Besides a physician, the other large category of caregiver is the midwife. In many countries of the world, midwives are the primary caregivers for women during pregnancy and labor. In North America, their place is not as well established. All states have provisions for the legal practice of midwifery. In Canada, most provinces have active midwifery promotion groups who have made significant efforts in establishing midwifery as a legal form of maternity care.
The emphasis of midwife training is that birth is a normal physiologic event rather than a medical condition. They learn methods for supporting and promoting women's physical and emotional health to optimize the reproductive process. The care they give consists of thorough physical assessment and prevention of complications through education in self-care, emotional support, and nurturing of the woman throughout her pregnancy and labor.
Midwives do not care for women with complications of pregnancy, underlying illnesses, or other high-risk conditions. Should any of these problems arise, a midwife will refer the woman to an obstetrician.
Within the broad category of midwife, there are several subcategories. In the United States, certified nurse-midwives are the most numerous. They are registered nurses who have taken an additional one or two years of training in midwifery. Many receive master's degrees when they complete their nurse-midwifery training. They usually practice in close cooperation with physicians in hospitals, birthing centers, and the home setting. Nurse-midwives are certified after passing an examination administered by the American College of Nurse-Midwives.
In some states, other types of midwives are recognized and licensed to provide maternity care. Licensed midwives practice in several states. They receive training comparable with that in midwifery training programs in Europe. They are called direct-entry midwives. They do not necessarily possess a background in nursing, but they usually have received some college education followed by a two- to three-year training program in midwifery.
At present, most licensed midwives practice outside the hospital, providing care for home births and birthing-center births. Their orientation and pattern of care are similar to those of nurse-midwives.
Lay midwives, or empirical midwives, practice in a number of states. Most lay midwives have received informal training-apprenticeship to an experienced midwife, participation in short courses or study groups, or extensive independent study. Their qualifications, experience, and standards of care vary; some practice within the law, and others practice without legal sanction. Lay midwives emphasize the spiritual, as well as the physiologic and psychosocial, aspects of birth.
If the midwife option interests you, you may wish to research the role of midwives in your own state. What midwives do and are allowed to do by law vary from state to state. In some areas midwives work with doctors, providing much of the routine care for women during pregnancy and labor. In some areas they do home deliveries only, while in other areas they work in hospitals.
No matter what type of practitioner you choose to assist you and your baby during childbirth, you need to make sure that they are the right person for you and your baby. Go to the next page to find out about important questions you should ask any practitioner you consider hiring.