National Midwifery Week 2015

It’s National Midwifery Week, which is why we’re addressing what exactly it means to be a midwife.

For a job description that’s loaded with immense responsibility and the potential to solve the world’s maternal health crisis, the title “midwife” is a little vague. It has been used throughout history to describe any person who delivers babies, whether she’s trained or not. It’s also used to describe highly trained and skilled healthcare professionals who can safely provide all the sexual, reproductive, maternal and newborn healthcare services necessary for about 90% of the world’s population.

In some countries, a local village woman who catches all the babies and learned her skills at her mother’s knee is called a midwife. In others, a trained birth attendant is a midwife. In Haiti where we’re invested in training “midwives,” and in some other developing countries the term is used to describe a care provider with approximately a year or more of specialized clinical training to perform basic maternal and women’s health services.

It’s that great variation in “who exactly is a midwife” that’s part the problem the world of midwifery is facing right now. Some mothers die because their “midwife” doesn’t know what she’s doing. Some “midwives” leave the profession or move to areas where there’s less need for her services because despite advanced training, her work isn’t respected or fairly compensated. It’s a problem international maternal health leaders are working to amend because development of nationally recognized training protocols to perform sexual, reproductive, pregnancy, childbirth, newborn and postpartum care at an acceptable standard is becoming increasingly essential to reducing maternal mortality.

The International Confederation of Midwives (ICM) provides this globally accepted definition for What Is A Midwife?:

• A midwife is a person who has successfully completed a midwifery education
• program that is duly recognized in the country where it is located and that is
• based on the ICM Essential Competencies for Basic Midwifery Practice and the
• framework of the ICM Global Standards for Midwifery Education; who has
• aquired the requisite qualifications to be registered and/or legally licensed to
• practice midwifery and use the title ‘midwife’; and who demonstrates
• competency in the practice of midwifery.

The United Nations Population Fund offers this list of basic services midwives routinely provide to protect the health of the mother and baby:

• Caring for women during pregnancy, childbirth and the postnatal period
• Treating complications due to miscarriages and/or unsafe abortions
• Providing newborn care
• Providing pre-pregnancy advice and health education
• Recognizing and addressing problems in the woman and newborn before, during and after childbirth
• Offering general health information, including reproductive health care and family planning
• Assisting women to successfully breastfeed
• Referring women and newborns for higher level care when complications arise during pregnancy and childbirth
• Providing additional health services in communities such as immunizations and treatment of common illnesses

In the US, the most familiar type of midwife with the widest scope of practice is the Certified Nurse Midwife who routinely works in doctors’ offices, clinics, birth centers, homes and hospitals. While in many parts of the world, midwives can perform C-sections, here in the US, CNMs provide the full range of services needed for normal, healthy women’s and maternal healthcare, but they don’t do surgery or take care of high-risk patients. In addition to Certified Nurse Midwives, there are many other education and licensing pathways that midwives can follow to become skilled providers. Here’s a breakdown of the types of midwives practicing in the US:

• Certified midwives meet American College of Nurse-Midwives (midwife.org) requirements, but aren’t necessarily nurses.
• Certified nurse-midwives are nurse- practitioners who are certified by the American College of Nurse-Midwives.
• Certified professional midwives meet North American Registry of Midwives certification standards.
• Direct-entry midwives are educated through self-study, apprenticeship, midwifery school or college/university-based programs that don’t include nursing. They include certified midwives and certified professional midwives.
• Lay midwives are sometimes called traditional, unlicensed or “granny” midwives. They’re educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren’t certified or licensed.
• Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.

It’s important to note that it’s a midwife’s skill level that determines her expertise, not necessarily the educational path she took to become a midwife. We know of exceptional midwives all around the world with both non-traditional and traditional educational backgrounds and licenses who are providing high quality care. We also know that many “midwives” lack the training and professional support they need and deserve to provide the skilled, responsible and desperately needed services they’re called to perform. That’s why EMC continues to support midwifery care and training in many of our programs around the world.