Call the Midwife! It's not just a television show with seven seasons on Netflix and an eighth season set to hit PBS in 2019. It's a profession and a calling. . . ring, ring, ring. Are you meant to pick up the call? In this article, we are looking at what is a midwife, and how to become one. Let's get started . . .
What is a Midwife?
First things first, do you remember learning about old English? That knowledge is going to come in handy right now. . . When defining what a midwife is, you have to look at the meaning of the word itself. Midwife literally means: "with woman" in old English. Mid meaning with and wife meaning woman.
This meaning of what a midwife is translates to the care they give and the relationship that they have with the women that they serve. It also is embedded in the way that they view birth and pregnancy.
According to an integrative review on midwifery and midwives, "Research and theoretical sources support the concept that being 'with woman' is a fundamental construct of midwifery practice as evident within the profession's philosophy. . . . The philosophy of being 'with woman' acts as an anchoring force to guide, inform and identify midwifery practice in the context of the rapidly changing modern maternity care landscapes."
Midwives are often the lead healthcare professional in a childbirth setting. However, for women with complicated or risky pregnancies, midwives typically work in tandem with a doctor, who can provide additional care if needed; or based on the risk level of a woman's pregnancy they may not take on a client but recommend an obstetrician that may best serve the woman's needs.
What is a low-risk pregnancy?
The level of a woman's risk level for a safe natural, birth experience is assessed using the following criteria based on a study conducted by Kimberly Gregory, M.D from Cedars-Sinai Medical Center in Los Angeles:
. . . in order to be a candidate for home birth, exam and laboratory tests must be within normal limits and show no evidence of. . .
Epilepsy or seizure disorder
Severe psychiatric disease
It should be noted even though pregnancies with multiples (twins/triplets) or babies that present as breech are not often taken on by midwives because of a slightly higher risk level; there are midwives that will take on clients with such pregnancies. Midwives that take on such clients often have the experience and knowledge needed and also view one or both (multiple pregnancy or breech) as a normal pregnancy.
3 Ways Midwives Build Relationships with Clients
A key aspect of midwifery is the relationship between the midwife and the expectant mother. Midwives focus on building strong relationships with their patients.
Certified Nurse Practitioner Kimla McDonald, who practices at George Washington University Hospital, says, "One myth I'd like to dispel up front is that midwives keep women from getting pain relief! If you want it, you can have it. You won't disappoint us! And it is not a competition. Having a baby is an intense experience. We provide the personalized care and support women really want and need."
Midwives often build these strong relationships with the expectant mothers that they are serving through the following three practices philosophies:
1. Location of care
Midwives often make home visits for prenatal appointments. And often do not just serve their expecting mothers in one setting type. Midwives can be helping a laboring mother either at a hospital, freestanding birth center, at a birth center out of a hospital, or midwives may be found on the labor and delivery floor at a hospital.
Midwives are on call for the expectant mothers that they take on as clients. Midwives do not work shifts with a predictable work schedule; unless they work at a hospital. They make appointments for prenatal visits, but when a mother goes into labor at 10 am or 3:20 am, they may be called on for a shift until the mother has delivered her child. For this reason, midwives always work with an assistant and have a backup midwife that they can have a client call in case two women go into labor at the same time.
3. View on birth
Midwives view birth as a natural event of life. It is not seen as a medical process, but as an event. Whereas a midwife, they are present, to be with a laboring woman and to help facilitate a baby's entry into the world safely with minimum interventions.
Midwifery Backed by Science
Scientific studies of midwife-led health care for pregnant women strongly support the practice. Research has consistently found that healthy women whose pregnancies are overseen by midwives are less likely to need surgery during childbirth and more satisfied with the overall experience than women who receive other kinds of natal care. Midwife-led childbirth also tends to be less expensive and less stressful for the mother. One major study published in the Cochrane Review concluded that healthy women should seriously consider working with a midwife as their primary health care provider during pregnancy and childbirth.
8 Different Services Midwives Offer
Midwives also specialize in providing women's health education, ensuring that their patients are equipped to care for themselves and their babies. Midwives care for their clients up to six weeks after a baby has been delivered. Here is a list of other services midwives may provide for the clients that they serve before and after pregnancy:
Annual gynecological exams
Family planning and contraception
Fertility education (nutrition, and exercise)
Labor and delivery care
Breastfeeding and lactation assistant
If the type of midwife you are seeing is a certified nurse midwife, they may also prescribe treatments such as surgery or medication; provide annual exams, pap tests, referrals for a mammogram, birth control, and referrals for colonoscopy. For example, the same way physicians or Nurse Practitioners do.
CNM Kilma McDonald sums up the full services and care all midwives give very well when she says, "We take care of women through their lifespan, and not just during pregnancy... We meet the majority of women's health service needs".
Now that we know what a midwife is and what they do, let's find the differences in the types of midwives, what the journey is like to become a midwife. . .
The 3 Different Types of Midwives
There are three types of midwives certifications. Each type is achieved through a different process to achieve the career path. There are certified nurse midwives, certified professional midwives, and direct entry midwives. Let's look at each type:
Certified Nurse Midwives:
A certified nurse midwife is also known as a CNM. This type of certification is provided through the American College of Nurse-Midwives.
By choosing the CNM pathway to become a midwife, a midwife may provide care and services in a hospital, birth center or home birth; and obtain licensing in all 50 states to practice their skills.
This is because certified nurse midwives are both registered and trained as nurses and midwives. At the conclusion of midwifery, schooling and education as a certified nurse midwife, this type of certification leads to either masters or doctoral degree.
