We need to talk about midwives...

Midwives are a crucial part of healthcare teams around the world - where I’ve worked all over the US, where I currently work in New Zealand, and practically every other country on the planet. However, the confusing regulation (or lack thereof) of midwifery in the United States is downright dangerous. If I, a board-certified obgyn who regularly worked with midwives all the time in the US, am confused by the patchwork of regulations, laws, and titles among midwives in the United States, how are patients supposed to figure out which providers will help them have a safe pregnancy and birth? Let’s discuss.
Watch next:
ObGyn Compares Home & Hospital Birth: • Is Home Birth Dangerou...
7 Key Postpartum Questions ANSWERED by ObGyn: • 7 Key Postpartum Quest...
Source:
www.gao.gov/assets/gao-23-105...
Want to support science & connect with us? Join the MDJ community:
/ @mamadoctorjones
I stream on Twitch weekly (usually Sundays): / mamadoctorjones -
Playlist of full-length Twitch streams for channel members: • Full-Length Live Streams
FOLLOW ME ON SOCIAL:
Instagram: / mamadoctorjones
Twitter: / mamadoctorjones
TikTok: / mamadoctorjones
** The information in this video is intended to serve as educational information and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/advanced practice provider. **
+++++++++++++++++++++++++++++++++++++++++++++++++++++

[@MissyAmy88]

As a Norwegian nurse it baffles me that "Midwife" is not a protected title. It should be a single certified profession as it is in Europe. In Norway if you are a Midwife that means you are a certified nurse who has a masters degree in midwifery. No one else is a midwife. Almonst everyone who gives birth in Norway does so with the help of midwifes. You can be sure that they have both the experience and knowledge needed. The US is backwards with so many things when it comes to healthcare.

[@seanbean002]

Same in Germany. The labor and delivery ward in hospitals are majority staffed by midwives. Then when assistance is needed, the OB, surgical nurses etc. come in - as was my case. But the midwives are so well educated and trained. The US is backwards in this regard.

[@TheDecoCottage]

Agreed! As an American I currently see a CNM for all my women’s related healthcare.

[@katrakossacino2620]

​@@TheDecoCottageAs in annual screenings? What about BV, yeast infections? Can they write scripts? Order a mammogram or any tests during pregnancy or regular care? Interested in USA and abroad.

[@nep_viu8291]

I agree, I'm a midwife student in Denmark and here nurses have *nothing* to do with birth or delivery. Our education is a "professionsbachelor", which means when you're done you have a bachelors degree fit for that specific profession, in this case midwifery. We have doulas (only private), midwives, SOSU'er (social and health assistant) and doctors who are the only ones really trained to assist with delivery. The US system seems to be very backwards as you so well put it

[@TheDecoCottage]

@@katrakossacino2620In the US a CNM has kind of along the lines as a Nurse Practitioner. It’s a registered nurse with additional additional training. In the US CNMs can order tests, prescribe medication, diagnose and treat common ailments, oversee a pregnancy and deliver babies. Mine is in the same hospital practice with OB/Gyn.

[@zainab58]

It's hard to discuss midwifery in America without spending some time on the historical fact that, in the course of the 19th century, midwifery as a profession was simply obliterated in the US, even while the rest of the world developed top-quality specialized training. So the US had to rebuild everything from scratch.

[@KxNOxUTA]

And they did a very poor job of that rebuilding!

[@SpySappingMyKeyboard]

What caused that obliteration? I have never heard of that

[@TehMomo_]

​@@SpySappingMyKeyboardprobably men...

[@bluedreams517]

@@SpySappingMyKeyboard Definitely men with a sprinkling of racism. Basically they were wanting to make the study of obstetrics legitimate as a medical/scientific practice that was systematic. So instead of using the existing network of midwifes (who were almost entirely women) to inform practice and start to unify care, they decided to villainize midwives as dangerous...often painting them as backwards and from questionable heritages. It wasn't initially effective....can't fully remember what finally led to the shift. But I think it was something about the hospital route becoming popular among upper class women which then led to midwifery further being seen as an uncouth/lower class practice.

[@dietotaku]

@@SpySappingMyKeyboard a for-profit education system and for-profit healthcare system, combined with a puritanical and therefore hugely misogynistic society, basically saying "no no we can't have WOMEN who haven't even had proper SCHOOLING (i.e. an expensive medical degree) go around delivering babies --forwaylessthanwecharge-- that's ludicrous!"

[@BexsBoxofConfusion]

My original life plan was to be a midwife. In Sweden it is 3 years for a nursing degree, 2 years work experience, and then a 2 year advanced midwifery degree. So 7 years in total to become a midwife. To me midwife should be a protected title that only people with a specific qualification should be able to call themselves. Others can be doulas, midwife assistant, birthing assistant… extra eyes and ears and hands

[@abigaileg7345]

Sweden has such outstanding healthcare!!! ❤ Saknar Sverige😢

[@SB-ht8uo]

The path to nurse midwife in the US is similar. 4 years for BSN, a few years of experience in the specialty and then a 3 year DNP midwifery program. I had NO idea there were midwifes without nursing degrees in the US. I think we need to advocate more for this specialty and for the protection of our patients.

[@Kiki-sf1em]

My daughter was born with a certified nurse midwife and she was amazing. I originally thought she would just be assisting an OB but she handled the entire delivery. At some point my daughter’s heart rate dipped a bit and an OB was paged and came in but by that point her heart rate was back up and the OB just said “looks like I’m not needed!” and left. My midwife was so calm, cool, and collected and was the perfect mix of encouraging without being infantilizing. With her support, I pushed my daughter out in less than an hour.

[@dietotaku]

sometimes i think if i'd had access to a midwife, maybe my first child wouldn't have been asynclitic, maybe my labors wouldn't have stalled and i wouldn't have had to go through 2 c-sections...

[@vickimcburney8977]

I'm glad that you had a good experience. My grandson was delivered by a stressed out, angry midwife, who missed all the signs of a serious complication. We nearly lost them both. She was too proud to ask a doctor for help. .

[@nic00001]

⁠​⁠@@vickimcburney8977i’m so sorry to hear that 😞 i hope your family and your grandkids are okay today

[@mellocheers9062]

What country was this?

[@Kiki-sf1em]

@@mellocheers9062 The US!

[@gwendofrendo]

LONG comment but I want to express how much your channel has changed my life. When I first started watching your channel in 2019, I was passionate about birth work and was planning on becoming a certified midwife who did exclusively home births because that's all I had experienced and been taught that was the only right way. My mom had 8 births (7 live births) and I (her eldest child) was the only one who was planned to be born in the hospital. The majority of her births ended up having to be transferred before or immediately after delivery. I think only one or two of my siblings were actually born at home with no complications, as well as one still birth. I was probably six or seven at the time and too young at the time of the stillbirth to know the details and if that baby could have been saved if she had been born in a hospital. That being my background, I wanted to be the type of midwife my mom used. I attended one of her births when I was 15 and she delivered my 12 pound 11 oz brother at home and immediately began hemorrhaging after he was delivered and she was rushed to the hospital. Most terrifyingly, the midwife did very little medical intervention (aside from telling my stepdad to call an ambulance) and just prayed for my mom and told her to will her body to stop bleeding. Luckily, both my mom and my little brother were/are okay. And yet this was so normalized to me that I held onto my dream of being a midwife for 5 more years after that experience. When I started watching your channel, I felt defensive about your attitude towards midwives (in the way that I knew them) but the way you demonstrated care and compassion towards all people and how passionate you were for your work kept me engaged. Your channel is a big part of the reason I ended up moving away from that career. While there were other reasons (i.e breaking away from evangelicalism, the pandemic giving me space to reevaluate, and doing my own research into science, gaining more trust in medicine in general, etc) I don't know that I would have had the capacity to open my mind to other options without the information and education your provided. I am very appreciative of your work and I wanted you to know that you made a difference in my life. While I never did go down the obgyn/nurse midwife field (I just completed an education in occupational therapy and am happier than ever), Obstetrics and gynecology have still continued to be special interests for me and I am still very excited when I see a new upload from you! Thanks MDJ!

