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Doctor or Midwife?

When you think of the word midwife, often the first thing to come to mind is home birth. Although some midwives do oversee births at home, the majority of Certified Nurse Midwives, CNM's, deliveries are in a hospital setting. If you have a healthy, low-risk pregnancy, a midwife may be a good choice for you.
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What is the difference in education between a doctor and a midwife?

Education requirements for doctors

In order 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 practice medicine.

Education requirements of midwives

Before 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 are different.

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.

Medical care, what can Certified Nurse Midwives do?

A CNM 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.

What CNM's cannot do

CNM's 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 developing profession.

What about insurance?

Almost all insurance companies cover costs of CNM services. Direct entry midwives are typically not covered by insurance.

How do I decide?

One of 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 fall into.


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