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What is a midwife?


A midwife serves and cares for childbearing women:

before, during, and after their pregnancies. She attends

childbirth, provides support during labor and delivery,

and supervises the general health care of women and children directly after birth.


The term midwife,  derived from the Anglo Saxon word, “mit wif”, meaning "with woman," was first recorded in 1300. Written accounts dating to the 2nd century confirm the role of midwives in the birthing process.


Midwifery is quite possibly the oldest profession on the planet, as women have been helping women to give birth since the dawn of humankind. Modern midwives provide care to women during normal pregnancies and deliveries and collaborate with and or refer to obstetricians or other physicians if health complications develop or the pregnancy becomes high-risk.


As trained health care professionals with expertise in supporting women to maintain a healthy pregnancy birth, midwives offer individualized care, counseling, education, and support to women and their newborns throughout the childbearing cycle.


Midwives provide continuous support to women with low-risk, uncomplicated pregnancies during pregnancy and labor. Communication between midwife and her client is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and encourage partner and family participation in the birth. They pay special attention to the family traditions, cultural values, and the personal preferences of the women in their care.


Safety is a high priority in midwifery and studies show that outcomes are as safe or safer than similar birth attended by physicians and in hospitals. As part of their commitment to nonintervention, midwives do not advocate the use of pain medication, invasive procedures and routine time management during the normal birthing process. They encourage women to actively participate in their birthing process. Midwives provide health care education and emotional and social support.


The continuous presence of a midwife during labor can reduce:

  • the length of labor,
  • the need for pain medication,
  • the likelihood of forceps or other operative devices
  • the possibility of cesarean delivery.

The Midwives Alliance of North America (MANA), the North American Registry of Midwives (NARM), the Midwifery Education Accreditation Council (MEAC), and Citizens for Midwifery (CfM) agreed on a short definition of what "midwifery care" means. However, just because a person is a midwife does not guarantee that they provide this kind of care; consumers looking for a midwife should ask questions to determine if a prospective caregiver will be able to provide the kind of care they seek.

The Midwives Model of Care


The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.


The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright © 1996-2004, Midwifery Task Force


There are two main categories of midwives in the United States, nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who are trained as midwives without being required to be trained as nurses first. Within the category of direct entry midwives are several subcategories reflecting the varying legal status of these midwives in different states and the fact that until recently there was no nationally recognized credential available for direct entry midwives.

Direct entry midwives include highly trained and very competent midwives; however, anyone may call herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are at least assured that she has met specific requirements for certification (re-certification every three years).


Here is a brief overview:

Direct-Entry Midwife (LDEM, DEM, LM, CM, RM, etc.)
  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.
Certified Professional Midwife (CPM)
  • Not required to be nurses.
  • Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.
  • Education programs accredited by the MEAC prepare students to meet the requirements for the CPM.
  • Out-of-hospital birth experience is required.
  • Have met rigorous requirements and passed written exam and hands-on skills evaluation, administered by the North American Registry of Midwives.
  • Legal status varies according to state.
  • Practice most often in homes and birth centers.


The North American Registry of Midwives (NARM)


In 1987 educators, midwifery program directors, and experienced midwives in the field of direct entry midwifery decided it was time to begin developing a national credential, the Certified Professional Midwife (CPM) credential, which is administered through the

North American Registry of Midwives and has rigorous standards for knowledge, skills

and experience.


As of 2008, there are 1403 CPMs in the United States, Mexico, and Canada. The nineteen states that license direct-entry midwives to attend births out of the hospital use the NARM exam or the CPM process as the basis for licensure. States that are seeking licensure for direct-entry midwives are planning legislation which requires the CPM credential for licensure.


The North American Registry of Midwives has a free brochure "How to Become a NARM Certified Professional Midwife (CPM)." You can request a copy or ask for more information about the CPM by contacting the North American Registry of Midwives at 1-888-84-BIRTH (eastern time), or by email at North American Registry of Midwives.


Legal Status of Direct Entry Midwives


As of 2015, 28 states recognize and regulate direct entry midwives. Because legislative efforts are constantly being made across the nation regarding the legal status and regulation of professional midwife, please refer to the Legal Status Chart for the most current status of midwifery across the country.

In 2005, the Direct-Entry Midwife Act, for the state of Utah, recognized the Certified Professional Midwife

as an autonomous maternity health care provider.

CPMs in Utah are licensed (LDEM) by the Division of Occupational and Professional Licensing.


Certified Nurse Midwives (CNMs) and Certified Midwife (CM)


Certified Nurse Midwives (CNMs)

  • Educated in both nursing and midwifery, primarily in the hospital setting; are "advanced practice nurses."
  • Must have at least a Bachelors Degree when training is complete.
  • Have successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam.
  • Out-of-hospital clinical experience is not required.
  • Are legal and can be licensed in all states.
  • Most practice in hospitals and birth centers.
  • In most states must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.


Certified Midwife (CM)


The Certified Midwife (CM) is a new credential from the ACNM that does not require a nursing degree but is otherwise similar to the CNM credential. As of 2007, the CM is legally recognized in three states: NY, MA, and NJ, but does not meet existing direct entry midwife licensing requirements in any other states.


For more information visit the American College of Nurse-Midwives websiteor contact them at 240-485-1800, or write to:

8403 Colesville Road, Ste 1550, Silver Spring, MD 20910

"You are a midwife, assisting at someone else's birth.

Do good without show or fuss.

Facilitate what is happening rather than

what you think ought to be happening.

If you must take the lead, lead so that the mother is helped,

yet still free and in charge.

When the baby is born, the mother will rightly say,

"We did it ourselves!"

from The Tao Te Ching

Home Birth Midwifery Service
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