Midwives
From LoveToKnow Pregnancy
Sometimes women want to choose midwives for their pregnancy care. A midwife is educated in normal birth and individualize their care based on the mother’s needs. They are trained in medical complications, but work with you to help you stay healthy through your pregnancy and for your baby’s birth.
What Is a Midwife?
Midwife means ‘with woman’. This means that the midwife tries to be “With you” during your pregnancy and in labor. Midwives are trained in different ways, and meet certain requirements for education and licensure.
What Do Midwives Do?
A midwife teaches, educates and empowers women to take control of their own health care. In most communities, they provide prenatal care, or supervision of the pregnancy, and then assist the mother to give birth. They manage the birth and watch over the woman and her newborn in the postpartum period. Most of these women encourage and monitor women throughout their labor with techniques to improve the labor and birth. Reassurance, positive imaging, and suggestions to change positions and walk helps labors progress. Many provide family planning services and routine women's health examinations, such as pap smears and physical examinations. They teach women about sexually transmitted infections and focus on prevention of the spread of infections.
What are the Different Types and how are they Trained?
There are three main types in the USA:
Certified Nurse Midwives (CNMs) and Certified Midwives (CMs) are educated in the disciplines of midwifery and nursing. This usually involves earning a Bachelor's degree and two more years of advanced practice education, leading to a Master's degree. CNMs and CMs can practice in all fifty states of the USA and meet the requirements for licensure of their individual state. They are Certified by the American College of Nurse Midwives (ACNM), and they complete a comprehensive course of study which prepares them for all aspects of pregnancy and birthing. They cannot perform surgery but are considered experts of normal birth. In 2005, The ACNM celebrated its 50th anniversary of midwifery in the USA. CNMs in most states within the USA can prescribe most medications, and in some areas also provide women's health care for women of all ages.
Certified Professional Midwives (CPMs) are individuals who have completed a specific course of study and go through a process of certification and examination. They meet the specific standards of the North American Registry of Midwives (NARM) which is the certifying body that offers both a national examination and a national validation process for professional direct-entry midwives, and CNMs who assist with birth at home. After successfully completing a course of study and a certification exam, the midwife obtains the title of CPM. The NARM certification process validates skills, knowledge, and experience. This certification is offered nationwide. The examination is based on Core Competencies established by the Midwives' Alliance of North America (MANA).
Direct-entry Midwives are women who do not have a nursing degree but have obtained their training through a variety of other routes. Many states license these women. Some states require a license to practice and in some, like Oregon, a license is voluntary. In some states, there is no licensing available. This category includes very experienced and well-trained midwives. Some practice in states where there is no reciprocity for the license they already have. This group may also include women who have declined licensing or certification for a variety of reasons ranging from the lack of experience necessary for licensure to being philosophically opposed to mandated protocols or government restrictions on parental rights. Some midwives are part of religious groups and practice only within a specific communities. In some states, a direct-entry midwife cannot charge for their services on penalty of prosecution.
A midwife without a nursing degrees is sometimes called an Empirical Midwife or lay midwife but this terms is often considered offensive by many in the profession. Most direct-entry prefer the more accurate term of midwife.
Where do They Assist with Birth?
Depending upon their training, these women can assist you with birth in the hospital, at home, or at a birth center.
CNMs and CMs can obtain hospital privileges and attend birth in the hospital. Some work with OB-Gyns or other care providers in a collaborative agreement. Some practice independently and consult with physicians if something becomes a problem during your pregnancy. CNMs and CMs also assist with home births and at birth centers and are able to prescribe medications as needed.
CPMs practice mainly in homes and in birth centers at which they obtain privileges. They usually cannot prescribe medications for you, but they spend time with you during the pregnancy, helping your prepare for your baby's birth. Their care is very woman centered, which means they are there to address your needs and help you have the birth that you would like to experience.
Midwives without licenses practice independently, and in a few states, they are practicing illegally. There are no minimum standards that guide their care, and it is possible they might not have the experience and knowledge necessary to handle problems that could occur during your pregnancy and labor. It is important to inquire about a midwife's education, experience, and membership in associations. Most US women practicing midwifery are part of professional associations which keep records, provide training, and require their members to aquire continuing education hours.
Are They Safe?
Most midwives share the philosophy that birth is a family and woman-centered event, and they are experts of normal, low-risk birthing. Decisions are made by the mother and the family, after discussing the issues. Statistics show that midwife-attended births are as safe as physician-assisted births. It is felt this is because these women believe in the normalcy of birth, and strive to keep women healthy and at low risk. In some countries such as New Zealand, the Netherlands, and Germany, a midwife attends almost all births, and physicians are available for back up or emergencies.
Additional Midwifery Resources
Additional Pregnancy and Birth Articles
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