Midwifery refers to the care of women and childbearing people during pregnancy, childbirth, and the postpartum period, as well as care of the newborn baby. Midwives—people who practice midwifery—may provide advice and education about pregnancy and labor to help people make informed decisions around childbirth. They support women and childbearing people through labor and birth and deliver babies in various settings including hospitals, birth centers, and in homes.

Some midwives also provide additional medical services, such as family planning and sexual, reproductive, and gynecologic health care, as well as care for newborns during their first weeks of life and primary care throughout a person’s life, beginning in adolescence.

Historically, midwifery has been practiced around the world for millennia. Today, in the United States, it is a legally recognized, professional vocation, with most midwives completing formal midwifery education and advanced training programs.

People in the United States have less access to midwifery than residents of many other high-income countries. For example, in the U.S., for every 1,000 live births, there are only 4 midwives, while in other high-income countries there are as many as 30 to 70 midwives.

Those who use midwifery services often report higher patient satisfaction than those who do not work with midwives.

“The midwives at Yale provide care through the lifespan, including gynecology, pregnancy care, hospital labor and birth management, and postpartum care,” says Yale Medicine certified nurse-midwife Heather Brigance, CNM. “A hallmark of midwifery practice is a strong focus on patient education and shared decision-making.”

A midwife is an individual who is trained in the care of women and childbearing people during pregnancy, labor, birth, and the postpartum period. Their scope of care may also extend to other medical services including care of the newborn, gynecologic care, family planning, and routine primary care. Some midwives are authorized to prescribe medications, conduct physical exams, order diagnostic tests, and make diagnoses.

In general, midwives promote minimal intervention during normal childbirth, though they advise interventions when medically necessary. They typically provide independent care for uncomplicated or low-risk pregnancies, and work with a physician to manage high-risk pregnancies. Midwives are also trained to identify complications during pregnancy, labor, and delivery, and can consult with or refer women and childbearing people to a physician should complications arise. They do not perform cesarean sections (c-sections), though they may assist doctors during the procedure.

In the U.S., there are three categories of certified midwives. They differ based on their educational background, education and training in midwifery, the settings in which they work, and the services they provide.

• Certified nurse-midwife (CNM). CNMs are licensed registered nurses (RNs) who have completed a graduate-level midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME). To be a CNM, they must also pass a national certification exam administered by the American Midwifery Certification Board (AMCB).
  
  Beyond care during pregnancy, labor, and in the postpartum period, CNMs can provide a broad range of health care services, including family planning, gynecologic health, preconception care, and sexual and reproductive health. They may care for the newborn during the first 28 days of life and offer primary care to individuals starting in the teenage years. CMNs conduct physical exams, order and interpret laboratory and other medical tests, make diagnoses, and admit, manage, and discharge patients.
  
  Most CNMs work in hospitals, though they may also attend births in homes, birth centers, and offices. They can be licensed to work and prescribe medications in all 50 states.
  
• Certified midwife (CM). CMs have completed a graduate-level midwifery program accredited by ACME. They must also past the same national certification exam that CNMs take. However, CMs are not registered nurses and typically do not have a nursing degree.
  
  CMs provide the same set of services as CNMs, however they are authorized to work and can prescribe medications only in certain states.
  
  Like CNMs, CMs most often attend births in hospitals, though they may also work in homes, birth centers, and offices.
  
• Certified professional midwife (CPM). CPMs must have at least a high school diploma or equivalent. They must also complete an education program accredited by the Midwifery Education Accreditation Council (MEAC) or an apprenticeship program and pass an exam administered by the North American Registry of Midwives (NARM).
  
  CPMs provide care, advice, and support during pregnancy, birth, and the postnatal period. They may also provide routine medical care during the first six to eight weeks of the baby’s life. However, CPMs cannot prescribe medications. They are legally authorized to work in many, though not all, states.
  
  CPMs typically attend births in homes and birth centers, though they may also work in offices.

Some midwives, often referred to as lay midwives, practice without having obtained a certificate. Unlike the other types of midwives discussed above, lay midwives have not completed a formal educational or apprenticeship program and are not considered medical professionals. Because they do not complete a standard educational or training program, their level of training and knowledge may vary. They usually provide midwifery care in homes or birth centers. In the U.S., regulations for lay midwives vary by state.

Medical insurance coverage for midwife services may vary by state, policy, and type of midwife.

Doulas are trained professionals who help childbearing people through the emotional and physical aspects of pregnancy, childbirth, and the postpartum period. They help people feel more comfortable during labor by helping them manage stress and pain. They also provide information about pregnancy, labor, deliver, and the postpartum period. They may also attend prenatal medical appointments and procedures, and can be present during labor, including during cesarean sections. However, doulas are not medical professionals. Unlike certified midwives and physicians, they do not provide clinical services or perform medical procedures.

Doulas can make up part of a patient’s maternity health care team, working alongside certified midwives, nurses, and doctors. Because doulas and midwives provide different services, people may use the services of both during pregnancy, childbirth, and the postpartum period.

Studies have found that using the services of a midwife can improve certain outcomes for the childbearing person and baby. For example, studies have shown that midwifery may reduce:

• Use of epidurals or regional pain management
• Number of instrumental deliveries (also known as assisted births, these deliveries involve the use of forceps or a vacuum device to assist in delivery)
• Number of caesarean sections (c-sections)
• Use of medications for pain relief during pregnancy, childbirth, and the postnatal period

Studies have also shown that childbearing people who use a midwife are more satisfied with the childbirth experience.

Yale Medicine's nurse-midwifery practice has pioneered efforts to make the birth process more mother and child-centered. We reduce the separation of mother and baby after birth, make sure that the laboring mother is attended to throughout the birth process and help women to have the greatest chance of achieving their desired birth.

The Nurse-Midwifery program is also one of the oldest in the United States, founded in 1956.

At Yale Medicine, there is a special relationship between obstetricians, maternal-fetal medicine specialists, and certified nurse-midwives. Because of the long history of midwifery in the Yale Medicine community, certified nurse-midwifery is embraced and the relationship is strong and positive.