The term midwife comes from Latin and means, “with womxn”. It has referred to the practice of wise womxn attending to other womxn prenatally, during childbirth, and during the postpartum period. In the United States, we have a long history of suppression of midwives and the practice of midwifery. The greatest attempts to push the practice underground occurred in the early to mid 20th century but still continue to some extent today.
In the relatively recent past, American midwifery has gone through a rebranding so to speak, and this shift has resulted in the development of midwifery licensure. Currently, there are three main types of midwives practicing in the United States: Certified Nurse Midwives (CNMs), Certified Professional Midwives (CPMs), and Traditional/Lay Midwives / Birth Attendants.
These types of midwifery are as diverse as womxn who practice them. If interested in hiring a midwife in the United States, one must first determine which kind of midwife would best meet their needs.
Certified Nurse Midwife
Certified Nurse Midwives, or CNMs, are licensed to practice midwifery in all 50 states. CNMs come to midwifery through a nursing tract after having already earned their RN, usually through a 4-year bachelor’s degree program. Following their RN, they complete specialized master’s level studies in midwifery, with programs ranging from one to three years in duration. Most CNMs practice in hospital settings, usually working under the jurisdiction of an obstetrician, though this is not always the case. In some states, CNMs also practice in birth centers, though this is rarely the case in states where CPMs are licensed. In some states, CNMs can also attend homebirth, however, this varies drastically and is a criminal offense in other states. In most states, insurance covers CNM care for a hospital birth. In some states, insurance covers CNM care for birth center and home birth attendance.
In my experience, most CNMs are excel in situations requiring non-surgical birth intervention, such as hospital birth, epidurals, spinals, narcotic pain medication, and induction. They are trained nurses with specific expertise in medical intervention for pregnant patients. Many also have training in helping women achieve “low or no intervention” births in hospitals. Some CNMs work in birth centers and home birth settings, offering support to physiological birth. However, many CNMs have never seen an uninterrupted physiological birth, neither in their training nor in their years of practice, especially those who have exclusively worked in hospital settings.
Certified Professional Midwife or Direct Entry Midwife
Certified Professional Midwives or Direct Entry Midwives, who I’ll refer to as CPMs for our purposes, are licensed to practice midwifery in 35 states. These licenses look different in each of these states. Depending on the state, CPMs have a large variant in legal scope of practice a legal protections. The remaining 15 states range from having bills in the legislature to no legal practice for CPMs whatsoever (if interested in this topic of legality and licensure, check out this link http://pushformidwives.nationbuilder.com/ ). Most CPMs learn primarily through a combination of classroom time and apprenticeship model learning, with education lasting for 3-4 years. At that time, prospective CPMs sit a national board exam to become licensed. Once licensed, most CMPs practice in homebirth settings. In some states, they are also the primary midwives in birthing centers. CPMs do not practice under the jurisdiction of an obstetrician. In some states, CPMs can accept insurance.
In my experience, CPMs range in style of practice from a managed care medical approach to a hands-off physiological birth approach. CPMs are trained to be experts in “natural” childbirth and often are. However, legislation and litigation often require midwives to comply with regulations and standards of practice that have been borrowed from the world of obstetrics.
Traditional Midwife / Lay Midwife / Birth Attendant
Traditional Midwives go by many names, often depending on the location they serve. TMs carry no official training or licensure and their paths to birth work are varied. Some come from indigenous backgrounds of learning while others have been taught the art of midwifery their whole lives. Others completed organized courses of study that are designed to provide clear education, but not licensure. Others prefer to turn away from licensure, due to its legal restrictions, narrowing the ‘allowed’ scope of practice. Some TMs previously held licenses and have decided to relinquish their licensure due to relocation, litigation, desiring a wider scope of practice, or ethical concerns. Traditional midwives are not covered by health insurance.
In my experience, traditional midwives are the only midwives in our current system that are unhindered by the restrictions of licensure. Those restrictions are often mandating non-evidence based care that is antithetical to the midwifery model of care.