You’ve probably heard of a midwife, but what you may not know is who they are and what they do that’s different from an obstetrician—the type of medical doctor who delivers babies. In this post, we’ll talk about the different types of midwives in the United States, as well as the midwifery model of care, which most midwives practice.
Certified nurse midwives (CNMs) have both nursing and midwifery training in the form of a master’s of science in nursing degree. Some work as nurses before becoming midwives, while others receive nursing training and then go straight to midwifery school without working as nurses. Most CNMs catch babies in the hospital, although there are some places where CNMs attend out of hospital births, either in free standing birth centers or at home.
Certified professional midwives (CPMs) and certified midwives (CMs) are midwives who have received midwifery training, but do not usually have nursing training as well. CMs usually have a master’s degree in midwifery, while CPMs may have formal academic training or receive training as a years-long apprentice to a practicing midwife or both. CPMs are generally considered to be experts in out of hospital birth.
The licensing and regulation for CNMs, CPMs, and CMs varies from state to state. In some states, for instance, CPMs cannot legally attend births at all. And while CNMs who live in places where they can practice to the full extent of their scope of practice are able to prescribe medication, catch babies in any setting, and provide abortion care, many states have laws that don’t allow this full scope of practice.
Traditional midwives train with experienced midwives and often serve specific communities that they are part of or have ties to. Sometimes traditional midwives obtain another certification as well, but they may opt out of certification and registration completely.
According to midwife Judith Rooks writing in the Journal of Nurse-Midwifery, the Midwifery Model of Care affirms the normalcy of menstruation, pregnancy, birth, and menopause, viewing these events as aspects of the life cycle, rather than pathological conditions that require medical or technological intervention. Should complications or diseases of pregnancy arise, it’s appropriate for midwives to consult and collaborate with an obstetrician who is an expert in the medical model of care or even refer the pregnant person to their care. [1]
The midwifery model of care also emphasizes the relationship between the care provider (midwife) and the pregnant person, who is considered the main decision-maker when it comes to healthcare choices and the main focus of that healthcare. [1] According to the American College of Nurse Midwives website, the midwifery model of care also takes into consideration the person’s life experiences and knowledge, which, along with scientific evidence, can then guide individualized care. The midwifery model of care also involves using human presence and skillful communication as a therapeutic modality—again emphasizing the importance of relationships in this model. [2]
So how does the midwifery model of care look in practice? When I had my babies and received well-person care at a birth center near my home, I felt listened to above all else. When I pushed for four hours with my first baby, I felt supported the entire time. When I had a somewhat complicated second pregnancy, I saw my midwives often, received the medication I needed, and texted or called as needed. I never felt like a burden or worried about calling because I had a relationship with the midwives in the practice. In the end, I was able to birth both my babies at the birth center without pain medication and into their dad’s hands and head home less than half a day later.
It’s true that an out of hospital, nonprofit birth center or a home birth setting is one of the best places to see the midwifery model of care in action, but it also works in the hospital. If I’d needed to transfer to the hospital at any point during my pregnancies or during birth, either for an emergency or for an epidural or surgical birth, my midwives could have come with me because as certified nurse midwives, they all had privileges at the hospital, too.
- Judith P Rooks, “The midwifery model of care,” Journal of Nurse-Midwifery, 1999.
- “Our Philosophy of Care,” American College of Nurse Midwives.
