By Nasima Pfaffl, President, Citizens for Midwifery

© Richard Kimbrough

Childbirth education students are typically attending classes in the last trimester of their pregnancy. Most likely, they have established care with a health care provider months ago. Families may receive care from obstetricians, family practice doctors or midwives and find themselves sitting next to each other in class. Conversations may come up in class about the type of care they are receiving. Some families, for a variety of reasons, may be considering changing providers. The educator may be asked what is the difference between the different types of providers who might help them with their birth. Today, guest contributor Nasima Pfaffl shares information about the midwifery model of care, for those families that are interested in pursuing care with a midwife. In future posts, a family practice doctor and an obstetrician will explain more about the type of care they provide. - Sharon Muza, Community Manager, Science & Sensibility.

At Citizens for Midwifery, we get frequent requests for information about birth with a midwife. Is it safe? What training does a midwife have? How is midwifery care different than other care?

We've pulled together some of our favorite resources for you to use as you educate families about their birth options. We hope you'll share with us your favorites that we've missed, in the comments section below.

Are there different kinds of midwives?

Yes. There are two main categories of midwives in the U.S., nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who trained as midwives without being nurses first. The majority of direct entry midwives are Certified Professional Midwives (CPMs); but this category also includes Certified Midwives and Licensed/Registered Midwives. The legal status of direct entry midwives varies in different states. The Midwives Alliance of North America (MANA) has good information on the kind of care direct entry midwives provide.

Direct entry midwives include highly trained and very competent midwives; however, anyone may call him/herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are assured that s/he has met specific requirements for certification (and recertification every three years).

Consumers can learn more about the CPM credential and why state licensing of midwives is important from the North American Registry of Midwives (NARM). Many states are also working on bills to license CPMs (check your state here at the Big Push site). The National Association of Certified Professional Midwives has resources about how CPMs practice and how midwifery organizations are working to integrate CPMs into the health care system.

Is midwifery care safe?

Midwifery care is generally provided for people who are at low-risk for complications during pregnancy and birth in one of three settings: hospital, home, or birth centers.

Many of the questions around safety center around home and hospital births. A recent study of birth center births found that people experienced very low cesarean rates, and stillborn and newborn death rates comparable to rates seen in other low-risk populations.

A growing body of research shows that, for low-risk people, home birth results in fewer interventions for the birthing parent and is safe for the baby. Citizens for Midwifery summarized the recent study published in the Journal of Midwifery and Women's Health. Judith Lothian also wrote a good summary in a previous post on Science & Sensibility. A helpful bibliography that outlines the research - and the quality of that research - around home birth can provide additional information.

What does midwifery care look like?

Midwifery care in the United States varies widely by provider and setting. The Midwives Alliance of North America is launching a series of videos called 'I am a Midwife' to educate consumers on common questions about midwife led care, including safety, training, how midwives collaborate with other health professionals, and how midwives and families work together to make decisions about care. You can watch the video and sign up for updates here.

Brochures describing the Midwives Model of Care are also available from Citizens for Midwifery. These brochures can be very helpful in describing the kind of care midwives provide.

Is midwifery care available in my community?

This depends on what kind of care you are looking for. Midwives are available in many, but not all, hospital settings. You may need to search a few different resources to get a complete picture of what is available in your community.

The Find A Midwife Tool from the American College of Nurse Midwives can help you locate certified nurse midwives and certified midwives.

Mothers Naturally's Find A Midwife Tool can help you identify midwives who are members of the Midwives Alliance of North America. They have members of all credentials.

The Birth Center locator will find the 10 birth centers closest to you (which could be quite far, depending on the legal status of your state).

If you have families in your classes exploring pregnancy and birth care with a midwife, these resources that you can share may answer questions and help them to decide what type of provider is the right one for them. What resources do you like sharing in your classes on the different types of care available? Let us know in the comments section. - SM

About Nasima Pfaffl

Nasima Pfaffl, MA is a medical sociologist with a focus on social movements and women's health. She is a second generation home birth mom. She is the current president of Citizens for Midwifery and has served on the board since 2006. She worked for the Midwifery Education Accreditation Council as their Accreditation Coordinator. She served on the MAMA Campaign steering committee, on the Birth Network National Board, the Coalition for Improving Maternity Services Leadership Team (Board), and as the Grassroots Advocates Committee Co-Chair and Survey Team Lead for The Birth Survey. Nasima focuses on coalition building and utilizing capacity building technologies and tools to make midwifery advocacy organizations stronger, more effective and able to create the change needed in our broken maternity care system. She lives in Florida with her son, daughter and husband. Nasima can be reached by email - nasima@cfmidwifery.org

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