It is not uncommon to have someone ask me what a midwife is when I tell them what I do, or to encounter confusion about the fact there are different types of midwives. Though somewhat unfamiliar in our country, midwifery has been the norm around the world for centuries. You can even read about two midwives, Puah and Shiphrah, in the book of Exodus, who were honored by God for caring for Israelite women and babies despite Pharaoh’s commands otherwise. Have you read this? In the book of Exodus, Pharoah, the king of Egypt, is quite the evil dictator, and despises the Israelites. He commands the midwives to kill any Israelite baby boy that is born. However, these two amazing midwives can’t comply. They continue to care beautifully for the Israelites, whether baby boys or girls, and when confronted by Pharoah they say that the Israelite women are so strong, that they deliver before the midwives can even get there.
What is a Midwife?
Any who, the word midwife simply means “with woman.” Though education and standards have changed (a lot!) since the time of the Exodus, the heart of midwifery remains the same - to support women through childbirth, care for their growing and newborn babies, and support women holistically as they begin their journey into motherhood. Midwives are educated to support women throughout the prenatal period, through assessment and education, and support them as they make informed decisions for the health of themselves and their children. Midwives are strong believers that birth is a natural, physiologic process, and that women are made to deliver babies, most often, without the need for intervention. Though midwives specialize in normal, low-risk pregnancies, they are trained to recognize deviations from normal and to intervene as necessary. If the needed care or deviation from normal is outside of their mandated scope of practice, midwives may co-manage or transfer care to a physician as necessary. There are three types of midwives, each with their own route of education and accreditation, though the main definition and philosophy apply to all.
What are the Different Types of Midwives?
The first type of midwife is a certified professional midwife (CPM). Commonly called community midwives or direct-entry midwives, there are two routes one may take to become a CPM. One option is to attend a midwifery school or university. This education includes structured classroom settings, as well as mentoring under a trained midwife where they see women for prenatal and postpartum visits, and attend a set number of labors and births as determined by the licensing board. These midwives in training, first attend births as an an oberserver; they are simply in the room of a laboring woman and witness the birth. The next phase they enter is that of an assistant, where they work closely with a trained midwife, offering additional hands and skills for such things as neonatal resuscitation if necessary. And the final phase, CPMs in training take the role of the primary midwife, all under the supervision of a licensed midwife. As the primary midwife, the CPM student is fully in charge of supporting the mother during labor, and assisting in the delivery of the newborn, managing any heavy bleeding of the mother, suturing if necessary and helping with immediate postpartum care, such as breastfeeding and bonding.
The second option for a CPM-to-be, is known as the portfolio method, and does not involve a classroom setting, but acts more as an apprenticeship (how most midwives were trained throughout history). The same number of clinic visits and births are still required, and the midwife in training must submit record of all clinic visits and births signed by their mentor midwife to the national midwifery board. Whether the portfolio method or attendance in an accredited midwifery education program, all community midwife students are required to sit for a national board exam to become certified, and then must apply for licensure in their state of practice, which then determines their exact scope of practice.
The second type of midwife out there is what I am, a certified nurse-midwife (CNM). CNMs are registered nurses who go on to get their masters or doctorate degree in nursing as a nurse-midwife, similar to the education of a nurse practitioner. My program, for example, was a combined program where I was able to get the education and clinical requirements to also become a CNM as well as a women’s health nurse practitioner. They often provide care in an OB/GYN clinic and deliver in hospitals, but can also work in birth centers or home birth settings. In most states, nurse-midwives can work independently, provide medication, as well as do well-woman, or annual, exams, and treat women for primary care and gynecological concerns. They can be providers for women in their teens all the way through the post-menopausal years, providing contraception, and administering hormone therapy for women experiencing menopause.
Similarly, the third type of midwife, is a certified midwife (CM). CMs are master’s or doctoral prepared midwives who are not nurses, but rather have their bachelor’s degree in another specialty, and have taken additional prerequisite courses in order to qualify for a graduate program in midwifery. CMs share the same scope of practice as CNMs. Both CM’s and CNMs are regulated by a national board called the American Midwifery Certification Board (AMCB), which creates the national board exam for certification. CNM's and CM’s are certified by this board, but licensed in their state of practice, just like a CPM.
How are Midwives Licensed?
No matter the type of midwife or which board oversees the credentialing, MEAC or AMCB, each state sets their own standards for midwifery practice, so some provision of care varies depending on which state you are in. For example, in the state of Idaho, midwives who practice outside of the hospital are not allowed to be the provider for a woman giving birth to twins. However, in the state of Washington, assisting a woman with the birth of twins is acceptable. No matter the exact scope, midwives in every state, and of every credentialing, are champions in providing skilled services for low-risk women throughout their pregnancy, birth and the postpartum period. So, if you are pregnant, would like to be pregnant, or need care for another women’s health related topic, consider a midwife for your care!
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