The term "midwife" means many things. It is important for consumers to know that not all midwives are the same. Any two given midwives can have a vastly different educational background, skill set, philosophy, scope of practice, and legal parameters. The difficult, yet critically important task for any consumer considering the care of a midwife, is how to find a midwife who practices safely. This is particularly difficult if you are seeking an out-of-hospital birth, in a state with no standards or regulation for midwifery practices.
"Safe" Midwifery refers to midwifery practiced as safely as possible, regardless of setting.
What does "Safe" Midwifery look like?
When compared to any other maternity care provider, CNMs who are licensed, insured, and work as part of a collaborative care model, have been shown to have the best outcomes in terms of neonatal mortality. Safety, for midwives working in the hospital setting, is a part of their professional culture. There are checks, balances, and oversight protocols in place.
A "safe" midwife attending home births or freestanding birth center births is more difficult to define. A licensed, insured midwife is still ideal. In out-of-hospital birth, it is critical to hire someone who values assessments and who will monitor for risk factors. A good out-of-hospital midwife should be able to clearly communicate her risking out criteria, and should express a philosophy that demonstrates understanding that not every woman is a good candidate for out-of-hospital birth. Women should be carefully screened, assessed, and monitored. If your midwife believes that every risk factor is a "variation of normal", or is telling you to "trust birth" instead of seeking consultation with a physician, please read more about language that would be a Red Flag.
A midwife who values safety will also have a closely collaborative relationship with a physician and/or hospital. It is always a good idea to speak to the collaborating partner to be sure everyone involved has the same standards and expectations for your care. Transfer of care protocols should also be identified and cross-referenced with all parties involved.
There are a few key factors that research has shown to impact positive outcomes in planned home birth.
Highly educated birth attendant (AMCB certified) (link to education and credentials)
Fully integrated into the healthcare system (ie collaborative care models)
Practices defined by scope of practice (link) through state regulation
Ready access to consultation
**Note: Points listed above are taken from ACOG and AAP's most recent statements on Planned Home Birth.
Visit "How to Find a Safe Midwife" for more detailed support on this topic.