Midwives in the United States
Certified Nurse-Midwives, Certified Midwives and Lay Midwives
Aug 26, 2008
In the U.S., midwifery care is regulated on the state level and by province in Canada. Midwives are categorized according to their level of education and their credentials and include Certfied Nurse-Midwives, Certified Professional Midwives and Direct-entry or Lay Midwives. Most midwives of all types follow the midwives model of care as opposed to the medical model of care, but there are some important differences.
Certified Nurse-Midwives
Certified Nurse-Midwives (CNMs) are trained in both nursing and midwifery. They primarily work in a hospital setting. According to the American College of Nurse-Midwives, CNMs are skilled primary care providers “as evidenced by their low rates of infant mortality, cesarean birth, episiotomy, and use of epidural anesthesia and their high rates of success in vaginal birth after cesarean” (2005). CNMs can sometimes prescribe medications and usually have access to hospital diagnostics and can consult with physicians when needed.
CNMs provide primary care to women of childbearing age including prenatal care, labor and delivery support, care of the newborn and mother after birth, gynecological exams, and family planning. CNMs are licensed in all 50 states and in the District of Columbia and they account for approximately 8% of all births in the U.S. (American College of Nurse-Midwives, 2008)
Certified Midwives or Certified Professional Midwives
Certified Midwives (CMs) (also called Certified Professional Midwives or Licensed Midwives) are midwives who do not have a nursing degree, but who have graduated from an accredited program, received certification from the American Midwifery Certification Board and have earned at least a Bachelor’s degree. They must pass the same strict licensing requirements as Certified Nurse-Midwives. CMs also provide primary care to women of childbearing age, just as CNMs do. They may be direct-entry midwives who have taken the steps for certification and/or licensure in their state.
CMs often attend births at home and in free-standing birth centers. CMs may or may not have hospital privileges, but some without them can work with a physician to access hospital services.
Not all states offer licensing for Certified Midwives, and each has its own state laws governing the practice.
Direct-entry Midwives or Lay Midwives
Direct-entry Midwives (also called Lay Midwives or Empirical Midwives) are not certified and may or may not be licensed in their state. They may have quite a bit of education and experience, but have not become certified because their state does not require it. They may simply prefer to work on their own without a governing body or they may be community-based midwives who serve only a small local segment of women.
Direct-entry midwives usually attend births at home or at freestanding birth centers. They may have learned their profession through apprenticeship, formal training or a combination of these. They may or may not hold a degree. Most direct-entry midwives run their own practices outside of institutions. They may or may not have a relationship with a physician for access to certain services and technologies.
Since direct-entry midwives are not regulated and come from such varied backgrounds, you may want to ask questions to gauge whether or not the midwife has adequate training and experience.
Your choice of birthplace or comfort level with a midwife’s experience, education or connections may help dictate who you ultimately choose as your care provider. It is also important to interview potential midwives to ensure their personalities and philosophies of birth match your own. Not every midwife will share your views on diagnostic testing, interventions, pain relief, inductions, homebirth or a vaginal birth after caesarean. To fully enjoy the benefits of midwifery care, keep looking until you find one who does.
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