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A BIRTH CENTER

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What is a Midwife?

Since the beginning of human history, women have helped other women in the transition to motherhood. Midwives are the primary health care providers in most countries where birth is an integral part of family life. Countries with the highest rate of midwifery care today – emphasizing competent prenatal care, education, and empowerment for the woman giving birth – also have the best outcomes for mothers and babies. The World Health Organization (WHO) declared in 1990 that birth was actually safer for mothers and babies when utilizing midwifery for pregnancy and childbirth.

Midwifery is based on a strong belief in partnership with childbearing women and respect for birth as a normal life event. Midwives strive to empower parents with knowledge and support their right to create the birth experience which is best for them.

Midwives respect intimacy, privacy, and family integrity, and draw on their own patience and understanding to provide care during pregnancy and birth.

  1. Midwives Today
  2. International Recognition
  3. Types of Midwives in the United States
  4. Midwifery in Washington State


Midwives Today

The modern midwife is a health professional who provides holistic heath care to the childbearing woman and newborn. She respects a wide range of women's need including personal and cultural values. Focusing on the natural processes of pregnancy, labor, and birth, she combines traditional skills and modern medical techiques to safeguard normal childbirth. The midwife maintains associations with physicians and other health care providers to ensure that mother and child have the best knowledge and technology available.

International Recognition

MAWS supports the international definition of the midwife (found here), developed by the International Confederation of Midwives (ICM) and the International Federation of Obstetricians and Gynecologists (FIGO). It is nearly a verbatim version of that issued by the United Nations' World Health Organization. The WHO defines a midwife as someone who...

...must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help.

She has an important task in health counseling and education, not only for the woman, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions of in any other service.

Types of Midwives in the United States

There are several types of midwives practicing in the US. Washington State recognizes Licensed Midwives (LMs) and Certified Nurse-Midwives (CNMs). LMs and CNMs are both licensed to provide primary maternity care services in WA state. For further details about midwives in WA state, click here.

Licensed Midwives (LMs)

In the US, midwifery is regulated at the state level and many states provide midwives with a license to practice midwifery. State rules and laws vary greatly. In WA state, Licensed Midwives are regulated by the Department of Health. For further details about Licensed Midwives in WA state,click here.

Certified Nurse-Midwives (CNMs)

Certified Nurse-Midwives (CNMs) are educated in both nursing and midwifery. After attending an educational program accredited by the American College of Nurse-Midwives Certification Council (ACC), they must pass the ACC examination and can be licensed in the individual states in which they practice. CNMs practice most often in hospitals and birth centers but some also attend home births.

Certified Professional Midwives (CPMs)

The CPM credential, issued by the North American Registry of Midwives (NARM), is accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE, formerly NOCA). The mission of ICE is to promote excellence in credentialing for practitioners in all occupations and professions. The NCCA accredits many healthcare credentials. For more information, click here.

There is more than one route to becoming certified as a CPM through NARM.. A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a skills assessment and written exam. The goal is to increase public safety by setting standards for midwives who practice the “Midwives Model of Care” predominantly in out-of-hospital settings. Click here for more information.

The CPM credential allows multiple routes of entry to the profession in order to encourage innovation in education, adaptability to evolving best practices of the profession, diversity in the pool of credentialed midwives and broad accessibility to the profession. The competency-based model for certification assures well-educated, skilled and competent providers. Click here for more information.

This national credential, dually held by more than half of Licensed Midwives in WA state, has been described in a publication titled Certified Professional Midwives in the United States: An Issue Brief. Click here to read this publication.

CPMs who wish to practice in WA state must apply to become a Licensed Midwife (LM). For more information about completing the requirements to become an LM in WA state, click here.

Direct-Entry Midwives

Direct-entry midwives, who are licensed in some states, are not required to become nurses before training to be midwives. The Midwifery Education and Accreditation Council (MEAC) is currently accrediting direct-entry midwifery educational programs and apprenticeships in the U.S. Direct-entry midwives' legal status varies according to the state in which they practice. They attend births most often in freestanding birth centers and in homes. In WA state, Direct-Entry Midwives can apply to be a Licensed Midwife by completing the requirements outlined by the state. For more information about completing the requirements to become an LM in WA state, click here.

Lay Midwives

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education. This term is also sometimes used in a derogatory manner. The origin of the term likely comes from the definition "Not of or belonging to a particular profession; nonprofessional" from a time when many midwives were unregulated or unlicensed. It also likely derives from the Greek laikos, "of the people" and may refer to a time when local birth attendants without any formal or recognized training served the needs of their local communities.