What is a midwife?

What is a midwife?

A midwife is a healthcare provider who is trained to care for you during your pregnancy, labor and delivery, and postpartum.

Midwives attend births in hospitals, birth centers, and homes. They are trained (and sometimes certified) specifically for midwifery and do not provide the same services as an obstetrician or a doula.

Some midwives also offer expanded care to women throughout life, including annual gynecologic exams, treatment of sexually transmitted infections, contraception, preconception care, and menopause care. Midwives may also offer basic primary care to female patients, including physical exams.

What does a midwife do?

Midwives provide:

• Prenatal care. A midwife will monitor you and your baby throughout your pregnancy, explain the physical and emotional changes you'll experience, and help you have a healthy pregnancy.
• Assistance with labor and delivery. A midwife will prepare you for labor and delivery and be there to deliver your baby.
• Breastfeeding guidance. A midwife will teach you about breastfeeding and help you get started when your baby arrives. If you have any problems with breastfeeding, your midwife may problem-solve with you or refer you to a lactation consultant.
• Postpartum care. Midwifery care includes postpartum visits to check on you and your baby. Your midwife will be accessible to you in the days following delivery.

At your first prenatal visit to a midwife, they'll take a comprehensive medical history, answer any questions you have, perform a physical exam, and have laboratory screenings done. Your midwife can make arrangements for any prenatal testing you want to have done that they don't do themself, such as ultrasound or amniocentesis.

During labor and delivery, a Licensed Midwife – either a certified nurse midwife or a certified midwife – can order an epidural for an anesthesiologist to perform (assuming you're giving birth in a hospital or birth center that has availability), or systemic (intravenous) medication, but they can't perform a C-section.

What are the different kinds of midwives?

There are two main classifications of midwives, certified nurse midwives and direct-entry midwives.

Certified nurse midwives (CNMs) are trained in both nursing and midwifery and are certified by the American College of Nurse-Midwives (ACNM). To be certified, a CNM must be formally educated in midwifery through an accredited program affiliated with an institution of higher learning, demonstrate clinical competence, and pass a rigorous national certifying exam. CNMs are licensed to practice in all 50 states, the District of Columbia, and Puerto Rico.

Most midwives in the United States are CNMs. Most CNMs attend births in hospitals, but some practice in birth centers and attend home births. CNMs can prescribe medications and treatments (including pain control medications for labor).

Direct-entry midwives (DEMs) typically attend home births, although some work in birth centers. They may learn their skills through self-study, through apprenticeship, or at an independent midwifery school or college.

The way in which direct-entry midwives are licensed and regulated varies from state to state. The state of Washington, for example, has stringent licensing standards, and DEMs there are reimbursed by both Medicaid and some HMOs for home births. In contrast, in some other states it's illegal for direct-entry midwives to practice. And a few states don't regulate direct-entry midwives at all.

You can find out the legal status of DEMs in your state on the Citizens for MidwiferyOpens a new window (CfM) or North American Registry of MidwivesOpens a new window (NARM) websites.

There are probably more DEMs attending home births than are CNMs, but this may vary according to region.

There are different terms used to define DEMs, and they sometimes vary from one organization to another. In general, these are the direct-entry midwife classifications you might come across:

• CPM or LM. Those who have met the standards for certification set by the North American Registry of Midwives (NARM) are called certified professional midwives (CPMs) or Licensed Midwives (LMs). One of the requirements for the CPM certification is out-of-hospital delivery experience.
• CM. A few direct-entry midwives are certified according to the requirements of the American College of Nurse-Midwives (ACNM) and are called certified midwives (CMs). CMs receive the same midwifery education and training as CNMs, but they are not nurses.
• Lay midwife or traditional midwife. These terms are sometimes used to describe a midwife who is not certified or licensed.

How popular are midwives?

Midwives are becoming increasingly popular. The number of new CNMs and CMs in the United States increased by 91 percent between 2005 and 2014. And the numbers rose from just under 11,500 in 2014 to over 13,000 in 2021. In 2019 (the most recent year for which the government has statistics), CNMs delivered 9.8 percent of the babies born in this country.

The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the March of Dimes all support the use of CNMs in providing safe healthcare to women.

Midwives are even more common in other parts of the world. In some European countries, midwives are the norm, and obstetricians provide primary care for complicated pregnancies only.

Benefits of having a midwife

Benefits of having a midwife include:

• Excellent birth outcomes. Several studies in the United States have shown that healthy women with normal pregnancies who choose CNMs are just as likely to have excellent outcomes as those who choose ob-gyns.
• Fewer medical interventions. Studies also show that midwife-attended births tend to have fewer medical interventions (including continuous electronic fetal monitoring, epidurals, and episiotomies). You're also less likely to have a cesarean section with a CNM delivery.
• A less routine, more individualized approach. Midwives consider you an active participant in all aspects of your care. They see every pregnancy as a unique event and encourage you to consider your options for labor and delivery and to personalize your own birth plan.

Whatever kind of birth you choose, a midwife will support you in your decision. That said, a midwife won't hesitate to use an intervention if it's necessary for your well-being or your baby's. For example, a midwife will guide you through a unmedicated labor if that's what you choose, but you'll still have the option of having an epidural during labor (as long as you're giving birth in a hospital). Midwives have obstetricians available for consultation and backup if needed.

