Midwife: Your Uncomplicated Pregnancy & Natural Childbirth Specialist
What is a midwife?
A midwife specializes in caring for pregnant women and their unborn children. Midwives deliver babies, provide initial newborn care, and may serve as a woman’s primary healthcare and gynecologic care provider. Depending on state regulations, a midwife may be a certified nurse-midwife (CNM), certified midwife (CM), certified professional midwife (CPM), or an uncertified and unlicensed lay midwife with minimal formal training.
The practice of midwifery varies greatly depending on state regulations and the education, training and certification of the midwife.
A midwife may:
Evaluate a patient’s medical history
Educate a patient about pregnancy; reproductive medical conditions; general health conditions, such as diabetes and thyroid disease; and strategies for birth and treatment of medical conditions
Provide care during pregnancy, labor and delivery, and postpartum (after delivery)
Refer or transfer patients to a doctor’s care as needed, such as for high-risk or complicated pregnancy, labor, delivery, or postpartum condition of the mom or baby
Perform reproductive health and cancer screenings including pelvic exams, Pap tests, breast exams, and sexually transmitted disease testing
Diagnose and treat certain acute and chronic diseases and conditions that affect women’s health and reproduction, including infertility and menopause, as allowed by state regulations. Midwives will refer patients to a doctor for further care if needed.
Screen, treat and monitor a range of conditions, such as high blood pressure, diabetes, depression, high-risk behaviors, and sexual dysfunction, as allowed by state regulations. Midwives will refer patients to a doctor for further care if needed.
Provide family planning and contraceptive counseling
Order and interpret laboratory and imaging tests and prescribe medications, as allowed by state regulations
- Collaborate, refer and consult with other members of a woman’s healthcare team to provide comprehensive care. This includes obstetrician-gynecologists, perinatologists, anesthesiologists, surgeons, genetic counselors, oncologists, and social workers.
Licensed and certified midwives may be known as a nurse-midwife, certified nurse-midwife (CNM), licensed midwife (LM), certified midwife (CM), and certified professional midwife (CPM).
Unlicensed and uncertified midwives may be known as a lay midwife, traditional midwife, traditional birth attendant, granny midwife, and independent midwife.
Who should see a midwife?
Any woman who wants to become pregnant or is pregnant should seek care from either a qualified midwife or an obstetrician-gynecologist as soon as possible to minimize the risk of pregnancy complications and help ensure the health of both mother and baby.
Many women who see midwives are seeking obstetric healthcare with a more interpersonal and less technological approach. Obstetric technology includes such practices as electronic fetal monitoring, artificial rupture of the membranes, and cesarean section. Qualified midwives are generally trained to treat pregnancy and childbirth as normal, natural processes, unless medical conditions or problems arise that require technological intervention or a higher level of expertise.
Adolescent and adult women also see certified nurse-midwives (CNM) and certified midwives (CM) for gynecologic and routine healthcare.
When should you see a midwife?
Consider seeking care from a midwife under the following situations:
You want to become pregnant or you are pregnant and you would like to experience pregnancy and childbirth with a minimum of technological interventions such as cesarean section.
You are pregnant and you do not have a high-risk pregnancy, such as having diabetes or twins or triplets.
You would like to have a home birth.
You are sexually active and need family planning counseling and contraception (birth control).
You do not menstruate by age 16, or if it has been more than one year since your last pelvic exam, Pap test, or breast exam.
- You engage in high-risk sexual behaviors and practices.
You can also seek care from a certified nurse-midwife (CNM) or certified midwife (CM) if you develop any of the following gynecologic symptoms or conditions:
Unusual, persistent, or foul-smelling vaginal discharge<
Bleeding between menstrual periods or heavy vaginal bleeding
Pelvic pain, severe cramps, or pain during or after sexual intercourse
Breast lumps or other changes in the breasts
What conditions and diseases does a midwife treat?
Midwives can treat various conditions and diseases depending on state regulations and the midwife’s level of education and training. All types of midwives care for women and their babies during pregnancy, labor and delivery, and postpartum.