[@MamaDoctorJones]

Thank you for sharing this!

[@tammystockley-loughlin7680]

Thank you for sharing your journey. I'm glad you found your calling...we definitely need more helpers in this world. Positive vibes from New Hampshire, remember to be kind to each other and yourself during these trying times.

[@anainesgonzalez8868]

Thank you for sharing! Just wanted to say I work as an occupational therapist and it was the best decision of my life I love my job.

[@elizabethlebaron9545]

That’s crazy, my certified midwife keeps cytotec on hand to stop bleeding.

[@preciousmourning8310]

I'm sorry you had to deal with that, consider being a nurse midwife instead of the lesser levels which aren't as safe.

[@33snowgal]

I had a certified nurse midwife in canda. Absolutely positive experience. 4 hospital births with them but they do homebirth as well and transfer if needed. And screened, hired and paid for by public health care I felt more in charge, they also did home visits the first few weeks which was a-mazing

[@marialeija6635]

I wish it was the case in the U.S unfortunately it doesn’t seem like we’re getting closer to that

[@maryblakley3590]

Same here! Gave birth twice in Ontario, both times with midwives. They are university trained and an integrated part of our health care system. It was an amazing experience both times (one hospital birth, one birth centre birth). The longer visits and six weeks of post-partum care was amazing.

[@joanna0988]

Same here in BC. My recovery was sooo much better than with doctors.

[@kvv90]

Had an amazing homebirth in Ontario with midwives. Had to briefly go to the hospital for stitching my fourth degree tear, but it doesn't change how positive my birth experience was. I'm so grateful our healthcare system includes highly trained midwives!

[@GoBlueGirl78]

Midwives here in Canada are regulated health professionals with midwifery degrees or nursing degrees plus graduate midwifery training. They can admit patients & deliver in hospitals, birthing clinics or at home, prescribe medications & order tests (their scope is being expanded, too). They provide wonderful prenatal & postpartum care for mom & baby for 8 weeks.They’re pretty incredible. I’ve never had a baby but I would absolutely have a midwife. ❤

[@jumpstart1o]

I LOVE how it actually comes down to the American health insurance system...again.

[@mxclaireharris]

I'm in the UK. I have antiphospholipid syndrome, I always delivered my babies earlier, I had a multidisciplinary team during pregnancy (specialist obstetrics, immunology, haematology and rheumatology) but all the time I was midwife lead through pregnancy and birth. My doctors only saw me when it was necessary. Our midwives are highly trained and it's a protected title.

[@rosesandtoeses]

Unrelated, but a friend of mine had APLS and didn't know about it until it was too late. Does it run in your family? How did you know to be tested for it?

[@mxclaireharris]

@@rosesandtoeses I knew because my first baby was too early. I had a live birth at 19+6 so they wanted to know why. Most families find out because of obstetric tragedies. Not only does it run in the family but you have to assume all family members have it from your level down (offspring, siblings and nibblings). That means no one should be on the pill (POP or depo only), pregnancies should be treated with aspirin throughout. It's a very serious condition and most doctors don't understand it. It acts by masking itself as any other autoimmune disease, so it's worse than any of those, plus all the thrombophilia issues.

[@rosesandtoeses]

@@mxclaireharris I am so sorry for your loss 💜 my friend didn't have any children before she passed so I had no idea it had such severe obstetric implications. However, she hadn't had a period for 5 years before she passed away, and she wasn't on any kind of birth control to cause that. Doctors didn't really do anything about it, you know how health care in the US can be.

[@mxclaireharris]

@@rosesandtoeses thank you and I'm sorry about your friend. AFABs do risky things involving hormones that are linked to clotting (periods, pregnancy, menopause and that's without the pill and hrt) so we are more at risk. If people haven't been officially diagnosed it's good to do things like taking aspirin (75 a day) and avoiding hormones at the very least which are things that can be done without too much input from doctors.

[@preciousmourning8310]

@@mxclaireharris Did you take only aspirin for your pregnancies or daily heparin?

[@kaylaboland637]

As a New Zealander it's wild to me that it's not the norm to have a midwife (fully trained and qualified) for a pregnancy!

[@heidir1113]

I know right?! They’re amazing people who deserve so much more respect and recognition! I had the same midwife for both my babies. With my second she was the only one in the room and it was wonderful.

[@taylorbarnett1199]

I work in the medical field and I had midwifery care and I couldn’t agree with you more! The lack of oversight, requirements and such is concerning and not safe for patients .. it’s also a shame that CNMs don’t attend births at home because of the hospitals rules. Insane

[@ameliasandoval8663]

I don't think many of them would want to anyway. If something went wrong, no only could they lose their midwife cert but their nursing license.

[@mallorylischer]

In Illinois CNM can do home births. I only know two. It’s different from state to state.

[@taylorbarnett1199]

@@mallorylischer they can, but if they do they lose privileges in certain hospitals. That’s what I’m saying

[@TB-rx1ue]

In Georgia, my midwife is a MSN RN CNM

[@leesiemoo]

Kiwi here - I had about 6 midwives through pregnancy, birth, and aftercare due to being considered "complex" . They were all fabulous and I felt so very cared for. Bonus being free on our public health system.

[@melissaf2763]

I'm in Ontario and had a midwife for my 1st birth in March. It's very comforting knowing exactly what training they have. Even if you give birth in a hospital (which I did) they come out to your home multiple times to check on you and baby! Don't know what I would have done without them during that time.

[@RachelBernholtz]

Congrats on your new baby. Its' so much easier here in Ontario with Midwives

[@mainstreammutant]

I have never been (and hopefully will never be) pregnant so I had absolutely no experience with midwives before. I was at my obgyn getting my annual exam and my doctor got called away to deliver a baby. The office staff asked me if I would mind having my pap with the nurse midwife on staff and I said sure. Seriously, what a great experience! I've been getting annual paps for about 16 years and it has always been handled rough and it hurt a little (that was just the way i thought it had it be, i have seen many different obgyns and it was always the same) but this nurse midwife was so kind and gentle that there was no pain at all. Midwives are under rated. I had no idea you could even have a pain free pap

[@sarahharris1512]

If we in the US had the same infrastructure/system around midwifery and hospital care as other countries do, I'd probably consider a home birth! But in the current US system it's just not a safe option in my mind and that's really a shame.

[@MariahRAchel1]

A lot depends on the midwife/team. I’ve definitely heard some scary stories about midwife’s who were underprepared to help their patients. I had a home birth last year and I had a hospital birth a few years ago. For my home birth I saw a midwife who had 2 partners. All CNM’s and they all attended births together so lots of hands just in case although my birth was very relaxed. I also saw 2 OB’s as needed for scans and things. My midwife really could do most common things like stitches and whatnot but they had us fill out a transfer form for the hospital before birth just in case we needed to go so it would be a smooth transition. Everything went great but I appreciated all their prep.

