The role of a midwife is to serve as a primary care provider, offering comprehensive care throughout pregnancy, labor, birth, and the postpartum period. This model of care focuses on the normal, physiological process of birth, emphasizing informed choice, preventative health, and individualized support. Selecting the right midwife requires understanding credentials, knowing where to search, and asking specific questions to ensure a good fit. This process should begin early in pregnancy to secure your preferred provider and establish a trusting relationship.
Understanding Midwifery Credentials and Practice Settings
Midwifery in the United States is regulated by three primary credentials, which define the midwife’s training and typical practice setting.
The Certified Nurse-Midwife (CNM) is a licensed advanced practice registered nurse who has completed a graduate-level program accredited by the Accreditation Commission for Midwifery Education (ACME). CNMs are licensed in all 50 states and primarily practice in hospitals and birth centers, though some offer home birth services.
The Certified Midwife (CM) follows an identical educational path and certification exam as the CNM but does not first hold a nursing degree. CMs are certified by the American Midwifery Certification Board (AMCB) and hold an equivalent scope of practice to CNMs in the few states where they are licensed, such as New York and New Jersey.
The Certified Professional Midwife (CPM) is trained specifically for out-of-hospital settings, such as homes and free-standing birth centers, and is certified by the North American Registry of Midwives (NARM). CPM training emphasizes a direct-entry approach, often through apprenticeships or programs accredited by the Midwifery Education Accreditation Council (MEAC). Licensing and the scope of practice for CPMs vary significantly by state, so confirming local regulations is necessary.
Practical Search Strategies and Resources
The search for a midwife should begin as soon as pregnancy is confirmed, ideally during the first trimester, because many practices book quickly. Begin your search using national directories maintained by professional organizations, which allow you to verify credentials and search by location and birth setting.
For CNMs and CMs, the American College of Nurse-Midwives (ACNM) offers an online database detailing providers and their associated birth locations. To find a CPM, search the North American Registry of Midwives (NARM) directory or seek resources from the National Association of Certified Professional Midwives (NACPM). Local resources, such as accredited birth centers, doulas, or parenting groups, are also excellent sources for referrals. Once candidates are identified, confirm their licensing status with your state’s health department or licensing board.
Key Questions for the Interview and Selection Process
The interview is a chance to align your expectations with the midwife’s practice, starting with their philosophy of care and approach to pain management and interventions. Ask about their views on continuous fetal monitoring, routine vaginal checks, and the use of natural methods for labor augmentation. It is helpful to know their statistics, such as their hospital transfer rate and primary reasons for transfer, to gauge their tolerance for variations of normal.
Emergency Protocols
A detailed discussion of emergency protocols is important for those planning an out-of-hospital birth. Ask how they manage common complications like shoulder dystocia or postpartum hemorrhage and what equipment they carry for maternal and newborn resuscitation. Inquire about the non-urgent transfer plan, including which hospital they transfer to and who will accompany you to ensure a seamless hand-off of care.
Team Structure and Postpartum Care
Inquire about the team structure and availability, specifically who their backup provider is and their qualifications if the primary midwife is attending another birth. Ask for details on postpartum care, including the number and timing of visits, which often extend up to six or eight weeks after birth. Postpartum care involves monitoring the recovery of the birthing person, conducting routine newborn assessments, and providing lactation support.
Addressing Logistics and Financial Considerations
Midwifery care is often structured around a “global fee” that bundles all routine prenatal, labor, birth, and postpartum care into a single cost. This fee typically ranges from a few thousand dollars up to $9,000, which is often more predictable than the out-of-pocket costs of a hospital birth. However, this global fee usually excludes services like lab work, ultrasounds, and hospital charges in case of a transfer.
Insurance coverage varies significantly, so verifying your benefits is the first step. CNMs are the most widely covered credential, as they are licensed in all states and often practice in hospital systems that are in-network with major insurers. CPMs and home birth practices are frequently considered out-of-network, though many will submit claims for direct reimbursement or provide a “superbill” for you to seek reimbursement.
Review the contract to understand what is included in the global fee and what is excluded, such as the assistant fee or the cost of a birth kit. Contracts should also specify the financial policy for a transfer of care. If you are transferred to a hospital during labor, the global fee is generally not refunded, as you are paying for the midwife’s continuous care and expertise up to that point. Many practices offer payment plans or financial hardship discounts.