A midwife is a trained healthcare professional who provides care for women before, during, and after childbirth, and yes, they do deliver babies. The specifics of a midwife’s role, including the procedures they perform and their practice settings, are determined by professional certification and state regulations. Understanding these distinctions helps recognize the diverse pathways of modern midwifery care.
Types of Midwives and Their Scope
The term “midwife” encompasses several distinct professional designations, each with different educational requirements and legal scopes of practice. The most common designation is the Certified Nurse Midwife (CNM). CNMs are Advanced Practice Registered Nurses who have completed a graduate-level degree in nurse-midwifery and are certified by the American Midwifery Certification Board (AMCB). This background allows them to practice in all 50 states, often with prescriptive authority, offering a full scope of care that includes gynecological, primary care, and maternity services.
A Certified Midwife (CM) follows a similar educational track and takes the same AMCB certification exam as a CNM, but without a prior nursing degree. CMs are trained to provide the same comprehensive level of care as CNMs, but their legal recognition and ability to practice vary significantly by state. This designation was created to expand access to standardized midwifery care for individuals from non-nursing backgrounds.
The third main designation is the Certified Professional Midwife (CPM), whose training focuses specifically on out-of-hospital birth settings, such as homes and birth centers. CPMs are certified by the North American Registry of Midwives (NARM) and complete their education through formal training programs and clinical apprenticeships. CPMs support low-risk, low-intervention births, but their ability to practice is regulated by state licensing boards, and they typically lack the prescriptive authority held by CNMs.
The Midwife’s Role During Labor and Birth
Once labor begins, a midwife’s role shifts to providing continuous, holistic support. They remain present throughout the labor process, offering encouragement and guidance. This model of care includes closely monitoring the progress of labor and the well-being of both the mother and the fetus.
The midwife uses external monitoring belts to track the pattern of contractions and the baby’s heart rate, looking for signs that may require intervention. They suggest non-pharmacological methods for pain management, such as hydrotherapy, massage, and breathing techniques. Midwives are trained to recognize complications early and collaborate with or refer care to an obstetrician if the situation moves beyond the scope of a normal, low-risk birth.
During delivery, the midwife manages the birth of the baby and the subsequent delivery of the placenta. Immediately after birth, they provide initial care for the newborn, including checking vital signs, monitoring breathing and temperature, and performing the first health assessments. Midwives also provide immediate postpartum care for the mother, monitoring physical recovery and offering initial support for breastfeeding.
Where Midwives Practice
Midwives practice in diverse settings, and the location often dictates the level of medical resources immediately available. Certified Nurse Midwives frequently practice within hospital settings, where they can attend births with access to a full range of medical resources. In this environment, the midwife works within a collaborative team, which provides a safety net if the birth deviates from a low-risk trajectory.
Another common setting is the freestanding birth center, a healthcare facility not physically located within a hospital. Birth centers are usually midwife-led and offer a comfortable, homelike atmosphere for low-risk pregnancies, often providing options like waterbirth and nitrous oxide for pain relief. These centers operate with established safety protocols, including a clear plan for rapid transfer to a nearby hospital should complications arise.
Finally, many midwives, particularly Certified Professional Midwives, specialize in attending home births. Home birth provides a personalized experience in a familiar environment, but it requires the midwife to bring necessary equipment for routine and emergency situations. Regardless of the setting, midwives must have a robust emergency preparedness plan ensuring quick transfer to a higher level of medical care if needed.