Choosing a direct-entry midwife

Choosing a direct-entry midwife

What is a direct-entry midwife?

Direct-entry midwives typically attend home births, although some work in birth centers. They may learn their skills through self-study, through apprenticeship, or at an independent midwifery school or college. Less than 0.5 percent of births in the United States are attended by a direct-entry midwife.

Those who have met the standards for certification set by the North American Registry of Midwives (NARM) are called certified professional midwives (CPMs). A few direct-entry midwives are certified according to the requirements of the American College of Nurse-Midwives and are called certified midwives (CMs). Midwives who are not certified or licensed are commonly known as lay midwives or traditional midwives.

Direct-entry and lay midwives are different from certified nurse-midwives (CNMs), who are educated in both nursing and midwifery, certified by the American College of Nurse-Midwives, and licensed to practice all over the United States. Most CNMs attend births in hospitals, but some practice in birth centers and attend home births.

Are direct-entry midwives licensed?

The way in which direct-entry midwives are licensed and regulated varies from state to state. The state of Washington, for example, has stringent licensing standards, and direct-entry midwives there are reimbursed by both Medicaid and some HMOs for home births. On the other hand, in some states, it's illegal for direct-entry midwives to practice. A few states don't regulate direct-entry midwives at all.

You can find out the legal status of direct-entry midwives in your state on the Midwives Alliance of North America or Citizens for Midwifery websites.


Find out how a midwife helps a woman through pregnancy, labor, and birth.

How can I tell whether a direct-entry midwife is the right choice for me?

You can choose a direct-entry midwife to care for you during your pregnancy as long as you're in good health (meaning you have no serious chronic medical conditions, such as high blood pressure, epilepsy, heart disease, or diabetes) and as long as your state allows it.

Midwives are an appealing option for women who want a more individualized, less routine approach to childbirth than many traditional obstetricians tend to provide, and particularly for those who want to give birth at home. Midwives focus on helping you learn about the physical and emotional changes you go through during pregnancy, teach you how to maintain good health habits, and consider you an active participant in all aspects of your care. They see every pregnancy as a unique event and encourage you to consider your options for labor and delivery and to personalize your own birth plan.

At your first visit to a midwife, she'll take a comprehensive medical history, answer any questions you have, perform a physical exam, and have laboratory screenings done. She can make arrangements for any prenatal testing you want to have done that she can't do herself, such as ultrasound or amniocentesis. If it turns out that you have a medical or obstetrical condition – such as high blood pressure or triplets – that requires the care of an obstetrician or a perinatologist (a high-risk specialist), she can refer you to one.

How do I find a direct-entry midwife?

To find a direct-entry midwife, check with local women's health clinics or call NARM at (888) 842-4784. Ask any midwife you're considering to give you client references, and make sure she's certified and licensed to practice in your state. If you're interested in delivering at a birth center, call the American Association of Birth Centers at (215) 234-8068 or visit the association's website.

What should I ask a direct-entry midwife?

As with any healthcare provider, look for competence, experience, empathy, and flexibility. Here are some considerations when making your decision:

  • What is her education, training, experience, and certification?
    Find out how much experience she's had, where she was educated and trained to be a midwife, and whether she graduated from a nationally accredited program. Ask whether she's passed a national certifying exam and whether she's licensed to practice in your state.
  • Who is her backup physician?
    Be sure she has formal backup arrangements with a local obstetrician and hospital. Ask how she handles emergencies and how far away the hospital is. Consider meeting with the collaborating physician.
  • How does her practice work?
    If you're planning a home birth and the midwife is in solo practice, ask her what she does if two women are in labor at the same time. If she's in a group practice or relies on midwives in another practice to cover her when she's away or at another birth, find out whether they're certified and licensed, and consider meeting them, too. Ask whether she'll stay with you if you need to be transferred to the hospital during labor.
  • Will your insurance company cover her services?
    Find out whether you'll be reimbursed by your insurance for her services. Check your coverage and find out how much it will cost if you need to be transferred to the hospital.

See our Midwife Interview Sheet for a complete list of questions to ask.