What Is a Midwife? Your Questions Answered
If you’ve been wondering what a midwife is, you’re not alone. Despite midwives existing for thousands of years, most people today aren’t well-acquainted with exactly what a midwife is, how midwifery works, or why women choose to use a midwife.
Though the profession is ancient, the education and training of modern-day midwives in America is very much up to date. Let’s separate fact from fiction and discuss what a midwife is, what midwives can do, and when you might consider using a midwife.
What Is a Midwife?
The dictionary definition of a midwife is “a person who assists women in childbirth,” and that certainly gets to the core of what a midwife is. Yet it doesn’t give much sense of why midwives exist in a world with obstetricians, nor what a midwife actually does.
The International Confederation of Midwives provides a much more involved explanation, which you can read here, but I’d like to offer my own take on a definition for midwifery.
Midwives are experts in normal. We’re part of the modern medical model, but we approach the entire process of pregnancy and birth from a different angle. Whereas physicians receive extensive training in pathologies and abnormalities, midwife training focuses on what is normal, what is physiologic. We then become adept at identifying when a situation moves outside of that norm.
Midwives primarily care for women with low-risk pregnancies, though some midwives work with obstetricians in high-risk healthcare settings. Our particular training and skill set, however, mean midwives truly shine in the low-risk realm of “normal.”
In the view of midwives, pregnancy and birth are normal, healthy processes. As such, many midwives take more conservative or alternative approaches to obstetric care than physicians. Surgeons — including obstetricians — are often primed to see pathology, and tend to take a more aggressive approach. For example, a large study of over 23,000 hospital births found that women using a midwife had a 30–40% lower likelihood of cesarean section than women using an obstetrician.
How Does Midwife Certification Work?
In the United States, we have three types of midwife certifications, each of which impacts the scope, environment, and state of a midwife’s practice.
Certified Nurse-Midwife (CNM)
Certified nurse-midwives (CNMs) are registered nurses (RNs) who earn a master’s degree in nurse-midwifery, giving them a robust foundation in both nursing and midwifery. They receive their certification through the American Midwifery Certification Board and are licensed to work in all 50 states and the District of Columbia.
Depending on the scope in which CNMs decide to practice, they may provide:
Primary care services
Full women’s health services, including yearly exams
Prenatal care
Labor and delivery care
Newborn care up to 28 days of age
CNMs are licensed to practice in any environment, whether that’s a hospital, a birthing center, or your home, and they can order lab tests, prescribe medications, and even diagnose conditions. All the midwives here at Haven Birth and Wellness are certified nurse-midwives.
Certified Midwife (CM)
Certified midwives (CMs) share many similarities with CNMs, but with one key difference: they aren’t registered nurses. CMs earn a master’s degree in midwifery, often building on a bachelor’s degree in a health-related field. Like CNMs, CMs are certified by the American Midwifery Certification Board and can prescribe medications.
However, CMs are currently licensed to practice only in nine states. Their role is growing, but access to a CM may depend on where you live.
Certified Professional Midwife (CPM)
Certified professional midwives (CPMs) hold a high school diploma at minimum, complete specialized training and coursework in midwifery, and earn their CPM credential through the North American Registry of Midwives. CPMs specialize in out-of-hospital births, practicing exclusively in homes and freestanding birth centers, and they can’t prescribe medications.
For now, only 36 states and the District of Columbia license CPMs, but the National Association of Certified Midwives is working to change that.
Unlicensed or Lay Midwife
In some states, unlicensed or lay midwives provide care. You might also hear them called “birth keepers.” The legality and regulations regarding unlicensed midwifery vary widely by state, and the topic has sparked much controversy over the years.
The Difference Between an Obstetrician and a Midwife
Midwives usually aren’t doctors, though some earn doctorate degrees in nursing. As outlined above, a certified nurse-midwife’s education includes an undergraduate degree with a registered nurse license, followed by a master’s program and certification in nurse-midwifery. An obstetrician’s route takes much longer; they must earn a bachelor’s degree, attend medical school, pass through a medical residency, and pass a board certification exam.
