What is a midwife?
In the United States there are multiple types of licensed midwife, which can be slightly confusing: Certified Nurse-Midwife (CNM), Certified Midwife (CM), and Certified Professional Midwife (CPM). The difference among these is related to educational background and clinical training, and has implications for a midwife’s clinical scope of practice (what clinical services she may legally provide and in what setting(s)).
I am a Certified Nurse-Midwfe (CNM), which means that I am a Registered Nurse with bachelors degree in nursing, as well a graduate degree in which I specialized in midwifery. CNMs work legally in all 50 states, and over 95% of us work in hospitals (not because we are not allowed to work in birth centers or homes, but because our training is largely hospital-based and almost all American women give birth in hospitals). CNMs make up the majority of licensed midwives in the U.S.
CMs also tend to work in hospital settings, have the same scope of practice as CNMs, and are certified by the same organization. Unfortunately, CMs are only legally recognized in a handful of states; it is a more recent credential in which “nursing” skills are incorporated into a single clinical degree rather than separated into two degrees of nursing and then midwifery.
CPMs are educated through institutionally-based or apprenticeship-based courses of study, work only in birth centers or homes, and are certified by their own organization. They are legally recognized in about half of U.S. states.
I believe that these professional divisions are confusing and unhelpful, and that there should be a unified educational pathway for midwives in the U.S., in which we are educated in (and eligible to work in) every setting: hospitals, birth centers and homes.
What Do Certified Nurse-Midwives Do?
CNMs are experts in women’s common and chronic healthcare concerns. While the clinical scope of practice of a CNM varies slightly by state, it broadly includes the care of women across the lifespan (i.e. from adolescence through menopause), including: gynecologic care and family planning; and care during the antepartum (before birth), intrapartum (birth), and postpartum (after birth) periods. It is also within our scope of practice care for newborns in the first few weeks of life and attend to routine primary care needs (i.e. your general healthcare needs that are not specific to reproductive health).
CNMs are independent clinicians; if you need a prescription we will write it for you and if you need lab work we will order and interpret it. We will perform your pap smear and your breast exam; we will teach you how to breastfeed and care for your newborn. We are trained to handle the common complications of pregnancy and birth, including infections, hemorrhages, shoulder dystocia (a baby who gets stuck on the way out), and lacerations (“tears”) that need suturing. As every type of healthcare giver should, midwives work in concert with other clinicians including physicians, consulting or making referrals as appropriate.
All midwives are trained within the Midwifery Model of Care, a philosophy and set of clinical skills that honors the woman as the central decision-maker in her care, and emphasizes what is normal, healthy, and socially important about pregnancy and birth. No matter what the healthcare concern or stage of life, midwives are trained to treat women as whole, autonomous human beings who are sometimes in need of help with their health.
What is the Difference Between a Midwife and a Doula?
Why Didn’t You Just Become an OB/GYN?
How Do I Find a Midwife In My Area?
How Do I Become a Midwife?