[@emilyhuffman7815]

It really depends on the midwives available to you. I loved my experience with homebirth midwives. My first birth ended up being a transfer due to exhaustion/dehydration (Our cpms were capable/trained to do IV fluids but our state doesn't allow it) and one of them came with me to hospital in a supportive role. My second was a perfect homebirth and I can't recommend it highly enough. . Homebirth midwives should have good working relationships with the local hospitals and make a point of not waiting to recommend transfer. My transfer was calm and literally all I needed was the fluids to get some energy & she was born within 20 minutes of arrival. But you must trust your team and any good midwife should be very transparent about their training & continuing education.

[@estherruth4692]

I found good homebirth midwives. So grateful I did. It’s worth it and totally possible to find good midwives who deliver at home in many places in the US. I absolutely hated my first birth in the hospital with a CNM who was part of a large midwifery group. I had only met her once before I gave birth. It was traumatizing and violent. Thankfully I was able to do everything naturally, but it left such a horrific taste in my mouth. You really need to trust and know your provider before you give birth. My next two births, one in the hospital, one at home, were far better.

[@ashleymills4233]

Home births are no riskier than hospital births if you have the right provider.

[@cierralynseventeen2298]

I'm a doula and I just attended a home birth last week. It was amazing. She had her midwife there but it was hands off. It is a possibility in the US. That was in Idaho

[@eliseb9180]

I'm in the UK and all woman receive prenatal care from midwives. I was technically high risk and consultant (OB/GYN) led, however my checkups were all done by midwives, a midwife was my first point of contact for any issues during my pregnancy and a midwife delivered my babies (in hospitals where there was an OB/GYN in the building, but i never saw them!) Edit - just got to the part where you mentioned the system in NZ, its very similar to how we work in the UK by the sounds of it

[@eliskakomarkova]

Same for me, but we live in Ireland. I was also a higher risk, I’m a wheelchair user, had to be on atb throughout pregnancy and some nerve damage in my pelvis. I’ve mentioned that my preference is a midwife led case at my innitial visit, I was seen by two OBGYNs to clear me and I had a consultation with an anaestesiologist regarding optimising pain management for me beforehand. Apart from that all my care was with midwives incl. my labour. I have delivered my baby vaginally, although I didn’t even believe I could! I’m still proud of myself.

[@cheekyb71]

I trained as a midwife in New Zealand, most of the tutors at college are UK midwives, it is an incredibly similar system. The main difference is that midwives prescribe here and are autonomous practitioners 😊

[@Raztiana]

It's the same in Denmark, and it works great.

[@mumofmany1498]

It's the same in Australia. I expect it's the same in all the developed world apart from the US

[@textilaerika]

It's the same in Sweden.

[@rebeccaburrow7199]

Texas here. My midwife for my first baby is the only independent cnm for a hundred miles. She is amazing and has been in practice so long she has pretty much trained all the cpn and lm in the whole area. Here in texas there are conditions that will graduate you out of independent midwifery, like gestational diabetes, high enough blood pressure, and other conditions. Then you are referred to an obgyn because you are higher risk. But honestly, most women are not high risk. I had all three of my babies at home with my midwife, fast, no complications. (You could also do the birthing center.) She carries pitocin for haemorraging, oxygen, pretty much everything a hospital would have outside of the surgery ward. She has not lost a mother or baby in 30 years. No bones about it, she is one of the best in her field and the midwives that train under her are fantastic too. Sadly, she was not covered by my insurance, so we paid out of pocket. But her fee was the same as what it would have been at the hospital after insurance! And my insurance didnt cover the first six weeks of care after the baby was born, but she did. Such intimate and personalized care. No regrets, 10/10 would do again. I wish every woman could use a midwife and give birth at home (i know that isnt always possible but i wish!). You are not treated like a problem waiting to happen. You are let to do what your body is designed to do and supported in every way. At least, that is my experience. My midwife appreciated the pancakes my dad made too. 😂

[@sarahp6554]

Thank you for talking about this. I loved my certified nurse midwives. For me going to the birth center and having a home-like birthing experience was amazing and comforting. I wish more people had the chance to have a birth like mine if that’s what they want. I was allowed to eat. They encouraged me to drink water the whole time. I got to labor in a tub and got to cuddle up in a queen size bed with my baby and husband afterwards.

[@katyluvsmath]

I delivered my 4th baby at a wonderful hospital in Colorado. I saw a CNM as my primary care provider for my pregnancy, but was also turned over to MFM due to placenta previa and some complications from that around 30 weeks. During my extended hospital stay, I was rounded on daily by MFM, but also by my CNM team. During my cesarean, my midwife came as well, which was super helpful for me having a more familiar person to support me once baby was delivered and my husband left with baby to NICU. I was so impressed at the cooperation between MFM and CNM teams. I definitely considered myself very lucky to have had a hospital nearby with these kind of policies and cooperation.

[@virginianielsen3480]

I had a home birth midwife here in Georgia and I had no idea until I gave birth how lucky I was to find a good, qualified one. My OB was going to be terrible- trust me, I heard plenty of stories- and I would’ve preferred a birthing center, but this was the best option I had. Georgia DOESNT even allow home midwives to be certified- anyone can cal themselves a midwife, and mine had to be certified through Tennessee. And they can’t tell why Georgia has such a high infant injury/mortality rate (in and out of hospitals, don’t even get me started on rural areas 😭)

[@WishGender]

I grew up and live in the states and for a long time I thought midwives were just a job that became obsolete. Like I thought midwives were a job that basically disappeared by the mid 20th century because of medical advancement. I was in my mid to late teens when I learned that midwives were quite common in other developed countries.

[@AlyssaTaylor9]

Same! I thought it was some antiquated, basically informal position that only existed because there weren't any hospitals or doctors around.

[@jennaS2020]

I’m a Scottish midwife and during my degree completed an assignment on midwifery in the US- I absolutely could not believe the difference in regulations!😱 we are required to independently facilitate 40 SVDs over 3 years of training to qualify- I was involved in well over 100/120 deliveries during that time too including instrumental and operative births 😊

[@our3geckos]

I had a midwife with 2 my youngest children...along side my OBGYN. She assisted in their deliveries, BOTH ended up being C-sections... One was an emergency, the other was a planned section with a tubul ligation also. My midwife was able to get to do her first tubal ligation on me❣️ A few years later, she herself had twins... I remember she was one of the first Midwives allowed in the OR here in Hawai'i 💕❣️ ✨I should edit this to say our youngest son will be 21 this month 🥰❣️✨ 💞 ALOHA FROM HAWAI'I 💞🌹 LYSSA 🌹

[@katiacleroux7376]

Thank you for voicing your concerns about over medicalisation of births. This was my eye opening moment on my first rotation on the ob floor. I immediately knew i would utilize the midwifery system here in Ontario.

[@emsteroo]

I had an amazing CNM with my vbac baby. She was evidence based, had admitting rights at my local hospital, and LISTENED to me. My appointments were at least 30mins and didn't feel rushed, she let me labor how I wanted to while ensuring safety and provided me the informed care I was hoping for. Finding an OBGYN with the same vibe near me is pretty much unheard of since they are all huge practices. I think if I had the CNM with my first, my csection would have been avoided. Thanks for breaking this down - I agree it's important to distinguish and tighten up the term midwife.

[@alidelatierra]

My grandma was a ley midwife turned CNM. My great grandma from my other side in Mexico was traditional Mexican midwife. They are both equally knowledgeable but in different ways .

[@the_Yellow_crayon]

Yes! They were probably more knowledgeable in supporting physiological birth than anyone trained in the medical model!

[@girliestmammy]

💖 As a Brit this was shocking information to learn about how things work in America! I had no idea that anyone, other than a specially trained nurse in midwifery, could call themselves a midwife!

