Certified Professional Midwives, Licensed Midwives, Certified Midwives, Certified Nurse-Midwives
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Midwives Addressing Health Disparities
Scope of Practice – Midwives
“The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct birthson the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency
measures.” Read Full Definition: Download PDF —From The International Definition of a Midwife (from International Confederation of Midwives)
The Midwives Model of Care – From Midwifery Taskforce (1996)
- The Midwives Model of Care is based on the fact that pregnancy and birth are normal life events. Any type of practitioner, including physicians can provide this approach to maternity care. It is a philosophy and approach to care, which is not limited to midwives alone.
The Midwives Model of Care includes:
- Monitoring the physical,psychological and social well-being of the mother throughout the childbearing cycle;
- Providing the Mother with individualized education, counseling, prenatal care, and continuous hands-on assistance during labor and delivery, and postpartum support;
- Minimizing technological interventions;
- Identifying and referring women who require obstetrical attention.
What are the types of midwives in the U.S.? How are they accredited and regulated?
There are two types of midwives practicing in the United States and California. The main categories are: Nurse-Midwives and Direct-Entry Midwives.
What is their training and education and who regulates their practice?
Certified Nurse-Midwives are Registered Nurses (Associates, Bachelors or Masters degree) who have received advanced training in midwifery; they are either certificated or Master’s prepared. They are accredited through The American College of Nurse Midwives In California, they are regulated by The Board of Nursing. (In other states, licensing agencies include: Boards of Nursing, Boards of Medicine, Boards of Midwifery/Nurse-Midwifery, Departments of Health).
Where do they practice and what do they provide?
Nurse-Midwives practice in clinics, hospitals, birth centers and client’s homes. The majority practice in hospitals. They provide well-woman gynecology, family planning, prenatal care and labor, birth and postpartum care. In Los Angeles, there are only 4 hospitals which employ midwives: California Hospital, UCLA Medical Center, Cedars Sinai Medical Center and Good Samaritan Hospital. Most do not have independent hospital privileges.
What are the legalities of Nurse-Midwifery?
Certified Nurse-Midwives are legal in all 50 states. Medical Doctor supervision is required by law, and Nurse-Midwives managing births outside the hospital must have a hospital back-up arrangement.
What types of insurance do they take?
Nurse-midwifery services are covered under Medi-Care (Medi-Cal), PPO and HMO and CHAMPUS insurance plans.
DIRECT-ENTRY MIDWIVES (Certified Professional Midwives, Licensed Midwives & Certified Midwives)
Where do they practice and what do they provide?
Previously called “Lay Midwives”, the second type of midwives are not nurses. They now referred to as “Direct-Entry Midwives”, meaning they enter the profession directly without first becoming nurses. Nowadays, the term “Lay Midwife” refers to an unlicensed, uncertified midwife. Many Direct-Entry Midwives are now Certified and/or Licensed. Licensed Midwives/Certified Professional Midwives practice in clinics, birth centers and homes. They provide well-woman gynecology and family planning, prenatal care, labor and birth and postpartum care of women and newborns. LMs do not have hospital privileges and conduct births in freestanding birth centers or in client’s homes. Hospital back-up plan and Medical Doctor supervision is required by California law. (See: The California Licensed Midwifery Practice Act of 1993 ).
What is the legality of Certified Professional Midwives/Licensed Midwives?
26 states have a licensing pathway for non-nurse midwives including California since 1994.(States regulate the practice of non-nurse midwifery variously by licensure, certification, registration, voluntary licensure, or permit). California Licensed Midwives (LMs) are regulated by the Medical Board of California Division of Midwifery Licensing. (Other states regulating entities include Departments of Health, Boards of Medicine, Boards of Midwifery). For a chart describing the legal status of direct-entry midwifery throughout the U.S., please go to: http://mana.org/statechart.html
What is CPM and LM training and education and who regulates their practice?
Certified Professional Midwives (CPMs) and/or Licensed Midwives (LMs) have entered the pathway through various means: self-directed study and/or apprenticeship, distance-learning programs, university-based education, and/or have received supervised clinical instruction under a preceptor midwife in out-of-hospital settings (birth center and homebirth). In California, CPMs are eligible to take the licensing exam offered by The Medical Board of California, which is the regulating entity for California midwives. Traditional apprenticeships are no longer eligible for accreditation and are not a legal educational pathway to obtain an education). CPMs – no matter which route taken to learn their trade — have taken a national certifying exam offered by North American Registry of Midwives, to become CPMs . The Midwifery Education Accreditation Council (MEAC) is authorized by the US Department of Education to accredit midwifery education programs and institutions. MEAC-accredited programs vary and may grant a certificate or an associate’s, bachelor’s, master’s, or doctoral degree. Most graduates attain a certificate or associate degree; there is no minimum degree requirement for the CPM certification exam. Licensed Midwives (LMs)/Certified Professional Midwives (CPMs) practice in out-of-hospital settings: birth centers and homes and more recently – health centers and clinics. Few have hospital privileges in California.
What are the legalities of Certified Professional Midwifery practice?
