Midwifery
The World Health Organization (WHO) describes two models of maternity care: the technical, or medical, model and the social, or midwifery, model.
The medical model of care focuses on what might go wrong, in an attempt to prevent those things from happening. This model assumes that pregnancy and birth are proved safe only after the baby is safely born. In some situations, this is perfectly appropriate.
The midwifery model of care is based on the fact that most pregnancies are a normal, low risk, natural function of a woman’s body. This model assumes that the partnership of a woman and a skilled attendant will result a safe, satisfying experience for the mother and her child.
Most independent health organizations around the world recognize two critical facts:
- Midwives are the best care providers in normal pregnancy.
- Women have the right to choose their care provider and location of birth.
Midwives focus on keeping pregnancy and birth normal, by...
- monitoring the condition of the woman and baby,
- providing unbiased education and resources about the evidence for and against all options, so the woman can make fully informed decisions,
- providing skilled care within the scope of their training, and
- making referrals when appropriate.
Are there different kinds of midwives?
Have you heard of CPMs, CNMs, LMs, RMs, and DEMs? The two main types of midwives are nurse-midwives (nurses who study midwifery) and direct-entry midwives, who focus on midwifery care.
Both groups get a good education in midwifery and serve an apprenticeship or internship to gain practical experience. Nurse-midwives have a strong background in the medical model of care, while direct-entry midwives focus on the midwifery model of care. Nurse-midwives go through a process to achieve the Certified Nurse-Midwife designation, while direct-entry midwives become Certified Professional Midwives through a similar process.
In the US, each state has its own requirements for licensing, some requiring these designations, and some not. In some states, it is still illegal to practice midwifery.
For more information on CNMs, see the site for the American College of Nurse Midwives at www.acnm.org. For more information on CPMs, see the site for the North American Registry of Midwives at www.narm.org.
Many other countries, like those of the UK and Europe, are much more midwife-friendly (and have better maternal mortality rates) than the US. Many of them created their healthcare systems to make the best use of trained midwives, who may carry the designation “Registered Midwife.”
Here is a summary of the initials you are likely to see most often:
| CPM | Certified Professional Midwife |
| CNM | Certified Nurse Midwife |
| LM | Licensed Midwife (licensed by state, sometimes in addition to a certification) |
| DEM | Direct Entry Midwife (usually not certified or licensed) |
| RM | Registered Midwife |
What about safety?
Midwifery care has been proven to be as safe as, if not safer than, medical care. Planned home birth has been proven to be as safe as, if not safer than, than planned hospital birth. The evidence supporting the safety of planned home birth with midwives is unequivocally clear. For links about midwives and home birth, see our References page.
Who benefits from midwifery care?
Midwifery care is good for women, regardless of income, socioeconomic status, or background. Poor women can especially benefit from the care that midwives provide, because they are...
- less likely to have other resources to help make birth safer and
- more likely to need an advocate if involved in the medical system.
The continuing personal attention that midwives provide is one reason why they have such good outcomes - they provide physical and emotional support, while monitoring the progress of pregnancy, so small issues don't become problems. Midwives do not rely as heavily as medical staff does on technology, which can sometimes lead to a false sense of security or to intervene based on false positive indicators.
The focus of MOMS is on marginalized women - women in countries like Sierra Leone. We advocate for good care for these women. Midwifery care, in America or abroad, is not at all second rate, but is as good as care in a hospital. It is as safe and is more focused on the laboring woman.
Teaching poor women to become skilled birth attendants provides double service:
- Women develop professional skills to save lives, increase their standing in the community, and provide an income.
- Pregnant women get WHO's preferred provider of maternity care.
