Midwives are growing in popularity, but still largely misunderstood. This three-part series aims to help you answer the question: What is a midwife and is one right for me?
When you think of a midwife, chances are you’re thinking of a “baby-catcher” — a person whose working life is focused on mothers, babies, and birthing.
But here’s a little known fact: Midwives don’t just catch babies. They’re underutilized and often misunderstood providers of reproductive healthcare in the United States.
In fact, many midwives, particularly certified nurse midwives (CNMs), provide comprehensive gynecological care that goes well beyond the scope of pregnancy and birth.
Midwives can provide a range of reproductive and gynecological healthcare services, including annual well-woman visits, contraception (including IUD insertion), fertility counseling, lab testing, and more — anything that doesn’t “involve an incision,” explains Chloe Lubell, CNM, WHNP, a certified nurse midwife and women’s health nurse practitioner in New York City.
Just over 8 percent of U.S. births are attended by nurse midwives, with another small percentage attended by certified professional midwives (CPMs).
How many midwives treat women without children? There’s no data on how many people are seeing midwives for care that goes beyond pregnancy and birth, but the American College of Nurse Midwives reports that 53.3 percent of CNMs/CMs identify reproductive care and 33.1 percent identify primary care as main responsibilities in their full-time positions.
Midwives who don’t consider reproductive care as a primary responsibility are focused on pregnancy after 20 weeks, labor, and delivery.
Nurse midwives, who are nurses who’ve completed graduate coursework in midwifery, have prescriptive authority in all 50 states. Midwifery care is completely appropriate for those who haven’t yet given birth, as well as for people who don’t wish to have children at all.
Lauren Crain, a digital marketer at HealthLabs.com in Houston, Texas, tells Healthline, “I thought that midwives were only for delivering babies, but when I was looking for a new OB-GYN, I ended up finding my midwife. It’s been empowering to see her — someone who has the same views and values who can provide with me the care I need without having to be pregnant.”
And there’s good reason as to why more people should consider midwives for their reproductive healthcare beyond pregnancy and birth — chiefly, the midwifery model of care.
What’s the midwifery model? Midwifery care involves a trusting relationship between the provider and person, who share decision-making. In general, midwives approach care of people with an emphasis on collaboration.
This model, as defined in part by the American College of Nurse Midwives, “honors the normalcy of women’s life cycle events, promotes a continuous and compassionate partnership, acknowledges a person’s life experiences and knowledge and… involves therapeutic use of human presence and skillful communication.”
“The midwifery model of care is a model that prioritizes and centers the patient, because it’s their body and it’s their healthcare,” Lubell explains.
Women who use midwives often express that their care feels more respectful, more holistic, and more collaborative than traditional gynecology.
Dani Katz, a doula based in New York City, started to see a nurse midwife after several disempowering encounters with gynecologists, encounters where she says she felt pressured into birth control options she wasn’t comfortable with.
Today, Katz sees a private midwife and says appointments with her feel “open and non-judgmental,” with considerable time spent discussing Katz’s reproductive and general health.
Lubell cites the patient experience as a motivator in the care she provides.
In terms of a pelvic exam, she explains, “We sit down in my office, we chat, and then we go into the exam room. I give them the option to wear their clothes or wear the gown. I outline step by step what I’m going to do and why.”
“Anytime I’m putting something somewhere, I’m telling them what, where, and why”
I say, “If at any point there’s something I’m saying or doing that doesn’t feel right, please just let me know and I’ll change my technique to make it more comfortable for you.” Constantly, I hear people say, ‘Oh! Thank you. No one’s ever said anything like that to me before.’”
This approach, which falls on the spectrum of trauma-informed care, may be more common when working with midwives.
Of course, there are many obstetrician-gynecologists who also strive to give wholly patient-centered care — but a crucial difference between physicians and midwives seems to be the framing of the provider-patient relationship, which is different from the very beginning of midwifery training.
In general, midwives approach care of people with an emphasis on collaboration.
Lubell, who in addition to her in-person practice provides online reproductive healthcare information and appointments at her website The Midwife Is In, stresses that midwives are focused on giving their patients information so they can make their own informed decisions.
Tyler Miller, a nanny in northern Kentucky who first became aware of midwives after her aunt became one, agrees. “I feel like they take the whole person into account, as part of their training. I’m able to use the information I get when I interact with a midwife so I can make better decisions about my health overall.”
There are four types of midwives:
- Certified nurse midwife (CNM): A midwife who’s completed both nursing school and midwifery training, then passed an exam certified by the American College of Nurse Midwives.
- Certified midwife (CM): A midwife who isn’t a nurse, but has a master’s degree in a health-related field. They take the same exam as CNMs.
- Certified professional midwife (CPM): A midwife who’s completed coursework and training in midwifery, and works exclusively in out-of-hospital settings. Certified through a different exam than CNMs and CMs.
- Traditional/unlicensed midwife: Their training and background varies, but they aren’t licensed in the United States. They often serve indigenous populations or religious communities like the Amish.
It’s not only nurse midwives who can provide reproductive healthcare — certified midwives (CMs) have the exact same scope of practice, but are only licensed to practice in Delaware, Missouri, New Jersey, New York, Maine, and Rhode Island.
Certified professional midwives can also provide some well-woman care, like pap smears and family planning counseling.
Hilary Schlinger, CNM, CPMr, who teaches midwifery students at Southwest Tech in Wisconsin, explains that the reproductive healthcare training for CPMs in the United States meets the worldwide International Confederation of Midwives standards — but that the ability for CPMs to provide this care to women is regulated (and often limited) by individual states.
Some midwives provide additional care, such as herbal medicine, inseminations, abortions, and more.
Often, whether or not the midwife can offer different kinds of specialized options depends on the practice structure in which they work, as well as their individual training.
Lubell has done additional training in working with LGBTQ populations, for example, including prescribing hormones for people who are pursuing gender confirmation.
Sometimes it depends, again, on the regulations at the state level. Midwives can prescribe medical abortion medication like misoprostol and mifepristone in 16 states, but, as advanced practice providers, they can only legally do aspiration abortions (using suction) in California, Montana, New Hampshire, Oregon, and Vermont.
If you’re interested in seeing a midwife, research the options in your area. Some midwives will work in collaborative hospital practices with doctors, while others will provide care out of birth centers or private offices.
Schlinger advises: “My advice is to find out more about a midwife’s practice and protocols so you aren’t expecting something that isn’t offered. For example, if you’re looking for a practice that is open to some alternative things, make sure that’s accepted before you go.”
Although midwifery care is often appropriate for people who are looking for an alternative or holistic influence, it’s by no means limited to those who prefer that paradigm
As Lubell says, “The whole point is that we’re here to support you and the kind of care that you want. I’m going to help you get that care. Midwives are here for you no matter what you want or need.”
Carrie Murphy is a freelance health and wellness writer and certified birth doula in Albuquerque, New Mexico. Her work has appeared in or on ELLE, Women’s Health, Glamour, Parents, and other outlets.