Wanna Be A Midwife?

Everything you need to know to pick your path to midwifery
June 10th, 2013

You Have a Call…

It’s no secret that a woman’s choice of provider (midwife or type pf physician) and place of birth (home, birth center, or hospital) are the two factors that most influence what kind of birth experience she is going to have. In fact, not just experience, but even outcomes for her and her baby. But if you had to choose between the two – provider and place of birth – which one element would you think is THE most influential?  Let’s assume a healthy mamatoto (motherbaby), a normal course of labor and a desire for minimal intervention. Now let’s picture a few different scenarios.

The first is an interventionist provider in a home birth or birth center setting. Not as likely I know, but possible. The number of interventions available are fewer, but one can still perform artificial rupture of membranes, do frequent vaginal exams, put time limits on the labor, restrict intake of food and water, and transfer when concerned things are not going well. In the next scenario, picture a non-interventionist provider in a hospital setting. All the interventions are available, but they are able to steer clear of many of them if not all, depending on the power dynamics of the hospital. So far, this discussion has focused on the labor and birth, consider also the impact of the provider on the antenatal period and the postpartum period when the birth setting has little influence.

My obvious point is that I believe choice of provider is the more critical of the two. I would hope that all women could make both choices freely, but sadly this is not true and we know it. Many women in today’s health system can’t make either choice. Their providers and places of birth are chosen for them – and in many settings midwifery is not available. That’s a problem and it is where you and I come in.

Stepping on the path to midwifery (and staying there) fulfills a critical need for our world. Mothers need midwives. The World Health Organization knows this, the international community knows this, and the research world knows this. Within a context of collaboration with the larger healthcare system, midwifery is the ideal form of maternity care for almost all mothers and babies. Yet in the US, nearly 9 out of 10 don’t have a midwife at their birth.

One of my concerns is that midwifery is sometimes associated only with homebirth, or birth centers, or drug-free birth. None of these things alone are midwifery. Midwifery is woman-centered. Caring for the mother and her choices. Some of the most beautiful, empowered, awesome births I have attended have not met any of those descriptions, yet I have also been at all of those types of birth. Most of the nearly 4 million births in this country are not at home, in a birth center nor drug free. Let’s meet women where they are, give them midwifery care and then go from there. Midwifery is for every woman.

So if you have been called. Answer that call. Don’t wait. Really. If you need support, ask for it. You are needed in every setting by every mother. We are here waiting to teach you, precept you, nurture you along, and welcome you to the midwifery community.

March 8th, 2013

Belly of The Beast

OK, I wannabeamidwife, but what kind of midwife should I be? A CNM, CPM, or a CM? What about the difference between being a nurse-midwife or a midwife that doesn’t become a nurse too?

When I pondered these questions in the late 80’s, it was easier to sort out my decision because there were fewer choices. National certification only existed for nurse-midwives and state licensed midwifery was rare. Since I wanted to be both certified and licensed, it was a pretty obvious choice for me – become a certified nurse-midwife. But now, national certification and state licenses exists for those who do not choose to becomes nurses first. Both the North American Registry of Midwives (NARM) and the American College of Nurse-Midwives have a certification process for midwives who do not go through a nursing-school process. (See blog “Alphabet Soup” for more details on how this works.) As for state practice, according to The National Association of Certified Professional Midwives (NACPM) “twenty six states now recognize direct-entry midwives in statute, 24 through licensure”.

This is much more consistent with the rest of the world where nursing and midwifery are not the same profession. I always say,” we don’t require physicians to become nurses first do we?” But then, nursing is it’s own, deeply honored profession rooted in strong values and ethics and there are those who find that nurse-midwifery is a rich blend of these two professions. But for me, I am clear it is two professions. I am happy people today can choose.

Having said that, I am a nurse-midwife and in the U.S. it can have advantages in terms of access to jobs, insurance reimbursement, and on a more philosophical level – access to birth settings and to women. Hence – the belly of the beast.

When a wannabemidwife talks to me about pathways to midwifery and what might be right for them, I ask them where they want to be practicing 5, 10 years from now? Homebirth? Birth center? Hospital? Different certifications may affect where they can most easily practice. I ask them to think about how important their compensation from their work as a midwife will be to their family. I also ask them to think about the costs of their education. Different routes to midwifery have different potential costs. What about the regulations in the state where they want to work? Do they know about that? I try to help them gather data. In the end, I talk about the “belly of the beast”.

Around 98% of the mothers in this country give birth in hospitals. Some by conscious choice, many because it is the only option they know, and still more because they have no choice. To the wannabemidwife – do you want to work with these women in “the belly of the beast’ where intervention-based birth is the norm and midwifery-led care is not? It will be tough. Or do you want to work outside the system in out-of-hospital birth where the locus of control is much more in the hands of the mother and the midwife? This shift of power usually has its price tag in terms of potential compensation and insurance reimbursement for your work. There are many factors to consider in deciding what is right for you.


As midwives, I think we all have a bit of Don Quixote in us and are fond of the battle. While I have worked in all settings, I am happy to to do mine within the belly of the beast. I feel these women deserve midwifery care and the option to have physiological birth if they choose (and yes it can be done in a hospital).  But I know my sisters and brothers who take on the rights of mothers and families outside the hospital work just as hard.  In choosing the right pathway for you to become a midwife, start to consider where the windmills are that call to you.