There are a few different types of midwives who have different levels of training and certification. In the United States, midwives fall under two main categories:
- Nurse midwives who are trained in nursing and midwifery
- Direct entry midwives who are trained in midwifery only
Certified nurse midwives (CNMs)
A certified nurse midwife (CNM) is a registered nurse who receives additional training in pregnancy and childbirth and has a master’s degree in nurse midwifery.
CNMs are considered part of the mainstream medical establishment and are certified by the American Midwifery Certification Board.
CNMs receive training in anatomy, physiology, and obstetrics. They are also able to make medical decisions that follow the medical community’s standards of care. Most CNMs are involved with deliveries in hospitals and are involved with obstetricians’ offices.
In most cases, CNMs will spend more time with you during labor than a doctor. CNMs will encourage and coach you along the way. This personal touch is one of the reasons many women rely on CNMs.
However, CNMs can’t perform cesarean deliveries and in most cases can’t perform vacuum or forceps deliveries. They generally care for low-risk women who are unlikely to need these types of interventions.
In some situations CNMs may help OB-GYNs or perinatologists with the care of high-risk women.
If you’re thinking about recieving care from a CNM, you should ask about the doctors the midwife works with. Even low-risk women may suddenly develop complications that require the expertise and special training of a doctor.
Certified midwives (CMs)
A certified midwife (CM) is similar to a certified nurse midwife. The only difference is that a CMs initial degree was not in nursing.
Certified professional midwives (CPMs)
A certified professional midwife (CPM) works independently with women delivering at home or in birth centers. CPMs attend births and usually provide prenatal care.
CPMs must pass a competency test by the North American Registry of Midwives (NARM).
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 complete prenatal care and attend home births or deliveries in birth centers.
Lay midwives
A lay midwife is not a medical professional. The training, certification, and ability of lay midwives may vary since most states have no single, established curriculum, training, or uniform certification process.
Lay midwives are generally not viewed as part of the mainstream medical community and often work with people who practice alternative medicine.
With few exceptions, lay midwives don’t deliver babies in hospitals. They usually help with deliveries at home or in birth centers.
Although most women can safely deliver at home under the care of a lay midwife, some women develop serious complications after labor begins. Because the training of lay midwives is not regulated, the ability to recognize complications varies.
Many obstetric complications occur so quickly that even prompt treatment by a doctor may be ineffective without the use of modern medical technology. Because of this, few doctors in mainstream American medicine recommend home birth or delivery by lay midwives.
Doulas
A doula generally assists the mother right before the birth and during labor and delivery. They provide emotional and physical support to the mother and can also help educate them. However, they don’t provide medical care.
Doulas are available to the mother before the birth to help come up with a birth plan and answer any questions the mother may have.
During childbirth, the doula will provide comfort to the mother by helping with breathing and relaxation. They will also provide massage and help with labor positions. After childbirth, the doula will help the mother with breastfeeding and may help during the postpartum period.
The doula will be there for the mother and help her have a safe and positive childbirth, even if it involves medication or surgery.
