Midwives are healthcare professionals who specialize in supporting individuals through pregnancy, labor, birth, and the postpartum period, while also providing care for the newborn. The word “midwife” literally means “with woman,” reflecting a philosophy centered on personalized, holistic care. Midwives are fully integrated into hospital systems, though their specific setting depends on their professional credentials and scope of practice. Their practice focuses on evidence-based support, viewing pregnancy and birth as normal physiological processes, and minimizing unnecessary medical intervention.
Understanding the Different Types of Midwives
The ability of a midwife to work in a hospital is determined by their certification, which dictates their education, training, and legal scope of practice. In the United States, the three main professional credentials are Certified Nurse-Midwife (CNM), Certified Midwife (CM), and Certified Professional Midwife (CPM).
Certified Nurse-Midwives (CNM) and Certified Midwives (CM)
CNMs are advanced practice registered nurses who complete a graduate-level program in midwifery. Their dual training allows them to practice in all settings, including hospitals, birth centers, and homes, and they provide a full spectrum of care, including gynecological services. CMs follow a similar graduate-level educational path and pass the same national certification exam as CNMs, but they do not have a prerequisite degree in nursing. Their scope of practice is nearly identical to CNMs, including the capacity to gain hospital privileges. Both CNMs and CMs are certified by the American Midwifery Certification Board (AMCB), and the majority practice in hospital settings.
Certified Professional Midwives (CPM)
In contrast, the CPM credential focuses specifically on expertise in out-of-hospital settings. CPMs are educated through a distinct training pathway, often involving formal education and clinical apprenticeship, and are certified by the North American Registry of Midwives (NARM). Their scope of practice is typically limited to providing care for healthy pregnancies, births, and newborns in home or birth center environments. This difference means that CPMs generally do not have admitting privileges to hospitals.
The Scope of Hospital-Based Midwifery Care
Midwives who work in hospitals, primarily CNMs and CMs, are fully integrated members of the healthcare team, providing comprehensive care across the lifespan. They offer a full spectrum of services, starting with routine gynecological and primary care, continuing through prenatal care, and extending into labor, birth, and postpartum recovery. During pregnancy, they order and interpret necessary laboratory and diagnostic tests, such as ultrasounds and blood work, to monitor the health of the pregnant person and the fetus.
In the labor and delivery unit, hospital-based midwives manage low-risk births, offering continuous physical and emotional support. Their approach emphasizes non-pharmacological pain management techniques, such as movement, hydrotherapy, and breathing exercises, while also facilitating access to medical pain relief options like epidurals. They maintain a collaborative relationship with obstetricians, anesthesiologists, and nurses, allowing for seamless consultation or transfer of care if complications arise.
This collaborative model ensures individuals receive team-based medical care while benefiting from the midwife’s patient-centered philosophy. The midwife remains with the patient throughout active labor, offering a consistent presence. They also provide initial postpartum care for the birthing person and the newborn, including breastfeeding support and immediate newborn assessments. This model is associated with benefits such as lower rates of Cesarean section and reduced use of other medical interventions.
Midwifery Practice Outside the Hospital
While many midwives practice within hospital systems, others specialize in out-of-hospital settings, providing an alternative for individuals with low-risk pregnancies. These practices typically occur in freestanding birth centers or within a client’s own home. Birth centers are healthcare facilities designed to offer a comfortable, home-like atmosphere while maintaining necessary medical equipment for immediate use.
Care in these settings focuses on maximizing natural physiologic birth, with minimal intervention and a high degree of personalization. Midwives who attend births outside the hospital, often CPMs or CNMs, carry equipment and medications to manage common issues like postpartum hemorrhage. They continuously assess risk and coordinate a safe transfer to a nearby hospital should complications arise during labor or delivery. This allows families to pursue a low-intervention birth experience while still having access to higher-level medical care when clinically indicated.