midwives assist at more than 70% of normal vaginal births. Though
midwives have only delivered a small percentage of babies in
North America, that percentage has been increasing since 1975.
Today midwives are licensed to practice in most 50 states and
provinces. Yet most aren't sure what they do, how they are trained,
or if they're even available. Is a midwife a viable option for
The word "midwife" comes from Old English and means "with woman."
Midwives have helped women deliver babies since the beginning
of history. There are references to midwives in ancient Hindu
records, in Greek and Roman manuscripts, and even in the Bible.
as 1560, Parisian midwives had to pass a licensing examination
and abide by regulations to practice. Not all midwives had this
level of education, however. English midwives received little
formal training and were not licensed until 1902. America inherited
the English model of midwifery.
midwives usually learned their craft through apprenticeship
and tradition. They remained ignorant of scientific advances
in fighting infection through hygiene and drugs such as penicillin.
By the early twentieth century, women and their babies were
more likely to die under the care of midwives than under the
care of doctors.
time, American medical doctors began a campaign against midwifery
in the press, the courts, and the Congress. They cited the poor
outcomes for mothers and babies under the care of midwives.
Today's research into the first few decades of the 20th century
suggests that doctors may also have wanted a greater market
share of the maternity business and did not welcome competition
the doctors' motivations, the rate of midwife-attended births
dropped during and after the campaign. In response to widespread
criticism from the medical establishment, the first certified
American nurse-midwifery school was founded in 1933. It aimed
to incorporate the necessary medical training into midwifery's
traditional approach to pregnancy and labor.
Kind of Training Does a Midwife Have?
Midwives today come from a variety of backgrounds. The subtitle
a midwife uses will indicate her education and training. Most
American midwives are Certified Nurse-Midwives (CNMs). They
have at least a bachelor's degree and may have masters' or doctoral
degrees. They have completed both nursing and midwifery training
and passed national and state licensing exams to become certified.
They are licensed in every state and may work in conjunction
with doctors. About 96% of CNM-assisted births occur in hospitals.
Midwife (CM) is not a registered nurse, but otherwise meets
the same qualifications as a CNM. Because this certification
has only existed since 1997, there are few CMs. Currently only
the state of New York recognizes this certification as sufficient
A lay or
direct-entry midwife may or may not have a college degree or
a certification. She may have trained through apprenticeship,
workshops, formal instruction, or a combination of these. Not
all states require her to work in conjunction with doctors,
and she usually practices in homes or nonhospital birth centers.
Not every state regulates direct-entry midwives or allows them
Professional Midwife (CPM) is certified by the North American
Registry of Midwives after passing written exams and hands-on
skill evaluations. Direct-entry midwives and CNMs can apply
for this certification. They are required to have out-of-hospital
birth experience, and usually practice in homes and birth centers.
Their legal status varies according to state.
According to Lisa Summers, DrPH, a midwife and staff member
of the American College of Nurse-Midwives (ACNM), a midwife's
education stresses that pregnancy and birth are normal, healthy
events until proven otherwise. A midwife views her role as supporting
the pregnant woman while nature takes its course.
also focus on the psychological aspects of how the mother-to-be
feels about her pregnancy and later on, the actual birth experience.
They encourage women to trust their own instincts and seek the
information they need to make their own valuable decisions about
pregnancy, birth, and parenthood. Dr. Summers is quick to add
that many medical doctors share these values. But an MD is more
likely to use preventive testing and medical technology - such
as ultrasound, continuous fetal monitoring, and the option of
pain medications during birth - as a standard part of care during
pregnancy and labor.
pregnancies undoubtedly require this approach. But many midwives
find it unnecessary for most uncomplicated pregnancies.
Does a Midwife Do?
Midwives generally spend a lot of time with a woman during prenatal
visits addressing her individual concerns and needs, and will
stay with her as much as possible throughout labor. They sometimes
encourage physical positioning during labor such as walking
around, showering, rocking, or leaning on birthing balls - recommendations
not usually associated with a typical medical doctor. Midwives
usually allow women to eat and drink during labor.
doctors, will use some medical interventions, such as electronic
fetal monitoring, labor-inducing drugs, pain medications, epidurals,
and episiotomies, if the need arises. A CM, CPM, or direct-entry
midwife may not legally be allowed to use these techniques without
a doctor's supervision. Birthing centers may or may not be equipped
for these procedures. Midwives of any licensing degree cannot
perform cesarean sections; if one were required, an obstetrician
would have to perform your delivery. If any potentially life-
threatening complications suddenly arose during delivery, midwives
should also involve an obstetrician. Certified midwives are
trained in basic life support for newborns and, in the event
of sudden complications with your baby after birth, can care
for the baby until a pediatrician or neonatologist (an intensive-care
specialist for newborns) is available.