The word “midwife” comes from Middle English and means “with woman.”  Midwives are the time-honored guardians of healthy pregnancy and childbirth. They provide comprehensive prenatal care and education, guide labor and birth, manage complications, and care for newborns. Many midwives also provide preconception care and routine well-body reproductive (or gynecological) care.

There are two types of midwives in practice in California: Licensed Midwives and Certified Nurse Midwives: 

• Licensed Midwives (LMs) complete a three-year, post-secondary midwifery education program, or the equivalent thereof, and then must pass a national certification exam administered jointly through the North American Registry of Midwives (NARM) and the Medical Board of California. Their training focuses on providing maternity care in community-based settings (such as private homes and birth centers) and encompasses both standard medical management of pregnancy and childbirth, as well as traditional midwifery skills (such as herbology, hands-on bodywork, and holistic preventative care). They are licensed and regulated by the Medical Board of California and practice autonomously, without physician supervision. Some LMs maintain an additional designation: Certified Professional Midwife (CPM). The CPM credential is issued by NARM and is the only NCCA-accredited midwifery certification requiring out-of-hospital experience. LMs provide the majority of planned home birth and birth center births in California.
• Certified Nurse Midwives (CNMs) are advanced practice nurses with a master’s degree in nurse-midwifery. Their training focuses primarily on hospital-based maternity care and rarely includes specific training in community or home birth. CNMs are governed and regulated by the California Board of Registered Nurses. Currently, CNMs are required to work under the supervision of physicians, meaning that most work in hospital settings.

The roles of doulas and midwives are not interchangeable. 

The midwifery model of care recognizes pregnancy and childbirth as normal and natural life processes. This model of care is rooted in the following: 

• A trusting and respectful relationship between midwife and birthing person that is egalitarian and non-authoritarian
• Nurturing and monitoring the physical, psychological, and social well-being of the birthing person throughout the childbearing cycle
• Individualized education, counseling, and prenatal care which promotes the birthing person’s well-being, autonomy, and self-determination
• Therapeutic use of the human presence, including continuous hands-on assistance during labor and birth, as well as, lactation and postpartum support
• Minimizing technological interventions unless necessary for the health and well-being of the birthing person and baby
• Collaboration and consultation with other health professionals to serve the needs of the birthing person and baby

Research shows that homebirth with a professional midwife is a safe option for low-risk pregnancies. Large prospective studies have shown that rates of medical interventions are far lower for homebirths compared to births in hospitals, without any statistically significant increase in negative outcomes.

In the U.S., low-risk birthing persons who planned a homebirth had a cesarean rate of just 5.2%, compared with a 31% cesarean section rate in the hospital. Homebirth is also associated with dramatically lower rates of induction, episiotomy, infection, and preterm birth, as well as, much higher rates of breastfeeding/chestfeeding and higher overall birth satisfaction.

You can find more information on homebirth safety here or check out the following studies: 

• Outcomes of planned homebirths with CPMs in North America
• Outcomes of planned homebirth after regulation in British Columbia

Here are some worthwhile films to help you decide if homebirth is for you:

• Born at Home
• Why Not Home?

Ultimately, questions of safety and risk are deeply personal. Each pregnant person and family must weigh for themselves the risks of birthing at home against the risks of birthing in-hospital, where unnecessary interventions and timetables, hospital-borne infection, and iatrogenic complications (meaning, caused by medical treatment) present their own dangers. You and your family must decide which set of risks feel safest to you and make the best choice for your situation.

What if there’s an emergency at home?

Licensed Midwives maintain certification in CPR/BLS for Healthcare Providers and in Neonatal Resuscitation (NRP) and are legally licensed to carry all medical equipment and medications necessary to safely manage low-risk deliveries and the most common concerns at home, including: fetal heart monitors (ultrasound Dopplers), oxygen, resuscitation equipment, emergency medications to stop bleeding, herbs, homeopathics, IV supplies, suturing equipment with local anesthetic, and more.

The excellent health of my clients combined with the high quality, preventive care I provide, mean that complications in labor and birth are rare. If a concern begins to develop, it is either addressed skillfully at home or we will discuss the need for transfer to a higher resource setting, as needed. In the case of a transfer of care, I ensure that your hospital provider has all the information needed and accompany you to provide support and guidance. 

Who can give birth at home?

Homebirth is an option for any pregnant person experiencing a healthy, low-risk pregnancy who desires to be supported and give birth outside of the medical setting, with minimal interventions, and who wishes to to take an active role in their health care. More than 80% of pregnant people are low-risk for complications for pregnancy and birth, so most are good candidates for midwifery care and homebirth.

Who is not a good candidate for homebirth?

There are certain conditions that rule out birth at home, as they create increased risks for both the birthing person and baby. These include high blood pressure, certain heart diseases and bleeding disorders, epilepsy, insulin-dependent diabetes, current alcohol abuse or drug addiction, cigarette smoking, uncontrolled asthma, kidney disease, liver disease, and significant mental health issues that might interfere with care.

Can I have a VBAC (Vaginal Birth After Cesarean) at home?

A previous Cesarean section does not automatically rule out having a homebirth. In fact, a VBAC at home is often statistically safer than a repeat C-section. This is evaluated case by case and depends on factors such as the type of surgical incision that was done, the number of previous c-sections, and the length of time between pregnancies. We would schedule a VBAC consultation to review your previous records and surgical report, as well as your pregnancy and health history, and then discuss your best options.

For general information about VBACs, go to:

• International Cesarean Awareness Network (ICAN)
• VBAC Facts

Can I have a waterbirth?

Yes! Laboring in water can be very soothing and help ease the labor process, even if you are not planning on actually giving birth in water. People typically find that giving birth in water:

• Increases relaxation
• Decreases pain
• Increases the ability to move around and change positions
• Provides an increased sense of control
• Increases satisfaction with the birth experience

I have professional grade birth tubs available for my clients to rent. The rental fee includes the tub, a tub liner, an air pump, and a sump pump. There are some additional supplies you must purchase. You are not responsible for cleaning the tub after birth—the birth team will take care of that for you.

To learn more about waterbirth, check out:

• The Evidence on: Waterbirth