Pregnant women and their families often turn to midwives for more personal care than they can normally expect to receive from a clinic or hospital. But if you're not familiar with midwifery practices, you may be unfamiliar with what a midwife actually does and how qualified she is to do it. Here's what you need to know about these birth and maternal care specialists.
Qualifications and Certifications
"Midwifery is legal in all 50 states, but midwives can have different credentials, so understanding qualifications can be confusing," says Martha Churchill, a certified nurse-midwife (CNM), Master of Science in Nursing (MSN), and coordinator of Midwifery Services at Fletcher Allen Healthcare, in Burlington, VT. "Know the laws in your state, and look for someone who has earned her credential by meeting national standards and requirements."
There are two roads to certification through programs approved by the national Accreditation Commission for Midwifery Education (ACME). Through these programs, which are offered by or affiliated with nursing schools at U.S. universities, a midwife is credentialed as a Certified Midwife (CM) or Certified Nurse-Midwife (CNM).
- A CM does not necessarily have a degree in nursing, but has a minimum of a bachelor's degree and has taken additional required coursework before entering an ACME-certified midwifery program. Registered nurses (RNs) who graduate from the same program earn the title of CNM. Both are then eligible to be licensed in individual states.
- A home birth provider may be a Certified Professional Midwife (CPM). CPMs are certified by the North American Registry of Midwives (NARM), but are not licensed to work in every state.
Work Environment
Midwives work in all types of settings, including hospitals, family planning clinics, birthing centers, and the armed forces. Depending on their credentials, midwives practice in offices and institutions and also assist in home births. They work in collaboration with physicians and also in private practice. Only a certified nurse-midwife can work in a hospital.
Practice
In addition to pregnancy coaching and assisting in labor and delivery, midwives offer postpartum and, in some cases, family planning and routine gynecological care. Depending on state certification or licensing laws, CMs and CNMs may prescribe medication and order lab tests. Education, counseling, compassionate listening, support, and continuous care are at the center of a midwifery practice.
Safety
Certified midwives are experts at normal pregnancies and childbirths. They are trained to adhere to specific standards of care, which ensure they are able to monitor the physical and psychological health of the mother and to recognize potential problems. If a midwife anticipates or experiences a problem that is outside her scope of practice, she will arrange further medical attention from an obstetrician (a physician) for the mother or baby, minimizing any risk of danger to either.
"The main difference between midwifery and obstetrics lies in the philosophical approach midwives use in their care of women," Churchill explains. "Midwives spend a lot of time with women and their families, developing more of a relationship to discern what is best for each mother as an individual."
Martha Churchill, CNM, MSN, reviewed this article.
Sources:
"Accreditation Committee for Midwifery Education (ACME)." American College of Nurse-Midwives. Web. Page accessed 18 June 2013.
http://www.midwife.org/accreditation
"Certification: The CPM Credential." NARM North American Registry of Midwives. Page accessed 26 August 2013.
http://narm.org/certification/
