Midwives have assisted birthing women throughout time. Today there are different types of midwives. Choosing a midwife? Read on (Click the title or "Read More.")

In the hospital-

The Certified Nurse Midwife and the Certified Midwife are sister types coming under the American College of Nurse Midwifery. Most midwives in Minnesota are Certified Nurse Midwives, first trained and registered as a nurse, and then taking advanced course work in Midwifery. The Certified Midwife goes directly from her Bachelor degree into a Masters in Midwifery without nursing school. Trained in Universities, for the most part, the CNM often works within the hospital system. The CNM keeps her skills sharp and works closely with other providers, such as physicians and nurses, as she manages a woman's labor. The CNM helps women with a variety of birth experiences, natural birth, waterbirths, epidurals, and inductions. Should a cesarean become necessary, she has an active cooperation within the hospital to get immediate help from obstetricians and surgical staff. We do have a popular male midwife, John Eads, in the Fairview system, so the pronoun she is used with the understanding that a few male midwives have crossed the gender line. 

Her RN is licensed under the Board of Nursing.  A few CNMs in Minnesota do homebirths, but the majority work within the hospital. All CNMs have the ability to prescribe antibiotics and other medications that may be needed by a pregnant, birthing or postpartum (post birth) woman. Nurse Midwives often provide well women care before and between pregnancies, as well as through and after menopause. Becoming a nurse before a midwife presents a broad set of skills for a wide range of health knowledge.

Not all insurance companies cover the care of Nurse Midwives. Check your coverage. For uninsured families, midwifery care can be arranged at Hennepin County Medical Center in Minneapolis, or at Regions in St. Paul. For a listing of Certified Nurse Midwives or Certified Midwives check the Minnesotans for Midwifery website or the MNmidwife.org site for hospital midwives. Not all hospitals support midwives. There is a slight, but notable, correlation that hospitals which include midwifes on staff also tend to offer more options to birthing women, even those under physician care. This is not to imply that most physicians working down the hall from a midwife are more holistic. Rather, it could be the nursing staff that carries over a greater incidence of maternal positioning or use of showers for pain relief in the hospitals where they see more non-pharmaceutical pain relief. 

In the home-

The Certified Professional Midwife comes under the North American Registry of Midwives with testing by the Midwives Education and Accreditation Council. The CPM has learned her craft from Midwifery schools approved by MEAC and/or through direct learning from more experienced midwives in an apprenticeship working relationship.

It can easily take an aspiring midwife 4-8 years of apprenticeship in Minnesota to develop her core compentencies. All CPMs must have attended at least 40 births before testing, of which she must have been a primary midwife for 20 births, of which 10 or more must include continuity of care from the initial visit through a home birth and postpartum visits. In a state where only 1/2 of 1% of births are in the home, obtaining a CPM is not likely quicker than going to school for a CNM. There are, of course, things the apprentice learns that can never be taught in school. The CPM route to midwifery is good for kinestetic learners and community based home birthing. The CPM is the only international certification for out-of-hospital birth experience. Many homebirth midwives look at health care in quite a different way than the nursing model. CPMs have occasionally worked in hospitals, as one did temporarily in SW Minnesota some years ago. CPMs have run birthing centers as Jill Kent once did in Moorehead, and Paula Bernini-Feigal currently does in Menomenie, WI.

Minnesota provides for voluntary licensure of the Traditional Midwife. Traditional Midwifery implies a direct route of obtaining knowledge, one on one. For the midwife who has obtained her CPM status, licensure is available under the Board of Medical Practice. A small group of physicians oversees a Midwifery Advisory Board and may or may not take advice from this board which includes CPMs and a parent. 

 
Some CPMs and all non-CPM direct entry (Non-Nurse-Midwife), except for the ACNM's CM, described in the first section, choose not to be licensed. They may believe that one profession, in this case, midwifery, should not place themselves in the position of being accountable to another profession, especially one who perceives themselves in direct competition (See the current American College of Obstetricians and Gynecologists statement against homebirth midwifery). There seems to be a lack of evidence of the Board of Medical Practitioners' own experience as homebirth attendants. The voluntary nature of Minnesota's midwifery statute is a protective measure against a monopoly of medical control over midwifery. When midwives can legally supervise themselves, constraint of trade is reduced and parents have more rights as well. 

 
Three varieties of midwives are described here as homebirth midwives. The licensed CPM, the unlicensed CPM and the non-CPM direct-entry midwife. As stated earlier, a very few CNMs also attend homebirths in Minnesota.

Both CPM and CNMs collaborate with physicians. This means that midwives work with doctors when a mother or baby's care requires physician involvement.  In the case of homebirth, many parents see a physician or a hospital midwife at some point in pregnancy, even attending a full course of prenatal care with both their home and hospital counterparts. Many midwives request a visit with a physician at some point, usually early, in pregnancy to establish a relationship and a chart in a medical setting. If hospital care becomes necessary in labor, most midwives will accompany the mother (parents) into the hospital and act as emotional support. The midwife won't be able to continue her midwife role directly until the mother is again at home.

Midwives are independent practitioners. Good statistics are the norm for midwives with either certification, and even without a certification when experience and collaboration are included. You can read about birth outcomes with midwives on another article here at MinnesotaBirth.com

What about doctors?

There are many fine physicians in Minnesota. Parents can work with Family Practice doctors, who can provide care for both mother and baby and so therefore reduce mother baby separation if requested. Obstetricians are surgeons and specialists in higher risk pregnancies within the model of Western Medicine. Some Family Practice physicians and Obstetricians enjoy working with low risk women who want a natural birth.

Statistics show that a doula will increase the success rate for a natural birth (the mother feels no need for drugs to ease the pain because natural methods of pain relief are more available from the doula). Doula care brings the rate of undrugged births up from 5% to 30% for all women the doula works with. (Kennell and Klaus, 1988)  When a woman desires a natural birth and prepares for one with a doula, her chance of having a natural birth in the hospital may be above 30%.