What Exactly Is A Midwife?

Photographed by Ashley Armitage.
If "midwife" only calls to mind that charming PBS drama, you could be unnecessarily limiting your reproductive healthcare options. The word "midwife" may have its roots in Old English (meaning "with woman"), but it's a very modern profession, and the people who have it do a lot more than just hanging around while someone else gives birth. They're highly skilled medical professionals.
The role of a midwife is to deliver babies, provide annual exams, write prescriptions, offer nutrition counseling, parenting education, and lots more, according to the American College of Nurse-Midwives. Midwives are experts in pregnancy and vaginal birth, and are also reproductive primary care providers, says Laura Zeidenstein, CNM, DNP, FACNM associate professor of nursing at Columbia University Medical Center and nurse-midwifery program director. So you can go to a midwife even if you've got no plans for children: You could see a midwife to get your IUD placed.
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There are also different types of midwives, which can make it harder to parse what you can expect from a midwife: certified nurse midwives and certified midwives. What's the difference? It's complicated.
"CNMs and CMs sit for the same national certification exam, which is administered by the American Midwifery Certification Board, and are equally qualified to be licensed as midwives," Zeidenstein says. The only difference is that CMs have entered the profession without a nursing license, she says. "But the midwifery education is equivalent." So although there are different educational paths for becoming a midwife, licensed midwives who are CMs or CNMs have been through an accredited midwifery program, Zeidenstein says.
Interestingly, CMs have to have at least a graduate degree to be licensed, and 82% of CMs have a masters, according to the ACNM. In the United States, the vast majority of midwives are CNMs, according to the American Midwifery Certification Board.
But there's also something called a "certified professional midwife," which is a whole separate role, with a different certification process. CPMs are less common in the United States, and typically assist in home births specifically, according to the National Association of Certified Professional Midwives.
There's a misconception that all midwives work in home births, but that's not true, Zeidenstein says. CNs and CNMs can work in the hospital, at birth centers, and by attending to home births. In the United States, nearly 99% of midwives work in hospitals, she says. "People hear midwives and still think, home birth, but only 1 to 2% of midwives practice in home birth settings," she says.
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If you're wondering where doulas fit into all this, they're more like a support person in the room than the medical professional actually delivering a baby. While there is a certification process to become a doula, they focus primarily on the emotional aspects of pregnancy and birth, Mariel Lugosch-Ecker, a certified doula for Open Hands Doula Care told Refinery29. You could also say that a midwife is your midpoint between a strictly clinical doctor, and a free-spirited doula. "Midwives focus on human relationships, social justice, and the strength that is gained when [birthing people] are respected and included in decision-making," she says.
They often work collaboratively with an Ob/Gyn and perinatologist, Zeidenstein says. In fact, American College for Nurse-Midwives research has shown that there are better health outcomes when health care is provided within a collaborative team, which includes midwives and Ob/Gyns, she says, adding, "Nobody should work in isolation."
Ultimately, midwives are there to support women and help them to make informed decisions about their care, Zeidenstein says. That means they practice and support a range of women's choices in childbirth, including whether or not to have an epidural in labor, she says. Like most things related to pregnancy and birth (and all of parenthood thereafter), the decision to use a midwife is highly personal. When they are called on, they've got a big job to do: "We support women, whatever their choices are," Zeidenstein says.
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