[@whychoooseausername4763]

As a fellow Brit, everything is shocking about the American healthcare system. I have the names of the midwife and the social worker who came to visit my mother and I over the first two years of my life in my health record. That was standard practice when I was a kid.

[@shirleymarie2288]

Most Americans don't know it unless they're in this field or have specifically done research, I wanted to be a midwife and wanted my children delivered by a midwife so I did research while pregnant with my first. I still only found that there were lay midwives and nurse midwives. I didn't know there were THIS many different types of midwife or that each state has different laws about who can perform what type of birth.

[@9044emily]

In the uk midwives aren't always nurses. There are some midwives who are nurses who have done a midwifery course on top of their nursing degree, however the majority of midwives now are registered midwives with the Nursing and Midwifery Council who do 3 years specifically as a midwife and are not nurses in any way. That being said I would 100% never use an American 'midwife' who didn't have a degree level of knowledge. Generally speaking home births in the uk are safe and midwifery care is a standardised practice with a protected title.

[@kerriprzeczewski4883]

As a NICU RN- I had to attend 15 births just to be the person attending deliveries to take care of baby. That’s on top of all the training I received on taking care of preemie/sick babies in general.

[@jenniferburns2530]

Over 30 years ago a friend who planned to become an ob/gyn became frustrated with her premed program and the assumption of every textbook, lecture, and study that the human male is the standard, normal body and anything else was not worth discussing except when the reproductive system was involved. She shifted her career plan to midwifery, and began learning about the different pathways to education and training. After being on the medical education track it was shocking to discover how poorly the laws and regulations (which vary significantly from state to state) were constructed, and it was difficult to find solid information on the quality of programs.

[@TeaAddict]

The difference between countries is astonishing. Midwifery is a full degree here in Australia and labour wards are generally staffed primarily by midwives, with doctors (OBs) called in as required. I loved all of the midwives who attended me during my first birth experience and I look forward to being looked after by them again with baby #2!

[@christytrimble2293]

In my hospital, all babies are delivered by CNMs unless it's considered a high-risk pregnancy or needed intervention (usually C-section) is required.

[@whatchyagonnado]

That sounds like a great idea!

[@lauracohen4914]

I love midwives. Both of my children were delivered with midwives, and I'm very grateful they were. They took time with me and listened to what I wanted and did not want. Excellent care.

[@julia_newsome.t]

Yay for the love for NZ midwives ❤ I live in Chch, NZ and I had different midwives with my kids and they were amazing. particularly my last birth when I had severe HG the entire 37 week pregnancy, with weeks spent in hospital on fluids and antiemetics, first with ng tube, then picc line and tpn, multiple complications - it was scary and hard on me and my family and my amazing midwife was with me every step of the way. Obviously obstetrics had to be involved as well and were also amazing, but my midwife was still central to my experience. She was also checking in way more often than officially required for the 6 weeks postnatal care, helping with breastfeeding advice etc. I will be forever grateful for her support during such a tough time. Every country deserves this type of midwife 💖💖💖

[@samnsaganbenner2730]

When I was living in the US I ended up going with a midwife, because the OB I was with was not listening to me in my prenatal appointments. I am so glad that I did go with a CNM. I completely agree though that midwives need to be able to accompany their patients in hospital transfers. I was transferred after giving birth due to hemorrhage. My midwife was not allowed to accompany me at the hospital, and it was up to me and my husband to convey what had happened. The hospital didn't know what to do with my newborn because he had not been delivered at the hospital (fortunately they got him a bassinet even though he was a visitor). I was also very lucky that I ended up with a CNM. I had no idea that you could end up with someone less qualified. Now that I'm in Canada, it's great that midwives have the freedom to attend hospital births and accompany in the case of a transfer. Thanks so much for your informative video. I really hope that things change for the better for midwives in the US.

[@maggiewinnike7309]

My mom is a CNM, and those are the only midwives I trust. My mom has her regular nursing degree plus a master's in Nurse Midwifery. It absolutely drives me crazy that people with no medical education from a reputable nursing school call themselves midwives.

[@preciousmourning8310]

Yeah, I'd only trust them. They're the only ones with enough medical training. You don't want to put your and your child's life in the hands of someone with a one year online certificate course like a CPM.

[@feliciasjoberg9886]

I'm Swedish and midwives are super duper common here.

[@annalundquist7247]

In Sweden a midwife has to first become a nurse, then get work experience, then they can study to become a midwife. And there is only that one way to get certified. So even though they do not have the same responsibility as a medical doctor, their education is almost as long (the doctor would also specialize in gynecology to handle pregnancy and birth etc). The standard is that a midwife handles basic reproductive care (contraceptives etc), pregnancy care and all normal vaginal births. The gynecologist would handle complications and all other extras.

[@NK-pr9xy]

It should be mentioned that there was definitely a campaign but doctors and hospitals to portray the only safe way to labor & delivery is through them. Some women will flat out refuse to be seen by a nurse midwife or nurse practitioner even during the first visit which is mostly for education. No one educates patients better then nurses, but the AMA has done a fabulous job at disparaging any APRN where many patients are starting to refuse to see them. I appreciate the fair presentation of CNMs in this video. I wish more doctors were this open minded and practical.

[@angb6616]

It is amazing that there’s all these different types of midwifery! You’re absolutely right that a patient shouldn’t have to determine which type can be what they need.

[@StraylightWintermute]

I was delivered by a CNM at a birth center in the US. I wish this was accessible to everyone, with nurse midwives being able to continue care in a hospital if necessary. The center I was born at eventually was forced to close because they were denied admitting privileges at the very close by hospital. Research says that stress has a major effect on the progression of labor, which makes sense -- I'm sure it was an advantage to early humans to be able to hold off a baby until you're safe, because it's such a vulnerable time -- so it's a major benefit to have a comfortable environment to spend labor in. Especially for first births, since labor can last for so long!

[@loveinseattle]

Thankfully midwifery is certified in Canada. I had great birth experiences with mine.

[@alexz3289]

I am about to start a bachelor of midwifery here in Australia (I AM SO EXCITED! I want to be an obstetrician one day but still waiting to get into medicine...) but I cannot believe it is so unregulated in the US? Here it can be actually quite hard to get into the program and takes over a thousand hours of placement. That's how it should be. This is just so confusing for a woman who wants the best care. Thanks for discussing

[@EllenRCox]

Wow! This blows my mind. I'm a New Zealander and chose to have a private OB for both my pregnancies because of my anxiety, which is not the norm and I paid "out of pocket" as they say in the US, but this always came with a midwife as part of the deal. The midwife was there for prenatal care (alternating with with OB) and worked with me on things like the birth plan. My babies were delivered by the OB, in a public hospital, but the in-house hospital midwives were also there. The midwives assigned to my OB then did my post-natal care, visiting me in my home for six weeks post-delivery to monitor my babies (and me). They helped with breastfeeding and were so supportive. They'd come as often as were needed - every couple of days when I was struggling with breastfeeding. I took for granted the care and professionalism of our midwives. It's hard to ignore the economic incentives in a system so tied to insurance like it is in the US. And its not like the medicalisation of birth there is seeing better outcomes - the infant mortality rate in NZ is 3.39/1000 births and 5.12/1000 births in the US.

[@tamarleahh.2150]

My midwife saved my daughter's life when she noticed she wasn't breathing after the water birth. Forever grateful!

