Midwifery (& Doulas, etc.)


Midwives provide care to mothers and babies during pregnancy and the period immediately postpartum.  The midwifery model of care views pregnancy and childbirth as natural, normal physiological processes, without inherent need for intervention.  (That is, interventions are reserved for when something specific happens to call for them, not used as a matter of course.)

Licensure varies from state to state but, in general, there are two “types” of midwives: nurse-midwives and direct-entry midwives.  These may be called by different titles, depending on the state in question.  For instance, here in Virginia we have Certified Nurse Midwives (CNMs) and Certified Professional Midwives (CPMs).  “Direct entry” does not mean lack of training; rather, it means that the midwife went straight into midwifery without “passing through” nursing first.

Most direct entry midwives are certified through an organization like NARM — the North American Registry of Midwives.  There is no particular time frame required for this training; it is competency-based.  That means a particular skill or milestone that takes one person two months to reach may take another eight months, depending on the time she has available to devote to training and the opportunities available to her for education, births to attend, etc.  A rough average is probably around 5 years.

Most direct-entry midwives have more training and experience in pregnancy and birth than most nurse-midwives, because the nurse-midwife’s training is split between that and other branches of medicine.  (Some nurse-midwives may have obtained additional education or experience in the field.)  Unfortunately, many mainstream medical practitioners are ill-informed and may pass on erroneous information, so know your own state’s licensure requirements.

Much of the time — ‘though not always — nurse-midwives are more medically-minded and quicker to employ interventions than direct-entry midwives.  And often, if both are licensed in a given locale, the nurse-midwives practice at the hospital and only the direct-entry midwives practice outside the hospital.  These are generalizations and you will find exceptions, but these are some things to be watching for.


Doulas are not really healthcare providers, per se.  A doula is a support person, most commonly for labor and delivery.  A doula may be especially beneficial if you’re planning a hospital birth but expect to go against the norm in certain areas.  The doula can advocate for you to the hospital staff, so you aren’t having to fight them while giving birth.

A doula can also provide more direct support during labor, such as helping time contractions, or giving bath rubs or cool compresses.  She can also help educate you regarding options and help you navigate a potentially unfamiliar environment.  Essentially, a doula is the stand-in for the experienced older female relative in a world where we don’t all have that.


North American Registry of Midwives
DONA International (originally “Doulas of North America”)