Understanding the 3 types of midwives
When it comes to choosing a midwife for your pregnancy and childbirth journey, it’s important to understand the different types of midwives in the US. Each type of midwife brings unique qualifications, training, and approaches to care. On this page, we will delve into the key differences between the three types by examining their distinct characteristics, pros, and cons, so you can be empowered with the knowledge you need to make an informed decision.
In the US, there are three classifications of midwives:
Certified Nurse Midwives (CNMs)
This midwife was a nurse first, continuing their education to specialize in providing care to women in pregnancy, birth, and postpartum. They serve under the direction of a physician, and typically only serve women in a hospital setting. There are some CNMs who offer home-based midwifery care.
PROS
Extensive medical education and training. They hold a graduate degree in midwifery, and are also a registered nurse, providing them an educational and experiential foundation in healthcare.
Broad scope of practice. They can provide prenatal care, birth support, and gynecological care.
Collaborative care. They typically work within healthcare institutions, allowing them to collaborate with physicians and access medical interventions when necessary.
Continuity of care. They can provide comprehensive care through a woman’s lifespan, from preconception to postmenopausal care, ensuring continuity and a long-term relationship with your midwife.
CONS
Only typically available in hospital settings. This limits the options for women seeking homebirth with this type of midwife. They may practice in birth centers.
Medicalized approach. Because of their affiliation with hospitals, and the basis of their education being in conventional medicine, CNMs are more likely to adhere to medical protocols and interventions, which may not align with women seeking a more natural birth experience.
Limited autonomy. They face restrictions and protocols imposed by hospitals or healthcare institutions, which could limit their ability to provide care according to their personal philosophy or approach.
Higher medical intervention rates. Due to their affiliation with medical settings, CNMs may have a higher rate of medical interventions such as inductions and cesarean sections compared to other types of midwives.
CNMs bring extensive education and training as registered nurses, providing a broad scope of care within healthcare institutions. While their association with hospitals may limit options and lead to a more medicalized approach, they offer comprehensive and collaborative care throughout a woman’s lifespan.
Certified Professional Midwives (CPMs)
This midwife was specifically trained to provide care to women during pregnancy, birth, and postpartum. They are certified by the North American Registry of Midwives (NARM), and are typically found in out-of-hospital settings such as homes and birth centers. In fact, a CPM is the only midwife in US with exclusive out-of-hospital training!
PROS
Focus on out-of-hospital births. They specialize in supporting women who prefer birthing at home or in a birth center, emphasizing natural birth and minimal interventions.
Autonomous care providers. They are not usually under the authority of a physician, allowing them to work with you in your best interest.
Extensive midwifery-specific training. They undergo specific education and training relating to midwifery, making them the experts in normal, low-risk, childbirth processes, and recognizing potential complications.
Broad scope of practice. They offer a full-spectrum of care including well-woman visits, well-baby care, antepartum and postpartum care, and counseling throughout pregnancy and life.
CONS
Limited access to medical interventions. Choosing a CPM and out of hospital birth means accepting a birth experience primarily without access to hospital resource and medical interventions.
Limited emergency equipment. While they are equipped to handle most normal births, they may have limited access to emergency equipment and interventions that hospitals provide in case of complications.
Legal challenges. They face legal restrictions in some states, which my limit their ability to practice, or result in a lack of recognition and support from the medical community.
Limited insurance coverage. CPMs may face challenges in obtaining insurance coverage for their services, which can result in increased out-of-pocket expenses for clients. You can read more about insurance coverage here.
CPMs specialize in out-of-hospital births, offering a holistic and intimate approach, with a focus on natural birth. However, limited access to emergency equipment, legal challenges, and potential insurance (and financial) limitations should be considered.
“Traditional” Midwives
All non-certified midwives fall into a class that has historically been referred to by many titles, including Traditional Midwife, Lay Midwife, Direct-Entry Midwife, Midwife, etc. These midwives are completely autonomous, choosing not to certify or be affiliated with any governing body. They often learn their craft through apprenticeships or cultural practices. It’s important to note that these midwives may not have any formal certifications or licenses.
PROS
Cultural relevance. They bring a deep understanding of cultural customs and practices, which can enhance the birthing experience for women seeking to honor their heritage.
Personalized care. They often offer individualized care that is deeply rooted in their community’s traditions and values.
Affordability: They may provide more affordable options for those who cannot afford hospital or professional midwifery care.
Community integration and support. Traditional midwives often have strong ties to the local community, and may be deeply embeded in their support network. They can provide a sense of community integration, trust, and familiarity throughout your childbirth journey.
CONS
Lack of formal credentials. They may not have any formal certifications or standardized training, which could limit their ability to provide evidence-based care or access certain resources.
Legal restrictions and recognition. Traditional midwives may face legal restrictions in some jurisdictions, making it difficult for them to practice legally, or be recognized by healthcare systems. This can limit access to certain resources and professional collaboration.
Lack of standardization. Due to variations in training (or lack thereof) and practices, there may be a lack of standardized protocols and quality assurance among traditional midwives.
Limited scope of practice. They have a limited ability to detect or handle high-risk pregnancies or complications, as they often specialize in low-risk, normal births. This may require transfer of care to a medical professional in certain situations.
Traditional midwives provide a sense of cultural relevance, personalized care, and community integration. However, due to the lack of formal credentials, legal restrictions, limited scope of practice, and potential inconsistencies in training, careful consideration is necessary to ensure alignment with your preferences and requirements.
It’s important to note that the pros and cons mentioned here are general observations, and may vary based on individual practitioners, local regulations, and personal preferences. It’s important to research and interview midwives in your area to gain a better understanding of their specific qualifications, experience, and approaches to care.
Choosing the right type of midwife is a personal decision that depends on individual preferences, values, and desired birthing experience. It is important to thoroughly research and interview midwives to ensure their qualifications, training, and approach align with your needs and expectations. Remember: the ultimate goal is to have a safe and empowering childbirth experience, supported by a skilled and compassionate midwife who respects your choices and priorities.
Kristy Wilson is a Certified Professional Midwife, and registered preceptor with the North American Registry of Midwives.
