A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.  A midwife will work with each woman and family to help identify their unique needs, whether they be physical, social or emotional.  When the needs or care required are outside of the midwife’s scope or expertise, she may refer the woman to another heath care provider.

There are several issues to consider once you have chosen to use a midwife instead of an OB-GYN.  The first and perhaps most important issue to address is whether you want a direct-entry midwife or a certified nurse midwife.

A direct-entry midwife is one who:

– Is not required to be a nurse.

– May or may not have a college degree.

– May or may not be certified by a state or national organization.

– May or may not be legal in your state.  21 states currently license or regulate midwives.

– May or man not have any affiliation with a doctor.

– May maintain an autonomous practices outside of institutions.

– Trains and practices most often in home or out-of-hospital birth center settings.

It is important to note that not all insurance providers will cover care given by a direct-entry midwife.  This may be the overriding factor in choosing between direct-entry and certified nurse midwives.

A certified nurse midwife is one who:

– Is educated in both nursing and midwifery, primarily in the hospital setting.

– Must have at least a Bachelors Degree when training is complete.

– Has successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives.

– Has passed an exam related to the above program.

– may or may not have out-of-hospital clinical experience.

– is legal and can be licensed in all states.

– typically is required to have some kind of agreement with a doctor for consultation and referral.

Ultimately your choice between direct-entry or certified nurse midwife will rest on your individual situation.  If you have a high-risk pregnancy due to a serious chronic medical condition like high blood pressure, diabetes or heart disease you should likely see an OB-GYN.  If you discover you are having twins or if complications develop during your pregnancy you may need to switch to an OB-GYN.

If direct-entry midwifery is illegal in your state, the choice has been made for you.  As has already been mentioned, your insurance company’s policy on midwives may also dictate the decision.  Additionally, you must decide if you are comfortable with a midwife without formal medical training, and who may or may not be licensed by an organization which can certify their ability.  However, if you wish to have your birth in a setting outside of a hospital, then you may wish to lean toward a direct-entry midwife, as 99% of certified nurse midwife births take place in a hospital.  Finally, the availability of the different types of caregivers in your area will greatly affect your choices.

What is the difference between a direct entry midwife and a certified nurse midwife?