What Is A Direct Entry Midwife ?

In the US, there are two types of midwives: the direct entry midwife (DEM) and the certified nurse midwife (CNM). If you are going to have a homebirth, it is very likely that you'll be attended by a direct entry midwife. However, there are few types of these midwives. This article explains what direct entry midwives are, their certification and legality issue.

Direct entry midwives (DEM) are midwives who enter the profession by a variety of routes distinct from nursing, including: apprenticeship with senior midwives, attendance of accredited midwifery program, and/or self-directed study of midwifery. These midwives usually provide services in out-of-hospital setting.

Types Of Non-Nurse Midwives

There are four types of direct entry midwives:

• Certified professional midwife (CPM)
  A Certified Professional Midwife is a direct entry midwife who has met the standards for certification set by the North American Registry of Midwives (NARM). A certified professional midwife may enter the profession through either apprenticeship, self study or midwifery school.
  
  If you want to hire a homebirth midwife, consider hiring a certified professional midwife since this organization is the only organization whose certification requires a midwife to have knowledge about and experience in out-of-hospital settings.FOr more information on certification by NARM, visit their website: www.narm.org.
  
  
• Licensed midwife (LM)
  Licensed midwife is a midwife who is licensed to practice in certain state. These midwives may or may not carry a national certification like the ones issued by NARM or ACNM.
  
  It is important to note that the legalility of midwifery varies from state to state. Therefore, before hiring a homebirth midwife, check the regulation governing midwifery practice in your state which can be found in The Midwives Alliance of North America (MANA) website: www.mana.org. If your state is the state where a midwife is required to have a license, then it is a good idea to get the licensed midwife to attend your homebirth.
  

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• Certified midwife (CM)
  A Certified Midwife (CM) is a non-nurse individual educated in the discipline of midwifery, who possesses certification from the American College of Nurse-Midwives (ACNM).
  
  In order to become a certified midwife, one has to have a background in health-related field other than nursing, completes ACNM-accredited midwifery education program (i.e. the same one attended by a nurse who wants to become a certified nurse midwife), and completes the national certification exam by ACNM.
  
  Since certified midwife is a new profession, CMs are not recognized by every state. Currently, only New York recognizes the Certified Midwife credential or offers an educational program to become a Certified Midwife.
  
  CMs usually practise in hospital, just like nurse midwives, and do not usually assist homebirth. In fact, since their midwifery education is similar to those of nurse midwife, then it is very likely that they may not have out of hospital birth experience under their belt when they first graduate.
  
  However, over the time, some of these midwives may be interested to assist out-of-hospital birth setting and build up experiences on that. Indeed, some nurse midwives, despite lack of out-of-hospital-birth experiences when they freshly graduated from the midwifery school, decided to focus on out-of-hospital for their subsequent career. Often, these nurses end up specializing in helping birth at free-standing birthing centers.
  
  
• Lay midwife
  Lay midwife is a midwife who is uncertified or unlicensed and who was educated through informal routes such as self-study or apprenticeship. Some people call these midwives traditional midwife, granny midwife or independent midwife.
  
  Although a lay midwife is not educated formally, or not certified/licensed (either because she chooses not to become certified, or there was no certification available for her type of education like it had been before the CPM credential was available), it doesn't mean that a lay midwife is an inferior practitioner.
  
  Many lay midwives have the good judgment and solid birthing skills that come from years of experiences. On the other hand, a newly certified/licensed midwife with only a few birth or years of experience may not be as competent as a lay midwife who has attended hundreds of births.

Certification and Legality Status of Direct Entry Midwife

Since the legality status of a direct entry midwife varies from state to state (see The Midwives Alliance of North America (MANA) website: www.mana.org), then if you are hiring a homebirth midwife, it's good to know which type she is, and what the laws are in your state pertaining to that type.

In states where midwifery is legally regulated, a direct entry midwife is usually required to have some sort of documentation which can be in form of state license or permit and/or certification from recognized national organization. The certifications/licensures let consumers know that the direct entry midwife has met a certain educational/knowledgeable standard to be what the certifying agency deems as safe. However, there are usually some restrictions, too, such as prohibition to attend breech baby and twins.

If you live in these state and want to keep everything legal, don't forget to ask your midwife's schooling or her path to midwifery, as well as her certification. It is important to remember that the term 'direct entry midwife' and 'lay midwife' can be used in so many different ways. The only thing you can be pretty sure of if a midwife uses these titles are that she is not a nurse-midwife. Therefore, asking the certification and her path of midwifery is more informative than just asking for a title.

In states where a midwifery is alegal (meaning: the midwives are not legally regulated, but not prohibited), you can pretty much go with any type of direct entry midwife, even if she's not certified or has a formal midwifery education. Indeed, in legal states, we tend to be more hung up on titles and education, but in reality, none of these is what makes a midwife a good midwife. Remember, Ina May Gaskins, who is a very good and famous midwife from Tennessee was a lay midwife to begin with. She did not go to midwifery school before she practised midwifery. True, she now carries national certification (CPM) and is also a licensed midwife (LM) for Tennessee. But, she was a good midwife long before she acquired these certification.

If you happen to live in illegal states, where non-nurse midwives are not allowed to attend a homebirth, then you theoritically cannot have a homebirth with a midwife. You can, however, have an unassisted homebirth or opt to give birth at a free-standing birthing centers.

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Midwifery articles:

• What is a midwife ?
• Midwife services: how a midwife care for you during pregnancy, labor/birth and after birth
• Midwife fee and how to pay for it
• How to choose and find a midwife
• In what birth setting you can use a midwife ?

Other articles which may interest you:

• Why choose to have a natural birth ?
• Why homebirth ?
• Giving birth at hospital
• Giving birth at a birth center

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