I've had a few people contact me to ask what my thoughts on the licensing of midwives are.
I know this is going to differ based on what country you're in, and where in that country you're located. Midwifery regulations are so different all over the world.
I'm in the United States so my experience of midwifery care is different than what a woman will experience in Canada, the UK, or elsewhere.
But here in the US midwives come in a few different varieties. There are certified nurse-midwives who go through nursing school and then get additional training in birth. There are also some states that license midwives based upon guidelines the state has determined; often these midwives are “lay midwives” meaning they've not gone through nursing or medical school. They have, however, trained extensively. There are also midwives who are not licensed and are lay midwives. Some of them seek and independent certification which makes them certified professional midwives. To get this certification they must pass rigorous testing (learn more at The North American Registry of Midwives).
So what are my thoughts on this? I definitely think that women called to be midwives should not be required to go through nursing school first. I may be biased because neither of my midwives have gone the nursing route. But in reality, in the US at least, most women who choose home birth are going to give birth with a “lay midwife” because most certified nurse-midwives deliver only in hospitals or birth centers. Very few attend births at home.
I think that a lay midwife can and (in general) will know birth as well as a certified nurse-midwife. They train extensively under midwives in the oldest way to learn a trade – apprenticeship. A midwife will have attended many, many births before she begins to see clients on her own.
As for my thoughts on licensing: I do not think a woman must be licensed to be a competent midwife. However, I am in favor of licensing such as the Certified Professional Midwife licensing. I believe it gives a level of assurance to the family seeking a midwife's services. It causes the midwife to keep current with studies, techniques, and literature. It shows accountability and professionalism.
State (or national) licensing varies and at times it can be a hindrance – some states may say that women seeking a VBAC (vaginal birth after cesarean) cannot attempt a home delivery with a state licensed midwife. Others say no twins. A midwife who doesn't follow state protocols for things could be penalized severely. However, in general state licensing again provides a measure of reassurance to the family. It creates accountability for the midwife, and can help bring midwives together into a unified network.
I am, in general, in favor of licensing midwives and I feel good about midwives who seek to be licensed in some way. There are sometimes restrictions placed on these midwives that they (or their clients) would rather not have. But in general licensing is a good thing from the viewpoint of the client.
Of course there will always be unlicensed lay midwives. There will always be unassisted childbirth. Women have the freedom to choose what they want. But I do think that licensing is generally a good thing for families, and a good thing for midwives.
If you have an opinion (if you're a woman using/considering a midwife, or if you're a midwife) feel free to contact me 🙂
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