Midwives FAQ

Midwives provide comprehensive care and education for women and their newborns during the childbearing year. This model of care encompasses women’s physical and emotional needs and fosters self-determination throughout the childbearing cycle. Midwives specialize in normal birth and generally refer high-risk women to obstetricians or other medical specialists.

Prior to pregnancy, midwives may offer family planning, well-woman gynecology services, and/or education and assistance with fertility issues.

During pregnancy, she provides comprehensive prenatal care that includes nutritional counseling and discussion of lifestyle issues, with plenty of time to answer any questions and discuss any concerns the family may have. The time spent prenatally establishes a trusting and intimate relationship with the woman and her family. Midwives view their relationship with each client as a partnership. The best way to have a healthy baby is to be a healthy mother. Midwife and mother work together to achieve this– it is a shared responsibility.

A midwife also attends the woman in labor, birth, and the immediate postpartum period, and provides care to the mother and her newborn up to 6 weeks postpartum. They must be able to recognize the warning signs of abnormal conditions requiring referral to a doctor and to carry out emergency measures when no additional help is available. They may attend births in homes, birth centers, or in the case of Certified Nurse Midwives (CNM’s), in hospitals as well.

Midwives consult with or refer to other health care providers when appropriate. They are responsible for keeping accurate records, informing clients of current medical practice in obstetrical care and state laws relating to childbirth, and filing birth certificates.

Direct-entry midwives usually work in clinics or have offices in their homes and attend births at the client’s home or in a birth center. They work in both urban areas (many home birth clients are well educated, young professionals living in the city) and in rural areas. Some rural communities, such as the Amish, have a strong preference for midwives and most women birth at home. Certified nurse-midwives usually work in hospitals, although a few have home birth or birth center practices.

Generally, direct-entry midwives do not receive a ‘salary’ that is predictable and dependable. Most direct-entry midwives have private practices, so their income depends on the volume of births that they attend and other services that they provide. A busy homebirth solo practice (one midwife practice) would attend 2-4 births per month. Midwives charge anywhere from $2,000-4,000 per birth, depending on their location. How busy your practice is depends on your location, how established you are in your community, and how well you promote your services.

Most CNMs are employees of practices and therefore receive a salary similar to that of a nurse practitioner in their geographic area.

Yes, there are different types of midwives in the United States. The two main categories of midwives are:

1. Direct-entry midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs), Licensed Midwives (LM) or Registered Midwives (RM), Certified Midwives (CMs) or unregulated lay midwives. The legal status and requirements for direct-entry (non-nurse) midwives vary from state. The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.
2. Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually also licensed in individual states as Nurse Practitioners (NPs). Most CNMs practice in hospitals or birth centers under the supervision of a doctor and must abide by the policies and procedures of the facility.

There are more CNMs than direct-entry midwives practicing in the United States, although direct-entry midwives attend the majority of normal births in hospitals and other settings in many western European countries and are utilized within the Canadian healthcare system.

Direct entry midwives are usually credentialed as Certified Professional Midwives (CPMs) by the North American Registry of Midwives (NARM). CPMs are graduates of accredited midwifery education programs or demonstrate that they have met all NARM certification requirements through equivalency, called the Portfolio Evaluation Process. CPMs have also passed the NARM national certification examination. Every three years, CPMs must renew their certification. Most CPMs are self-employed and practice in home or birth center settings. Go to NARM.org or NACPM.org for more information on the CPM.

Some direct-entry midwives are state-licensed and in some states, national certification is optional. A midwife who holds a license but may or may not have attained the CPM credential are called licensed or registered midwives. They are legally allowed to practice without being a CPM or CM, as long as they are licensed or regulated by the state.

There is a direct-entry midwifery credential offered by the American College of Nurse Midwives (ACNM) called the Certified Midwife (CM). Certified midwives have graduated from a midwifery education program accredited by the ACNM Division of Accreditation and have passed a national certification exam administered by the American Midwifery Certification Board (AMCB). They can practice legally throughout the United States. Go to ACNM.org for more information on this option.

Certified Nurse Midwives (CNMs) are registered nurses who have graduated from a midwifery education program accredited by the ACNM Division of Accreditation, and have passed a national certification exam administered by the AMCB. Many CNMs have received their midwifery education as part of a Master’s Degree program. Most CNM’s work in hospitals, although some attend home births and practice in birth centers. Go to ACNM.org for more information on CNMs.

Some direct-entry midwives choose not to pursue any credential, license, or registration and complete their training through apprenticeship and self-study. Occasionally, the media will use the term “lay midwife” to mean any non-nurse midwife.

Licensing requirements for direct-entry midwives vary from state to state. Some states require licensing, some have voluntary licensing, some states do not regulate direct-entry midwives, and others have laws prohibiting the practice of direct-entry midwifery. MANA, NARM, and CfM all maintain webpages cataloging state-by-state requirements.

Most direct-entry midwives are not covered by professional liability insurance, unless it is required for practice in their state or for participation in healthcare plans. Some midwives cannot afford or choose not to purchase professional liability insurance, and at times it has been unavailable to purchase. Instead, most midwives rely on the personal relationships they have with their clients, conscientious practice, and the informed consent and shared responsibility with women and families that they encourage in their practices.