Certified nurse-midwives (CNM) and certified midwives (CM) are also qualified to provide primary healthcare for adolescent and adult women and treatment for female reproductive system problems. This may include:
Preconception health including pregnancy planning, some types of infertility, and some types of genetic counseling
Reproductive and sexual health including menstrual irregularities, menopause, sexually transmitted diseases (STDs), sexual dysfunction, yeast infection, pelvic inflammatory disease (PID), and sexual assault and violence against women.
What tests does a midwife perform or order?
Midwives can order or perform certain diagnostic and screening tests depending on state regulations and the midwife’s level of education and training. Midwives who are not permitted by state law to order laboratory tests usually have backup arrangements with a healthcare provider who can order any necessary tests. Tests may include:
Cancer screening including Pap tests, endometrial biopsy, and colposcopy (cervical exam)
General health tests including complete blood count (CBC), mental health screening, urinalysis, blood glucose (sugar) test, liver function tests, cholesterol panel, thyroid hormone tests, and blood pressure screening
Pregnancy health tests including pregnancy test, ultrasound, Rh factor test, and oral glucose tolerance test
Reproductive health tests including pelvic exam, breast exam, pelvic ultrasound, and sexually transmitted disease (STD) tests
What procedures and treatments does a midwife perform or order?
Midwives order or perform various procedures and treatments, which vary depending on the training and certification of the midwife and state regulations. In general, all types of midwives perform vaginal birth procedures, including vaginal birth and episiotomy for normal, low-risk births. Midwives do not perform cesarean sections or other types of surgery.
A midwife will transfer your care to an obstetrician-gynecologist, perinatologist, endocrinologist, surgeon, or other specialist if you or your baby has a condition that falls outside of the midwife’s scope of care.
Certified nurse-midwives (CNM) and certified midwives (CM) are qualified to perform additional procedures and treatments that may include:
Chronic disease management including monitoring and prescribing medications for well-controlled type 2 diabetes, hypothyroidism, and high blood pressure in non-pregnant women
Family planning including prescribing birth control pills, hormone patches and shots, cervical caps, and intrauterine devices (IUDs)
General health procedures including physical examinations, immunizations, and nutrition and weight counseling
Midwife training and certification
Education, training, experience, licensure and certification are key elements in establishing a midwife’s level of competence. In the United States, the states regulate the practice of midwifery. The licensing requirements and scope of practice vary among states. In some states, a midwife may practice without becoming licensed or certified in the specialty.
When looking for a qualified midwife, ask if he or she has been certified by the American Midwifery Certification Board or the North American Registry of Midwives. Certification in midwifery verifies that a midwife has completed education and training in the specialty and has passed competency examinations.
You may want to search for a midwife who has experience in assisting births in your preferred location if you are pregnant and you would like to give birth at certain type of location such as a hospital, birthing center, or in your home.
The three types of professional credentials for midwives in the United States include:
A Certified Nurse-Midwife (CNM) has earned a graduate degree in midwifery from a school accredited by the Accreditation Commission for Midwifery Education (ACME); has a current registered nurse (RN) license; and has passed a national CNM certification exam administered by the American Midwifery Certification Board. CNMs can hold state licenses in any state, and can practice in hospitals, clinics, birthing centers, and private homes.
A Certified Midwife (CM) has earned a graduate degree in midwifery from a school accredited by Accreditation Commission for Midwifery Education (ACME) and has passed a national CM certification exam administered by the American Midwifery Certification Board. CMs can hold state licenses in certain states, and can practice in hospitals, clinics, birthing centers, and private homes.
- A Certified Professional Midwife (CPM) has either apprenticed with a certified midwife or has attended a midwifery education program (at the associate, undergraduate or graduate level) accredited by the Midwifery Education Accreditation Council; and has passed a national CPM certification exam administered by the North American Registry of Midwives (NARM). CMs can hold state licenses in certain states, and typically practice only in birthing centers or private homes.
To maintain certification in these three types of midwifery, a midwife must participate in the continuing certification programs on a regular basis.
The term “lay midwife” generally refers to a midwife who is not certified or licensed and is practicing midwifery with or without legal recognition. Lay midwives may have completed a formal or informal training program, such as a self-study or an apprenticeship program. Some lay midwives may choose not to become certified or licensed.