Definition of a midwife. The word midwife describes a woman who is "with women" at birth. Midwives practice under a philosophy of care that focuses on the specific needs of women, empowers women to actively participate in their health care, and minimizes unnecessary intervention. Certified nurse-midwives and certified midwives are highly educated professionals who work collaboratively with physicians.

About the American College of Nurse-Midwives. The American College of Nurse-Midwives (ACNM) is the largest and oldest organization for the midwifery profession in the United States. We are proud of the reputation earned over the last 75 years by our certified midwife (CM) and certified nurse-midwife (CNM) members.

Deciding on midwifery care. All CMs and CNMs have earned at least a bachelor's degree, and more than 80 percent hold a master's degree or higher. CMs and CNMs graduate from a nationally accredited education program, pass a rigorous national certification exam, and are licensed to practice. Certification helps to ensure that midwives provide their clients with a safe mechanism for consultation, collaboration, and referral if needed.

Certified nurse-midwives (CNMs) and certified midwives (CMs) offer a variety of high quality health care services for women. When you first visit your midwife, she or he will take a complete family and personal medical history, and give you a thorough and gentle examination. Birth control counseling, prescriptions and follow-up examinations are available. CNMs and CMs specialize in caring for women during pregnancy, labor and delivery, as well as after birth. Midwives care for adolescents, women of childbearing age and women during menopausal years.

Today's CNM/CM is a skilled healthcare professional who provides primary healthcare to women. This includes evaluation, assessment, treatment, and referral to a specialist, if required. CNMs and CMs emphasize health promotion, education, and disease prevention. CNMs and CMs provide preconception counseling, care during pregnancy and childbirth, normal gynecological services, and care of the peri- and post-menopausal woman. With health education as a primary focus, CNMs and CMs help prevent problems and assist women in developing and maintaining good health habits. Midwives can prescribe medications including methods of contraception and treatment for common infections.

CNMs/CMs are highly educated. Certified nurse-midwives (CNMs) and certified midwives (CMs) graduate from an accredited education program and pass a rigorous certification exam. Because of the high standards established for education and certification, CNMs are licensed in all 50 states and the District of Columbia. They are experts, held to the rigorous standards of practice set by the American College of Nurse-Midwives (ACNM) and by state licensing organizations. They attend continuing education programs offered by hospitals, universities, and ACNM. Certified midwives (CMs) must meet the same rigorous standards of practice as CNMs, but they do not have a nursing degree.

Certified Nurse-Midwives Provide Quality Care
According to a 1998 study of birth certificate data comparing outcomes for physicians and nurse-midwives in 1991*;

• The risk of neonatal mortality was 33 percent lower for births attended by CNMs;
• The risk of delivering a low birth weight infant was 31 percent lower for CNM attended births;
• The mean birth weight was 37 grams heavier for CNM attended births;
• The infant mortality rate was 19 percent lower for CNM attended births.

Certified Nurse-Midwives Are Cost-Effective
A study at two Kaiser Permanente Medical Centers in California showed a 13 percent or $292,000 reduction in payroll costs at one center and a 7 percent or $2 million reduction at another center when CNMs were added to the obstetric team.

If only 100,000 births were attended in birth centers, not only would access to care improve, but annual savings would total almost $314 million. **

*Source: MacDorman MF, Singh GK. Midwifery care, social and medical risk factors, and birth outcomes in the USA. J. Epidemiol Community Health, 1998: 52:310-317.
**Source: Health Insurance Association of America and National Association of Childbearing Centers Annual Survey, 1995

*taken from "Midwives: Frequently Asked Questions," Every Baby magazine, Issue Four.