Overview of Midwifery
A midwife attends childbirth, provides support during labor and delivery, and supervises the general care of women and children directly after birth. The term midwife, meaning "with a woman," was first recorded in 1300. However, accounts dating to the second century confirm the role of midwives in the birthing process. Contemporary midwives provide care to women during normal pregnancies and deliveries and call on obstetricians or other physicians if complications develop. Midwifery is a professionally regulated field.
Midwifery provides continuous support to women with uncomplicated pregnancies during pregnancy and labor. Communication between midwife and the pregnant woman is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and most encourage family participation in the birth. They pay special attention to the cultural values and personal preferences of the women in their care.
Safety is also a priority in midwifery and studies show that outcomes are the same as physician-attended births. As part of their commitment to nonintervention, midwives do not advocate the use of pain medication or invasive procedures during the normal birthing process. They encourage women to actively participate in the birthing process. Midwives provide health care education and emotional and social support. The continuous presence of a midwife during labor can reduce:
- The length of labor
- The need for pain medication
- The likelihood of forceps or other operative devices during delivery
- The possibility of cesarean delivery
There are two recognized types of midwives in the United States: direct entry midwives and nurse-midwives. The credentials differ; however, certification requires that both types are trained in childbirth and committed to providing continuous care to women throughout childbirth. Midwives maintain working relationships with physicians in case of emergencies or complications.
Direct Entry Midwives
A direct entry midwife (DEM) enters the field of midwifery through an apprenticeship, community-based training, or a field other than formalized nursing education. They have a long-standing commitment to women's health care and experience-based training. Most often, DEMs provide care to women giving birth at home.
During the past 50 years, many pregnant women have chosen obstetrics for their method of care and midwifery experienced a decline. Within the last 10 years, there has been a push to standardize the education of DEMs through certification and credentialing. Since 1996, DEMs can attain certification from the North American Registry of Midwives as "Certified Midwife" (CM), a professionally recognized title. Midwifery is currently experiencing an upswing in popularity.
Requirements for Certified Midwives
Direct entry midwives may have completed apprenticeships with midwives and/or physicians, performed independent studies, and/or completed midwifery school. To attain Certified Midwife status, they must also:
- Complete prerequisite health science requirements
- Graduate from an accredited, university-affiliated midwifery education program
- Earn at least a baccalaureate degree
- Successfully complete the national certification exam
The American College of Nurse-Midwives (ACNM) developed the requirements to guarantee competency for CMs. CMs are held to the same standards for practice, philosophy, and code of ethics as certified nurse-midwives. The certification examination is the same as for certified nurse-midwives and is administered by the ACNM Certification Council (ACC).
CMs practice independently, at medical clinics, or at hospitals as physician assistants. As a relatively new profession, CMs are not recognized by every state. Insurance providers may cover their services and many CMs have a sliding scale.
Nurse-midwives are registered nurses who have completed accredited midwifery programs. Once certified, they are certified nurse-midwives (CNMs). Nurse-midwives can write prescriptions and provide a variety of care, including:
Nurse-midwives collaborate with physicians, especially in problem pregnancies. In general health care, nurse-midwives work with other medical professionals to provide comprehensive health care resources. When additional medical advice or surgical care is needed, they refer women to the appropriate physician.
The philosophy of nurse-midwifery is based on providing health care to women, while acknowledging and respecting their needs. They encourage patient education, active participation, clear communication between the provider and the woman, and an individualized health care experience.
Perhaps the best-known facet of nurse-midwifery is the commitment to facilitating uncomplicated pregnancy. Nurse-midwives provide information about different types of care available and encourage women to enhance their pregnancy by being involved. Nurse-midwives advocate birth education, natural childbirth, and the participation of the entire family. They rely on technology only when it is medically necessary. Thus, cesarean sections and episiotomies are less common when care is provided by a CNM.
Requirements for Certified Nurse-Midwives
The tradition of nurse-midwives has existed since the 1920s and the American College Nurse-Midwives (ACNM) formed in 1955 to oversee the development of the field. The ACNM has defined the criteria for nurse-midwifery. Nurse-midwives receive education and training in nursing and midwifery and must be licensed. The requirements for certification are similar to those for certified midwives.
To become a Certified Nurse-Midwife (CNM), candidates must successfully complete these requirements:
- Completion of an accredited nursing program
- Licensure as a Registered nurse
- Satisfactory completion of a program in nurse-midwifery from an accredited institute
Once a candidate meets these requirements, he or she can take the national certification examination administered by the ACNM Certification Council (ACC). After passing the exam, the candidate receives nurse-midwife certification. Because state licensing laws vary, there may be additional requirements.
The National Center for Health Statistics reports that in 1998, 277,811 births were CNM-attended in the United States. CNMs usually work in private physician practices, hospitals, clinics, free-standing birth centers, and health departments. They may have their own private practices and occasionally attend home births. All states mandate Medicaid reimbursement and most require private insurance reimbursement for nurse-midwifery services.
Finding a Midwife
Your family physician or OB/GYN can refer you to a midwife in your area. In addition, the ACNM has a 24-hour toll-free number that provides the names of ACNM certified midwives, sorted by zip code: 1.888.MIDWIFE (1.888.643.9433). This information is also available online at www.midwife.org/find.cfm.
When choosing a midwife, it is recommended that you ask the following questions:
- Where did you receive your education? Are you certified?
- How long have you been practicing? Where do you now practice?
- Describe your approach to midwifery, including, the role of the patient, expectations, and collaboration with physicians.
- Do you attend the entire labor process or does another nurse-midwife take over?
- If complications occur, what is the procedure?
- What are your fees? Do you accept insurance?
- Do you encourage families to be present during labor and birth?