Midwifery. How does it work in the US?

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My daughter is in her second (of three) years of Midwife training. When qualified she will be able to deliver babies as an independent practitioner, including home births, and will also undertake pre-natal and post-natal care.

I have seen no mention of Midwives on the forum. Does the US have them? It's a seperate training and speciality here leading to a degree in Midwifery only, not in general nursing.

And this is why we need standardization of Midwifes! There are different types of Midwifes, as many have mentioned.

There are a variety of pathways into midwifery.

Check out http://www.midwife.org for Certified Nurse Midwife

Check out http://www.mana.org for Certified Professional Midwife Info

Now for the confusing part! Yes CPM midwifery is still illegal in some states (even if that midwife is certified) but the majority do recognize Midwifery as a profession.

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Specializes in Electrophysiology, Medical-Surgical ICU.

Idk about home births but my clinical teach I had the past 2 semesters is a CNM and a womens health NP....she use to do biths by here self all the time before the hospitals stopped letting midwifes do births...there is another hospital about 15mins away that still uses midwives for hospitals births ...I'm in upstate NY...so it probably depends where your @

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Specializes in Emergency Department.
In the U.S. there are two types of midwives. The lay midwife is not a nurse but someone who has taken courses in midwifery. This type of midwife is not licensed as a nurse and most institutions will not recognize them for practice.

We prefer the term direct-entry midwife to lay midwife. I am a direct-entry midwife (DEM) and my credential is called Certified Professional Midwife (CPM). I am licensed by my state's medical board (LM). When I finish nursing school in December I will be an RN, a LM, and a CPM. If I choose to move onto grad school I will give up the LM and earn the credential of Certified Nurse-Midwife (CNM).

North American Registry of Midwives (NARM) oversees CPM education.

Midwifery Education Accreditation Council (MEAC) oversees the schools that educate CPMs

American College of Nurse-Midwives (ACNM) is the professional organization for Certified Nurse-Midwives and educational programs.

For specifics on the legal status of DEM/CPMs, see this chart: Direct-Entry Midwifery State-by-State. You can see that most states that license or regulate DEMs require them to be CPMs. That is, follow a fairly uniform pathway and take a standardized board exam similar to NCLEX, keep up with CEUs, re-credentialing every 3 years, peer review, etc. It's more than just taking some courses in midwifery, just as RNs have to do more than just take some courses in nursing to be more than lay nurses.

Home births are legal in ALL 50 states but as others have pointed out, the practitioner is who may be restricted.

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I'm pretty sure that the term "lay midwife" could still be used. Not all midwives get certification. A lay midwife would truly be someone who just goes around delivering babies with no documentation that she has the right to do so. Like a grandma that delivered all her grandchildren at home and many babies of her friends. She might consider herself a midwife. To me, THAT is lay midwifery.

Then direct-entry midwife would be licenced and have a formal recognition of their education. I think the problem in the US is that we are not educated as a country on what being a midwife really means. Most people picture the "lay-midwife" scenario as mentioned above- someone who delivers babies with no official right to do so.

If more people would realize that the so-called "illegal" practice of midwifery is applying to people who have studied childbirth and done long clinical rotations in the feild of home births, they might not react so quickly to the word "midwife."

Also, I wanted to correct the word "most" in the claim that "most CNM have their master's degree." The term is ALL. In order to be a CNM, you must get your master's degree in nurse-midwifery and sit for boards as a CNM. The new trend will even be for CNM to be getting the DNP degrees in the near future, along with all other advanced practice nurses.

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Specializes in Emergency Department.
I'm pretty sure that the term "lay midwife" could still be used.

It could but what I'm trying to impart is lay midwife is an outdated term.

A lay midwife would truly be someone who just goes around delivering babies with no documentation that she has the right to do so. Like a grandma that delivered all her grandchildren at home and many babies of her friends. She might consider herself a midwife. To me, THAT is lay midwifery.

You have provided a perfect illustration of the outdated terminology. Today, your example is uncommon.

Then direct-entry midwife would be licenced and have a formal recognition of their education.

