Today there are more than 13,000 certified nurse-midwives practicing in the U.S. They attend about 8% 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.
- 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.
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 their 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 internal 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.
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 their 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.