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Types of Midwives: A Discussion 3: More about Midwives by Daphne Singingtree CM, LDEM

Introduction to discussion of types of midwives

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More about Midwives
by Daphne Singingtree CM, LDEM

Why Choose a Midwife?

Midwives have provided supportive care to birthing women through the ages. Today's midwives are competent and caring professionals who work in a variety of settings including hospitals, birth centers and at home. Midwives work with physicians and hospit als in those few instances where emergency intervention is needed. Recent studies * have shown women under the care of midwives experience fewer cesarean sections, less invasive procedures, fewer premature births, and report a gr eater satisfaction with their birth experience then those delivered by doctors. Midwives on the average spend more time with clients and are able to give personal, individualized care.

Selecting a Midwife

Midwives offer a wide range of services to expectant families. Each midwifery practice may differ in approach, philosophy, and choice of birth place. By planning to visit at least three midwifery practices, parents increase their chances of finding the r ight midwife for their individual situation. As educated consumers of health care, parents should ask about training, qualifications, certification, backup services as well as philosophy and approach. Feel free to ask specific questions such as the numb er of babies delivered, rate of transports or c-sections, type of equipment carried, or experience with specific complications. Parents can use the free "get acquainted" or orientation visit midwives offer to find someone they are comfortable with.

Types of Midwives

Midwives receive their training through various avenues:

Certified Nurse-Midwives (CNM)

Registered Nurses who have completed an additional 1-3 years of training. CNM's are required to work with a physician, they can obtain hospital privileges, and can write prescriptions. In most places, Certified Nurse Midwives attend both birth center and hospital births, in some areas they also do home births.

Certified Midwives (CM) or Certified Professional Midwives (CPM)

direct entry midwives (trained directly into midwifery without becoming a nurse first) who are certified by their state organization or through the North American Registry of Midwives. They receive their training through various methods such as appre nticeship, certifying programs or schools. Licensed Direct Entry Midwives (LDEM or LM) are Certified Midwives who have a state. They are licensed by a state board. CMs and LDEMs attend births at home. Licensing laws vary state by state.

CNM's, CPMs, LDEMs and CM's are required to pass comprehensive written and oral exams, to attend a required number of births, to have continuing education and peer review, and to practice by specific guidelines and protocols.

Direct Entry Midwives or Lay Midwives

receive their education primarily through apprenticeship with another midwife's practice or through informal schooling. Training and experience will vary among individuals. Some direct entry midwives choose not to get certified or licensed due to ph ilosophical beliefs. They attend births at home.

* "A Meta-Analysis of Process of Care, Clinical Outcomes, and Cost-Effectiveness of Nurses in Primary Care Roles: Nurse Practitioners and Nurse Midwives" a study prepared for the American Nurses Association 1993 "Safest Birth Attendants: Recent Dutch Evidence, Midwifery"; reprinted napsac news 17,#3 Fall 92, pp 1-3---

Daphne Singingtree CM, LDEM
Director, Oregon School of Midwifery

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Last updated Mar 6, 1996 by Donna Dolezal Zelzer, djz@efn.org