[@gellisbarber1786]

I was delivered by a nurse midwife in 1978. My first son was delivered in a hospital by an OB. My second was a homebirth with a lay midwife. The system in the US doesn't give many options in between. If you want a midwife, there are few hospital options. If you opt for a homebirth, there's almost no CNM or CMs that do them. FWIW, the lay midwives I've met all came highly recommended and had attended hundreds of births. Like any profession, certification isn't going to tell you everything about experience or anything about bedside manner. You have to do research.

[@KxNOxUTA]

Yeah that is the point. You can even have highly trained doctors whit lots of skills but then they're a jerk and thus none of their professional care ends up being accessible to you and damage can come from that. That's why I appreciate how she made the distinction that all helpers have their place in the process, but distinctions should be clear enough to enable people's educated choices on what help they choose to access.

[@sandcat66]

New Zealand has the most amazing and highly trained midwives. I had 2 home births and both midwives were so comforting and reassuring . Amazing experience

[@Jordyn64]

I am a midwife in Australia - 3 year bachelors degree with hundreds (maybe thousands) of hours of clinical placement and intense theoretical learning. It is similar in ways to New Zealand but NZ is still superior to us. As a midwife, I am the primary care provider throughout pregnancy, brith and postnatal. I call an obstetrician for medical advice or help when needed. Maternity care is not gold standard in Australia but the US is appalling.

[@coralieb.8219]

I'm a french midwife and it's way different in France. Only certified midwives here, with a master degree for now but it will become a doctoral degree in a few years. We also do the gynecologic follow-up (contraception, abortion, hpv test and vaccination...) I don't know if it's common in other countries but that's how it works in France. And it seems weird to see how midwifery is considered in the US, with different types of midwives, and just high school degree for CPM. It's confusing for women looking for pregnancy care 😢

[@war5561]

I had a nurse midwife and I loved my experience. They only use OBs at my hospital for high risk births. Had preeclampsia, still induced and delivered by the midwife.

[@cupcake1406]

Were you considered high risk since you had preeclampsia or was it under controlled? Did you have an epidural? I am happy to hear that you had a positive birthing experience.

[@rexana_rexana]

Reading the comments, seeing how being a midwife nearly everywhere else is soo completely different than the US, it changes my perspective on a few things, specifically quite a few years ago I was visiting my sister in England. I met a lot of her friends, one in particular was pregnant and she'd mentioned having a midwife. I didn't really think much of it, all I knew was what I'd learned online and from my mom and that was that midwives were an option, but could be worrisome due to needing to vet their credentials and the fact that not all of them had an overseeing body like doctors do. I was kinda a POS as a teen so while part of me was worried for the child, another, very small part of me judged her for putting her comfort over the safety of her child. I didn't say anything however and Im so glad I didn't! She was so very nice! Over the years Ive not only learned that midwives don't ONLY do home birth, and can just generally help through pregnancy too, AND Ive learned there's a lot of reasons someone might choose a home birth, AND I should respect that decision, AND NOW Im learning that it's mostly America that allows (what I would consider) under trained people to label themselves midwives. Everywhere else it's a very serious education/occupation and doesn't have the same connotation. You learn something new every day

[@sandrawyman-noaafederal2505]

Glad you learned not to be so judged, too bad Doctor Jones needs to learn that lesson too. Healthy pregnancy does not need an OB .

[@coralieb.8219]

​@@sandrawyman-noaafederal2505no but it needs a professional, certified midwife. We study midwifery for 6 years in France before we can call ourselves midwives. It's not something you can do with just a high school degree.

[@katiemarshall4340]

Hi daughter of a midwife/family planning nurse, it's mostly midwife's that do the most during delivery. It's only OBs that take over where complications arise. Mum has a degree and over 30yrs experience in childbirth to help the mother out, obvs for an epidural the OB does it. I had a feeling New Zealand was similar to us here in UK

[@eileennwachukwu7620]

OBs don't do epidurals...usually that is a anesthesiologist or in some states a CRNA.

[@ameliasandoval8663]

I've had three high risk prenancies with 3 preterm deliveries (pprom, polyhydramnios, incompetent cervix, irritable uterus, GD, preeclampsia, and a placental abruption). I never got the opportunity to see a midwife but i had always wanted to. Their care seems so much more holistic.

[@tiffanywheeler48]

My first midwife was a CNM and had a birth center with privileges at a hospital. My home birth 6 weeks ago was with a CPM who also has a nursing degree but she didn’t want to spend the outrageous amount of money to become a CNM. Her apprentice actually delivered my son, under her supervision, and did a fantastic job. The apprentice also had training in Guatemala where they have to be well trained since they don’t have easy access to hospitals. After my water broke we lost her heart rate. Even with shoulder dystocia, he was out within’ minutes! They had resuscitation equipment ready but he started crying very quickly and has no issues that were noticing.

[@tiffanywheeler48]

Where I live, if you want a vbac your only option is a home birth with a midwife. My midwife actually told the OB who did my stitching in labor and delivery after I had my son that she would stop seeing vbac patients if hospitals allowed them but women should have the option to vbac. She had never seen a tear like mine in her 20 years delivering babies so she recommended I have an OB who maybe had do it. She stayed with me the entire time and was able to learn something about how to do my type of tear. (She did say the OB did it how she would have done it if I had chosen to have her do it instead.)

[@notevenaunicorn]

I have a CNM as my provider for my pregnancy, and I'm so happy with the level of care I've had so far. They've been so informative, aren't pushy at all, and always make sure all of my questions are answered.

[@drbaureis5934]

It's confusing to midwifery students as well. Trust me, I've been there. This system needs to be properly regulated and understood by all parties involved, but it is severely lacking in continuity.

[@NadiaSeesIt]

My midwife was a part of a medical group of OBs. I gave birth at the hospital with my midwife and labor nurses only but an OB was there if my birth became complex or if i needed an emergency procedure. It was great for me. I was pushing for four hours because my baby's head was large and partially stuck. I have no doubt that an OB would've made me get a C section. I'm always going with a midwife who is a part of an OB group.

[@jenniferford2067]

It was always weird to me watching Call the Midwife and realizing that they’re all nurses and part of the healthcare system because the small community I grew up in only had midwives who attended home births for people who didn’t want traditional medical care. It always meant no pain meds, no care that I would have considered actual medical care.

[@ccb4708]

Wow thank you for shedding light on this! Very very important for the general public to know. Thank you for being objective

[@samwasson19]

I totally get what you're saying about the clarity of types of midwives and the training they get. I wish that the profession was more respected and regulated in the US! I am going to a midwife clinic for my pregnancy, and all the midwives there are Licensed Midwives and CPM. Is licensed midwife maybe just a Washington state thing? This is what their website says about it: "Licensed Midwives in Washington have completed a comprehensive midwifery program at a state-accredited school, and have passed the state licensing exam. Program standards are based on those adopted by the International Confederation of Midwives and the International Federation of Obstetricians and Gynecologists. Licensed Midwives are trained and authorized to provide complete maternity services." The clinic also has a CNM that does consults basically but doesn't attend births at their birth center. I love the care I've received there so far (27 weeks)! They are always professional and knowledgeable and I feel totally confident in their hands ❤️ Plus we are just a few minutes from the hospital at their birth center, and I know they would get me there if needed.

[@waterdragon3367]

Im actually hoping to become a cnm, so this information is super helpful! It really sucks that I will probably have to leave my home state to get my higher level degree, and im not even sure how to go about that. Not only is this information confusing to paitents, but also to students who may be wanting to pursue the field. Thank you for some clarification!