The legality of CPMs vary from state to state; though a legal designation is some states, it is not in CA (for a CPM to practice his/her trade in California, she/he must become a Licensed Midwife by passing the examination administered by The California Medical Board).
Will insurance will pay for Licensed Midwives and Certified Professional Midwives services?
Yes and No. Certified Professional Midwives services are not covered by insurance or Medi-Cal in California. PPO insurance covers Licensed Midwives in California. Licensed Midwives are officially designated Medi-Cal CPSP providers and are qualified under health care reform to be reimbursed through freestanding birth centers and clinics. In Los Angeles County, Medi-Cal does not cover homebirth midwives, and the few Birth Centers that there are in Southern California either do not take Medi-Cal or do so on a limited basis. Licensed Midwives (LMs) are currently working in Medi-Cal clinics and Federally-Qualified Health Clinics (FQHCs) throughout California including Los Angeles and Orange Counties. (Private insurance covers Direct-Entry midwives in some states; Medicaid covers in 10 states for home birth, additional states cover if birth occurs in birth center).
Certified Midwife (CM) is a designation which was created by The American College of Nurse-Midwives to allow for non-nurses to become midwives through university-based education commensurate with nurse-midwifery education to allow persons without a background in nursing to become midwives through university based education. This pathway also provided an opportunity for foreign-trained non-nurse midwives to obtain licensure to practice in the U.S. without become a nurse-midwife. This designation was created in New York state in 1992. Distinct from Certified Professional Midwives (CPMs) who obtain accredidtation through the North American Registry of Midwives via multiple pathways — apprenticeship, self-study, distance learning and university-based education–the ACNM’s Certified Midwife pathway was not intended to create a legal pathway for apprenticeship-trained homebirth midwives. Instead, the intent was to free Nurse-Midwives from the “structural and institutional dominance of nursing”, and was intended to create separate boards of midwifery and directors of midwifery for midwives working in hospital settings 1. (Davis-Floyd & May, 2006). CMs must obtain a Master’s degree; a master’s degree is the minimum requirement for the AMCB certification exam. There are few colleges that provide a educational program, the first one being in Brooklyn, NY (SUNY-downstate). CMs are not available in California at present; as they’re are only Licensed in New Jersey, New York, and Rhode Island. They are authorized by permit to practice in Delaware, and are authorized to practice in Missouri, though this may change as the awareness of the benefits of midwifery are more widely recognized and greater demand for non-nurse midwifery education opportunities increase. [ 1 Davis-Floyd, R. and May, M., Idealism and Pragmatism in the Creation of the Certified Midwife: the Development of Midwifery in New York and the New York Midwifery Practice Act of 1992, in Mainstreaming of Midwives: The Politics of Change (New York: Routledge, 2006).]
For more information, contact us. Read more at:
“Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives” Download PDF
- Childbirth Connection: “Choosing a Caregiver, Birth Options: Midwives for Maternity Care“
- American College of Nurse Midwives (ACNM): “Our Moment of Truth: A New Understanding of Midwifery Care“
- Citizens for Midwifery (CfM): “The Midwives Model of Care”
- Midwives Alliance of North America (MANA): Mothers Naturally Video Series: Exploring Birth Options [Video] Watch Now
- Legality of Direct-Entry (non-nurse) midwifery in the US, State-by-State (from MANA ) Click Here
- Questions to ask when choosing homebirth midwives
Find a Midwife:
- American College of Nurse Midwives (ACNM) – Find a Certified Nurse-Midwife or Certified Midwife in the USA (Hospital, Birth Center or Homebirth).
- California Association of Midwives (CAM)– Find a Licensed Midwife in California (Homebirth or Birth Center).
- Midwives Alliance of North America (MANA) – Find a Certified Professional Midwife in the USA (Homebirth or Birth Center).
- California Licensed Midwives – Find a Licensed Midwife on California Medical Board website and view status of their license (active, surrendered, cancelled, prohibited, etc.).Look Up Midwife
- Midwife Robin Lim, CNN 2011 Hero of the Year: Acceptance Speech ( with Anderson Cooper) [Video] Watch Now
- Midwife Robin Lim, CNN 2011 Hero of the Year: Backstage Interview (with Dr. Sanjay Gupta) [Video] Watch Now
- Childbirth Connection: “Midwifery Care Evidence-Based Practice Brief” Download
- Childbirth Connection: “Imperative to Train More Midwives” by Carol Sakala, Ph.D., MSPHDownload
- UCSF Pew Report: The Future of Midwifery (1999): Download
- Scope of Practice for California Nurse-Midwifery: California Board of Registered Nursing, The California Nurse-Midwifery Scope of Practice
- Business and Professions Codes for Licensed Midwifery: California Medical Board Division of Midwifery Licensing, The California Licensed Midwifery Practice Act of 1993
- Statistics on Outcomes of California Licensed Midwives/California Medical Board Annual Report – Summary of Medical Board activity, summary of physician and surgeon licensing and complaints filed, and statistics on birth outcomes of non-nurse midwives MBC-2011-2012 Annual Report [see page 4].
Please go to The Coalition for Improving Maternity Services website for more information and additional resources at: http://motherfriendly.org.