A Direct Entry Midwife is generally a midwife who attends women who chose to birth at home or in a birth center. They may learn their skills through an independent midwifery school or college, apprenticeship, self-study or a combination. A Certified Professional Midwife (CPM) has met the standards for certification set by the North American Registry of Midwives (NARM.)

Certified Nurse Midwives are educated in both nursing and midwifery. CNM's are certified by the American College of Nurse-Midwives. CNM's primarily attend birth in a hospital setting.

Washington state requires practicing midwives to be licensed. A Licensed Midwife (LM) meets stringent standards set by the state but is not necessarily certified. Medicaid and some HMO's will reimburse for home births with a Licensed Midwife.

In the rest of the US, standards and regulations on midwifery vary. Visit Citizens For Midwifery at www.cfmidwifery.org for more information on the Midwives Model of Care and the legal status of midwifery care state by state.

Childbirth is a major life experience that is as unique as the woman giving birth. Since the beginning of time childbearing women have sought the individualized care, advice and companionship of midwives. Like their ancient predecessors, the modern midwife focuses on the fundamental belief and understanding that pregnancy and birth is a normal and natural process. Today’s midwife is an autonomous health professional who specializes in the complete and personalized healthcare of childbearing women and their newborns.

Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week’s BMJ.

Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited.

In the largest study of its kind internationally to date, researchers analysed over 5000 home births involving certified professional midwives across the United States and Canada in 2000. Outcomes and medical interventions were compared with those of low risk hospital births.

Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America.

A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions,” say the authors.

“This evidence supports the American Public Health Association’s recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States.”