In California and many other states, there are two types of midwives: Certified Nurse-Midwives and Licensed Midwives. A Certified Nurse-Midwife (CNM) is a registered nurse with additional training and certification in the practice of midwifery and who is licensed by the Board of Registered Nursing. A California Licensed Midwife (LM) is held to the same standards and body of knowledge as a CNM but is licensed by the Medical Board of California and does not write prescriptions for allopathic medications. Some Licensed Midwives are also registered nurses but most enter the midwifery profession directly as per the European model of midwifery.
Sheila Kitzinger is an internationally respected British childbirth educator. In her book, Homebirth, she writes eloquently about the role of the midwife:
The modern, professionally trained midwife is a specialist in childbearing, qualified to take responsibility for women prenatally, through the birth itself, and for four weeks afterward. She has specific skills to support the physiologic process, to understand deviations from the normal and to know when obstetric advice or assistance is required. Unlike the obstetrician, the main focus of her interest is the normal, not the pathological, and the whole woman rather than one organ, the uterus. Midwives working outside a hospital resort to intervention less readily than hospital midwives, because events that would be considered abnormal according to the paradigm of standard hospital labor are considered normal away from the rigid protocols of the hospital.
When a midwife attends in quiet confidence, she is able to tolerate inaction and can watch and wait on this child's coming to life, giving the mother of her own strength and inner joy. She blends with the surroundings, merging with the pattern of the woman's life. She does not take charge or take over. She does not "manage" labor: in many ways, her task is a more difficult one than this. It demands great strength of personality. She needs to observe minutely and with sensitive awareness everything that is happening in the labor and to be aware of what is happening in the mind of the woman she is attending.
A good midwife understands when she should stand back and let things unfold, and knows when she needs to intervene. And the interventions are rare. Far more often she gives quiet, tender support to the woman in her care, simply allowing the energy of birth to sweep through the mother's body, and helping her to find strength within herself. When you stand watching a river in full flood, you know that you cannot fight its power. But you can use it so that its flow sweeps you onward.
A woman should be able to expect open and honest communication with the midwife. Instead of "reassurance" there is frank explanation, exploring of options, a genuine sharing between the two women, which goes far beyond the trite phrases that are sometimes trotted out in an attempt to keep a patient docile and placid.
When a woman and her midwife relate to each other with mutual respect, warmth and openness, it is as if they are on a journey together in which exciting discoveries are made, their understanding deepens, and they are both enriched by the birth experience.
A good midwife is not only someone who delivers a baby. She is midwife to a woman's transformation to motherhood and a man's transformation to fatherhood. She is midwife to all the dreams and hopes surrounding the coming to being of that child, and to the process of maturing and growth that is involved for both parents.