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Explore Birth Outside The Hospital with Midwives: Which Type is Right for You?

| October 4, 2020

Most people visit their OB/GYN for check ups and annual reproductive health care, but midwives also provide well woman care even when you aren’t pregnant. Understanding the range of support services and the difference in what your physician may be able to provide versus a midwife can help you navigate your potential birth options. In the age of Coronavirus where there are heavier restrictions on patients planning hospital births, exploring birth outside the hospital has become a necessary, and in some cases, a primary option for folks who don’t want to be separated from their partners or doulas during childbirth. Some midwives only practice in certain hospitals, while others only practice in birth centers or home birth settings.

But when you choose a hospital for your place of birth, you are subject to the protocols and policies of that particular institution, those rules can change at any time, we have seen this during the pandemic where public and private hospitals alike closed their doors to doulas and in some cases birthing people were forced to labor alone with zero support. Hospitals operate from a risk oriented mindset to protect themselves against legal action. So the providers may make decisions or suggest procedures that aren’t aligned with your vision for the birth, but are compliant with hospital policy and protocol. Your choice of where to birth should be a thoughtful one and all options – home birth, birth center and hospital should be explored with equal weight.

For Women of Color, particularly Black women and Native American women who are 4-5 times more likely than White women to experience pregnancy complications and die due to childbirth related causes, it is critically important to explore a relationship with a qualified and culturally competent midwife who can support you. And despite the incredible legacy Black women have in midwifery in this country, Black currently represent less than 2% of the nation’s reported 15,000 midwives. That’s a problem and we need more so we have a chance at addressing these birth disparities in real time.

As you envision the birth experience you desire, it will help you decide the type of care provider you would feel most comfortable with. Turning to home birth as an option while in crisis, stressed out and under a deadline to transfer your care, is challenging because the midwifery model is not adequately supported by our current health care model and there aren’t enough midwives to care for everyone. Search for and interviewing a provider earlier in your pregnancy can lead to better success, more transparency and a better relationship with the care provider.

Midwives are Your Partners in Pregnancy + Birth

Midwives are your partners in the birth process, they are following your lead. While you may find some midwives who practice in hospitals, most practice outside in home birth settings or birth centers. You are a consumer with consumer rights. You should set the tone and arc of your experience and clearly define what matters most to you and your family. Your provider acts as support and guide to help execute the steps to take along the path that you choose.

Interested in Out-Of-Hospital Birth?  

There are a many qualified practitioners for you to choose from if you want to give birth at home or in a birth center. As long as you are classified as “low-risk”, you are a candidate for these options. You want to get an understanding of their experience, their training, philosophy, perhaps speak to previous clients or do some basic google research!

Here are a few options to consider:

Direct Entry Midwife (DEM)

A DEM has a wide range of training and experience which lends to their abilities and safety in practice. They do not have nursing education as a prerequisite for midwifery education. They may or may not have attended midwifery school per se, but will have apprenticed with a midwife for 1-3 years, longer in most cases. They may or may not have credentials or a license to practice midwifery issued by their state. Note that it has become increasingly difficult for midwives to practice freely, so the credentials may not even be available in her state. To better understand how a DEM practices, you will need to interview them and speak with previous clients. Please note that because we are oriented to prefer and exalt folks who are credentialed, we may miss out on a great DEM who is more qualified than a credentialed, licensed midwife. These are folks who are trained on the front lines and often lean into self-taught techniques and ancestral traditions layered within the context of a clinical experience. DEM will work with healthy birthing people and attend homebirths. They will take cash payment, not insurance.

Certified Professional Midwife (CPM)

A CPM is a midwife who is credentialed by the North American Registry of Midwives (NARM). The NARM verifies that their education and skills fall into a standard of competency and those standards are determined by NARM. Certified Professional Midwives will have at least 3 years of midwifery-based education and 1 year of apprenticeship with a qualified midwife. The CPM qualifies a midwife for licensure in some states, while in others they must pass additional exams and take additional trainings for licensure. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings, with their education and clinical training focused on providing midwifery model care in homes and freestanding birth centers. In some states, CPMs may also practice in clinics and doctors offices providing well-woman and maternity care.CPMs work with healthy birthing people and they attend homebirths or births at freestanding birth centers, or birth centers that operate outside and independent of the confines of medical institutions. CPMs accept cash payment and insurance will depend on what state you are located in.

Licensed Midwife (LM)

A Licensed Midwife is normally a CPM who has applied for and undergone the testing or other  requirements of her state in order to practice midwifery legally there. LMs will work with healthy birthing people and attend homebirths or births at freestanding birth centers. LMs typically accept insurance, although this depends on the rules of their particular state.

Certified Nurse Midwife (CNM)

A CNM is a Registered Nurse (RN) who has a Master’s degree in midwifery. Certified Nurse-Midwives are trained in both nursing and midwifery. Their training is hospital-based, and the vast majority of CNMs practice in clinics and hospitals. Although their training occurs in medical settings, the CNM/CM scope of practice allows them to provide care in any birth setting. Because they are  credentialed to work in a hospital, they can often provide care for a patient who is high-risk and therefore not a candidate for homebirth. CNMs also work with clients who want midwifery care with in a  hospital setting. Many CNMs will work with birthing people at their homes or in the hospital setting, although some do not attend homebirths either because they choose not to or because they are not allowed to due to malpractice insurance regulations and institutional privileges. Some attend births in freestanding birth centers. This varies from state to state. CNMs accept insurance.

Traditional Midwife (Community Midwife)

There are midwives who—for religious, personal, ethical and philosophical reasons—decide not to become certified or licensed. They are called traditional midwives. They believe that they are ultimately accountable to the communities they serve; or that midwifery is a social contract between the midwife and client/patient, and should not be legislated at all; or that birthing folk have a right to choose qualified care providers regardless of their legal status. They lean into ancestral practices, herbalism, rituals and traditions  that are often undervalued by the medical system. They typically accept cash, no insurance and work on a sliding scale basis with clients.


Curious in learning more?

Join us for our upcoming Mama Glow Webinar – Celebrating National Midwifery Week 

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