A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy and birth; offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle. Midwives provide care for women experiencing normal pregnancies and births.
A midwife works with each woman and her family to identify their unique physical, social, and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.
The Certified Professional Midwife (CPM) credential and the North American Registry of Midwives
Not required to be nurses.
Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.
Have met rigorous requirements and passed written exam and hands-on skills evaluation.
Administered by the North American Registry of Midwives.
Legal status varies according to state.
Practice most often in homes and birth centers.
What is the difference between a midwife and a doula?
A midwife is a primary care provider who is trained and educated to provide full prenatal care for low- to moderate-risk women, monitor mother and baby during labor, catch the baby, handle most emergencies, do a thorough newborn examination, and provide postpartum care for mother and baby for up to six weeks after birth.
A doula is a trained labor support person. S/he is specially educated and trained to inform parents of options, support them emotionally, and provide physical and emotional comfort measures during labor, birth and postpartum. Some doulas help women postpartum with things like meals, helping with other children and assisting with breastfeeding and newborn care. Others concentrate on pregnancy and birth. S/he does not perform any clinical duties such as blood pressure, vaginal exams, heart tones, or catching babies.
Is homebirth legal?
It is legal in all 50 states for the parents to have their baby where and with whom they desire. The question of legality is whether or not it is legal for the midwife to assist a family in a homebirth.
Certified Nurse Midwives (CNMs) are licensed in all 50 states, but each state has different requirements for them to be able to attend homebirths legally.
As of right now, 26 states recognize and regulate non-nurse midwives (although for two of the states, New York and Rhode Island, only the CM credential is acceptable). Regulation varies from state to state, including licensure, certification, registration and documentation. Only 9 states and the District of Columbia actually prohibit the practice of direct entry midwives, but in 5 more states licensure is required but unavailable. In the remaining states direct entry midwives practice without any kind of state regulation, and in a few the legal status in not entirely clear. South Carolina licenses Certified Professional Midwives. Georgia requires licensure for midwives, but will not give licenses to non-nurse midwives.
Refer to this legal status chart for the most current status of midwifery across the country.
What services does a homebirth midwife provide?
Midwives provide all standard prenatal care on the usual schedule. They will monitor you and your baby throughout labor, arriving at your home during the active part of labor. They do a complete head to toe examination of your baby. Also, the midwives clean up all the mess from the birth and start your first load of laundry. Postpartum care for you and your baby is provided for six weeks after the birth and usually includes at least 1-2 visits at your home and another visit or two at the midwife’s office. Most homebirth midwives offer waterbirth services. Some homebirth midwives may attend VBACs (Vaginal Birth After Cesarean) at home for select women if the state law allows.
Most homebirth midwives do not have ultrasound machines. Midwives do not perform cesarean sections or circumcisions. Midwives do not carry or administer epidurals or any kind of pain relief medicines.
How much does a homebirth cost?
The average cost of a natural, drug free, vaginal birth in the hospital can run between $6,000 and $10,000 depending on your location. And that’s just the hospital fee! The doctor is often another $2-3000. Most midwives in GA and SC charge an average between $2500 and $4500. That is for all your care -- prenatal, birth, newborn and postpartum. What a bargain!! I accept multiple forms of payment, including credit cards and PayPal. Your fee is a global fee, meaning that it is all-inclusive. You get prenatal care, your birth, newborn exam, and postpartum care covered in my fee. There are no discounts for late to care, but discounts are available for medicaid clients, cash only pay, and early pay. I can help you find a way to afford a better birth.
Will my insurance pay for homebirth?
Again, this depends on what, exactly, is written into the midwifery law in your particular state. South Carolina requires that all insurances that provide maternity coverage pay for licensed homebirth midwives. This does not mean your midwife is necessarily an in-network provider, but most likely would be covered at out-of-network rates. Tricare does not pay for CPMs in any state. This is a Federal issues. Because Georgia will not give a license to non-nurse midwives, they are not covered under any Georgia insurance. Even if midwives and homebirth are covered in your state, be sure to ask if your midwife bills insurance, or accepts medicaid, or if you will need to pay out of pocket first and then possibly seek reimbursement. In any state, a homebirth can be reimbursed out of a medical savings account or FSA.
What if something goes wrong?
Most complications during pregnancy and birth allow plenty of time for the midwife to assist the family in transferring to the hospital or a doctor. However, there are no guarantees in birth, and sometimes urgent situations must be dealt with at home. Certified Professional Midwives are trained to handle most birth emergencies, such as hemorrhage, baby not breathing, vaginal tears, or stuck shoulders. CPMs carry the basic equipment to deal with these emergencies including herbs and/or medicines for bleeding and resuscitation equipment.
Do midwives have hospital privileges or work with a doctor?
Certified Nurse Midwives sometimes have hospital privileges. Certified Professional Midwives do not have hospital privileges. Many of them do collaborate and consult with physicians, but due to physician reluctance to provide this service, the doctor may not be near you, or may not have privileges at a hospital near you.