Midwifery Care: Scope, Types & Collaborative Practice

Midwives are autonomous primary maternity care providers for low-risk pregnancies, practicing in hospitals, birth centers, and homes.

Credential	Education	Scope	Practice Settings
CNM (Certified Nurse-Midwife)	RN + MSN/DNP in midwifery (ACME-accredited)	Full scope: primary care, gynecology, pregnancy, birth, postpartum, newborn (28 days), prescriptive authority (all 50 states)	Hospital (94%), birth center, home, clinic
CM (Certified Midwife)	Non-nursing bachelor's + MS in midwifery (ACME)	Same as CNM (no RN license)	Limited state recognition (9 states + DC)
CPM (Certified Professional Midwife)	Apprenticeship/MEAC-accredited program; NARM exam	Out-of-hospital birth only (home, birth center); no prescriptive authority in most states	Home, birth center (state-dependent)
Lay / Traditional Midwife	Informal apprenticeship; no national certification	Varies; often unregulated	Home birth communities

Prenatal: Risk screening, labs, ultrasound referral, education, nutrition, psychosocial support.
Labor & Birth: Continuous support, physiologic birth promotion, intermittent auscultation, hydrotherapy, position changes, emergency recognition/transfer.
Postpartum (6 weeks): Maternal recovery, breastfeeding support, newborn assessment, depression screening, contraception.
Well-Woman/GYN: Annual exams, contraception, STI screening, menopause (CNM/CM).

CNMs/CMs have formal collaborative agreements with OB/GYNs.
Transfer criteria: preterm labor, preeclampsia, abruption, non-reassuring fetal status, need for C-section.
Seamless transfer = shared records, communication, mutual respect.

Cochrane: Midwife-led continuity models → ↓ interventions, ↑ satisfaction, comparable safety for low-risk.
WHO: Midwives could avert 83% of maternal/newborn deaths with full resourcing.