Choosing a Care Provider
After you have decided where you feel most comfortable giving birth, you'll want to find a care provider who attends births in that setting. If you have chosen a hospital, you have the option of being assisted by either a Family Practice Physician, an Obstetrician, or a Certified Nurse Midwife. Birth Centers are most often staffed by Certified Nurse Midwives or Licensed Direct Entry Midwives, but a few may have physicians on staff as well. Homebirths in our area are attended by either Certified Nurse Midwives or by Direct Entry Midwives.
In the United States, midwifery is regulated on a state-by-state basis. This means that each state decides whether or not to recognize licensing and certification standards set by various agencies and organizations. For simplicity, midwifery can be discussed in two broad categories: Certified Nurse-Midwives and Direct-Entry Midwives.
- Certified Nurse-Midwives (CNM)
Certified Nurse-Midwives are licensed and regulated in all 50 states and Washington DC. They may work in private practice or as part of a group with other midwives and/or physicians. Many have hospital privileges in our area. CNMs also work in free-standing birth centers and a few in this area offer homebirth services. CNMs are registered nurses who have at least a Masters degree in nursing. They have gone on to complete an advanced education program focusing on pregnancy, birth, postpartum, and well-woman care. Finally, they have passed national testing requirements set forth by the American College of Nurse-Midwives. - Certified Midwives (CM)
A Certified Midwife is educated in the area of midwifery specifically (as opposed to general medicine and nursing), and is certified according to the requirements of the American College of Nurse-Midwives. Some states offer and recognize individuals certified through means other than those of the ACNM as Certified Midwives, (CM) so it may also be used to designate these individuals. - Certified Professional Midwives (CPM)
Certified Professional Midwives are independent practitioners of midwifery who have met the rigorous certification standards developed by the North American Registry of Midwives. These standards encompass various educational routes requiring experience in out-of-hospital settings, dedication to the Midwives Model of Care™, and successful completion of a written examination. Continuing education is a requirement to maintain certification as a CPM. - Direct-Entry Midwife (DEM)
Direct-Entry midwives are educated in midwifery through self-study, apprenticeships, independent midwifery schools, or college/university-based programs separate from the study of medicine or nursing. DEMs practice under the Midwives Model of Care™ providing care to healthy women and newborns primarily in out-of-hospital settings.
Family Practitioners (FP) are medical doctors who have chosen to care for people of all ages, both men and women, without focusing on any one disease or body system. Some family practice physicians provide routine obstetrical care. There is less of a focus on pathology in labor and birth with many FPs and they tend to have lower rates of surgical intervention than might be expected with an obstetrician. FPs usually deliver in hospitals in the US, but a few do attend births in birth centers or at home.
An obstetrician is a surgeon who has specialized in the area of labor and birth. Obstetricians are trained in the diagnosis and treatment of problems that arise during pregnancy, labor, and the immediate postpartum period. Some obstetricians also specialize in high-risk pregnancies. These doctors are usually called Maternal-Fetal-Medicine Specialists. Many obstetricians work in group practice with several other physicians or midwives with a rotating "call" schedule. This means that s/he may or may not be the one to attend your birth. Obstetricians rarely remain with women throughout labor; they are consulted by the hospital staff during each phase of the birth process and most often called when birth is imminent.
