Midwife, Midwives & Midwifery

The midwifery model of care is based on the ancient art of caring for women through all of the cycles of their lives. Midwifery hasbeen an art and profession for as long as women have given birth. Midwifery in the United States is currently on the cusp of great change. Midwives (and the women they serve) must work together to promote midwifery as a viable profession and art, a safe and sane alternative in an ever more strange world. The direction that midwifery takes will depend a lot on the women who call themselves midwife and the women and families we serve. Citizens for Midwiferyis a national consumer group dedicated to promoting the midwifery model of care.

There are those who see division of the larger midwifery community as a way to thwart the "menace of the midwife". Many different strategies have been used to diminish the midwifes art. Goodnews Network offers an historical perspective on the early 1900's Plan to Eliminate the Midwifeand a beautiful view of how we may gracefully move into the future of midwifery.

The name game is just another attempt to deprive women of the company of midwives, and midwives the company of their sisters. Labeling midwives and attaching judgement or favor to one type of label over another does not promote good health care for women, it only serves to continue the proliferation of the medical model in womens health care issues.

The current attempts to pigeonhole a midwife as this or that is unaccpetable to this midwife, as are the many perjoratives that are offered regarding a midwifes training........ie. doc in drag, lay midwife, medwife, home birther, granny midwife. The only person who may truly define a midwife is herself. In the current national climate of the United States, education, licensing and regulation seem to be another matter entirely.

A midwife is a midwife is a midwife. The letters behind a midwifes name DO NOT define her to a larger popluation, they merely define her within and to a small circle of those who are similarly lettered, and maybe not even then. The site of a midwifes practice also does not define her, except within the protocols of the site itself. The educational route of a midwife does not define her, except to help her maintain a standard of training that qualifies her as midwife within her chosen sphere. Midwives most often choose to refer to themselves by a name that has personal meaning. A classic example: I am a licensed, direct entry midwife with an Associates of Science degree in Midwifery, trained in the apprentice and academic models, with clinical experience at home and hospital and prefer to call myself a home based midwife.

The practice of midwifery has many variations and commonalities as well, regardless of the educational background of the midwife. However, the requirements, rights and responsiblities to practice midwifery of any kind differ from state to state. Each state addresses differently whether the practice of midwifery even requires their attention and if so delineates the requirements for practice, whether a formal relationship with an OB is required, licensing requirements, formal and informal education, prescriptive ability, who may be accepted for care, continuing education, peer review and any other issues relative to this art. The Midwives Alliance of North America has a document online that contains detailed information on the Legal Status of Direct Entry Midwives: State by State. For further information on who to contact regarding the status of midwifery in your state visit the MANA map.html at www.mana.org, the CfM State, National and International Contactsand State-By-State Midwifery Information(as of 2/17/98 these sites are undergoing MASSIVE updates and upgrades of their websites, please check back soon, if site is not fully functional yet....and be patient, much of the work is done by volunteers who are working hard to keep us up to date)

Direct Entry Midwives, (DEM and variations on LM, TM, CM) are just that.....women who generally entered midwifery directly rather than through another profession (such as nursing), although some DEMs have education and/or degrees in other fields. DEM's are referred to by many names. The following examples only scratch the surface: Lay Midwife, Licensed Midwife, Community Midwife, Traditional Midwife, Granny Midwife, home based midwife, Midwife, "aunties" and many regional/personal variations. In general, most DEM's are independent practitioners and attend women at home, in birth centers and a very few attend women in hospital. Peer review and grievance processes are common among DEMs, generally each state licensing bureau or professional association determines its implementation. We are trained in a variety of ways.

Religious practitioners of Midwifery  While this type of midwife has practiced since the dawn of religion, I know little of them.  If you do, please help me to provide informationl here.

Lay Midwives and Granny Midwivesare legal in some states and are often apprentice trained (in the fashion of women teaching women, traditional model of midwifery) and spend many years as assistant to other midwives, with most birth experience in the home, while learning, before attending women in childbirth on their own. The academic aspects of training generally includes home study, distance learning and hands on workshops or classes.

