What Is a Midwife?

What is a midwife, and what do they do? We'll break down the main types of midwives to help you decide if a midwife is right for you.

a pregnant lady is examined by midwife at the clinic

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When it comes to choosing who will care for you during pregnancy—and labor and delivery—it makes sense that you would want someone who can give you one-on-one time. Research has shown that having a trained midwife can lead to lower rates of cesarean section, fewer medical interventions, and lower rates of infection and maternal mortality. But what does a midwife do, and do you need one?

Read more to learn more about the different types of midwives, and whether or not you should choose one for your pregnancy and postpartum period.

What Is a Midwife?

A midwife is a healthcare professional who focuses on pregnancy, including labor and delivery, postpartum care, and newborn care. You can find midwives in hospitals, birthing centers, or private practices where they can perform home births.

"They provide comprehensive prenatal, intrapartum (birth), and postpartum care. Unless complications arise outside of the scope of midwifery care, they can be someone's primary prenatal care provider," says Jenna Benyounes, DNP, WHNP, NMCP, a certified nurse midwife and director of clinical talent acquisition strategy at Quilted Health. "Depending on state laws, many midwives are trained and able to provide gynecological care. This may include prescribing birth control, performing medical abortions, and providing fertility assistance."

Although midwives can perform their services in multiple settings, 94% of certified nurse midwives (CNM) attend hospital labor and delivery, where they attend 9% of all hospital births. They also attend 50% of all home births and 40% of all births in birthing centers.

What Does a Midwife Do?

Since there are different types of midwives, they can provide different levels of care. Some, for example, have more schooling, professional training, and credentials, giving them wider access to patients, including hospital settings. Other midwives have less training and, therefore, can offer fewer services, including practicing in a hospital. Some services that midwives offer include:

  • Confirming and dating a pregnancy
  • Prenatal care, including ultrasounds and some blood work
  • Education and support for labor and delivery
  • Attending to labor, birth, and newborn care
  • Postpartum education, support, and care
  • Providing education on nutrition, family planning (including birth control), lactation, fertility, and reproductive health
  • Providing health screenings, including breast exams, pap tests, sexually transmitted infections tests, and exams for other infections

Understanding what education, training, and certification your midwife has is essential when considering what services they can provide.

Types of Midwives

The short answer is yes, there are different types types of midwives—each of whom are certified (and trained) to do different tasks and things. Lay midwives and certified professional midwives typically attend deliveries at home or in birth centers, Emily Hoger, RN, CNM, a board-certified nurse-midwife at Keystone Women's Care in Pennsylvania, explains. "There are also certified nurse-midwives (CNM) or certified midwives (CM), who may attend deliveries in the home or birth center but most commonly do so in the hospital," she adds.

Hoger explains that some midwives operate out of the hospital and may not seek licensure, or it may not be required by their state to attend deliveries at home. According to data published by the Midwives Alliance of North America, not all states offer licensure to midwives, which means that midwives can be limited in the services they provide, including working in hospitals, ordering labs, or prescriptive medicine. In states where licensure does exist, those who wish to be a certified nurse midwife must obtain an academic degree and be licensed by their state in both nursing and midwifery.

Different Types of Midwives

  • Certified Nurse Midwife (CNM): CNMs earn advanced academic degrees in nursing with additional training and licensure for midwifery.
  • Certified Midwife (CM): CMs are midwives who receive certification and licensure after approved training. Unlike CNMs, however, CMs don't have a nursing degree. CM can practice in hospital settings like CNMs.
  • Certified Professional Midwife (CPM): CPMs are typically independent midwives with certification through the North American Registry of Midwives, which uses an accredited certification program to ensure excellence. CMPs receive training that includes education and supervised clinical experience.
  • Direct Entry Midwife (DEM): DEMs are unlicensed and uncertified midwife professionals who receive training through midwifery school, college programs, or established apprenticeship programs. They can provide prenatal care and attend labor and delivery in birthing centers or home settings.
  • Lay Midwife: Lay midwives are unlicensed, uncertified midwives and are trained without a specific academic or professional standard, including being self-taught. As such, they are not generally considered to be professional health care providers, and they tend to practice outside the mainstream medical community.

The Difference Between a Midwife and an OB-GYN

The main difference between a midwife and an OB-GYN is training. Acccording to Christine Armstrong, MD, FACOG, a board-certified OB-GYN in Manchester, Connecticut, an OB-GYN is a physician who has completed four years of medical school and four years of residency training while a midwife is a board-certified nurse who has completed two years of post-graduate studies, if they are a CNM that is. "Many practices have a shared model where all patients see both physicians and midwives. In other cases of a midwife-only practice, physicians serve as consultants for more difficult cases or if any patients need surgical intervention."

Midwives at all levels of midwifery can—and do—deliver babies. However, they cannot give an epidural since they are not trained to do so; that is something an anesthesiologist or a certified nurse anesthetist (CRNA) does. Also, midwives do not perform C-sections, but they can assist a physician during the procedure.

"Midwives are experts in vaginal birth. All midwives can deliver (or 'catch') babies. They cannot perform C-sections, but CMs and CNMs may be able to assist OB-GYNs during a C-section, depending on the hospital and its policies. Midwives assisting with out-of-hospital births that require a transfer to a hospital may be able to be present and act as emotional support during the surgery," says Benyounes. "CNMs/CMs working at a hospital can order epidurals and other pain medications. Thus, if you're giving birth in a hospital and have a midwife as a provider, you can certainly request an epidural."

Should I Hire a Midwife?

Choosing a health care provider during pregnancy is a big decision, and a midwife won't be a perfect fit for every pregnant person. That said, midwives can offer robust care through prenatal, labor and delivery, postpartum, and newborn stages.

"If you do not have a complicated obstetric history, then you would be a perfect midwife patient," says Dr. Armstrong. "You can always research practices in your area, and they will let you know if you're a good fit for the practice. Depending on the midwife, they may be comfortable managing some patients with issues such as diabetes and hypertension along with a collaborating physician."

If you decide to hire a midwife, make to ask a few important questions:

  • Are they licensed and certified to offer midwifery services?
  • What doctor and hospital do they practice?
  • Will they stay with you during labor and delivery?

Key Takeaways

Midwives can offer individualized, one-on-one-type care for low-risk pregnant people. This often includes an educational component to help new parents through labor and delivery as well as the initial stages of postpartum, newborn care, and lactation. There are different types of midwives who can offer services in hospitals, birthing centers, or home settings. Some midwives have more rigorous training than others, including licensure, academic and clinical training, and certification requirements depending on state laws. Make sure to talk to your midwife and ask about all training and certification, including which doctors and hospitals they practice with.

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