[@Luthien_0]

I truly respect and enjoy listening to your opinions on midwifery in the US and elsewhere. I appreciate that you tell the facts, without putting down other providers. It can be difficult to have a home birth where I live. NY insurance has to cover at least some of the cost of home birth, but I live in a rural area and there is only 1 practice (with just 2 midwives) that does home birth. Interestingly, one of them is a CM and the other is a CNM. NY is also one of the 8 states that allow CM certification. The history of midwifery moving to Obstetrics is very interesting. It was originally rooted in racism and misogyny that has been difficult to get rid of. I think we have come a long way since then (when it was only men in OB, tying people to tables and knocking them out to deliver babies), but I definitely agree we could do better. I absolutely agree that it would be beneficial to have certification more standardized and use midwives for low risk pregnancies and OBs for higher risk. Thank you for all you do and being the voice we all truly need ❤

[@scottishgirl1100]

I am in Canada I am so happy that here all midwives have to have a certain level of training including University to become one. I had the best experience with my son

[@auranacuran]

Thank you for this video! The fact that there is this ambiguity is seriously one of my hot buttons!

[@amixeblu]

My grandmother had 10 children during Belgium's war era and a decade beyond. Her grandmother was a registered midwife. 8 children came into the world through her assistance, at home, with a doctor present as well. Her last two were hospital births as her gran no longer worked as a midwife by then. At the hospital they barely had to assist my grandma. She had uncomplicated births, thank goodness. She was OK with the hospital as well and had no issues.

[@skullgarden2417]

In Florida we have an awesome midwife system. We have certified midwives who can go to a specialized school in Gainesville or St. Pete (and it’s a long program) and I had a a team of three certified midwives for my home birth. I felt very safe.

[@interlocution6619]

I had a Certified Nurse Midwife when I gave birth to my son in a birthing center that was attached to the specialized women's health care unit of the hospital. It had all the comforts of a modern birthing center and still had access to the advanced technology of the hospital if any complications should arise. Colorado did not allow lay midwives at that time. I don't know what they allow now. It was the best of both worlds. I highly recommend it. My birthing experience was wonderful and my midwife was amazing all through my pregnancy. She educated me on the changes happening in my body and what to expect. She gave me a book on what to expect after the baby was born. My experience was very different from the women I knew who chose a hospital and OBGYN. Although an OBGYN could also be available in a home-like birthing center as well. I think we need both - I also think that many women don't have the birthing options they should because the patriarchy looks at them as silly.

[@xThexButlerx]

I had the same cpm with my 3 kids. The first she was still a student and had a cpm with over 700 under her belt assisting her. By the time I had my second she had become certified. By the time I had my 3rd she had her own business. But with the school she went to where I met her, they had to assist many births before becoming lead with a teacher backing them up, then a bunch of births as leads with the teacher but also in-between their own patients assisting other midwives with their mom's also, then they get their certification. She was involved in so many before getting certified. But I know that was just the school she went to.

[@Brijeanius]

May I ask the school? I am also a current student...

[@xThexButlerx]

@@Brijeanius it's shut down now. They shut down a year ago after they changed owners from the original. New person ran it into the ground and ran all the moms off.

[@scoylephoto]

Can we talk about your statement "getting privileges is complex"? Is this another crazy thing that Grey's Anatomy does? Like...there are multiple episodes I have seen where one of the old doctors that used to work there comes in for a cameo episode or a special case and walk in to a mass tragedy and just walk up to someone and say give me privileges and they are like "ta da, you have privileges, go help" and its just a verbal thing while running down a hallway. No paperwork or process or anything, just a verbal announcement. It's like Michael Scott "declaring" bankruptcy.

[@zzevonplant]

Yeah, that's definitely not how it is in real life. I don't know all the ins-and-outs of the process of getting hospital privileges, but it's definitely not as simple as, "sure bro, jump in" lol. Not at all.

[@thehutch7728]

It’s an application process. At least some (possibly all?) have a “fast track” application for if a patient of yours is currently in hospital and they feel you’re needed, but either way, it’s definitely not as easy as “declaring bankruptcy.” 🤣

[@ENSerenova]

Privilages are a lot more complex than being able to have someone say "ta da you have privilages", though the process can be expedited for emergency/disaster situations when additional clinicans are needed rapidly, or to award temporary privilages so an outside clinican can follow their patients care at hospital, but it's still more complicated than a brief conversation in a hallway to be granted. In very brief a hospital need to be able to prove that they have verified that a clinican has appropriate education, certification, licensure, meets standards of clinical competency and professionalism, etc for the care the provide. Once verified hospital grants them privilages for the scope of care they provide with in the hospital setting depending on their qualifications and relationship hospital has with them. (e.g. a new hire is likely to have "provisional" privilages which may be restricted in scope and temporary while they are under probationary period, an outside expert who sees a handful of cases at hospital per year but who doesn't work for hospital routinely may have "courtesy" privilages which allow them to follow cases and participate in care when requested, but not allow them to admit patients directly to hospital, a psychiatrist employed by hospital would likely have admitting and general privilages but not surgical privilages because that would be outside of the scope of care they provide, etc).

[@iamwheels1305]

Im a CNM student and there is a lot of different clinical requirements in terms of numbers, but for the program Im in the number of births specifically is 40 total. The total amount of contact hours is 675, but you could go over trying to finish other clinical requirements or waiting on getting those 40 births. But like i said theres more than just number of births we need to be attendent to. I love this video and I LOVE your transparency and support for better collaboration between providers, hospitals, and Midwives. Many CNMs would love to do home births but the laws and how the insurance/hospital systems are set up just puts too many hoops up. Ive been a recipient of both midwifery care in the US and the Netherlands and its so sad to see the US SOOOOO BEHIND in this realm of healthcare. Thanks for this video!!

[@mamadragonful]

I did what was called "shadow care". I had a homebirth midwife and a hospital midwife team. The hospital team didn't know I was planning a homebirth. My homebirth midwife didn't have admitting privileges, so if I had to transfer she would have to leave me at the door. It was surprisingly uncomfortable for me to have a fundamentally dishonest relationship with the hospital team. It was nice to be able to come clean after the homebirth went well. It was interesting to see the two systems side by side for the same birth, however. The homebirth midwife was incredibly careful to keep me in a low risk category, very diligent about checking and rechecking for possible risk signs. The hospital team weren't negligent by US standards, but certainly more...relaxed about checking things like iron levels and sugar in my urine. They had plans to save me with a blood transfusion if I was anemic, for example. The homebirth midwife was committed to making sure I didn't get anemic. I'm glad I had the option to transfer to hospital folks who knew my medical history if that had become necessary. But I got vastly better care from the homebirth midwife. Cost quite a lot, though. The homebirth midwife was all out of pocket. I was also shocked to discover that the hospital team only had one visit planned after birth. My homebirth midwife did all the postpartum and neonate care for the first six weeks.

[@ourtinytownhome-stead]

I basically could have written this, though my hospital provider knew what I was planning, and she secretly was in favor, but couldn't officially endorse. She was in no way negligent, but because the system only allowed for short appointments (10ish minutes w/ Dr, + 5ish w/ nurse), she wasn't able to do such in depth care like my midwife could (half to 1 hr appts). We did it this way so that insurance could cover things like ultrasounds and blood tests, which reduced our out of pocket costs. We also wanted to have a relationship with the hospital providers, so a transfer would be smooth if needed, but both times worked out just fine at home. My midwives also have good relationships with all the surrounding hospitals, and will continue care as basically a doula in the event of transfer.

