Table of Contents

What Is Midwifery?

Midwifery is the health profession focused on providing care to women during pregnancy, labor, birth, and the postpartum period. Midwives — the practitioners of midwifery — also provide general reproductive healthcare, including gynecological exams, contraception counseling, and newborn care. It’s one of the oldest health professions in existence, and in much of the world, midwives attend the majority of births.

The Oldest Profession in Healthcare

Midwifery predates medicine by millennia. Every human culture has had birth attendants — experienced women who helped other women through labor and delivery. The earliest written references appear in Egyptian papyri from around 1500 BCE, and the Hebrew Bible mentions midwives by name (Shiphrah and Puah, who defied Pharaoh’s order to kill Hebrew male infants).

In ancient Greece, Hippocrates wrote about midwifery practices. In Rome, Soranus of Ephesus produced a detailed obstetric textbook around 100 CE that was used for over a thousand years. Throughout the medieval period and into the early modern era, midwives were the primary — often the only — attendants at births across Europe, Asia, Africa, and the Americas.

The professionalization (and marginalization) of midwifery is a more recent and complicated story. In Europe, the rise of obstetrics as a medical specialty in the 18th and 19th centuries gradually pushed midwives to the sidelines. Male physicians — who could use forceps and, later, perform surgical interventions — claimed authority over birth. In the United States, this displacement was nearly complete by the mid-20th century: by 1955, midwives attended fewer than 1% of births.

That trend has reversed significantly. By 2020, certified nurse-midwives attended about 12% of U.S. vaginal births. In countries like the Netherlands, Sweden, and the United Kingdom, midwives attend the majority of births — and those countries consistently outperform the U.S. on most maternal and infant health metrics.

Types of Midwives

Not all midwives have the same training or scope of practice, and this distinction matters a lot.

Certified Nurse-Midwives (CNMs)

CNMs are the most widely recognized midwives in the United States. They’re registered nurses who have completed a graduate-level midwifery program (master’s or doctorate) accredited by the Accreditation Commission for Midwifery Education and passed a national certification exam.

CNMs can practice in hospitals, birth centers, and home settings. They can prescribe medications, order diagnostic tests, and provide primary care to women across the lifespan — not just during pregnancy. They are licensed in all 50 states, though practice authority varies. In some states, CNMs practice independently; in others, they need a collaborative agreement with a physician.

There are roughly 13,000 CNMs practicing in the United States.

Certified Midwives (CMs)

CMs have the same graduate-level midwifery education and pass the same certification exam as CNMs, but they enter midwifery from a non-nursing background (they may hold bachelor’s degrees in other health sciences). Currently, CMs are only authorized to practice in a handful of states.

Certified Professional Midwives (CPMs)

CPMs are credentialed through the North American Registry of Midwives. Their training focuses specifically on out-of-hospital birth — home births and birth center births. Educational pathways vary: some attend accredited midwifery schools, while others learn through apprenticeship. CPMs are licensed in about 35 states, though legal status and regulations differ considerably.

Direct-Entry and Traditional Midwives

In many parts of the world, midwives learn through apprenticeship and community-based training rather than formal degree programs. The WHO estimates that there are approximately 900,000 midwives globally, and a significant proportion — especially in low-income countries — have this type of training.

What Midwives Actually Do

The scope is broader than most people realize. Midwifery care spans far beyond catching babies.

Prenatal care includes regular check-ups to monitor the health of both mother and baby, blood tests, ultrasound referrals, nutrition counseling, exercise guidance, and screening for complications like gestational diabetes, preeclampsia, and preterm labor risk.

Labor and birth is where midwives are most visible. The midwifery model emphasizes physiologic birth — letting the body do what it’s designed to do, with minimal unnecessary intervention. Midwives monitor fetal heart rate, provide pain management support (positioning, hydrotherapy, breathing techniques, and in hospital settings, epidural referrals), manage normal deliveries, and handle immediate newborn care.

Postpartum care continues for weeks after birth: monitoring physical recovery, supporting breastfeeding, screening for postpartum depression and anxiety, providing contraception counseling, and offering newborn assessments.

General reproductive health — many CNMs provide annual gynecological exams, Pap smears, STI screening and treatment, contraceptive management (including IUD insertion and implant placement), and menopausal care.

The Midwifery Model vs. the Medical Model

This is where the debate gets heated — and where genuine philosophical differences about birth become apparent.

The medical model of childbirth, dominant in U.S. hospitals, treats birth as a medical event that requires monitoring and often intervention to ensure safety. Continuous electronic fetal monitoring, IV fluids, epidural anesthesia, labor augmentation with Pitocin, and cesarean section are standard tools. The assumption is that birth is potentially dangerous and medical readiness for complications should be the priority.

The midwifery model treats birth as a normal physiologic process that usually goes well without intervention. Monitoring is typically intermittent (listening to fetal heart tones periodically rather than continuously). Pain management leans toward non-pharmacological methods first. Movement and position changes during labor are encouraged. The assumption is that healthy women with low-risk pregnancies generally don’t need medical intervention — and that unnecessary interventions can themselves cause problems.