Beyond the educational differences, the core divergence between obstetricians and midwives is their approach. The medical model of care and the nursing model of care comprise two very different ways of addressing pregnancy and birth.
What Does a Midwife Do?
Now that you know what a midwife is, let’s look in more detail at what a midwife does.
At our core, midwives exist to support women. By providing individualized, relationship-based care, we empower women both in their general wellness and through the processes of pregnancy, birth, and postpartum to make informed choices and participate actively in their care.
When a woman experiences the joy of holding her child for the first time, we’re there with her. We’re also beside her when a woman experiences the heart-rending loss of a baby. We walk with women through their greatest joys and deepest sorrows, offering support, care, information, and empathy.
Midwives often see women from the trying-to-conceive stage all the way through to the postpartum period. With midwives engaged in broader scopes of practice, women can find care for every stage of their reproductive health, from puberty to menopause.
At Haven, for example, we provide all routine care during pregnancy, labor, birth, and postpartum, including orders for ultrasounds and lab work.
Midwives in Labor and Delivery
When attending a home birth, midwives come prepared with an arsenal of equipment, though with the hope that most will remain unneeded. We offer nearly everything a normal, healthy birth would involve in a hospital, but in a space that truly belongs to the mother, with no red tape or hospital policy to get in the way.
If any kind of invasive care is needed, for instance, we strive to perform it while the baby is nursing in the mother’s arms to lessen the newborn’s pain. Even in home settings, we can provide IV fluids, medications, and/or antibiotics if needed or wanted by the mother. Follow-up care takes place in the home as well, meaning mothers get to stay snuggled in with their newborns rather than running back and forth to check-ups.
During births, midwives actively monitor both mother and baby’s health by taking vital signs and using a Doppler to listen to the baby intermittently. Midwives may also perform cervical exams, though they usually try to keep those to a minimum.
Midwives receive extensive training to manage birth-related complications like shoulder dystocia, postpartum hemorrhage, first- and second- degree lacerations, and even newborn resuscitations. If a woman’s labor stalls, midwives offer alternative methods — from position changes to herbs to homeopathy to essential oils — to support labor progress and identify the source of delay without arbitrary time constraints. And if unforeseen complications arise outside our scope of expertise, we maintain good relationships with physicians and hospitals so our clients get the care they need quickly and efficiently.
For home births, midwives facilitate a more comfortable birthing experience, using strategies like water immersion to relieve pain and increased freedom of movement to relieve discomfort and facilitate labor progress. From beginning to end, a midwife’s goal is to come alongside women and facilitate the best possible pregnancy, labor, delivery, and recovery.
What Midwives Don’t Do
Midwives don’t perform surgeries of any kind, though some individuals with specialized additional training may be qualified to perform simple procedures like tongue tie releases or circumcisions. Strictly speaking, however, this falls outside the scope of a midwife.
Midwives don’t generally use vacuums in their practice, but if they do it will be quite limited. They also don’t use forceps, repair most third- or any fourth-degree lacerations, or administer epidurals. Though midwives don’t perform cesarean sections, some do assist with them.
Who Uses a Midwife?
Once you know what a midwife is, you may wonder when using a midwife is a good idea and when it isn’t.
First, any woman can use a midwife at any time in her life. With regard to home births, specifically, midwives primarily care for healthy, low-risk women and pregnancies. Medical complications that would require additional medical care include:
Hypertension
Uncontrolled diabetes
Heart disease
Other ongoing conditions, depending on the individual case
Women who choose to have a midwife want physiologic support often described as “high touch, low tech” during a birth. They typically want hands-on support, but as little intervention as possible.
