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 13,000 certified nurse-midwives practicing in the U.S. They attend about 12% 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.

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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:

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.

What Are the Benefits of Using a Midwife?

Midwives can help women have a more natural childbirth experience. They often offer more personalized care than medical doctors, which includes taking the time to talk to the mother-to-be about her concerns and needs.

Some research suggests that midwives lower the risk of infant mortality and reduce the need for C-sections and other interventions. One study showed that births attended by a midwife had a 19% lower infant death rate and a 31% lower risk of delivering a low-birth-weight baby. Another study showed that nurse-midwives had 4.8% fewer C-section rate than obstetricians and used fewer resources, such as forceps and vacuums for delivery. (The reductions in mortality and complications, however, may be because midwives generally handle very few high-risk deliveries.)

Are There Any Risks to Using a Midwife?

Some states do not allow midwives to administer pain medications or to provide certain medical interventions such as electronic fetal monitoring.

And if there is a problem with the newborn, the midwife can only administer basic life support. At a hospital, obstetricians, pediatricians, and neonatologists can step in to handle these issues if they arise.

Most midwife-assisted births take place in hospitals, but some women prefer to give birth at home. The American College of Obstetricians and Gynecologists does not endorse home births, because complications can occur even in otherwise normal pregnancies, and women who give birth at home don't have access to doctors or specialized medical equipment.

Giving birth at home can be especially risky if you are pregnant with more than one baby, or if you have gestational diabetes, high blood pressure, or other risk factors. If you do decide to give birth at home and your doctor and midwife agree to it, have a plan for how you will get to a hospital in case problems occur during the birth.

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How Do I Choose a Midwife?

Some obstetric/gynecologic practices have a midwife (or midwives) on staff. If yours doesn't, you can find a midwife in your area by contacting the American College of Nurse-Midwives. Make sure the midwife you choose is certified and licensed to practice in your state. Find someone who is experienced and trained in emergency procedures. It's also important to find someone you're comfortable with, who respects your wishes about your pregnancy and delivery.

Ask your prospective midwife about her position with regard to medical interventions such as continuous fetal monitoring, pain medication (including epidurals), inducing labor, and C-sections. Talk to a few midwives to find the one who best fits your needs.

WebMD Medical Reference Reviewed by Kecia Gaither, MD, MPH on September 18, 2014

Sources

SOURCES:

American College of Nurse Midwives: "What is the difference between a nurse-midwife, midwife, and doula?";  "A brief history of nurse-midwifery in the U.S.;" "More on CNMs/CMs;" and  "What is a Midwife?"

MacDorman, M. Journal of Epidemiology and Community Health, 1998; vol 52; pp 310-317.

Rosenblatt, R. American Journal of Public Health, 1997; vol 87; pp 344-351.

Blix-Lindstrom, S., Midwifery, 2004; vol 20; pp 104-112.

American College of Obstetrics and Gynecology. "ACOG Statement on Home Births."

Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol 2014;211:390.e1-7

American Journal of Obstetrics & Gynecology, Volume 211, Issue 4, Pages 390.e1–390.e7, October 2014

Sources

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