Types of Midwives

What is a Midwife?

The word midwife means "with woman". A midwife attends prenatal care visits and is present at the birth of your child. She is also there during the post-partum period to provide care as well as advice for mom and baby.

There are three main types of midwives:

Certified Nurse Midwife (CNM)
Trained nurses with additional study in midwifery. Can attend births in hospitals or birthing centers. In some states CNM's also attend home birth. Services are generally covered by insurance, depending on your plan and limitations within it. Is accountable to the hospitals and birthing centers at which they work, and must follow all birth procedures outlined by the AMA, supervising doctors and hospitals.

Certified Professional Midwife (CPM)
A midwife who has passed the North American Registry of Midwives (NARM) competency test and is awarded the CPM Certificate. Only attends out-of-hospital births. Services are sometimes covered by insurance, and many CPM's may be willing to negotiate costs and possibly trade for their services. Depending on individual state laws, CPM's can be licensed and certified with the state, and must follow state laws and guidelines regarding birth procedures, and in some states they have been banned. Sometimes midwives are certified through the state they practice in, and can be referred to as Licensed Midwives (LM).

Direct Entry Midwife
An independent practitioner who has learned the skill of midwifery through study, apprenticeship, a midwifery school or college that is not a nursing program. Only attends out-of-hospital births. Services are almost never covered by insurance, but many DEM's are willing to negotiate costs and possibly trade for their services. DEM's may be licensed or unlicensed. Check with the laws where you live, and make sure you find out your midwife's qualifications when making your choice. If a DEM is unlicensed, it can allow more flexibility in birth procedures because they are not constrained by state guidelines, but it also means she has no legal protection from the state. DEM's are outlawed in some states. DEM's are sometimes also referred to as Lay Midwives.

Certification and licensing are separate. Certification is done through NARM and granted by them. Licensing is handled on a per state basis, and each state has its own licensing laws regarding midwives. A midwife can be certified by NARM and not licensed in her state, and depending on the state laws, a midwife may be licensed but not certified.

In my state Licensed midwives are referred to as LDEM's (Licensed Direct Entry Midwives), and they have received their CPM designation from NARM and registered their licensure with the state. Unlicensed midwives in my state may be referred to as DEM or Traditional Midwife (an uncertified, unlicensed midwife with unspecified training).

How to find a midwife:

First, find out if your state licenses midwives! Then visit MANA, Midwives Alliance of North America.

If there's more than one midwife in your area, you have lots of options! Interviewing perspective midwives is a great way to narrow down your choice and find the best one for you. Birth is all about choice, right down to your care provider. Keep in mind that each midwife is different, and it's important to find the one that is best for you. Some midwives will be more natural-minded and some will lean more on medical interventions, so ask lots of questions and find the one who will fit your needs and desires for birth. Be sure to ask your midwife about her experience, training and/or qualifications to determine if you feel she has what you are looking for.

My own midwife is unlicensed, but she received her midwifery education through an accredited midwifery college and has over 15 years of experience working in home birth midwifery, and also attends hospital births as a doula. I felt her experience and training were sufficient for what I wanted, and the certification was simply a piece of paper when it came to the question of her qualifications. Each midwife is different, and each state has its own laws governing midwives, so please choose carefully.