A midwife is a type of healthcare provider that offers a range of services pertaining to prenatal, birth, and sometimes family planning. Midwives value and support physiological birth with low interventions and natural modalities.
In the United States there are several different types of midwives with varying amounts of education, regulation, and practice standards. We will break down these categories of midwifery below including differences in education, regulation, and practice standards.
CNM or Certified Nurse Midwife- A certified nurse midwife is a registered nurse with an advanced practice degree in midwifery. This level of education is equivalent to a master's degree or sometimes a PhD. Certified Nurse Midwives are regulated by the American College of Nurse Midwives and state health boards, usually a medical or nursing board. Certified Nurse Midwives meet and exceed standards written by the International Confederation of Midwives (ICM). The ICM is the golden standard for direct entry midwifery globally. These midwives attend birth in and out of hospital.
CM or Certified Midwife- A certified midwife completes a graduate program accredited by the Accreditation Commission for Midwifery Education (ACME) and are board certified through the American Midwifery Certification Board (ACMB). Certified midwives follow the same standards and regulations as Certified Nurse Midwives. Certified Midwives differ from Certified Nurse Midwives in not being nurses before becoming midwives. These midwives attend births in and out of hospital.
DEM/CPM or Direct Entry Midwife/Certified Professional Midwife- This type of midwife is also known as a traditional, or licensed midwife. Direct entry midwives' educational levels vary depending on state regulation. Some direct entry midwives attend accredited programs through Midwifery Educational Accreditation Council (MEAC), some receive no academic education and become midwives through an apprenticeship program through the North American Registry of Midwives, other midwives attend various levels of non-nationally accredited educational programs. Regulation varies by state. Some states regulate direct entry midwifery through medical and nursing boards, some by varying licensing agencies, midwifery boards, or unregulated. Direct entry midwives create their own practice standards and are not required to follow standards followed by CNMs and CMs. These midwife types only attend births in out of hospital settings.
It is unclear why the United States allows so many different variations in the midwifery profession. Our midwifery system is unique, in countries with comparable economic status only one title for midwifery exists. These are national credentials held up to global standards and current scientifically backed clinical practices. Often these countries' educational programs for midwives are most similar to nursing or CNM degrees in the US. These inconsistencies in education, standards, and regulations often leave potential patients confused and unsure on what kind of provider they are hiring. This lack of clarity and transparency around the profession of midwifery inherently removes informed consent to the most important people involved, mothers and their babies.
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