What is a Midwife?
Typically, midwives are described as clinicians specializing in reproductive health with a particular focus on pregnancy, birth, and the immediate postpartum period. My personal view, however, is that this is a very pale description of the work that midwives do and one that fails to highlight the unique approach that midwives take to healthcare.
I say that midwives are healthcare providers specializing in life’s transition periods: adolescence, the pregnancy/birth/postpartum cycle, the neonatal period, and menopause. Historically, midwives have also provided care for the dying and I believe this should be reincorporated into the work of contemporary midwives because it bears such a striking resemblance to the essential qualities of care during birth. The fullest expression of a midwife’s work is therefore as a cradle-to-grave clinician, educator, and guide through the periods of expected, physiologic change that, despite being normal, also involve intense vulnerability in a individual’s health.
Certified Nurse-Midwives (see below for the variety of types of midwives) are independent clinicians who care for women and trans folks with any of a vagina/uterus/ovaries/breasts.* 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 insert your IUD, and perform your pap smear and breast exam. We will teach you how to feed 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. Some midwives also perform ultrasounds, circumcision, and surgical first assist during cesarean sections. As every type of healthcare provider 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 individual as the central decision-maker in their care, and emphasizes what is common, healthy, and socially important about transformative experiences like pregnancy and birth. No matter what the healthcare concern or stage of life, midwives are trained to treat those in their care as whole, autonomous human beings who are sometimes in need of help with their health.
*Care for trans folks by midwives varies substantially by legal jurisdiction and individual midwife.
How are Midwives Trained?
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-Midwife (CNM), which means that I have a graduate degree in midwifery, as well as being a Registered Nurse with bachelor’s degree in nursing. The terminal degree for a CNM is currently either a clinical doctorate or master’s degree. 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. Ideally, I think that this would mean a single, national certification as a CM, ensuring a separate professional identity from nursing.
What is the Difference Between a Midwife and a Doula?
In contrast to a midwife (see my description above), a doula is a person whose main focus is physical and emotional support during labor. They are experienced in non-pharmacologic pain relief and play a significant role in helping the person in labor to advocate for their needs, especially in a hospital setting when those needs are often ignored. Doulas may also help educate a family prenatally on the childbearing process, and may have additional specialties in breastfeeding or postpartum support. Research has shown that using a doula in labor leads to lower cesarean section rates, less need for labor-augmenting drugs and labor anesthesia, and greater satisfaction with the experience of childbearing.
Organizations like The Doula Project are also expanding the role of doulas to support across the spectrum of pregnancy, including abortion support.
Why Didn’t You Just Become an OB/GYN?
Especially considering the fact that midwifery involves years of education and clinical training (post-bac work for those of us who studied Chinese the first time around, possibly a second bachelor’s degree, a master’s, and possibly a doctoral degree) midwives are often asked why they didn’t become obstetricians instead.
Most people are unaware that obstetricians are specialists in the pathologies of pregnancy and birth, and that they are generally trained poorly, if at all, in normal pregnancy and childbearing. It is not the case that knowing how to handle the severe complications means understanding how to handle a lack of complications, and it is certainly the case that obstetricians run the risk of creating pathology where there isn’t any given their lack of familiarity with what normalcy looks like.
I became a midwife because I am primarily interested in the normal, extraordinary processes of human reproduction and sexuality, and in supporting people through these vulnerable periods with the greatest degree of well-being and dignity possible. I am also particularly interested in preventative care (e.g. normalizing blood sugar before pregnancy to prevent fetal complications from ever occurring, or turning a breech baby to obviate the need for a discussion about preemptive cesarean section). The majority of people experience reproductive lives that fall within the range of normal and require the assistance of someone experienced specifically in what is common and physiologic as opposed to severely pathologic. With all due respect to the many capable OB/GYNs I know, that is central the training and expertise of a midwife and not an MD.
How Do I Find a Midwife In My Area?
For those based in the US: the American College of Nurse-Midwives has a search tool on their website, although it may not be 100% complete and will only list CNMs and CMs (see above for the differences among midwifery certification/education processes). You can also contact the Midwives Alliance of North America for listings that would include CPMs near you.
How Do I Become a Midwife?
Take a look at the description of the various types of midwives above (“How are Midwives Trained?”). The American College of Nurse-Midwives has more information on the educational path to becoming a CNM or CM, while the North American Registry of Midwives describes the path to becoming a CPM.