What midwives can and cannot do
Despite the popular image of the midwife as a woman who delivers babies in women's homes, the majority of midwife-attended births actually take place in hospitals or in birthing centers located within hospitals. In this setting, if a midwife deems an intervention such as fetal monitoring or labor induction necessary, she can employ it. A certified nurse-midwife always has a relationship with a doctor and hospital in the event of emergency during a birth at a freestanding (nonhospital) birth center or in a woman's home. "And if a woman is deemed 'high risk' at any time during her pregnancy or labor, she will be referred to a doctor," Corry says.
Midwife-licensing qualifications and what they legally can and cannot do vary by state. Although they don't administer epidurals or perform C-sections, they often will assist if a woman needs the surgery. But what most sets midwives apart from obstetricians is the fact that they provide continuous physical and emotional support during labor and delivery. The upside is that women are more likely to be pleased with their birth experience and less likely to have an unwanted C-section.
Choosing a midwife
To protect both you and your baby, choosing a properly trained, qualified midwife is essential. ACNM-certified nurse-midwives (CNMs) and certified midwives (CMs) all have at least a bachelor's degree, and more than 70 percent hold at least a master's degree. They have graduated from a nationally accredited education program and passed a rigorous national certification exam. Certified professional midwives (CPMs) are certified by the North American Registry of Midwives after passing a written exam and hands-on skill evaluations. Lay, or direct entry, midwives, a designation that represents no standardized qualifications, may or may not have a college degree or certification. They may have trained through apprenticeships, workshops, formal instruction or a combination of these. Not all states require lay midwives to work in conjunction with doctors, and they usually practice in homes or freestanding birth centers.
Once you've found a midwife you fully trust, it's even possible that a longer-term relationship may develop. "I just saw my midwife again, for my annual gynecological exam," Noelle Hawton says. "She is so caring about me as a whole person. We talk about how work is going now that I have three kids, how my parents' recent health problems are affecting me, if my husband and I are making time for each other and so on. I've actually thought that it would be nice to have her as a friend."