[@aoifedunphy645]

I have given birth twice in NZ and was so amazed with amazing care I received by midwives and how quickly they got obstetrics involved when needed too. Both midwives I had with RN midwives with hospital background too. Due to complex problems I had throughout pregnancy I had hospital births(also I am a total wimp and wanted to have an epidural but couldn't because babies came too quickly 😅) I received amazing care and even spent 2 weeks in hospital each pregnancy having 2 cerclage surgeries and 11 weeks in NICU with my oldest paying $0

[@lynsiesalazar8913]

I delivered my first with an OB and my second I didn’t actually have a choice on who delivered, it was just whoever was at the hospital when it was time to push and the hospital had both OBs and midwives. Once I was close to giving birth both came in to introduce themselves and the (male) OB (whom I had never met) told the midwife he wanted to attend over my birth but he had a c-section and said he hoped I didn’t have the baby before he was done. Once he left the room she he obviously didn’t know how labor worked because it waits for no man 😂 the midwife did deliver my daughter and it was honestly an amazing experience but I totally understand and agree with the need for consistent requirements to ensure patient safety and a high standard of care

[@sarahgoldberg6614]

I'm in Ireland and all of the antenatal scans were done by midwives, which was great, because they could tell you what was going on. The one time a doctor sat in on a scan was to train her because I was carrying twins and she hadn't seen m/any uncomplicated twin pregnancies and needed to know what to look at with 2 in the third trimester. My next door neighbour is a midwife, and it was a post graduate degree after she had been a nurse for a while.

[@emiliamolinacampos849]

Hi! Im from Chile, south america. Here midwifery is a certified profession, it has its own carreer at uni, we study 5 years and take care mostly of the public system. Being a nurse here is very different than a midwife, we also have obgyns but mostly for the private health system. The public system obgyns take care of high risk pregnancies or cesareans.

[@GizmoAndKiwi]

I had no idea! In Germany we have one kind of midwives and they all have a certain level of training - there was a change recently so that everyone that wants to be a midwife now has to do it via bachelor's degree, before that you could do another route without college/university, but it's always been regulated by a specific law (Hebammengesetz). You know if they are allowed to call themselves midwife, they have a specific level of training. Of course that's no guarantee for perfect care, but I'm still a bit shocked that it is so vastly different in the US - and probably super confusing for pregnant people.

[@zagrizena]

Regarding the number of births for certification I think it's good to consider that midwives providing home birth assistance physically cannot attend as many births as an OBGYN or a CNM in a maternity hospital in the similar time frame. They virtually can only take one birth per shift (or sometimes multiple shifts) and they cannot schedule to attend births daily, if they want to provide safe and reliable care for all clients. While it means they have less experience with stage 2 labour, their opportunities are a priori less frequent. So to expect them to match your numbers might force them to remain in training for at least few times longer than they currently have to.

[@taviag4302]

I'm an Australian GP. I did extra time in obstetrics coz delivering babies is awesome. Typically a midwifery student would do 40 catches, medical students did 4. We attended many more labours of course but they didn't count unless the baby came out 😂. Thing is when a midwife graduates with her 40 catches she goes into a team environment, anything happens it the baby starts to come she presses a little buzzer and her team leader appears. Another button for all hands in an emergency. The obstetric team only attends the birth suite if there is a concern, likewise the paediatric team for the baby. Everyone has their role and works together, the culture is to flag problems early. Private system is a little bit different of course.

[@jacquiz.6837]

Thank you for lending your expertise to this topic. I think one major downside to how midwifery was professionalized in the US is that the price of certification gatekeeps knowledge about how to give birth safely from the general public. Also, midwife education tends to be white and Western centric. People should be able to give birth using whatever method is culturally relevant to them! And it should be free! And the knowledge of how to give birth safely should be free and shared widely!

[@feliciasjoberg9886]

5:02 In Sweden in the ob dep., most often a midwife works with an assistant nurse. But sometimes two midwives work together with or without an assistant nurse. There's also ob/gyns. They participate in births when needed. There might be student doctors and midwives at bigger hospitals. Source: 1177, the national healthcare system’s dedicated website

[@susannawerth5890]

I wish I would have had this info before my childbirth. Especially as an immigrant I felt completely lost with the health system and evaluating best choices for me. There was no one really available to give such general information. Your videos are awesome!!!

[@SailorMomma]

When you add on the fact the entire regions of the US also have an hour plus highway driving to hospital with birthing facilities and independent birth centers near hospitals are only in large cities, it is even more astounding. If you need a specialist [e.g. MFM], you may have to drive or even temporarily move to a major city just to get the care you need. Ancedotal sources from friends and family, as well as casually following the obgyn/midwife field for 20+ years.

[@RobertHeslop]

Here in the UK, there's a separate degree of 3 years in Midwifery, so they are specifically trained in that field of medical care. That course is on the same campus as me, where I'm studying Nursing Science (Adult - RN), and then if I want to become licensed in Midwifery after my degree, it's another 3 years of training to earn an MSc (Master of Science) compared to 18 months for me to do a postgraduate in something like district nursing, or 18 months in research etc. So you do need that full-time commitment here and it has to be via University as its also aligned with the Nursing and Midwifery Council (The NMC)

[@abigaileg7345]

My CNM made my birth sooooo amazing!!! She was absolutely fabulous & I truly needed her so much during my birth journey. I had NO idea how midwifery was organized & classified here in the US!!! I appreciate this knowledge & can see where it can be problematic!!!

[@sarahmyotte5750]

I’m my state in the US midwife’s may only be trained by one institution, only CNM’s are recognized,CNM’s are allowed to work independently or in a hospital setting interchangeably. I worked with CNM’s for a hospital birth with my first pregnancy and it was an amazing experience. Legally recognized midwife’s in this state make up for 17% of deliveries! And hospitals that include midwifery as a care option have significantly lower mortality rates 🎉

[@AddisonBellCoaching]

I am very lucky because I live in Texas but had a CNM that had privileges at a hospital and a attending physician at the hospital if we had to transfer. They had thier own birth center. I wish everyone had this as an option as long as they are a safe fit for a midwife birth. I adored my midwives and so we need to make some changes in U.S to this standard of care. Thanksnfor the video

[@SelmaGrytzellMusic]

I’m a midwife in Sweden which requires a 3 year nursing education, 1 year of clinical practice and then 1,5 more years to study a masters degree to become a midwife. We have a requirement of 50 births to be able to graduate which could seem like a low number. However it’s a realistic number for the amount of clinical practice we do. As a midwife in Sweden you can choose to work in prenatal care, taking care of the pregnant woman or you can choose to work with birth. However we can also work with sexual and reproductive health amongst women and teenagers and prescribe contraception. There are many areas we have to cover in a 1,5 year long education that doesn’t just include birth. I would however say that the midwives here are very competent and the women can feel safe when giving birth.

[@osuzyq828]

I had a certified nurse midwife who was originally for Johannesburg, South Africa when I had my first daughter in 1983, in San Antonio, Texas as a birthing center which was technically across the street from a hospital. There was an attending physician, but she was the one with me the most, and she was great! Depends upon your situation, but she was my second birth, first with no complications. I thought about home birth 5 years later, but found a doctor who was very cool with the Bradley Method. 9 years later, I wish I had gone with a better doc and hospital, but everything turned out fine. I’m so glad for your videos talking about all these complex birth issues!

[@catic15]

My first child, in 1991, was with a CNM who was in independent practice. She delivered mostly at a free-standing birth center, but also for home births, and she had admitting privileges at Stanford Medical Center - one of the key factors in my deciding on her, as i was a "moderately high risk" patient due to my weight and age. She had delivered over 4,000 babies during her career and had a wealth of training. When i had my second child in 1994 I started with her, but due to rising malpractice insurance costs she closed her practice halfway theough my pregnancy and i ended up going through my HMO's OB/GYN. I still believe that if I had been able to stay with Kay (my CNM) I might not have needed a C-section with that delivery, but that's another story . . .