Neither model is entirely right or wrong. The medical model saves lives when complications arise. The midwifery model produces better outcomes for uncomplicated pregnancies. The real question is matching the approach to the individual — high-risk pregnancies need medical management, while low-risk pregnancies often benefit from a less interventionist approach.

What the Evidence Says

The evidence on midwifery outcomes is strong and remarkably consistent.

A 2016 Cochrane systematic review (considered the gold standard in evidence-based medicine) analyzed data from over 17,000 women across 15 randomized controlled trials. Women who received midwife-led care were:

Less likely to have an epidural
Less likely to have an episiotomy (surgical cut to widen the birth opening)
Less likely to have an instrumental delivery (forceps or vacuum)
Less likely to give birth prematurely
More likely to feel in control during labor
More likely to be satisfied with their care

There was no difference in cesarean section rates or serious adverse outcomes (neonatal death, maternal death).

A 2019 study in The Lancet went further, estimating that universal midwifery coverage could prevent 83% of maternal deaths, stillbirths, and neonatal deaths globally — primarily in low-income countries where access to any skilled birth attendant remains limited.

The United States spends more per capita on maternity care than any other country, yet ranks worst among high-income nations for maternal mortality. The maternal death rate is roughly 32.9 per 100,000 live births (2021 data) — compared to 2-5 per 100,000 in countries with strong midwifery systems like the Netherlands, Sweden, and Norway. The reasons are complex (inequitable access, high obesity rates, racial disparities), but the underuse of midwifery is part of the picture.

Where Births Happen

Hospital

About 98% of U.S. births occur in hospitals. Midwives (primarily CNMs) attend births in many hospital settings, often working alongside obstetricians. Hospital-based midwifery combines the midwifery model’s philosophy with immediate access to surgical and emergency facilities if complications develop.

Birth Centers

Freestanding birth centers are facilities designed specifically for low-risk births attended by midwives. They’re typically located near hospitals for quick transfer if needed. Birth centers offer a home-like environment — no IVs, no continuous monitoring, freedom to move and eat during labor. Transfer rates to hospitals range from 12% to 18% for first-time mothers.

Home

Planned home births with qualified midwives are a small but growing segment — roughly 1.3% of U.S. births in 2021. Research from countries with integrated home birth systems (like the Netherlands and the UK) shows outcomes comparable to hospital births for low-risk pregnancies when attended by qualified midwives with clear transfer protocols.

The U.S. data is more complicated because home birth regulation varies dramatically by state, and some home births are unplanned or unattended. A 2015 NEJM study of Oregon births found slightly higher neonatal mortality for planned home births compared to hospital births, though the absolute risk remained very low.

The Workforce Gap

The world needs more midwives. The WHO estimates a global shortage of 900,000 midwife, nurse, and physician positions in sexual, reproductive, maternal, and newborn health. This shortage is concentrated in low- and middle-income countries where maternal mortality rates are highest.

In the United States, the shortage is felt differently — there are enough midwives, but they’re unevenly distributed and face regulatory barriers in many states. Expanding midwifery access, particularly in rural and underserved communities, is one of the most cost-effective strategies for improving maternal outcomes.

Midwifery is not alternative medicine. It’s not anti-technology. It’s an evidence-based health profession with thousands of years of history and a growing body of research demonstrating that for most pregnancies, it produces outcomes as good as or better than standard obstetric care — at lower cost and with higher patient satisfaction. The question isn’t whether midwifery works. The question is why it isn’t used more.

Frequently Asked Questions

What is the difference between a midwife and an OB-GYN?

An OB-GYN is a physician who completed medical school and a four-year residency in obstetrics and gynecology. They are trained surgeons who can handle high-risk pregnancies and perform cesarean sections. A certified nurse-midwife (CNM) is an advanced practice registered nurse with a master's or doctoral degree in nurse-midwifery. Midwives specialize in low-risk pregnancies and focus on minimizing medical interventions, while OB-GYNs manage the full spectrum of complications. Many women see both during pregnancy.

Is giving birth with a midwife safe?

For low-risk pregnancies, yes — extensive research supports the safety of midwife-led care. A landmark 2016 Cochrane review of over 17,000 women found that midwife-led care was associated with fewer interventions (epidurals, episiotomies, instrumental deliveries), fewer preterm births, and higher maternal satisfaction, with no difference in adverse outcomes. The key is proper risk screening and access to emergency medical care if complications arise.

Can midwives prescribe medication?

Certified nurse-midwives (CNMs) can prescribe medications in all 50 U.S. states, though some states require physician oversight or collaborative agreements. They commonly prescribe prenatal vitamins, pain management medications, contraceptives, and antibiotics. Certified professional midwives (CPMs) and direct-entry midwives generally cannot prescribe medications, though regulations vary by state.

How much does a midwife cost compared to an OB-GYN?

Midwife-led births typically cost less than physician-attended hospital births. A midwife-attended hospital birth averages $4,000-$6,000 in the U.S., while a physician-attended hospital birth averages $5,000-$11,000. Birth center births with midwives average $2,000-$6,000. Home births with midwives average $2,000-$5,000. Most insurance plans, including Medicaid, cover CNM services, though coverage for out-of-hospital births varies.