Licensed Midwivesare legal in some states and are requred to complete formal education and/or licensing requirements relative to the state in which they practice. They are most often trained in the academic and apprentice models through formal accredited programs (one in the country is university based). The traditional skills of midwifery are promoted, with birth in the home being the preffered experience, although many have hospital and birthing center experience as well. For further information on direct entry midwifery please visit the Midwives Alliance of North America


Certified Midwivesare a new type of DEM, although even this is misleading. While they are not required to have a degree in nursing, they are required to have a degree in something (anything) before entering a CM program. None are currently practicing. CMs will have graduated from an ACNM accredited school with university based education, educated in the nurse midwifery model rather than the traditional model, with most of their experience in hospital or birth center. They will be expected to take the ACNM national licensure exam. The legal status of this type of practitioner is unsure since the ACNM exam is meant as the licensure examination for nurse midwives who are legal in every state, while they (CMs) are in reality, DEM's who are not legally able to practice in every state. The first class is due to graduate in May of 98, i think. Stay tuned, should be interesting. An update is due after national Midwives Alliance of North America 97 conference in late October, should have clearer picture of the future of the CM (as of 6/9/98......still no further clarification available from ACNM, stay tuned). For further information on the Certified Midwife visit The American College of Nurse-Midwives


Certified Professional Midwives, CPM come from a variety of backgrounds including direct entry and nurse midwifery. A rigorous national examination tests academic and practical skills. They are recognized in many states as legal practitioners of midwifery. Some are independent practitioners and some have practice agreements. They attend women in all settings, but must have home birth experience to become a CPM. To maintain the CPM status peer review is also strongly encouraged and a formal grievance process is in place. For more information about the Certified Professional Midwife please visit Certified Professional Midwife

Certified/Community Nurse Midwives, CNM have either an associates or bachelors degree in nursing, then additional training in nurse-midwifery (most often in hospital settings, with some birth center and very few having home birth experience during training). University based training is common as are certificate programs, although the latter are being phased out as educational routes for CNMs. CNMs have national licensure similar to CPMs and practice legally in all states. CNM's most often have an OB with whom they develop practice agreement/guidelines. They attend women in hospital, birth centers and at home. The name Community Nurse Midwife is also becoming used by CNMs. For more information about Nurse Midwives please visit The American College of Nurse-Midwives

Some states say that midwives practice medicine. Those of us trained in the manner of the traditional model may also have some additional medical skills, but I for one do not practice medicine, I practice midwifery.

The information offered here is based on one midwife's perspective. Talk with the midwife you are interested in hiring and ask her about herself. Search the web for more information on midwifery. This article is not meant to be presented as the only perspective on midwifery in the United States. For a somewhat different perspective, that of a CNM who has long supported and promoted midwifery by sharing information on the internet, please visit sci.med. midwifery's information series Midwifery: Introduction~ Midwifery: Bibliography~ Midwifery in the United StatesA short bio of the author is at the end of each of these "Midwifery" documents. Please take the time to read these important additions to any review of contemporary midwifery. Be sure to visit the sites that are hotlinked in this article. For more background on how I gained the perspective presented in this article please visit Midge Jolly, home based midwife, ASM, LM




copyright Midge Jolly, ASM, LM 1998
midgewife@aol.com
http://members.aol.com/Midgewife/byanyothername.html
***Permission granted to reproduce freely if done in entirety, attributed with web/email addresses, author notified of destination and all citings/reviews/feedback shared.

I remain open to updating the information on this page as necessary to accurately reflect the current national midwifery climate. Only by continuing to
share information will midwifery survive.
Please share your comments, insights, feelings and web resources by emailing me at
midgewife@aol.com


updated 02/17/98.

return to
midwifes dream~home based care
Midgewife's Home Page
Midwives Association of Florida
WHO defines midwife
Florida's Midwifery Schools
early discharge planning
Protocol1...admit to care