Midwives

What is a Midwife?

For many women who have a normal, low-risk pregnancy, a midwife can offer everything from prenatal care to the baby's delivery. Midwives tend to view birth as a normal, healthy event which, in most cases, works best with as little medical intervention as possible. Midwives are trained to watch for and identify potential or actual complications and, if necessary, can provide emergency treatment until additional medical assistance is available. Licensed midwives work with a physician backup. Although regulated individually by states, the following categories of midwives are recogonized in the United States:

Types of Midwives

• CERTIFIED NURSE MIDWIFE

A CNM is a registered nurse who has completed her degree in midwifery. She usually works through a hospital, obstetrician's office or birthing center. She sometimes works under the direction of a physician. A Certified Nurse-Midwife does not necessarily have a Master's Degree; many have only an Associate Degree, with a Certificate in Nurse-Midwifery. The commonality is that all are certified through the ACNM and/or its certifying agency- the ACC- via a nationally administrated exam. A Certified Midwife is certified through the same mechanism. A LICENSED midwife is one who is licensed in his or her state to practice midwifery.

• CERTIFIED MIDWIFE

A CM is certified by her state or midwifery organization. She has generally passed both oral and written tests, and has had her practice scrutinized. She may have received her training in a school, or in a manner similar to the lay midwife (below).

• LAY MIDWIFE or DIRECT-ENTRY MIDWIFE

This is a woman who has apprenticed with an experienced midwife and may have attended additional workshops and classes to supplement her education. Her focus is on homebirth or she may have a birthing room available in her own home or clinic. She may be affiliated with a physician, but is not under the physician's directive.

Questions for Midwives

• How did she become a midwife?
• What training has she had?
• Is she certified or licensed with any organizations?
• Does she belong to any midwifery organizations, attend conferences, workshops, subscribe to professional journals?
• What is her basic philosophy of childbirth?
• How many births has she attended as the primary midwife?
• Does she handle higher risk situations, such as twins or breeches?
• What is the fee for her services, how must it be paid, what does it include?
• What kinds of services are included in prenatal care? (early detection of problem areas for the mother and baby; nutrition information; exercise recommendations; in-home care; recommendations for parent education via books, videos, or classes)
• Does she work with another midwife or assistant at births?
• What does she do if there are two births at the same time?
• How do you reach the midwife; does she have a pager allowing 24 hour access?
• How does she handle problems or complications that might develop during labor?
• What standard and emergency equipment does she carry? What herbs or medicine does she use? Which ones does she not carry and why?
• Does she have any affiliation with a physician who can answer unusual questions either during the pregnancy or in an emergency?
• What is her policy for transporting to a hospital?
• What medical facility would she use? Has she developed a good working rapport with them?
• What kind of postpartum care does she provide? (frequency of baby check-ups; assistance with nursing)

(from The Homebirth Choice by Jill Cohen and Marti Dorsey)

You may want to check out the Mass. Friends of Midwives home page.

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