Health & Pregnancy

Certified Nurse-Midwives, Certified Midwives, and More

For centuries, midwives have provided care to women during childbirth. Midwives today offer this care to women not just during the birthing process, but also throughout their reproductive lives.

Today there are more than 7,000 certified nurse-midwives practicing in the U.S. They attend about 10% of all births in this country, but the numbers are on the rise. 

What Kind of Training Do Midwives Have?

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

• Certified nurse-midwives (CNMs) are trained as both nurses and midwives. They have at least a bachelor's degree (and most also have a master's degree), and they must pass a national certification exam from the American College of Nurse-Midwives (ACNM) and receive a state license to practice.
• Certified midwives (CMs) are college-educated and certified by the ACNM. Because this is a relatively new specialty, not every state licenses CMs.
• Certified professional midwives (CPMs) are trained midwives who are certified by the North American Registry of Midwives (NARM). Not all states certify CPMs.
• Direct-entry midwives (DEMs) may have a college degree, or they may have trained through an apprenticeship, or learned their trade through self-study, workshops, or other instructional programs. Most attend births in homes or birth centers. Not all states recognize DEMs.

History of Midwifery

Centuries before obstetricians were delivering babies in hospitals, midwives in Europe attended to women as they gave birth to their children at home. The term "midwife" comes from the Old English phrase meaning, "with woman."

Midwifery in the U.S. began with a woman named Mary Breckenridge, who was determined to provide health care to people living in the remote Appalachian Mountain region. While on a trip to Europe, she was so impressed with the skill and care European nurse-midwives provided their patients that she brought several British nurse-midwives to America and established the Frontier Nursing service in rural Kentucky. It was the first real nurse-midwifery program in this country.

In 1955, a public-health nurse educator named Hattie Hemschemeyer started the American College of Nurse-Midwifery, the first organization of nurse-midwives in the country. The organization later changed its name to the American College of Nurse-Midwives.

What Do Midwives Do?

The main function of a midwife is to provide support and care to women during labor and delivery. However, midwives today don't just attend births -- they offer many types of gynecologic care. 

Midwives can:

• Perform gynecological exams
• Help with preconception planning
• Provide prenatal care
• Assist during labor and delivery
• Offer guidance with breastfeeding and other newborn care issues
• Help women who are going through menopause

Women have reported that they are more satisfied about their ability to make decisions about the birthing experience when they are assisted by a midwife as opposed to an obstetrician. Although midwives are trained to provide medical assistance when necessary, they prefer to avoid interventions, such as forceps and C-sections during delivery.