I often tell clients that midwives are hands-on in support and hands-off in intervention. Our goal is to support, not to manage. This may include activities like squeezing mom’s hips, rubbing her back, and routine care like monitoring mother and baby’s health, but not intervening unless there’s a clear indication present or we’re all in agreement that something needs to happen.
Is It Cheaper to Give Birth at Home With a Midwife?
With the unpredictability of medical costs and insurance coverage in this country, the only answer to this question is, it depends.
Midwife home births may be less costly for women with high-deductible health insurance plans or an insurance policy that specifically covers home births. A medical cost-sharing program, or health share, can also help reduce expenses. Some of the programs we’ve seen reimburse well for home births include Liberty HealthShare, Samaritan Ministries, and Christian Healthcare Ministries. The only caveat is that you must be signed up as a member prior to becoming pregnant.
If a woman’s insurance plan covers 100% of an in-hospital birth but none of a home birth, then the latter option will of course be more expensive. That said, Haven has clients who opt to disregard their insurance coverage and pay out of pocket for a home birth anyway. The care and approach of a midwife-assisted home birth versus a hospital birth means that much to them.
One advantage of using a midwife or birthing center is transparency in pricing. Infamously, hospital patients have little to no idea of what they’ll be charged by the end of a stay. They could end up with a bill from the hospital, a separate bill from the obstetrician, another from the anesthesiologist, and yet another from a department they never knew was involved! Midwives and birthing centers offer clear, upfront pricing that allows you to make informed decisions from the start.
What Questions Should I Ask Before Choosing a Midwife?
If you’re interested in working with a midwife practice, asking strategic questions will help you find the best fit for you. Consider asking:
What are the midwives’ experience and education?
What do they bring to home births?
How prepared are they to handle complications?
Can you decline elements of care?
Will they personalize your care, or does everyone get the exact same?
How available are they for concerns, questions, and needs throughout the pregnancy?
It can be helpful to meet a midwife you’re considering so you can determine whether you fit with their philosophy and approach. At Haven, for example, we take a more alternative approach to healthcare, preferring to try natural methods when possible before turning to medications or other medical interventions. Not all midwives practice this way, though it’s a common approach among midwives who attend home births. What’s important is to find someone with whom you feel safe, comfortable, and confident.
I always recommend that women meet with at least two midwives before making a decision. Word-of-mouth recommendations from friends, mom groups, or even social media can provide excellent insight into different providers.
What Is a Midwife: Final Thoughts
One of my mottos is this: The way a woman experiences becoming a mother matters. Using a midwife is the best way I know for women to set themselves up for the best birthing experience possible.
For women with normal, healthy pregnancies, birth almost always goes well, and midwives help support that outcome. For instance, they reduce your chances of unnecessary interventions, sometimes significant ones like cesarean sections, as mentioned above. At Haven, for example, our C-section rate is about 5%, while the national average has risen to 32%. They also provide encouragement, support, and information as you need it during labor — something traditional hospital births simply can’t provide.
I hope anyone wondering what is a midwife walks away from this post with the knowledge that midwives are genuine medical professionals with the tools, training, and experience to provide valuable care for women. We don’t show up unprepared and hope for the best; we bring all the modern equipment and knowledge necessary to bring both mother and baby through the birthing experience happy and healthy.
Lauren Drees, CNM, MSN
Lauren Drees is a Certified Nurse Midwife and the founder of Haven Birth and Wellness. With over a decade of experience and having attended more than 1,000 births, Lauren is dedicated to providing compassionate, personalized care to women throughout their pregnancy, birth, and beyond.
Disclaimer: The content on the Haven Birth and Wellness website is created and/or reviewed by qualified Certified Nurse Midwives and healthcare professionals. We strive to provide accurate and detailed information for our readers. However, this blog is intended for informational purposes only and should not be considered a substitute for professional medical advice. Your own healthcare provider is best equipped to understand your unique situation and medical history. Always consult with your healthcare provider before making any decisions that may affect your health.