Not necessarily. Direct-entry midwife means they are not nurse-midwives (nurse education plus post-baccalaureate or master's certificate in midwifery). There are two organizations who offer credentialing of direct-entry midwives:

  1. the Certified Professional Midwife credential from North American Registry of Midwives (NARM)
  2. the Certified Midwife credential from the American College of Nurse-Midwives (ACNM).

As for formal recognition of their education:

  • Certified Professional Midwives (CPMs) are legal and licensed in 25 of 50 states
    • You cannot be licensed in those states unless you are a CPM
    • You cannot be a CPM unless you follow the education pathways of either the Portfolio Evaluation Process (NARM) or graduate from a Midwifery Education Accredition Council (MEAC) approved program

    [*]Certified Midwives (CMs) are legal in 3 of the 25 states (NY, NJ, RI)

    • SUNY Downstate and Midwifery Institute of Philadelphia are the only two ACNM approved programs
    • Some MEAC approved schools qualify

Further:

  • Direct-entry midwives are outright illegal in 10 states
  • Direct-entry midwives are legal in 15 states but licensing isn't available

I think the problem in the US is that we are not educated as a country on what being a midwife really means.

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Most people picture the "lay-midwife" scenario as mentioned above- someone who delivers babies with no official right to do so.

I hope you will learn more about midwifery so you can propel the profession forward in your future role of labor and delivery nurse, and away from the granny midwife model you have come to perpetuate. You will undoubtedly come across midwives of every kind in your career and impress them with your knowledge. I can't tell you how frustrating-- and demeaning-- it is for me to introduce myself, explain my role, education, and credential only to be slapped back with the lay midwife tag and ignored.

Also, I wanted to correct the word "most" in the claim that "most CNM have their master's degree." The term is ALL. In order to be a CNM, you must get your master's degree in nurse-midwifery and sit for boards as a CNM.The new trend will even be for CNM to be getting the DNP degrees in the near future, along with all other advanced practice nurses.

In turn, I would educate you that being a Master's prepared nurse-midwife is a fairly new requirement itself. There are many CNMs out there whose highest degree of study is a BSN. In fact, the CNM who caught my own babies is an ADN prepared nurse with a Bachelor of Nursing Administration (not a BSN). She had no hospital clinical experience before sitting for the boards in the mid-90s.

I hope I've been helpful!!:cool:

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yes- we have midwives galore!!! :-D

And no, i don't believe it's illegal for midwives to do home births. Living in Wisconsin we have a very large Amish community. Most of the time they do it on their own at home, (kinda scary...) but sometimes call in a midwife and the entire community uses money from the "community money" fund to pay in cash for hospital bill. (Honestly i remember this from high school when we had cultural diversity day haha)

They only go to hospital if there are complications. I personally think it is pretty risky, and i wouldn't do it but if they are aware of the risks of it, and sign maybe some consent form?? then i don't see a problem with it. Its completely their own and personal choice.

i could be totally wrong in this but i swear i thought i heard that somewhere.

The Amish don't do it on their own so to speak, they tend to bring in women that they feel are skilled to assist them. Sometimes those women are Amish, Mennonite or other sects of the AnaBaptist faiths. They will go to a hospital if it's a high risk situation and they will also bring in "outsiders" if they trust them. I have two friends who are former Amish themselves and they have shed a ton of light on their culture. Far as hospital bills the individual Amish family whose bill it uses their own money first to pay their hospital bill if the bill is too large then the community as a whole pays it off. I suppose they sign the necessary consent forms during hospital stays but the chances of being sued by them are slim to none. In fact there was a huge case involving a midwife in PA a few years ago, many people felt that judge & the PA legislature were trying to scapegoat a single woman in their quest to shut down all midwives. The public in many states backlashed against PA and anyone else who they thought was "anti midwife." Reality is many people do not hospitals/corporations and certain tactics that are being used to regulate midwives. The Amish who normally avoid attention & courts at all costs showed up in droves in support of this particular midwife, she had sucessfully delivered hundreds of healthy Amish babies throughout the years.

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