Who’s Your Midwife?
Your Alternative Options in Prenatal Care and Birth
Congratulations! You’re pregnant… and excited… and nervous… and experiencing all the emotions and physical symptoms that accompany a new pregnancy, be it your first or your fifth. You may be one of the thousands of women looking for an alternative to the “traditional” medical version of birth that has become the norm in the United States. Perhaps you’re thinking about finding a midwife. But did you know that there are several different types of midwives available that provide care to pregnant and birthing women? Very few people understand the difference among the certifications. Your insurance carrier probably doesn’t, and coverage may depend on provider type. So here’s the low-down on midwifery and what it looks like today in the U.S.
Certified Nurse Midwife (CNM)
Certified Nurse Midwives (CNMs) make up the bulk of American midwives. A CNM is a registered nurse (RN) with nursing experience who has received additional training in delivering babies and providing prenatal and postpartum care to women. They are certified by the American College of Nurse-Midwives (ACNM). CNMs are licensed through, and affiliated with, an OB/GYN. They deliver babies primarily in the hospital or hospital-affiliated birthing centers.
Licensed Midwife (LM)
A Licensed Midwife is a midwife who is licensed to practice in a particular state. A LM may or may not have had previous medical training. Different states have different licensing requirements, but not all states have a licensed midwife designation. For example, the state of South Carolina recognizes and regulates midwifery and midwives’ role in home births and at free-standing birth centers. North Carolina, however, does not.
Certified Professional Midwife (CPM)
A Certified Professional Midwife (CPM) is trained in midwifery and has met the standards for certification set by the North American Registry of Midwives (NARM). They may or may not also be a LM or CNM. Many states, including South Carolina, use the NARM exam as the state exam for licensure as well.
Lay Midwife
A “lay midwife” is educated through informal avenues and does not typically have any certifications or licenses.
Before we talk about how to decide which kind of midwife is best for you, we need to first identify the four main locations for having your baby.
Since the early 1900’s, American women have transitioned from giving birth at home to birthing in the hospital. The vast majority of babies born in the U.S. today are born in hospitals. For example, according to www.cdc.gov, in 2006 the breakdown of where American women delivered was as follows:
99% in Hospitals (including hospital-affiliated birthing centers)
0.58% at Home
0.25% at a Free-Standing Birth Center
0.07% “Other”
As you may have already deduced from the definitions of midwives above and the statistics, most birth centers are affiliated with a hospital and staffed by Certified Nurse Midwives. They are also typically attached to, or at least associated with, a hospital.
So now comes the hard part—deciding which type of midwife is right for you. Ultimately it comes down to the experience you want to have and what model of care you feel is best for you.
Since the 1970’s the movement for natural childbirth has experienced a resurgence in popular culture. Until about a hundred years or so ago, all women had unmedicated childbirth and typically it was at home. Pregnancy and birth are normal physiological processes, and for most low-risk women, a midwife can provide the consistency of care and emotional support that large obstetric practices and hospitals cannot. Finding the right midwife can make all the difference.