Types of Midwives

Art by Catie Atkinson @spiritysol

CNM Anne Margolis talks about what to expect during prenatal care with an out-of-hospital midwife. If you are interested in learning more, please visit Anne HomeSweetHomebirth.com ; https://www.facebook.com/homesweethomebirth/ https://www.instagram.com/homesweethomebirth/ https://twitter.com/Anne_Margolis

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There are several options for midwifery care in the United States, during preconception, pregnancy, birth and postpartum; and there a variety of routes to becoming a midwife, with different types of education, licensing, and abbreviated titles that seem confusing to the public. Each midwife has her own personality, philosophy, standards, level of experience, and practice guidelines – even within the field of midwifery. Some are more medically slanted or bound by the protocols of their collaborative obstetricians, others are more holistically minded and practice the midwifery model of care regardless of local medical standards of care, and there is a wide range in between.  As you look at and begin to search for your midwife or group midwifery practice, here is a list of midwife titles, training and what they can do to help you. I recommend you interview a few in your area, if you have the option, so you can find one with whom you are most comfortable.

Certified Nurse-Midwife (CNM): A CNM is an individual who is trained and skilled in the disciplines of midwifery and nursing as a registered nurse (RN). The certificate in midwifery is a post graduate training that requires a bachelor’s degree prior to admission, and some states like New York, a masters degree is required for licensure. Occasionally you might see the term registered nurse midwife used interchangeably. Her education and training are standardized across the country according to the requirements of the American Midwifery Certification Board (AMCB) (http://www.amcbmidwife.org/), and her professional organization that sets educational and practice standards is called the American College of Nurse Midwives (ACNM) (http://www.midwife.org/. She provides care to all women from puberty, throughout the childbearing and menopausal years, including newborn care, well woman gynecology and primary care. She can be legal and licensed in all 50 states, and her services are covered by most insurance companies; she can work in all settings such as private practices, clinics, hospitals, free standing birthing centers, and your home. Of all the midwives, CNMs tend to be most respected and accepted among physicians and hospitals, and the American College of Obstetricians and Gynecologists fully supports them. Most CNM’s education touches on alternative healing modalities and a midwife who is interested in these can learn more about them through continuing education required to maintain certification and licensure. While CNM education includes out of hospital birthing – not all CNMs can get clinical training sites for homebirth or freestanding birthing centers, depending on the availability of those options in each locality. Many CNMs have worked previously as obstetric nurses, which provides additional skills and experience needed to deal with complications and emergencies, but also can impact how she practices.

Certified Midwife (CM): A CM is a relatively new credential in the US, but is actually more similar to the independent midwifery profession in many other modern countries. A CM is an individual with a postgraduate education in midwifery, without the required degree in nursing  - although the training incorporates the knowledge and skills of nursing that are relevant to midwifery. She has to take the same certification exam as a CNM, and ACNM considers the midwifery education and certification to be identical to that of a CNM, thus recognizing these degrees and scopes of practice as equivalent. Unfortunately, A CM is currently only recognized in a few states including NY and NJ, but the ACNM’s lobbying for change remains ongoing.

Certified Professional Midwife (CPM): A CPM is a national credential developed by the North American Registry of Midwives (NARM) (http://narm.org/), in an effort to maintain rigorous and standardized education skills and experience for individuals to provide the midwifery model of care through other means. Multiple routes of education are recognized – so both those who graduate from a midwifery education program accredited by the Midwifery Education Accreditation Council (MEAC) (http://meacschools.org/) and certified nurse midwives can qualify for this credential, as can certified midwives, without a requirement to be a nurse – although a high school degree is required. Learning by apprenticeship, self and group study is highly valued. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. They generally train and practice only in home and freestanding birth center settings, although this can effect their experience  managing complications and emergencies seen more commonly in hospitals. Many do not have gynecology or primary care education, although they tend to have some training in a variety of holistic alternative modalities. CPMs are legal in some states, neither legal nor not legal in others, and illegal and subject to jail sentence in other states and their ability to carry medical supplies and administer medications if needed, varies according to state laws. Midwives Alliance of North America (MANA) (http://mana.org/ is their main professional organization, which is open to midwives of all educational backgrounds and practice styles. While only a CM or CNM can belong to the ACNM, quite a number of CNMs and CMs are MANA members, especially those who practice midwifery in out of hospital settings. Unfortunately there has been some conflict between the ACNM and MANA, with strong opinions on either side, but ultimately these are the organizations that advocate for midwives, the families they serve, and promote practice excellence in the midwifery model of care. MANA is dedicated to unifying and strengthening the profession, while recognizing the diversity within it.

Direct-Entry Midwife (DEM): A DEM is a midwife who is trained in midwifery without having to be a nurse, via multiple routes of education. Her education and experience can vary widely. She may be educated in the discipline of midwifery through self-study, apprenticeship without a college degree, or she may have attended a MEAC accredited midwifery school, or graduated from a university-based program accredited by the AMCB. This includes CMs and CPMs, and any independent practitioner who decides to call herself a midwife. She may be highly skilled, experienced and competent…or not. Her legal status varies according to the state where she practices. In the states where CMs are licensed, the scope of practice and settings are identical to a CNM. All other DEMs mostly practice midwifery in home and some free standing birth centers. A DEM who is not a CPM or CM/CNM tends to prefer to remain independent and autonomous of any institution or organization for personal, philosophical or religious reasons. Some choose not to be licensed or legally regulated at all, and as such, most insurance companies will not reimburse their services. These midwives are sometimes referred to as lay midwives, community based, granny or traditional midwives. Such DEMs tend to feel that women have a right to choose qualified care providers regardless of their legal status, and feel they are accountable to the particular communities they serve, not the state laws, formal educational requirements or organizational standards of care.

Licensed Midwife (LM): An LM refers to any above practitioner who meets the requirements for legally practicing midwifery in a specific state. A CNM can qualify for her midwifery license in all 50 states, while only some states provide licensure for other forms of midwifery education and degrees. So while you may be able to have a legal homebirth in states where only a CNM can be licensed, an unlicensed midwife could risk arrest by attending your homebirth, for practicing midwifery without a license – no matter her level of training and expertise; this can get complicated if a medical referral, hospital transfer, or emergency services is needed – as she will need to protect herself by leaving or not being truthful about her role, and your medical provider will have difficulty obtaining needed medical records and report of events to provide you with appropriate care.

Registered Midwife (RM): A RM is a midwife with a state recognized legal licensure status to practice homebirth, for direct entry midwives who have trained through a program approved by the Midwifery Education Accreditation Council (MEAC) or proof of equivalent apprenticeship and academic study. It is especially useful for midwives who do not qualify for the midwifery licensure of a CNM/CM, but practice in a state where direct entry midwifery is legal, like Colorado.

Now that you know some of the differences between the various types of midwives and their titles, you hopefully have some information to help you find a midwife with whom you are most comfortable.

Art by Catie Atkinson @spiritysol

Art by Catie Atkinson @spiritysol

For more information about midwives and the midwifery model of care visit: http://cfmidwifery.org/midwifery/faq.aspx

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