)
If you are going to have a home birth, odds are that you will choose a direct-entry midwife (DEM). DEMs are midwives who did not have to go to nursing school. They enter the profession by a variety of routes, such as completing an accredited midwifery program, being an apprentice to senior midwifes, and/or going through self-directed study of midwifery. In most cases, DEMs provide services in out-of-hospital settings.
Most DEMs are qualified care providers who go through comprehensive training and examinations for certification. This certification is offered by the American College of Nurse-Midwives (ACNM) and the North American Registry of Midwives (NARM). The practice and credentials for midwives will differ throughout the United States.
There are four types of DEMs, including:
- Certified professional midwife (CPM): A CPM has met the standards for certification set by the North American Registry of Midwives (NARM). A CPM can enter the profession through apprenticeship, self-study, or midwifery school. When looking for a midwife, you may want to hire a CPM, as their certification requires them to have knowledge and experience in out-of-hospital settings.
- Licensed midwife (LM): An LM is a midwife who is licensed to practice in a certain state. They may or may not have a national certification like those issued by NARM or ACNM. Whether it is legal for an LM to practice will vary from state to state. If you are considering an LM for your home birth, check the regulations in your state.
- Certified midwife (CM): This non-nurse midwife receives certification from the ACNM. CMs have a background in a health-related field other than nursing, complete an ACNM-accredited midwifery education program (the same program as the nurse who becomes a CNM), and completes the ACNM's national certification exam.
CMs are not recognized by every state, as this is a fairly new profession. CMs normally practice in a hospital and do not usually assist in a home birth. They are often working in a hospital environment, although many wind up helping at freestanding birth centers.
- Lay midwife: This midwife is uncertified or unlicensed. A lay midwife is educated through informal routes, such as self-study or apprenticeship. These are often called the traditional midwife, granny midwife, or independent midwife. Although they may lack formal education, it doesn't mean that a lay midwife is inferior to other care providers.
In many cases, lay midwives have years of experience of solid birthing skills and good judgment calls. Do not dismiss the lay midwife when you are looking for a home birth care provider. Compared to some newly certified/licensed midwives who have only been through a few births, a lay midwife can have years of experience and delivered hundreds of babies at home.
(Click Considering Home Birth for more information on the benefits midwives can offer and more details on what they do.)