Choosing a midwife shapes the experience of pregnancy, birth, and the immediate postpartum period. This process requires a methodical approach, starting with understanding the types of providers available and verifying their credentials. The goal is to secure a partnership with a qualified professional who supports your specific vision for care. This guide helps you navigate this important selection process.
Differentiating Midwifery Credentials and Practice Settings
The first step in selecting a midwife involves understanding the different credentials, as they dictate the provider’s training, scope of practice, and typical practice environment. The two most common types are the Certified Nurse-Midwife (CNM) and the Certified Professional Midwife (CPM). These designations represent distinct educational pathways and legal scopes of practice.
A Certified Nurse-Midwife (CNM) is an advanced practice registered nurse (APRN) who holds a master’s or doctoral degree in nurse-midwifery. They must pass the national certification exam administered by the American Midwifery Certification Board (AMCB). CNMs are licensed in all 50 states and their scope of practice is extensive, allowing them to provide care across a woman’s lifespan, including gynecological and primary care. They practice in various settings, including hospitals, birth centers, and homes.
In contrast, a Certified Professional Midwife (CPM) is an independent practitioner certified by the North American Registry of Midwives (NARM). The CPM credential specifically requires knowledge and experience in out-of-hospital settings, such as home births and birth centers. CPM education often includes a clinical apprenticeship or graduation from a midwifery school. Their scope of practice is typically limited to care during healthy pregnancy, birth, and the postpartum period for low-risk clients. Legal recognition and scope for CPMs, who are sometimes licensed as Licensed Midwives (LM), vary significantly by state.
Essential Vetting: Verifying Licensing and Training
Confirming the midwife’s legal standing to practice in your location is essential before an interview. Licensing requirements are managed at the state level. Use your state’s online health or nursing board portal to verify the midwife’s license status, checking for active status, expiration dates, and any disciplinary actions.
Beyond state licensure, verify the national certification relevant to their credential. The American Midwifery Certification Board (AMCB) offers instant verification for CNMs and Certified Midwives (CMs). For CPMs, certification is confirmed through the North American Registry of Midwives (NARM). Verifying these credentials ensures the midwife has met standardized educational and competency requirements.
The Interview Process and Establishing Philosophical Fit
After confirming legal qualifications, the interview assesses the compatibility of the midwife’s practice philosophy with your preferences. Interviewing multiple candidates is recommended to compare approaches to care. This ensures you find a provider whose core beliefs about birth align with your own.
Philosophy of Care
Questions should focus on their approach to common labor scenarios. Ask about their typical caseload size to gauge availability and their views on pain management, including non-pharmacological methods. Inquire about when they recommend interventions and their beliefs on the role of technology versus natural progression in a low-risk birth.
Logistics and Availability
Address practical compatibility by clarifying communication protocols, such as how they can be reached for urgent questions during the prenatal period. Ask who will attend the birth, as many practices involve a team of midwives or assistants. You should be comfortable with everyone on the staff.
Contingency Planning
This discussion is necessary, particularly for out-of-hospital births. Ask about specific protocols for transferring care to a hospital during an emergency or for non-urgent reasons, like prolonged labor. Ensure they have an established relationship with a backup physician or hospital. Understand their role in supporting you if a transfer becomes necessary during labor or birth.
Understanding Financial Agreements and Care Logistics
The final stage involves formalizing the financial and logistical agreement for care. Many midwifery practices use a global fee structure, a single charge covering routine prenatal care, birth attendance, and standard postpartum follow-up. Clarify exactly what is included, as the fee typically excludes external services like laboratory testing, ultrasounds, and prescription costs.
Coverage for midwifery services varies widely based on the provider’s credential and state regulations. CNMs are often covered by most insurance plans, especially in a hospital setting. CPMs, however, may be considered out-of-network or not covered in some states. Contact your insurance provider directly to verify benefits, including whether the midwife is in-network and the reimbursement percentage for the global fee.
A care contract should be signed after all financial and logistical details are clarified. This contract secures your care and typically outlines the schedule of prenatal visits, the expected length of postpartum follow-up, and the payment schedule. Reviewing the contract ensures mutual understanding of the commitment and services provided.