[@bluedreams517]

I'm a rare person who had a CNM do my homebirth care in the US. I would absolutely LOVE for the US to get on board, have CNM = Midwife care and find means to continue care if there needs to be a transfer to the hospital. My midwife's policy still entailed her getting full payment of services, but I can definitely see how the lack of continued care is its own deterrence with entering the hospital. You can either stay with the Midwife who knows you well and have a personal relationship with...or you can go with medical staff you've never met with with your midwife at best being demoted to a glorified doula. It would be nice to have a system that helps envelope existing midwives into whatever needed training they needed to qualify as CNM's, have CNM's have ability to care for clients in and out of hospital, and reduce the weird dissonant practice we currently have in the US.

[@NarnyGiggles]

We're using a CNM for our care and are very much hoping for a homebirth. We live 10 minutes from the hospital and our midwife acts as a doula in the case of a transfer into hospital, which was important to us. I really can't imagine choosing a CPM over a CNM but there are many in our community who do so. I so wish my state had birth centers. Hospitals keep killing any proposed birth centers and so we are advocating at the state level to change the certificate of need laws. A big ugh at the system.

[@MrRachaelSmith]

I do completely agree it is extremely confusing, and there should be more transparency and oversight when it comes to midwifery training and licensing, I think it’s important to also take into account the mother’s right to choose what level of training her midwife has. I have had 2 home births with CNMs and for this birth specifically chose a CPM because I wanted a midwife that did NOT have hospital experience. I am not trying to bring the hospital into my home and my birth. Personally, I think the best thing we can do for pregnant people is to give them all of the information and education about their options and then trust that they can make the best decision for their bodies and their births.

[@ersmith09]

I had a great unplanned experience with a certified midwife just recently. TLDR; I had a planned induction that progressed too quickly for the OB to be called (or pain meds to be administered); the certified midwife was calm and gave me clear instructions about what to do and our baby was born without issue. She was amazing and it was such a positive experience for something that was unplanned.

[@kakefyll]

The required births for cpms is similar to norway(and also the eu) actually. We always have an experinced midiwfe in the unit that oversees the unit that can assist you. Midwife care is very safe in norway and we have a low mortality. So I dont know about 50 or so births being low really? I think a lot actually deliver more than the requirements too though. Maybe that plays a role? Just surprising to hear its deemed low when its the eu standard.

[@regenbogentraumerin]

AFAIK that's 50 births in total for CPMs, including those they only observe and those they assist a senior midwife with. That's about as many as german midwifes (and I guess european ones in general) have to do completely on their own (under supervision ofc) plus several hundred hours of observing and assisting before that. There also are specific requirements how many of those have to be high-risk, how many breech etc., I couldn't find any requirements about that for CMPs.

[@kakefyll]

@@regenbogentraumerin I see, that's a bit different then. I thought it was deliveries they themselves had done. Because in Norway it's 50 births delivered by yourself, but also care for 40 high risk women during labour (not delivery though) and some other qriteria that I can't quite remember but in regards to taking care of women during active labour, during pregnancy and women's health and gyn procedures etc

[@regenbogentraumerin]

@@kakefyll Ah, right, I didn't remember that correctly. It's caring for women with high-risk births and assisting in the delivery, but not 'leading' the delivery, in Germany as well. I guess all in all it's pretty similar if not exactly the same in Norway and Germany. Being mainly trained in hospitals vs. at home/ in birthing centers (like CMPs) would also make a huge difference in how experienced someone is in dealing with difficult deliveries I think. Their training really seems to be lacking quite a bit in comparison.

[@MariahRAchel1]

For my last pregnancy I mainly saw a CNM who had 2 CNM partners for when she was sick or anything like that, they all attended births together as much as possible. I also saw 2 OB’s, one specialized in hormone supplementation because I needed a lot, and one just reviewed my scans, and then I had a prenatal chiropractor because my pelvis went rogue 😵‍💫 having a whole team of professionals was a wonderful experience and i felt so heard and cared for. First pregnancy experience was a typical OBGYN hospital birth and everything was always rushed with very little communication in any direction it felt like. So anyways I agree that there’s an advantage to having midwives and doctors work together.

[@myriamtouil3347]

THANK YOU SO MUCH FOR YOUR WORK ❤❤❤❤❤

[@lauravalle3766]

As a CNM, there’s a lot to unpack as to why we have different routes to midwifery. It had heaps to do with racism and white, male obstetricians. Lots of books and articles about midwifery history in the US. It’s too lengthy to type here. I’ve worked in both the UK and the US and we have MORE education and training in the US when we have a CNM as we have a master’s degree in nursing, nurse-midwifery. Midwives in the UK are entry to practice with a Bachelors and they don’t have to be a nurse first. Whilst we do have CMs in the US, they are not recognized in all 50 states. Many CMs practice in NY where they do both home births and hospital births and follow their patients into the hospital. The reason why CNMs often cannot do this is due to issues accessing hospital privileges or restrictive practice laws that do not allow us to admit our own patients. I’m guessing people did not give you a report okay transfer due to state laws seeing lay, direct entry, or CPM midwives as alegal or illegal. There are so many issues surrounding midwifery care in the US including regulations at the state and hospital level that restrict our practice as CNMs. The AMA has lots of money and resources to keep us from being able to practice fully.

[@junehoward3923]

I’m a mother of 7. I had widwives with my 1st 3 babies. Best experience ever. They all worked in a drs office which was in the hospital. Then they were dropped by the hospital due to liability. Last 4 babies delivered by a dr well last one by a nurse cuz the dr didn’t make it on time. I would choose a midwife over the drs anytime. To be fair all my drs were males and tougher and rougher than the midwives. No female ob/gyn in my town. The midwives were gentle and knew what I was going through. I would never give birth anywhere but a hospital in case an emergency arised and needed a dr.

[@heidisawyer5600]

My daughter is 27. At that time a hospital birth only (no pregnancy care and assuming no complications) was 11,000. The whole 7 months of care and delivery was under 2,000 with our midwife

[@jegallant]

I had 2 CNMs in NM. One with each birth. I loved both of them. Since I didn't deliver with an OBGYB, I can’t say which is “better” but if I were ever to have another child I would deliver with another CNM.

[@julieannelovesbooks]

Thank you so much for this great video!!! I learned a lot from this. I definitly agree with your final standpoint, if it's confusing for you, it's confusing for people about to give birth. As someone who grew up in Europe, it's so weird to me that Midwife is not a protected title and not all midwives have the same amount of education. Correct me if I'm wrong, but only nurse midwifes like in the US are allowed to practive midwifery here in Europe.

[@Samanthabrownsingson]

This video is extremely educational. I live In NJ and just hired a CNM for a homebirth. They also have privileges in a near by hospital (as you mentioned in the video). There are only two practices in NJ that have privileges in the hospital near by. I 100% if you are a CM or CNM you should also have privileges in the hospital incase the homebirth isnt going as planned. Thank you for this information!

[@1239762696]

Just a thought to share, for CPMs, their number of births experienced before certification is much lower due to (as far as I'm aware) only being allowed to work in home birth which takes on a much lower client load than hospitals. A typical home birth midwife will only take 4-6 clients a month due to the longer prenatal visits and more time commitment that comes with this type of practice vs a shared practice vs in hospital they may have 20+ and also cover on call shifts for other midwives.