The Role of a Certified Nurse Midwife

A certified nurse midwife is someone who helps care for women during pregnancy and delivery.  They are more common in other parts of the world, but are becoming increasingly popular in the United States.

Types of Midwives
Most US midwives are certified nurse-midwives (CNMs), meaning they have been certified by the American College of Nurse-Midwives (ACNM). Certified nurse-midwives are capable of performing gynecological checkups, prenatal and postnatal care and delivery. Most certified nurse-midwives deliver babies in hospitals, although some attend births at home or in birth centers. Certified nurse-midwives have obstetricians as a backup in case there are any complications. To become certified by the ACNM, the midwife must be educated through an accredited program at a college or university and pass a difficult national certifying exam. 

Another type of midwife is a direct-entry midwife. Direct-entry midwives typically do home births, with a small portion attending births at birth centers. Direct-entry midwives may be certified by the North American Registry of Midwives, making them certified professional midwives (CPMs), or they may be certified by the ACNM. Those certified by the ACNM are called certified midwives (CMs). They typically learn their trade through self-study and apprenticeship. 

While certified nurse-midwives are licensed to practice anywhere in the United States, licensing requirements for direct-entry midwives vary from state to state. Direct-entry midwives are not legally allowed to practice in some states, while some states do not regulate them at all. Only a few states allow direct-entry midwives to be reimbursed through health insurance.

There are also lay or traditional midwives, who are not certified or licensed.

What is the Role of a Midwife in Pregnancy?
A midwife will first assess your medical history and current medical condition. A midwife cannot perform ultrasounds or amniocentesis, so she will arrange for you to have prenatal testing done elsewhere.

Certified nurse-midwives will aid in the delivery of your child. If there are unexpected complications during labor, a certified nurse-midwife is trained to recognize the signs. These midwives will have an obstetrician they can call to confer with or to assist in the delivery.  Generally the midwife will stay with you and continue to support you during your labor.

Is a Home Birth Right for You?
The ACNM supports home births, saying that qualified midwives and medical professionals are capable of performing at-home deliveries, given the proper equipment and backup. On the other hand, the American College of Obstetricians and Gynecologists states that giving birth at home is hazardous to both mother and baby. A home birth is often chosen by women who want to have as much control as possible over their labor and delivery. When giving birth at home, you have the option of having whomever you want with you, and you can be in a comfortable, familiar setting. 

If you choose a home birth, be sure to have a qualified professional at your side. It is essential for the midwife or physician to have an agreement with a local hospital, in case something should go wrong.  The hospital should be close by in case you need to reach it quickly.

A good question to ask a midwife who will be performing a home birth is whether they carry supplies to start emergency treatment if it is necessary. You never know when a newborn will need to be resuscitated or if you will need oxygen or an IV.

Is a Midwife Right for You?
If you are a healthy woman interested in an alternative to the traditional OBGYN-delivered birth, then a midwife may be right for you. Women with high blood pressure, heart disease, diabetes or other chronic medical conditions should stick with an obstetrician or perinatologist (an obstetrician who specializes in higher-than-normal risk for complication pregnancies), as they are better equipped to deal with complications that may arise from pregnancy and delivery. Women expecting multiples or those who have had serious complications in past pregnancies are also usually referred to an obstetrician or perinatologist.

Midwives are the way to go if you want to deliver at home. They are also known for taking the mother's needs and desires into high consideration, making labor more pleasant and allowing the mother to have a better chance at sticking to her birth plan.

What to Ask Your Potential Midwife
You may want to ask your midwife who her backup obstetrician is, and whether you can meet him or her.

Ask about her experience. For example, how many babies has she delivered? Where did she attend school? Is she certified by ACNM? Licensed by your state? 

You may also want to get some information about her practice. Find out if she works solo or with a group. If she works alone, what will happen if more than one woman goes into labor at the same time? Ask if other midwives in her group share the same views on childbirth and medical intervention. It is also a good idea to find out if they have hospital admitting privileges. 

The most important thing when choosing a midwife is making sure that you feel totally comfortable with her. You want to trust your midwife's judgment, as she will be primarily responsible for you and your baby during delivery.

Will Health Insurance Cover a Midwife?
Many health insurance policies cover certified nurse-midwives, although they may not cover other types of midwives. Find out what your insurance will cover and what you will need to pay out of pocket when deciding whether to use a midwife.

How to Find a Midwife
The ACNM can help you find a midwife in your area. You can reach them at www.acnm.org or via telephone at (888) 643-9433.

You may also be able to find a midwife by contacting your hospital. They can provide you with a list of midwives who practice at their hospital.

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