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Midwife Assisted Homebirth
by Lauri Smit
Midwife means "with woman." Women, not doctors, have traditionally helped one another give birth for most of human existence. In the six countries with the lowest infant mortality rates, 70% of births are attended by midwives. Midwives attend 5% of births in the U.S., which rates 24th in infant mortality.

There are three types of midwives: the certified nurse midwife, the certified professional midwife and the lay, or direct-entry, midwife.

Certified Nurse Midwife
A CNM is a registered nurse who is trained in nursing and midwifery and who has met American College of Nurse-Midwifery (ACNM) certification requirements. She may attend births in a hospital, a birth center, or at home with a physician back-up. A CNM enjoys fully secure legal status in the U.S.

Certified Professional Midwife
A CPM is certified by the North American Registry of Midwives (NARM), which requires passing of the national registry exam established by the Midwives Alliance of North America (MANA). A CPM receives training in a midwifery school or an apprenticeship.

Lay or Direct-Entry Midwife
A lay, or direct-entry midwife (DEM) has apprenticed with an experienced midwife. She may also have received training through workshops or midwifery school. A lay midwife attends births in birth centers or at home. She may or may not have a back-up physician.

CPMs and DEMs face legal issues in many states. For a detailed list of the legal status of each type of midwife in each state, please visit http://www.cfmidwifery.org/states/.

Midwives have varying levels of training and experience. It's important to interview as many as possible to find one with which you feel compatible. Here are some questions to help you make your decision:

  • How was she trained? Is she licensed/certified?
  • Does she have membership in midwifery organizations? Attend workshops or conferences? Subscribe to professional journals?
  • What is her experience? How many births has she attended?
  • Does she handle higher risk situations, such as breech, twins or VBAC?
  • What do her services include? Prenatal care? Home visits? Postpartum follow-up? Lab work? Childbirth classes?
  • Does she work alone or with assistants? How many? Will you be able to choose one of the assistants to be at your birth? How often will you see this assistant during your pregnancy? What is her role?
  • What is the maximum number of births that she attends per month? What would happen if two births were occuring at the same time? Has she ever missed a birth? Does she have a back-up midwife? Can you meet this person before the birth?
  • How can you reach her? Does she have a pager? A cell phone? An answering service? If not, how do you reach her? Is she available 24 hours a day at all times? What if she goes on vacation?
  • What experience has she had with complications? Which ones? Has she ever had to resuscitate a baby? How would she handle hemorrhage? What is her policy regarding hospital transport?
  • What equipment does she bring to births? Oxygen, IV fluids, ambu-bag for baby? Medications for hemorrhage?
  • What is her medical back-up situation? Is there a particular back-up physician? Is this covered by your insurance? Does she have hospital privileges?
  • What are her fees? What is included? What if you move or change your mind during the pregnancy? How does she want to be paid?
  • What is her philosophy of care? Why is she a midwife? What are her basic beliefs about birth? What are her expectations of you regarding self-care in pregnancy? Do you like her and feel comfortable in her presence? Can you talk openly and honestly with her? Can you trust her, and yet feel free to make your own decisions? Do you want her at your birth?
Be sure to be clear about what you expect from your midwife. Let her know your wishes for the birth as well as any fears you may have.

Prenatal Care
Prenatal visits may occur in the midwife's home, office, or your home. True midwifery care is personalized care. A typical prenatal visit is relaxed and friendly and usually lasts 30 minutes to an hour or more. The midwife and client are a team, but the responsibility rests with the expectant mother, who is in control of her care.

The Birth
When the mother's labor begins, she calls the midwife. The midwife stays with the laboring woman throughout her labor and assists with delivery. The midwife is watchful for any complications or signs of distress in either the mom or baby. Throughout labor, the midwife asks permission to perform any procedure and explains to the mom and family what she is doing and why.

The woman's labor is allowed to progress at its own pace. In the comfort of her own home, the laboring woman can be less inhibited about trying different labor positions and locations. She can sit on the toilet or go for a walk outside. She can eat or drink whatever she wants. She listens to her body's cues.

The baby is immediately placed on the mom's chest for immediate bonding. Any assessments of the baby can be made while on its mother. In the rare case of complications, the midwife is trained in neonatal resuscitation and CPR.

The midwife stays for an hour or two after the birth and checks in again in a few days and at about 6 weeks postpartum. She is also available by phone to answer any questions or help with any problems or concerns.

Finding A Midwife

To find a midwife in your area...

  • look in the Yellow Pages under midwife.
  • call childbirth educators, planned parenthood, La Leche League and other birth resources in your community
  • call state organizations
  • call MANA at 888-923-6262
  • call ACNM at 202-728-9860
  • access MidwifeSearch.com, an international directory of midwives and doulas

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