Certified nurse midwives are fully trained, registered nurses who receive additional training in pregnancy and childbirth and who have passed a rigorous certification examination. Certified nurse midwives are considered part of the mainstream medical establishment. The training nurse midwives receive in anatomy, physiology, and obstetrics enables them to make medical decisions in accordance with the medical community's standards of care.
In most cases, certified nurse midwives will spend more time with you during labor than a doctor, encouraging and coaching you along the way. This "personal touch" is one of the reasons many women like to receive their obstetrical care from certified nurse midwives.
Certified nurse midwives, however, cannot perform cesarean sections and in most cases, cannot perform vacuum or forceps deliveries. Certified nurse midwives generally care for low-risk women who are unlikely to need such interventions. In some situations, certified nurse midwives may participate in the care of high-risk women in conjunction with an obstetrician/gynecologist or perinatologist. If you're thinking about receiving obstetrical care from a certified nurse midwife, you should ask about the availability and quality of the physicians with whom the midwife works. Even low-risk women may suddenly develop complications that require the expertise and special training of a physician.
Nurse midwifery is a perfectly appropriate option for many pregnant women and most communities view certified nurse midwives as important, respected, and valuable members of the healthcare community.
Unlike certified nurse midwives, lay midwives are not medical professionals. The training, certification, and ability of midwives may vary since most states have no single, established curriculum, training, or uniform certification process for lay midwives. Lay midwives are generally not viewed as part of the mainstream medical community and often align themselves with the practitioners of alternative medicine. With few exceptions, lay midwives do not deliver babies in hospitals but rather at home or in specially constructed birthing centers. Many lay midwives pride themselves in utilizing traditional delivery methods.
Although most women can safely deliver at home under the care of a lay midwife, some women develop serious complications after labor has begun. Because the training and experience of lay midwives is not regulated or uniform, the ability to recognize such complications varies from person to person. Many obstetric complications occur so rapidly that even prompt treatment by a physician may be ineffective without the immediate availability of modern medical technology. Because obstetricians encounter emergency conditions that can become life-threatening or harmful to the mother or baby if not properly treated in a hospital, few practitioners in mainstream American medicine choose home birth or recommend delivery by lay midwives.
A doula is a woman who has experience as a labor coach, but who is generally unknown to the patient. The qualifications of a doula can vary widely, yet they are not expected to play any role in the actual delivery of the baby. For women who do not have their own labor coach (such as a spouse, family member, friend) a doula can provide support and direction. Though obstetrical outcomes are no different with and without a labor coach, the use of pain medicine and the time to delivery can be shortened when a dedicated labor coach is present.