Midwifery - What is it all about? A Celebration of Birth & Life, San Diego

What is a Midwife?

A midwife is a trained professional with special expertise in supporting women in maintaining a healthy pregnancy, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.

A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.

The Midwives Alliance of North America, the North American Registry of Midwives, the Midwifery Education Accreditation Council and Citizens for Midwifery agreed on a short definition of what "midwifery care" means. However, just because a person is a midwife does not guarantee that they provide this kind of care; consumers looking for a midwife should ask questions to determine if a prospective caregiver will be able to provide the kind of care they seek.

Midwives in the U.S.
There are two main categories of midwives in the U.S., nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who trained as midwives without being nurses first. Within the category of direct entry midwives are several subcategories reflecting the varying legal status of these midwives in different states and the fact that until recently there was no nationally recognized credential available for direct entry midwives. Direct entry midwives include highly trained and very competent midwives; however, anyone may call herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are at least assured that she has met specific requirements for certification (and re-certification every three years).

Home Birthing Discussion
A discussion on the topic of Home Birthing and licensing midwives in North Carolina and other U.S. states with Russ Fawcett and Jennifer Block.

Brief Overview
Direct-Entry Midwives (including Licensed Midwives)

Not required to be nurses.
Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
May or may not have a college degree.
May or may not be certified by a state or national organization.
Legal status varies according to state.
Licensed or regulated in 21 states.
In most states licensed midwives are not required to have any practice agreement with a doctor.
Educational background requirements and licensing requirements vary by state.
By and large maintain autonomous practices outside of institutions.
Train and practice most often in home or out-of-hospital birth center settings.

The Certified Professional Midwife (CPM)
Credential and the North American Registry of Midwives

Not required to be nurses.
Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.
Education programs accredited by the Midwifery Education Accreditation Council prepare students to meet the requirements for the CPM.
Out-of-hospital birth experience is required.
Have met rigorous requirements and passed written exam and hands-on skills evaluation.
Administered by the North American Registry of Midwives.
Legal status varies according to state.
Practice most often in homes and birth centers.

The North American Registry of Midwives (NARM)
In 1987 educators, program directors and experienced midwives in the field of direct entry midwifery decided it was time to begin developing a national credential, the Certified Professional Midwife (CPM) credential, which is administered through the North American Registry of Midwives and has rigorous standards for knowledge, skills and experience.

As of January 2004, there are over 850 CPMs in the United States, Mexico, and Canada. The nineteen states that license direct-entry midwives to attend births out of the hospital use the NARM exam or the CPM process as the basis for licensure. States that are seeking licensure for direct-entry midwives are planning legislation which requires the CPM credential for licensure.

The North American Registry of Midwives has a free brochure "How to Become a Certified Professional Midwife (CPM)." You can request a copy or ask for more information about the CPM by contacting the North American Registry of Midwives at 1-888-84-BIRTH (eastern time), or by e-mail North American Registry of Midwives.

Certified Nurse Midwives (CNMs) / ACNM's CM Credential

Certified Nurse Midwives (CNMs)

Educated in both nursing and midwifery, primarily in the hospital setting; are "advanced practice nurses."
Must have at least a Bachelors Degree when training is complete.
Have successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam.
Out-of-hospital clinical experience is not required.
Are legal and can be licensed in all states.
Most practice in hospitals and birth centers.
In most states must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.

Certified Midwife (CM)
The Certified Midwife (CM) is a new credential from the ACNM that does not require a nursing degree but is otherwise similar to the CNM credential. As of 1998 the CM is legally recognized in only one state (NY) and does not meet existing direct entry midwife licensing requirements in any other states.

Legal Status of Direct Entry Midwives
As of 2003, 21 states recognize and regulate direct entry midwives (although for two of the states, New York and Rhode Island, only the CM credential is acceptable). Regulation varies from state to state, including licensure, certification, registration and documentation. Only 9 states and the District of Columbia actually prohibit the practice of direct entry midwives, but in 5 more states licensure is required but unavailable. In the remaining states direct entry midwives practice without any kind of state regulation, and in a few the legal status in not entirely clear. So, direct entry midwives are practicing essentially legally in about 34 states, but are considered unlawful or illegal in 14 states. However, these figures are subject to change as new legislation is enacted or new legal opinions are established that can change status in the a-legal states where direct entry midwives are neither specifically regulated nor specifically prohibited.