Certified Professional Midwives:
A certified professional midwife is also known as a CPM. This type of certification is provided through the North American Registry of Midwives (NARM). Certified professional midwives undergo similar expectations as a certified nurse midwife.
One difference in expectations and qualifications is that a certified professional does not need to also hold a nursing license. For this reason, the certified professional midwife pathway may be a good choice for a person who has a bachelor or masters degree in a different field other than nursing or the behavioral health field.
Another difference is, certified professional midwives also are required to have experience with home births and certified nurse midwives are not. Certified professional midwives are independent midwife practitioners who focus mainly on pregnancy and home births or birth center births. Certified professional midwives do not work in hospitals.
One potential drawback to the certified professional pathway to becoming a midwife is the legal status of it. At this time, their CPM's are only allowed to become licensed to practice midwifery in the following five states: New York, New Jersey, Rhode Island, Maine, and Delaware.
Direct Entry Midwives:
Direct entry midwives obtain their experience and knowledge about midwifery through apprenticeships, self-study, or independent colleges or schools. The legal status of this route varies by state.
7 Steps to Become a Midwife
You might be wondering, what do I need to become a midwife? There are 7 steps as to how to become a midwife. Here is a list:
Examine: What is your career path? Is midwifery your calling? Or is being a midwife's assistant, doula, birthing class instructor, or a birth photographer more your calling?
Land on a career: If after examining your many options, you see yourself being a midwife, embrace it.
Read: Get books on midwifery, birth stories, and the biographies of midwives. And hey, don't forget to catch Call the Midwife to past some time.
Look at your education: What fields have you embraced through your higher education? Have you already divided into the field of nursing and/or behavioral health? Or are you looking into midwifery as a career field shift?
Choose: Which of the three types of midwifery (certified nurse midwife, certified professional midwife, or direct entry midwife) are you going to pursue?
Complete: Complete the training and certification requirements needed for the midwifery path that you have chosen.
Practice: Start practicing the art of midwifery care either through a position at a hospital, birth center or establish your own business as a midwife and the act of being self-employed.
What Qualifications are Needed to Become a Midwife?
"It's not all about birth and babies", says certified Nurse Midwife Kimla McDonald, "but that's why most of us get into the field". Every person has their reasons for choosing a career, just like certified Nurse Midwife Kimla McDonald.
Let's look at what ten qualifications are needed to get into the field and become a midwife as well as the attributes and characteristics needed to be a midwife:
1. Excellent communication skills
2. Developed active listening skills
3. Well-refined observation skills
4. A high ability to work as a team with others
6. Problem-solving skills
7. Deductive reasoning skills
8. Steadfastness and calmness
9. Organizational skills
10. Time management skills
In a survey on becoming a midwife, "Forty-two midwifery alumni viewed becoming a midwife as a blend/combination of:
1. gaining the knowledge and practical skills required for the profession
2. management skills in areas of running a business
3. Working with other people
4. Navigating local procedures and processes effectively
5. Balancing work with personal life
6. Gaining confidence in one's competence
7. and having support along the way".
Midwifery Schooling and Education
The schooling and education that you need will depend on the route you choose to complete your path to midwifery.
If you choose to become a certified nurse midwife, the first step is to complete a bachelor's degree in nursing and then to receive a license as a registered nurse. Then follow it up with receiving a graduate degree in midwifery.
If you choose to become a certified professional midwife you will need a bachelor's degree in any behavioral health field or any other field and then training to be a midwife.
If you are looking at becoming a midwife through the direct-entry pathway, it is recommended that you look at networking with local midwives for an apprenticeship.
There are many colleges, universities, and independent midwifery schools in the nation.
How many years to become a midwife?
The length of time it takes to become a midwife again is connected to the path you choose to go into midwifery.
Certified nurse midwife and certified professional midwife: A minimum of four years for the required bachelor's degree and then two to three years for the completion of a masters degree in midwifery or training required.
Direct entry: A minimum of three years and a maximum of seven years.
Midwifery and Salary
Midwife salary can range based on the state you live in, the type of midwifery licensing and certification you have, and if you provide care to your patients in their home, birth center, or hospital.
If you choose to become a certified nurse midwife, and work in a hospital or a birth center within a hospital, according to the Bureau of Labor Statistics, the average yearly income can range from $91,000 in Maryland to $132,000 in California.
If you choose the certified professional midwife or direct entry midwife pathway, and either work at a freestanding birth center or run a business offering home birth services to women. You may find yourself earning $200-$7,000 per birth. You may only also find yourself taking on no more than one to three clients per month.
Midwife or Doula?
Often times, people on the journey to Midwifery will first become a doula to gain experience around birth while getting a feel for the field or before they start their education as a midwife. Others prefer to choose a career as a doula over being a midwife.
There are both differences and similarities between the roles and care that midwives and doulas provide women.
29-1161 Nurse Midwives. (2018, March 30). Retrieved October 11, 2018, from https://www.bls.gov/oes/current/oes291161.htm
Bradfield, Z., Duggan, R., Hauck, Y., & Kelly, M. (2018, April). Midwives being 'with woman': An integrative review. Retrieved October 8, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28807466
Children, B. O., Y., & Families, A. (2013, September 23). Assessment of Risk in Pregnancy. Retrieved October 9, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK201935/
Patterson, J., Macznik, A. K., Miller, S., Kerkin, B., & Baddock, S. (2018). Becoming a midwife: A survey study of midwifery alumni. Women and Birth. doi:10.1016/j.wombi.2018.07.022