is the difference in education between a doctor and a midwife?
requirements for doctors
to become a doctor, one must got to school for a minimum of
11 years. The typical path to becoming a doctor includes four
years of college, followed by four years of medical school,
followed by another three years of internship and residency.
Medical school is a very rigorous program and requires a deep
commitment to graduate, pass medical boards, and ultimately
requirements of midwives
describing the education required to become a midwife, it
is important to differentiate the two types of midwives, CNM
and direct entry (lay) midwives. We will describe the education
and certification criteria separately as the paths to each
Certified Nurse Midwives
CNM's begin their career in nursing school. Before attending
most nurse midwifery schools, a bachelors degree is required
(usually in nursing). This is followed by completion of
a nurse midwifery program. The majority of CNM's have attained
a masters degree. Where medical school has a broad focus,
focused on disease processes and treatments, midwifery school
has a very specific focus on care of the healthy pregnant
mother. Midwifery school is also quite challenging with
high academic standards. It requires dedication to the nursing
profession and a passion for prenatal care.
Direct Entry or Lay Midwives
Traditionally, midwives were trained as an apprentice attending
births with an experienced midwife. There are some who still
follow this model exclusively and to a certain extent this
is the approach given to the direct entry midwife. However,
there is a growing trend towards certification and licensure
and a formal education program for the lay midwife. The
lay midwife of today has completed a formal education program
covering prenatal care for the healthy pregnancy. She does
not typically have a degree in nursing. She is expected
to attend a required number of births and pass a proficiency
exam before becoming certified. Certification is available
to the direct entry midwife through the North American Registry
of Midwives, NARM. Licensure is also available in a very
limited number of states. Direct Entry midwives primarily
work independently, performing home births and is not typically
covered by health insurance.
care, what can Certified Nurse Midwives do?
can safely care for a normal, low risk pregnancy. She can
independently manage routine gyn exams, prenatal exams, and
delivery. In most states, she can write prescriptions. However,
state laws vary on prescriptive limitations. Since most CNM's
work in a hospital setting, she also can authorize pain management
options such as requesting an epidural from an anesthesiologist.
CNM's cannot do
do not perform Cesarean sections. They do not manage high
risk pregnancies and complications such as multiple pregnancies,
high blood pressure, and diabetes. If you develop a complication
during pregnancy, your CNM is trained to recognize symptoms
and would likely transfer care over to a doctor.
Direct Entry midwives are very limited as to what they can
do. They have no prescriptive authority and usually are not
authorized to deliver in a hospital setting. Only a few states
offer licensure to direct entry midwives and it is still a
all insurance companies cover costs of CNM services. Direct
entry midwives are typically not covered by insurance.
do I decide?
the best ways to decide is to find a practice that has both
midwives and doctors. Many facilities will allow you to rotate
between doctor and midwife until you decide your preference
for delivery. Perhaps the biggest reason women choose a midwife
over a doctor is the difference in approach to labor. Generally
speaking, doctors are present only for the actual delivery
of the baby and periodic checks through labor. Midwives are
typically present through the duration of labor and childbirth.
Choosing between a doctor and a midwife is a very personal
decision. It may help to write down your goals for pregnancy
and delivery and see which model of care your goals for pregnancy