What is a Midwife? What is a Doula? What is Evidence-based practice? What is Informed Consent?

What is a Midwife?

“Midwives are the traditional care providers for mothers and infants. Midwives are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care that is utilized in all of the countries of the world with the best maternal and infant outcomes such as The Netherlands, United Kingdom and Canada.”  (Midwives Alliance of North America – MANA)

“A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.  A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife’s scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.  The Midwives Alliance of North America, the North American Registry of Midwives, the Midwifery Education Accreditation Council and Citizens for Midwifery agreed on a short definition of what “midwifery care” means. However, just because a person is a midwife does not guarantee that they provide this kind of care; consumers looking for a midwife should ask questions to determine if a prospective caregiver will be able to provide the kind of care they seek.

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. Within the category of direct entry midwives are several subcategories reflecting the varying legal status of these midwives in different states and the fact that until recently there was no nationally recognized credential available for direct entry midwives. Direct entry midwives include highly trained and very competent midwives; however, anyone may call 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 at least assured that she has met specific requirements for certification (and re-certification every three years).”  (Citizens for Midwifery)

What is a CNM?

“A Certified Nurse Midwife (CNM) is a registered nurse who has graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and has passed a national certification examination to receive the professional designation of nurse-midwife. All 50 states provide CNM licensure. CNMs may qualify for the CPM credential by documenting out-of-hospital experience and passing the NARM Written Exam.” (National Midwifery Institute)

What is a CPM?

A Certified Professional Midwife (CPM) is a knowledgeable, skilled, and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care.  The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.

In the United States, most CPMs own or work in private home- or birth center-based practices, providing unique and critical access to normal physiologic birth, which profoundly benefits mothers and newborns.  CPMs generally carry a relatively low client load (averaging 3-6 births per month), which allows for more personalized and comprehensive care than typical obstetrical practices.  The scope of practice of the CPM is derived from the NARM Job Analysis but may vary based on state laws and regulations, and individual practice guidelines developed by each midwife.

The guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care.  In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary.  The key elements of this education, monitoring, and decision-making process are based on Evidence-Based Practice and Informed Consent.

What is a DEM?

“A Direct-Entry Midwife (DEM) is an independent practitioner educated in the discipline of midwifery through apprenticeship, self-study, a midwifery school, a college, or university-based program distinct from the discipline of nursing. A direct-entry midwife provides the Midwives Model of Care to healthy women, pregnant people, and newborns through the childbearing cycle primarily in out-of-hospital settings including homes and free-standing birth centers. Many states have their own legal requirements for education and licensing of direct-entry midwives. Registered Midwives (RM) and Licensed Midwives (LM) are examples of direct-entry midwives. DEMs are not nurse-midwives.” (National Midwifery Institute)

In the State of Maryland, the term “Direct-Entry Midwife” is used to refer to all midwives other than Certified Nurse Midwives, for the purpose of licensure by the State Board of Nursing.  Thus in Maryland, licensed DEMs include CPMs as well.

What is a Licensed Midwife?

A Licensed Midwife is an individual who has been issued a license to practice midwifery by a licensing board in the state where they practice.  This is a legal designation conferring certain rights, restrictions, and legal status as a practitioner and is not the same as certification or credentialing by a midwifery education or accreditation board.  Licensing requirements and standards vary from state to state.  Currently 28 states have a licensing process for non-CNM midwives.  Some states allow non-licensed midwives to practice openly, while others designate the practice of midwifery without a license as a Class C felony.  Legislative approval of state licensing for non-CNM midwives in Maryland was achieved in 2015, with the first licenses issued in January 2017.

What is a Doula?

“The word doula is a Greek word meaning women’s servant. Women have been serving others in childbirth for many centuries and have proven that support from another woman has a positive impact on the labor process.  A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience.  Doulas can also be referred to as labor companions, labor support specialists, labor support professionals, birth assistants, or labor assistants.  Most often the term doula refers to the birth doula, or labor support companion. However, there are also antepartum doulas and post partum doulas.”  (American Pregnancy Association)  Read more about doulas HERE.

What is Evidence-based Practice?


Evidence-based Practice refers to a thoughtful integration of the best available evidence, coupled with clinical expertise.  As such it enables midwives and their clients to address healthcare questions with an evaluative and qualitative approach.  Evidence-based decisions flow from a process that includes the assessment of current and past research, clinical guidelines, and other information and resources in order to determine the best course of care.” (NARM)

“Evidence-based midwifery is a process of involving women in making decisions about their care and of finding and weighing up information to help make those decisions.  This information is drawn from knowledge of the individual needs and values of the woman and her family, information taken from the clinical examination, and evidence about treatments, place of care, and forms of support.  Evidence-based midwifery is founded on an understanding that not only physical safety, but also the personal integrity of the mother, baby and family are important outcomes.  Our concern is not only with the short-term outcomes, but also with an understanding that care may affect the family in a number of important ways for many years to come.  Outcomes such as the form of feeding, emotional wellbeing and the love between mother, baby and family are of fundamental importance and are likely to affect the individuals involved for a lifetime.  Birth is the most formative event of life, and sensitivity to the potential influence of care is crucial to evidence-based midwifery.”  (Lesley Ann Page, The New Midwifery: Science and Sensitivity in Practice)

Today in the USA, evidence-based maternity care is unusual. The consequences are complications that often lead to preventable cesarean sections and future health problems for mom and baby.

What is Informed Consent? 

“Informed Consent refers to the rights of healthcare consumers to be fully informed about testing or treatment options so that they can then make an educated “choice” among those options.”  (NARM)

Informed Consent allows individuals to consider all the benefits and risks of each option before choosing those benefits and risks they deem most acceptable and appropriate for themselves, their families, and their circumstances.  Any “consent” given under duress, threat, or fear, and any “consent” given without full disclosure and clear comprehension of both the benefits and risks of all options (including the option of doing nothing and allowing nature to proceed without intervention), is not true Informed Consent.

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