What is a Midwife?
Certified Nurse-Midwives are highly skilled, professionally trained, autonomous women's health care providers. Certified Nurse-Midwives (CNM) deliver obstetrical services and well women care across the life span and work collaboratively with Ob/Gyn physicians as well as all health care providers to provide complete obstetrical and health services to women. A CNM is an advanced practice nurse who has completed a Masters degree in nursing, midwifery or a related discipline and has passed a certifying examination in order to be eligible for licensure in the Commonwealth of MA.
In addition to Massachusetts, CNM’s are licensed to practice in all 50 states, the District of Columbia, Puerto Rico, Guam and American Somoa. They are defined as primary care providers in federal law and Medicaid reimbursement for services of Certified Nurse-Midwives and Certified Midwives is mandatory in all states. For more information about Certified Nurse-Midwives and to learn more about Certified Midwives, an equivalent designation of midwives not yet licensed in Massachusetts, visit the website for the American College of Nurse-Midwives at www.midwife.org.
There are other types of midwives practicing in Massachusetts. For a complete list of these other provider types, including Certified Professional Midwives (CPM), and to learn more about their practice, visit the website for Massachusetts Midwives Alliance at www.massmidwives.org.
Hospital and Out-of-Hospital Birth
The majority of MA midwives attend births on labor and delivery units, whether at major academic medical centers or small community hospitals. Just less than 10% of MA midwives attend births in birth centers, home-like places where women and their families can labor and birth naturally and without undue medical intervention.
Well Woman Care
In addition to pregnancy care, CNMs are trained to provide well woman care, like gynecological exams, vaginal infections, breast exams and family planning, for women of all ages.
Q: What are the hallmarks of midwifery care?
A: Midwives recognize as normal the physiological processes of pregnancy, birth and menopause. Midwives advocate non-intervention in the absence of complications, promotion of family-centered care, and advocate for informed choice, shared decision-making, and the right to self-determination of the women and families they serve. (ACNM. Core Competencies for Basic Midwifery Practice; 2002)
Q: How many midwives work in MA?
A: Approximately 500 CNMs and 40 CPMs currently work in MA. In 2008, midwives attended more than 20% of the vaginal births in the Commonwealth. (Brewin D, Kelleher C.Caring for Women: A Profile of the Midwifery Workforce in Massachusetts. Boston, MA: University of Massachusetts; 2011).
Q: Where do midwives work in MA?
A: Most midwives in MA are CNMs, and the majority of these work in hospitals, birth centers, and their affiliated clinics. CPMs work in birth centers and attend home births. (Brewin D, Kelleher C.Caring for Women: A Profile of the Midwifery Workforce in Massachusetts. Boston, MA: University of Massachusetts; 2011). See the “Practice Directory” page for a listing of specific practices and their locations.
Q: Is midwifery care safe?
A: Research demonstrates that for healthy women, midwifery care is as safe as that provided by physicians. Moreover, several studies have found that midwifery care offered some advantages to women and their babies, including: a lower rate of birth by Cesarean, fewer episiotomies, decreased risk of infant mortality, a shorter postpartum hospital stay and increased satisfaction with the care provided (ACNM. Nurse-midwifery in 2008: Evidence-Based Practice. 2008).
Q: Can midwives prescribe medication?
A: CNMs have prescription privileges in MA. In addition, those working in hospitals can order any of the available pain relief medications, including epidurals.
Q: What if I develop complications?
A: Midwives always work as members of a care team including physicians. If a woman develops health complications at any time, her midwife will consult with or refer to a physician as appropriate. Midwives are trained to respond to medical emergencies effectively and are certified in newborn CPR.