There are a lot of misperceptions of what midwives do. There is a lack of acceptance and awareness of our scope of practice, and a limited understanding about the different types of midwives. Yet, midwives have practiced in countless cultures across the globe since time immemorial.
Since the 1930s, competitive medical markets have threatened to jeopardize the practice of midwifery, but today midwifery has been successful in reintegrating to become a valued element of the maternity care model and creating intimate care to close gaps across women’s lifespans. Women are able to walk through all stages of life seeking out this unique blend of care and support.
When people hear I am a midwife, their response is “What is that?” or “Well, I’m far past having babies.” But, as a certified nurse midwife, did you know I am an independent, primary care, full-spectrum women’s health care practitioner?
There are also a few professional designations under the umbrella of midwifery: certified nurse midwives, direct-entry midwives (certified professional midwives, certified midwives) and traditional midwives. Not all midwives share the same education, training, credentials, scope of practice and state recognition. But, despite this, we all have similar views on the importance of focusing on the physical, psychological and socio-economic well-being of the woman, minimizing interventions and providing hands-on care and lifelong support.
What are the characteristics of each designation?
Certified nurse midwives (CNMs) are trained and licensed in both nursing and midwifery. We are advanced practice registered nurses (APRNs) backed by ACNM (American Certified Nurse Midwives) and must graduate from a master’s-level nurse-midwifery education program. We hold a state license and have prescriptive authority, and 18 states allow us to diagnose and treat without physician supervision. A vast amount of training is provided in clinic and hospital settings that allows us to provide care in any birth setting. Because we have dual advanced training in nursing and midwifery, we provide qualified care for all women’s health care needs (annuals, gynecologic needs, contraception, family planning, treatment of STIs and infections, etc.), with an emphasis on low-risk prenatal, delivery and postpartum care.
MYTH: Nurse midwives only focus on pregnancy and birth.
FACT: Nurse midwives work with families throughout all stages of life.
CNMs offer a variety of care, including conducting physical exams, performing diagnostic tests, prescribing medications, counsel and education for patients, monitoring fetal development and attending pregnancy-related issues and managing preventative acute and chronic illnesses of women through all stages of life.
We practice evidence-based medicine, and we love collaborating as needed and do so to give you the best, safe care you deserve. We do not substitute for an OB/GYN doctor but are independent practitioners to fill the gaps of care throughout a woman’s life. Midwives are needed and are a key part of every community. We provide full-spectrum women’s health care/prenatal care while focusing on preserving true midwifery of “with woman.” And, we believe every person has the right to ethical, equitable, accessible and quality health care.
Certified professional midwives (CPMs) are the only midwifery-credentialed practitioners requiring knowledge and experience with out-of-hospital settings. Their education focuses on providing midwifery-model care in homes and freestanding birth centers. Backed by NARM (North American Registry of Midwives), you must have a high-school degree and complete the NARM evaluation process or graduate from a midwifery program accredited by Midwifery Education Accreditation Council. This council may grant a certificate, associate’s, bachelor’s, master’s or doctoral degree; most practitioners obtain a certificate or associate degree.
CPMs can provide initial, ongoing, comprehensive assessments, diagnosis and treatment to women throughout their childbearing cycle. They can be licensed or have some sort of legal recognition in 31 states, with variation(s). They do not have prescriptive authority.
Certified midwives have a master’s-prepared background/degree in a health-related field other than nursing, and graduate from a master’s-level midwifery education program. They can provide a full range of primary health care services and work in a variety of settings. Very few states legally recognize and license certified midwives.
Traditional-lay midwives choose not to become certified or licensed in midwifery due to personal or cultural reasons. They believe they are accountable to the communities they serve and that women have the right to choose qualified providers regardless of their legal status.
Hallmarks of Midwifery
- Advocacy of non-intervention in normal processes in the absence of complications
- Recognition of menarche, pregnancy, birth and menopause as normal physiologic and developmental processes
- The therapeutic value of human presence
- Empowerment of women as partners in health care
- Promotion of family-centered care
- Advocacy of informed choice, shared decision-making and the right to self determination
- Facilitation of healthy family and interpersonal relationships
Mothers and women are born too. We must preserve the value in this, close the gaps in women’s health care and increase the rights of ethical, equitable, accessible and quality health care. Midwives have become a collaborative asset in this care making remarkable care solutions and partnerships.
I know I’m a bit biased, but what an amazing career I have, and I add a holistic spin on my care model–to serve women without time constraint, provide a safe and home-like environment and partner with women to provide alternative care modalities to fit who they are, not what the medical model wants. It’s not about putting a Band-aid on it, but instead ripping it off and finding the root cause and solution. It’s a partnership. It’s shared decision-making. It’s assuring you do not fall through the cracks. This job isn’t a job; it’s my dream that’s come alive.
I am here for it, and I am with woman.
Anne, APRN, CNM, WHNP