Q: I'm thinking of using a midwife during my pregnancy. What should I look for?

A: Many women in the U.S. choose to deliver their babies with the help of a midwife instead of an obstetrician. Some moms-to-be choose a midwife because they want to deliver at home or in a birthing center, while others may decide to deliver in a hospital but want to avoid many of the medical interventions that tend to occur more often during physician-assisted births, like fetal monitoring, internal exams, drugs such as Pitocin, and episiotomies.

If you decide to deliver with a midwife, it's important to find someone you're comfortable with and whose personality you mesh with, since this person will be helping you through one of life's most exciting, intimate and, yes, painful moments. But before you begin your search, remember that not all midwives have the same credentials. Understanding the differences among them will ensure you get the kind of care and support you want.

• Certified nurse-midwives (CNMs) and certified midwives (CMs) have completed a program accredited by the American College of Nurse-Midwives (ACNM), but CNMs have additional nursing degrees. They both must pass an ACNM certification exam and apply for licensure within their state.

Like ob-gyns, certified nurse-midwives and certified midwives may provide preconception, prenatal, and postpartum care, as well as labor management and delivery. Most CNMs deliver babies in hospitals, but they may also attend home births and deliveries in birthing centers. They may write prescriptions, use Pitocin to speed labor along, or order an epidural. Some CNMs also assist with a cesarean section delivery, if needed.

• Certified Professional Midwives (CPMs) are midwives who are certified by the North American Registry of Midwives (NARM). While their competency requirements are the same as CNMs and CMs, their educational requirements and examinations are different from the standards of the ACNM and may include apprenticeship, self-study, and private midwifery schools. CPMs are licensed on a state-by-state basis and their legal status often changes with new government regulations, so visit a reputable Web site like the North American Registry of Midwives for information on your specific state. Since CPMs do not work in hospital settings, they specialize in drug-free methods of pain relief (that means no epidurals or analgesics). In some states CPMs are allowed to administer Pitocin, but only for postpartum use and not to induce or speed up labor.

• Lay midwives are not certified or licensed through any national organization and usually do not hold advanced degrees, so their practices are generally limited to home births and certain birthing centers. They carry no malpractice insurance, have no hospital privileges, and are held to no standard of safe, quality care. They do not qualify for HMO provider panels or third-party reimbursement. However, if a woman needs to be transferred to the hospital during labor elsewhere, a lay midwife can often act as her doula once the doctor takes over her care.

When you're choosing a midwife, you should meet her back-up physician (if she has one) since this doctor may be called to step in if complications arise during your pregnancy or labor and delivery). It's also a good idea to tour the hospital or center where she practices and find out if she's able to assist with a c-section if necessary. Many insurance companies will cover the services of CNMs or CMs just as they would an ob-gyn.

If you decide to work with a lay midwife at home or in a birthing center, be sure the center is accredited by the Commission for the Accreditation of Birth Centers (CABC) and that there is a clear plan in place to transfer you to the hospital should the need arise.

Answered by