Humans have practiced midwifery for thousands of years. These days, fewer than 10 percent of births in the United States are attended by a midwife, but that number is growing. A midwife provides one-on-one care to a birthing person in a home, birth center, clinic, or hospital. They are trained to closely monitor the mother’s health through pregnancy, childbirth, and the postpartum period with minimal medical intervention. They are also excellent at providing individualized education and hands-on assistance, as well as identifying situations in which a woman may require a physician's attention.

Midwifery can enhance the general health of both mother and baby and is a good alternative for many people. Let’s take a look at how to choose a midwife and why you may want to use one.

What is a Midwife?

Midwives are healthcare providers who’ve been instructed in uncomplicated gynecological and obstetric care. Midwives lean toward a more holistic, natural approach to pregnancy, labor, and delivery. People often opt for a midwife when choosing a nonmedicated birth or if they prefer to experience childbirth at home.

Midwives are usually not physicians but frequently work alongside obstetricians and gynecologists in a hospital setting to provide access to any additional care their patients may need. A midwife is only advised when the pregnancy is low-risk or if there are only mild complications. 

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Types of Midwives

There are several types of midwifery certifications based on differing levels of experience and education.

Certified nurse midwives (CNMs) 

CNMs have completed nursing school and have a graduate degree in midwifery. These healthcare providers are certified by the American Midwifery Certification Board and can work anywhere nationwide. They are qualified to diagnose conditions, provide annual exams, prescribe drugs, provide nutritional counseling, and order lab tests. They can work in homes, birth centers, or hospitals.

CNMs receive training in anatomy, physiology, and obstetrics. They are also qualified to make medical determinations that follow the medical community’s standards of care. Most CNMs work with deliveries in hospitals and are affiliated with obstetricians’ offices.

Typically, CNMs will spend more time with you during labor than an obstetrician. CNMs will motivate and support you during the process. This more intimate interaction is one of the primary reasons many women depend on CNMs.

Certified midwives (CMs)

CMs have completed their undergraduate degree in something other than nursing but have earned a master’s degree in midwifery. CMs are certified by the American Midwifery Certification Board and are qualified to prescribe medications. 

Certified professional midwives (CPMs)

CPMs work in birth centers or homes. They have completed coursework and are certified by the North American Registry of Midwives. CPMs are not licensed to practice in all states and can’t prescribe medications.

Direct entry midwives (DEMs)

A direct entry midwife (DEM) practices independently and has learned midwifery through a midwifery school, apprenticeship, or college program in midwifery. DEMs provide total prenatal care and attend deliveries in homes or in birth centers.

Unlicensed or lay midwives 

​​A lay midwife (sometimes called a “granny midwife”) is an unlicensed, non-certified individual who works almost exclusively in homes. While they may be highly experienced and skilled, they aren't certified or licensed. They are not viewed as part of the medical establishment and typically work with people who practice alternative medicine. 

Lay midwives are either self-taught or have received some other type of training which could include an apprenticeship. Because of this, their training and abilities may vary. While many low-risk deliveries can happen safely under the watch of a lay midwife, some people develop severe complications once labor starts. Because the education of lay midwives is varying and unregulated, the skills and proficiency to identify complications vary. Many of these complications can arise so rapidly that even quick intervention by a physician may be useless outside a medical setting. Because of this, few physicians advise home delivery by unlicensed or lay midwives.

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Should I Use a Midwife?

During labor and delivery, a midwife is more likely to remain alongside you during the entire process. They also provide personalized education, counseling, prenatal care, and hands-on assistance. A midwife might be a great option for you if you prefer this kind of one-on-one care. 

There are several advantages to using this type of practitioner: 

• A reduced instance of C-section
• A reduced instance of assisted delivery or induction
• A decreased risk of perineal tears
• A lower instance of induced labor and anesthesia
• Increased flexibility with a home birth
• More control over the type of healthcare you receive

For people who have certain health conditions that could become problematic during pregnancy or the birthing process, cooperation between a midwife and a doctor is recommended. These health conditions may include:

• Multiple babies
• Hypertension
• Seizure history
• Diabetes
• Prior high-risk pregnancy

Using a midwife who treats labor and delivery in a hospital setting can mitigate this risk and provide you with additional insurance if problems arise. 

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Questions to Ask Before Selecting a Midwife

Many parents-to-be meet with potential midwife candidates in advance to get a sense of their personality and how they practice. Make sure you feel comfortable with whomever you choose before enlisting their services. There are a few questions you may want to ask before selecting a midwife: 

• Do you attend births at home, in a birthing center, and/or at the hospital?
• What are your training, experience, and certifications, and do you have references?
• What are your childbirth philosophies and values?
• What types of screenings or tests do you do during pregnancy?
• What is your plan in case of a medical emergency?
• Do you work with a physician or OB/GYN? 
• Do you accept medical insurance?

The Takeaway

A midwife can be a wonderful addition to your healthcare team. They are perfect for low-risk pregnancies and deliveries or when you prefer a more holistic, individualized approach to your healthcare. Not all midwives have the same training. When searching for a midwife, it’s important to review their experience, qualifications, licensing, and certifications. Ensure they have a good professional relationship with an obstetrical partner. Whether you choose to hire a midwife, a physician, or use a hybrid of both, your practitioners will work together to assist you in having the healthiest, happiest outcome possible.

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