The word ‘midwife’ dates back to Middle English, but the role of midwifery extends to modern day. The term midwife originally referred to a woman who was “with” another woman giving birth, but now, there are more nuances to this meaning.
While many of today’s midwives stay with women while they give birth, their duties are more extensive — they may assist people of all genders throughout pregnancy planning, labor and delivery, postpartum periods and general reproductive health screenings. Today’s midwives often shine in their holistic, patient-forward approach to reproductive health care and are most suited to manage low-risk patients. But because they are not medical doctors, they have some limitations in the services they can provide.
Dr. Kecia Gaither, a double board-certified OB-GYN and maternal fetal medicine physician who is the Director of Perinatal Services and Maternal Fetal Medicine at NYC Health and Hospitals in the Bronx, says that midwife-led care can be physically safe and emotionally rewarding for many low-risk pregnancies.
“In low-risk hospital births, midwife-led care is associated with lower rates of induction, episiotomy, operative and cesarean, compared with obstetrician-led care, without worse outcomes,” Gaither says. “Choosing or negating midwifery care should rest on the individual’s medical risk profile, birth setting, and preferences for style of care, pain management and tolerance for emergency transfer of care.”
If you are considering working with a midwife, it can be important to understand the scope of what they can offer you — and how that fits what you are or aren’t hoping for during your pregnancy.
[READ Pregnancy Checklist]
Roles of Midwives
Midwives play many roles to support reproductive health. Midwives may assist patients throughout pregnancy, help them prepare to give birth, work with them during labor and delivery, and offer support in the postpartum period. Midwives may also provide reproductive care and screenings to people outside of pregnancy, such as prescribing birth control or administering “well” visits, too.
Michaela Ward, a certified nurse-midwife at The Ohio State University Wexner Medical Center, says that people don’t always realize that midwives can care for patients “across the lifespan” and not just during pregnancy. She adds that “almost every woman can benefit from midwifery care,” with some exceptions, such as people who have complex gynecological conditions such as cancer or severe endometriosis, experience severe pelvic pain or have surgical needs, which tend to require more advanced medical care.
In a survey released December 4, 2025, The Ohio State University Wexner Medical Center revealed that many Americans misunderstand midwives’ roles in health care, including that only one in five Americans are aware that midwives can provide women’s annual gynecological exams.
The range of services a midwife can provide can depend on what type of midwife they are — and their level of education.
[READ: These Are the Types of Doctors Women Should See.]
Types of Midwives
There are various types of midwives and levels of midwifery skills. You can get a sense for a midwife’s skill level by looking up their credentials, which should be publicly available. How well they utilize their skills, however, can be a very individual assessment — so it can be important to interview your midwife before working with them, especially if you are looking for an emotionally supportive relationship.
Still, the highest level of midwifery is a certified nurse midwife, or CNM, and is awarded to midwives who have completed nursing school and hold a graduate degree in midwifery. Of note, not all midwives attend nursing school and obtain a graduate degree.
Some types of midwives, their required education and the services they can provide include:
— Certified Nurse Midwife, or CNM. This is a credential the American Midwifery Certification Board awards to midwives who have completed nursing school and hold a graduate degree in midwifery. CNMs can offer labor and delivery care and nursing duties, including prescribing medications, ordering tests and diagnosing certain conditions. They can also assist in aspects of reproductive care outside of pregnancy, such as women’s well visits. CNMs are currently licensed to practice in all 50 states and the District of Columbia.
— Certified Midwife, or CM. This is a credential the American Midwifery Certification Board awards to midwives who hold a graduate degree in midwifery but have not completed nursing school. Like CNMs, CMs can prescribe medications. However, they are not licensed to practice in all 50 states, so where you live may influence your access to a CM. According to the American College of Nurse-Midwives, CMs are currently licensed to practice in 12 states: Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, New Jersey, New York, Oklahoma, Rhode Island and Virginia. They can also practice in the District of Columbia.
— Certified Professional Midwife, or CPMs. This is a credential the North American Registry of Midwives gives to midwives who have completed relevant coursework. CPMs have limitations to the services they can provide — including that they cannot prescribe medications — and where they can work — as they are not licensed to practice in every state.
— Lay Midwife. This term describes midwives who do not have a license. Lay midwives may be self-taught or the recipients of an alternative form of training, such as an apprenticeship. Without an official license, lay midwives tend to work in people’s homes and may be unattached to larger health care organizations.
Comparison of midwife types
| Type of Midwife | Credentialing Body | Required Education | Licensing & Practice Area | Key Services |
| Certified Nurse Midwife (CNM) | American Midwifery Certification Board (AMCB) | Nursing school and graduate degree in midwifery | Licensed in all 50 states and D.C. | Prescribing medications, ordering tests, diagnosing conditions, labor/delivery and women’s well visits |
| Certified Midwife (CM) | American Midwifery Certification Board (AMCB) | Graduate degree in midwifery (no nursing school required) | Licensed in 12 states and D.C. | Can prescribe medications |
| Certified Professional Midwife (CPM) | North American Registry of Midwives (NARM) | Relevant coursework | Not licensed to practice in every state. | Cannot prescribe medications; has limitations on services |
| Lay Midwife | None (Unlicensed) | Self-taught or alternative training (e.g., apprenticeship) | Unlicensed | Typically works in people’s homes, unattached to larger healthcare organizations |
Denise Castellanos, a CNM and the lead midwife at MemorialCare Saddleback Medical Center’s Women’s Health Pavilion in Laguna Hills, California, explains that “not all midwives are created equal.”
