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Before medical care advanced to the point that the majority of women had their babies in medical facilities, midwives were an essential function of the community. Midwives were generally knowledgeable about the birthing process and how to handle minor emergencies during birth (e.g. cords around necks, turning the breech baby, etc.).
However, as the medical profession began to take over the delivery of babies, midwifery became a lost art. But now, as hospital-acquired infections are becoming more communicable and deadly, many parents are turning to midwives for their birthing option.
What Exactly Is a Midwife?
A midwife is a person who has studied female anatomy, obstetrics and gynecology, focusing on pre-natal care, the birth process, and post-natal care for mother and baby. There are five types of midwives: nurse midwife, certified midwife, certified professional midwife, direct-entry midwife and lay midwife.
Nurse Midwife (NM)
According to the Mayo Clinic, a nurse midwife “specializes in women’s reproductive health and childbirth. Nurse midwives provide care to women from adolescence through menopausal years. For pregnant women, they provide care during prenatal visits, attend the birth and provide care after the baby is born. Nurse midwives have similar roles to OB/GYNs (a type of nurse) but focus on natural techniques for childbirth and reproductive care.”
The nurse midwife must become certified through the American Midwifery Certification Board (AMCB). Qualified candidates for the exam must submit proof of licensure as an RN or NP and complete an accredited nurse midwifery program.
Certified Midwife (CM)
According to the American Pregnancy Association, a certified midwife must hold a bachelor’s degree from an accredited university as well as be certified by the American College of Nurse Midwives.
Certified Professional Midwife (CPM)
The American Pregnancy Association defines a certified professional midwife as one who has received training in midwifery and meets the North American Registry of Midwives. Educational backgrounds of CPMs vary.
Direct Entry Midwife (DEM)
The direct entry midwife is independently trained through various sources, including self-study, apprenticeship, and midwifery school or university. DEMs do not generally have a certification.
Lay Midwife (LM)
A lay midwife has studied independently or through an apprenticeship but is not licensed or certified.
What Education/Training Is Required
All midwives have to go through some training. According to the American College of Nurse-Midwives, “There are approximately 38 midwifery education programs in the United States accredited by the Accreditation Commission for Midwifery Education (ACME). All ACME-accredited programs adhere to the core curriculum necessary for safe beginning practitioners of midwifery that are required for accreditation. Each individual program has its own admission requirements and offers different pathways and degrees.”
The National Midwifery Institute is one program that produces certified midwives and certified professional midwives. The program coursework consists of courses in history and politics of midwifery, prenatal care, communication, facilitating labor and assisting delivery, labor complications and transport, postpartum care, breastfeeding, and maternal adjustment, charting, venipuncture, and lab work to name a few. Students are also required to complete credits in group study and complete 1,890 clinical hours (including being present for home births).
Working in Hospitals vs. Working Independently
It is not uncommon to see midwives working alongside OB/GYNs in the hospital setting. As a rule, the midwife who has taken care of you during your pregnancy will handle the delivery unless advanced medical intervention is needed.
According to Live Well, a website of Unity Point Health, “There are many advantages to working with a midwife within a hospital during your pregnancy and delivery." These advantages include:
- Being in a hospital means you'll have access to modern technology
- Being in a hospital means there will be talented obstetricians available in case of emergencies
- You'll receive personalized care and emotional support from a midwife
- Midwives who work in hospital settings have more amenities at their disposal, such as whirlpool baths and hydrotherapy, than midwives delivering in a home setting
- By having a midwife by their sides during labor, women tend to actually need less medical intervention
- Because they generally support a natural birthing process, women with low-risk pregnancies whose deliveries are supervised by a certified nurse midwife undergo fewer inductions and are less likely to have a C-section, which leads to a shorter recovery time
“There is a common myth that by choosing a midwife, you have limited yourself to an all-natural birth plan. However, midwives will support you and your decisions throughout your pregnancy and delivery. Whether you’d like to have an all-natural birth or have the option for medical intervention, your midwife will work with you to create a plan that’s right for you and your new baby.”
Working as an independent midwife is a bit trickier. Each state in the United States has different requirements. Some states require that a CM or CPM have a collaborative agreement with a supervising physician. Others require a collaborative agreement with a pharmacist for the ability to prescribe necessary medications. There are 25 states that do not require any collaborative agreements for CNMs or NMs.
Job Salary and Outlook
The Occupational Outlook Handbook states that nurse midwives generally make around $100,000 annually. With the increased interest in the services of midwives, the job growth outlook is at 21%, much higher than average, with more than 60,000 new positions available in the next seven years. There is no data on CMs, CPMs or DEMs.
Being a midwife is an enjoyable and rewarding career. Depending on the path you choose, you can help families bring joy into their lives with every new baby you help deliver.