Is a midwife right for me?

A midwife might be right for you if you're looking for an individual approach with fewer routine medical interventions. You may also opt for a midwife if you'd like to deliver in a birth center or at home.

In some cases, a midwife may not be an option. If you have a chronic medical condition, such as high blood pressure or diabetes, or you have what's considered a high-risk pregnancy (because of certain serious complications in a previous pregnancy, for example), or are carrying multiples, you'll need to see an obstetrician or a maternal-fetal medicine specialist (a physician who specializes in high-risk pregnancies). In some cases, you could have both a midwife and a doctor provide your care.

How does a midwife handle complications?

Midwives are trained to recognize problems that may develop during pregnancy, labor, birth, and the postpartum period. If a complication arises that they can't handle themselves, they will contact the obstetrician they work with or the one you have lined up for backup. If necessary, your midwife will have you transferred to the hospital.

Feel free to ask your midwife about her consulting physician – you may want to meet him or her at some point before your due date. Even if your midwife does need to call in a doctor to help, she'll probably continue to be involved and provide support and care throughout the birth and afterward.

Talk with your midwife about what will happen if you need to be transferred to a hospital. Your midwife may come with you to the hospital and continue to attend your birth, especially if she's affiliated with the hospital. Depending on your needs and the hospital protocol, she may even be able to deliver your baby (though if you've been transferred for complications, you may need specific medical care that she can't provide, such as a C-section).

Keep in mind that if your midwife isn't affiliated with the hospital, she won't be able to treat you once you get there. And the hospital staff may or may not be supportive of her involvement.

How can I find a midwife?

To find a certified nurse midwife (CNM), visit the American College of Nurse-Midwives websiteOpens a new window for an online practice locator and other information about CNMs. Or call the ACNM at 240.485.1800.

To find a direct-entry midwife (DEM), check with local women's health clinics. Ask any midwife you're considering to give you client references. The North American Registry of Midwives (NARM) can verify if a midwife is certified as a CPM if you call them at 888.842.4784.

If you're interested in delivering at a birth center, call the American Association of Birth CentersOpens a new window (AABC) at (215) 234-8068 or visit the association's website. The birth center you choose may have specific midwives they work with.

If you want to give birth at a specific hospital, call the hospital and ask for the names of midwives who practice there.

Look for a midwife you feel comfortable with and who communicates well. As with any healthcare provider, look for competence, experience, empathy, and flexibility. Here are some considerations when making your decision:

• What is the midwife's education, training, experience, and certification?
  Find out how much experience she's had, where she was educated and trained to be a midwife, and whether she graduated from a nationally accredited program. Ask whether she's passed a national certifying exam and whether she's licensed to practice in your state.
• Where does the midwife practice?
  Does she deliver only at the hospital, or only at private homes? Does she work at a birth center?
• Who is the midwife's backup obstetrician?
  Be sure she has formal backup arrangements with a local obstetrician and hospital. Ask how she handles emergencies and how far away the hospital is. Consider meeting with the backup obstetrician.
• How many providers are in her group?
  If you're interviewing midwives in a group practice, think about what size group you're comfortable with and ask whether all the midwives in the group have the same practice philosophy. Will you be able to meet and get to know every midwife who might attend your baby's birth?
• What are her criteria for transferring a home-birth candidate to the hospital?
  Ask her how much time she typically gives women to deliver before considering transfer. At what point would a labor without progress lead to a hospital transfer?
• How have the midwife's previous transfers from home to hospital gone?
  Ask her whether the hospital staff are familiar with and receptive to home-birth transfers.
• How does her practice work?
  If you're planning a home birth and the midwife is in solo practice, ask her what she does if two women are in labor at the same time. If she's in a group practice or relies on midwives in another practice to cover her when she's away or at another birth, find out whether they're certified and licensed, and consider meeting them, too. Ask whether she'll stay with you if you need to be transferred to the hospital during labor.
• Will your insurance company cover the midwife's services?
  Find out whether you'll be reimbursed by your insurance for her services. Check your coverage and find out how much it will cost if you need to be transferred to the hospital.

How much does a midwife cost?

Depending on where you live, for a home birth a midwife might charge from about $1,500 to as much as $11,000 for her complete services – including prenatal care, labor and delivery, and postpartum care.

If you have a midwife for birth at a hospital or birth center, the services are usually included as part of your bill. In some instances, however, a midwife will bill separately for some or all of her services. Be sure to clarify what will be charged and when.

Some other things to consider:

• Many U.S. insurance plans, including Medicaid, cover services by licensed midwives. In fact, Medicaid reimbursement for licensed midwifery care is mandatory in all 50 states, and most states require private insurance reimbursement for licensed midwifery services.
• Some providers will cover midwifery within hospitals but not at home or at birth centers.
• Some states (like New York) mandate that home birth must be covered by Medicaid as well as commercial insurance. If yours doesn't, ask your midwife about a sliding scale or payment plan.

• Birth centers generally charge less than hospitals and midwives generally charge less than obstetricians – but you'll need to do the math to compare your out-of-pocket expenses.

Choosing a caregiver for your pregnancy and delivery is a big decision. Explore your choices: an obstetrician-gynecologist, a family physician, a certified nurse midwife, or a direct-entry midwife.

Learn more:

• What to expect at your prenatal visits
• Pregnancy to-do list: First trimester