Castellanos, who is also a nurse practitioner and Doctor of Nursing Practice, adds that what sets her apart from lower-level midwives “is the foundation of my practice: years spent at the bedside, working shoulder-to-shoulder with my fellow nurses and physician colleagues.”
“That hands-on experience is priceless,” Castellanos adds.
Additionally, her rigorous education as a CNM, her position at the Women’s Health Pavilion — where her patients can experience a safe birthing environment near certified OBGYNs — and her commitment to “integrating evidence-based, up-to-date practices” into her health care approach also allow her to raise the standards of her patients’ care and facilitate positive birth experiences, she says.
[READ: Delivery and Labor: What to Expect at the Hospital]
Midwives vs. Doctors
The highest level of midwives, CNMs, can act similarly to OB-GYNs. But, unless they have obtained another advanced medical degree, they cannot act the same — and CNMs’ medical powers are limited. For instance, while many CNMs can prescribe medications or order medical procedures, such as ordering an epidural, CNMs typically cannot administer medications or perform procedures.
Some limitations of CNMs include:
— CNMS are not trained and licensed to perform C-sections.
— CNMs are not trained and licensed to perform vaginal deliveries that require mechanical or artificial assistance, such as forceps or vacuum extractors.
— CNMS do not perform complex surgical repairs such as 3rd-or 4th-degree perineal lacerations. However, CNMs are qualified to and can perform repairs on minor lacerations and episiotomies.
— Some emergency complications may also require immediate physician involvement.
Because midwives’ medical powers are limited, they are not best suited for everyone. It can be wise to work with a medical doctor if you are experiencing a high-risk pregnancy
, expect or desire to rely heavily on medication or procedural interventions during labor and delivery.
But when it comes to labor and delivery, plans are subject to change — and some low-risk pregnancies can turn high-risk on delivery day. To stay ahead of the unknown, some midwives work closely with medical doctors to swiftly transition you to higher care during emergencies.
“In these situations, care is promptly transferred to our OB-GYN team to ensure the highest level of safety for both the patient and the newborn,” Castellanos says.
She adds that CNMs typically follow protocols and agreements for how to refer patients to a physician if and when the patient’s condition deviates from the norm, or if the CNM is not qualified to address a specific concern.
“In an ideal setting, all patients cared for by a hospital-based CNM would be considered low risk with no known complications,” Castellanos says. “However, some patients may fall into a slightly moderate-risk category, and in these situations, CNMs collaborate closely with our backup OB-GYN physicians to ensure safe, comprehensive care.”
[READ: 7 Ways to Make Your Childbirth Easier]
Midwives vs. Doulas
A midwife is very different than a doula, who is another person who supports a patient during pregnancy. Doulas do not have medical training, unless the person carries an additional degree, whereas many midwives are trained as nurses.
Why Work With a Midwife?
Whether or not you work with a midwife is a personal decision. Working with a midwife may be a rewarding experience if you anticipate a low-risk pregnancy and desire less medical but more emotional support during your birthing journey.
Some reasons you might want to work with a midwife during pregnancy include if you prefer:
— Holistic healthcare approaches
— Social and emotional health supports
— More personalized attention
— Shared decision-making conversations with your midwife
— Minimal medical interventions (as is safe), such as reducing reliance on medications or procedures
— Flexibility of birth location, in some circumstances
“Typically, as CNMs, the holistic care approach embraces the whole patient — not only her physical well-being but also her psychological and social health,” Castellanos says. “This sort of care can be comforting and helpful to patients.”
“What’s more,” she adds, “midwives deal with pregnancy, labor and delivery every day, so they gain specialty knowledge after years of field experience, which is backed by their rigorous training and education.”
In addition to preparing midwives to take care of you, as their patient, training also prepares them for when to call in extra support from an OB-GYN team, Castellanos adds.
Working with a midwife outside of pregnancy, such as for medication management, annual visits or menopause care, can also be a good idea for patients who are looking for a caring provider — or to avoid scheduling delays with any pending OB-GYN shortages.
[10 Ways to Find OB-GYN Care in a Maternity Care Desert]
Questions to Consider Before Choosing a Midwife
Before deciding whether or not you want to use a midwife during your pregnancy, consider what type of birthing experience you are hoping for — and whether a midwife or OB-GYN can best provide this. After thinking about your individual wants and needs, it can be important to interview doctors or midwives to find someone who is a good fit for your pregnancy. Each individual may put their own twist on the practice, so the type of provider who best suits you may surprise you.
— What type of medical support are you hoping for during this pregnancy?
— Are you more interested in natural, holistic forms of pain management or are you looking for a medication-forward approach?
— Do you want to play an active role in “shared decision making,” or would you prefer your provider to make decisions for you?
— What type of emotional support or communication do you want from a provider?
— Where do you want to deliver your baby? Some midwives work in hospitals, whereas others work in birthing clinics or in the home. Consider where you would like to give birth, and ask the midwife if they can meet this request.
— What type of insurance do you have, and what services/providers will it cover?
— Are you experiencing a high-risk pregnancy that would be better managed by an OB-GYN? While your doctor should alert you if your pregnancy is high risk, some examples of people who experience high-risk pregnancies are those diagnosed with medical conditions like preeclampsia, placenta previa, cardiac disease or diabetes.
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What Is a Midwife? originally appeared on usnews.com
