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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Are you on FaceBook? I would love my midwife (who is on my page) to be able to comment to what you wrote. I believe that she is a CPM but I would have to double check that. Otherwise, I LOVED reading your thoughts. Wish that I had some strong ones of my own but since I am new to this, I don’t have a very *sound* opinion, just my own personal preference. Which was that I thoroughly enjoyed having Cailyn’s birth at home with a midwife and would NEVER go back to the more standard western practice… even if midwifery were deemed illegal.
I’m a licensed midwife in South Carolina and also a CPM. First , I’d like to comment on the term “lay midwife”
In the dictionary the term Lay is to have no body of knowledge and the term was deemed by the medical profession to refer to people who assisted in birth that were not physicians. Unfortunately this term has STUCK and does not really describe the different types of midwives out there. If you are a Direct Entry midwife, meaning you do not have a nursing degree first, you can still be unlicensed and yet still have didactic training as well as apprenticeship. In some states in the US, a venue for licensure is provided. However, each states licensure process differs along with the states regulation on practice.
So… to answer the question “should midwives be licensed?’ Personally, I have extensive training and experience as a practicing Direct Entry Licensed Midwife. However, my state regs, don’t allow me to practice what I have been trained to do. Not to mention, that I believe every woman has the right to a homebirth with a trained professional of their choice. This should include V-bacs, twins, breeches, anyone who is having an uncomplicated pregnancy. There are times, when I wish I wasn’t licensed so that I could provide the services that my regs prevent me from doing. So I’m glad there are direct entry midwives that are not licensed that are willing to serve all womens needs without restriction, other than possible prosecution as most of these restrictions have been handed down by ACOG, not a body affiliate of midwifery practice. Ideally, all midwives should work together to ensure that our profession is considered safe , no matter what your title. I know that some consumers think, if your licensed, that makes you a good midwife. Is the same true for doctors? It’s up to the women in our country to set the standard of care for birth in this nation. Educate yourselves and then decide the best course of action. It is your body and child after all. The women who have been practicing midwifery legally or illegally are truly courageous individuals who have been fighting the system along time to give women the right to birth as they choose.