Options: Midwives for Maternity Care



What types of caregivers provide maternity care? What are my options?

What are the "Midwifery model of care" and the "Medical model of care"?

What is a midwife?

Where do midwives practice? What are trends in the use of midwifery care?

What types of midwives practice in the U.S.?





What types of caregivers provide maternity care? What are my options?

Several types of midwives and several types of physicians provide prenatal care, attend births, and care for women after birth in the United States. This page provides information about these options.

The great majority of childbearing women in the U.S. are well and healthy, and can consider choosing from among the full range of maternity caregivers. If you have a serious medical condition or are at high-risk for developing such a condition, you will probably want to (1) be in the care of a doctor who has completed a residency and is board-certified in obstetrics (see below), and (2) plan to give birth in a hospital. Maternity caregivers understand and can advise you about situations that may call for more specialized care.

What are the "Midwifery model of care" and the "Medical model of care"?

Views of the childbearing process and of appropriate care for childbearing women vary. Two contrasting perspectives are often called the "midwifery Model of Care" and the "Medical Model of Care." There are striking differences in the two models. These differences can have a great impact on your experience and outcomes.

Here are some contrasts between the two models:

Midwifery Model of Care

Focus on health, wellness,
   prevention
Labor/birth as normal
   physiological processes
Lower rates of using
   interventions
Mother gives birth
Care is individualized

Medical Model of Care

Focus on managing problems
   and complications
Labor/birth as dependent on
   technology
Higher rates of using
   interventions
Doctor delivers baby
Care is routinized

Naturally, the midwifery model describes the practice of many midwives, and the medical model describes the practice of many doctors. But many caregivers combine elements of both. It is possible, but less common, to find doctors whose practice most closely resembles the midwifery model of care and midwives whose practice most closely resembles the medical model.

Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs and values. Many women have a clear preference for one or the other of these models.

Midwives and Maternity Care

What is a midwife?

Midwives are well-suited to care for healthy women who expect to have a normal birth. They provide prenatal care, care during labor and birth, and care after the birth. Many give priority to providing good information to women, involving women in decision-making, and providing flexible and responsive care. Many work to avoid unnecessary tests and treatments; and women under the care of midwives typically are less likely to have a cesarean, an episiotomy, and other interventions than women receiving care from doctors. Some midwives provide continuous support throughout labor and birth, which has many benefits for women, infants, and families and no known risks. midwives often encourage, are well-informed about, and provide much support for breastfeeding.

Some midwives also have additional training and credentials for childbirth education, breastfeeding consultation, and/or doula care.

Where do midwives practice? What are trends in the use of midwifery care?

Midwives attend births in many hospitals throughout the United States, and they attend most of the births that take place in out-of-hospital birth centers and homes. They provide prenatal care and care after birth in many settings.

At this time, midwives attend about eight percent of births in the U.S. — over 300,000 every year. The trend shows a steady increase in use of midwifery services over time. (In 1975, midwives attended about one percent of U.S. births.) In contrast to the U.S., midwives are the most common maternity caregiver in many countries in Europe and elsewhere.

What types of midwives practice in the U.S.?

Certified nurse-midwives (CNMs) are educated in the two disciplines of nursing and midwifery. They are registered nurses who have graduated from a nurse-midwifery education program accredited by the American College of Nurse-Midwives (ACNM). They are "certified" when they pass an exam of the ACNM Certification Council, and are licensed by their state to practice nurse-midwifery. All 50 states license CNMs, and most midwives who practice in the U.S. are CNMs.

CNMs are trained to provide prenatal care, care during labor and birth, and follow-up care to the mother and newborn after the birth. Most CNMs attend births in hospitals, but they also attend births in out-of-hospital birth centers and in women's homes. CNMs may also provide "well-woman" care, such as gynecological checkups, pelvic and breast exams, and pap smears, as well as family planning care.

CNMs may work within a midwifery-owned and led practice, in a practice with physicians, or as employees of hospitals, health plans, or public agencies. In all cases, they are required to have established relationships with physicians for consultation, collaboration, and referral, as needed.

Certified professional midwives (CPMs) have passed the certification examination of the North American Registry of midwives (NARM). Candidates for this exam are educated in core content areas, complete a core set of clinical experiences, demonstrate core skills, and present practice plans (including care guidelines and an emergency care plan). The NARM certification process recognizes multiple routes of entry into midwifery, and most CPMs become midwives without first becoming a nurse. Many states in the U.S. license CPMs or legally recognize them in other ways.

The CPM credential requires knowledge of and experience in out-of-hospital settings, and most CPMs attend births in women's homes or in out-of-hospital birth centers. They usually do not practice in hospitals. CPMs provide prenatal care, care during labor and birth, and care of the new mother and her baby in the early weeks after birth.

Certified Midwives (CMs) are new professionals in the health care field. The American College of Nurse-Midwives (ACNM) has recently begun to certify midwives who do not also have training in nursing. Although not registered nurses, CMs may have backgrounds as physician assistants, physical therapists, or other health practitioners. CM education closely mirrors the education of certified nurse-midwives, and CMs graduate from an education program accredited by the ACNM. CMs are "certified" when they pass the same exam that the ACNM Certification Council gives to certified nurse-midwives. The settings in which they practice and the care they provide are comparable to CNMs. New York is the only state with CM licensure at this time.

Other midwives offering home birth services do not have any of the above credentials. State regulatory mechanisms for such midwives vary widely, from recognition to prohibition of their practice. Although they may have considerable education and experience, established arrangements for consulting with and referring to physicians, and other important qualifications for midwifery practice, women who are considering using their services must carefully explore these questions with the midwife.

Most recent page update: 1/17/2008


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