A midwife is a trained health professional who provides care throughout pregnancy, labor, birth, and the postpartum period, and in many cases also serves as a primary provider for routine gynecological health. Their scope goes well beyond “catching babies.” Midwives monitor the physical and emotional well-being of both mother and newborn, manage pain, prescribe medications, order lab work, and refer to physicians when complications arise.
Care During Pregnancy
Prenatal care is one of a midwife’s core responsibilities. This starts with confirming and dating the pregnancy, then continues with regular visits that track the health of both the pregnant person and the developing baby. During those appointments, midwives order and review ultrasounds and blood work, screen for conditions like gestational diabetes and preeclampsia, and monitor fetal growth and position as the due date approaches.
Beyond the clinical checks, midwives spend a significant share of each visit on education and counseling. They walk you through what to expect during labor, discuss nutrition, help you develop a birth plan, and address the psychological and social dimensions of pregnancy. This emphasis on individualized education is central to what’s known as the Midwifery Model of Care, which treats pregnancy and birth as normal life processes rather than medical events that need to be managed.
What Happens During Labor and Birth
During labor, a midwife provides continuous, hands-on support. That means monitoring the mother’s vital signs and the baby’s heart rate, assessing how labor is progressing, and helping with pain management, which can range from breathing techniques and position changes to ordering an epidural in a hospital setting. If needed, a midwife can perform an episiotomy, deliver the newborn and placenta, and begin immediate newborn care.
One measurable difference in midwifery-led care is a lower rate of surgical intervention. A study published in the journal Birth comparing outcomes between obstetrician-led and midwife-led intrapartum care found that patients receiving midwifery care had a cesarean rate of 8.9%, compared with 15.2% for those under obstetrician-led care. Patients in the obstetrician group also experienced higher rates of labor induction, epidural use, and operative vaginal delivery. The tradeoff wasn’t one-sided: midwifery-led care was associated with slightly higher rates of postpartum hemorrhage. Still, the overall pattern reflects the midwifery philosophy of minimizing technological interventions when the pregnancy is progressing normally.
Postpartum and Newborn Care
A midwife’s role doesn’t end with delivery. In the hours and weeks after birth, they provide postpartum recovery support, monitor for complications like excessive bleeding or infection, and help new mothers with breastfeeding through hands-on education and troubleshooting. They also educate both parents on infant care basics.
For the newborn, midwives perform initial physical assessments and coordinate standard screening tests. One of the most important is the newborn blood spot screen, a heel-prick test typically done between 24 hours and 5 days after birth. A few drops of blood are collected on filter paper and sent to a lab to check for dozens of metabolic and genetic disorders. In some states, a second screen is collected between 7 and 28 days of age. Midwives practicing in out-of-hospital settings handle these screenings directly, though some have noted that the heel-prick technique requires specific training to get right.
Well-Woman and Gynecological Services
Many people don’t realize that midwives, particularly certified nurse-midwives, provide routine gynecological care to women who aren’t pregnant at all. This includes Pap tests, breast exams, screening and treatment for vaginal and sexually transmitted infections, contraception counseling, and family planning. A certified nurse-midwife can function as your primary reproductive health provider for years without a pregnancy ever being part of the picture. They also counsel on nutrition, fertility, and general wellness.
When a Midwife Refers to a Physician
Midwives are trained to recognize when a situation moves beyond their scope and requires obstetric or surgical intervention. During labor, the most common reasons for transfer include failure to progress (labor stalling in either the first or second stage), signs of fetal distress, and antepartum hemorrhage, which is heavy bleeding before delivery. After birth, retained placenta, postpartum hemorrhage, and perineal trauma that needs surgical repair are common reasons for referral.
For first-time mothers, failure to progress and requests for an epidural (in out-of-hospital settings where one isn’t available) drive many transfers. For mothers who have given birth before, nearly half of all transfers happen after the baby arrives, often for complications like heavy bleeding or concerns about the newborn. Identifying these situations early and coordinating a smooth handoff to an obstetrician is a core midwifery competency.
Types of Midwife Credentials
Not all midwives have the same training or legal authority, and the differences matter.
- Certified Nurse-Midwife (CNM): Holds a master’s or doctoral degree from a university-affiliated nurse-midwifery program. CNMs are advanced practice nurses with the broadest scope of practice, including prescribing authority in all 50 states, though the specifics vary. In some states they prescribe independently, including controlled substances. In others, certain drug classes require a collaborative agreement with a physician.
- Certified Midwife (CM): Similar education and certification to a CNM but without a nursing degree as the foundation. CMs are credentialed through the same professional organization (the American College of Nurse-Midwives) and have equivalent clinical training, but are only licensed in a handful of states.
- Certified Professional Midwife (CPM): A credential that recognizes multiple educational pathways, including apprenticeship. CPMs must meet clinical requirements, pass a skills evaluation, and pass a written exam. They primarily attend births in homes and freestanding birth centers rather than hospitals.
Prescribing and Legal Authority
Prescriptive authority for midwives, especially CNMs, varies significantly by state. In New York, licensed midwives can prescribe both controlled and non-controlled substances and order diagnostic tests within their scope. In Kansas, nurse-midwives can prescribe any drug consistent with their role, including controlled substances. Arizona allows independent prescribing of most controlled substances but restricts certain opioids. On the more limited end, Puerto Rico permits nurse-midwives to order only vitamins, antibiotics, contraceptives, and immunizations for uncomplicated pregnancies.
These differences shape what a midwife can do in practice. In states with full prescriptive authority, a CNM can manage nearly all aspects of a low-risk pregnancy and routine gynecological care without physician involvement. In more restrictive states, they work under collaborative agreements that require a physician to co-sign certain prescriptions or treatment plans.
How Midwives Work With Doctors
In hospital settings, midwives and obstetricians often share the same labor and birth unit. Research into how these teams function has identified four pillars of effective collaboration: building trust and respect, maintaining clear communication, establishing shared clinical guidelines, and balancing each provider’s autonomy. When these elements are in place, both patient outcomes and clinician satisfaction improve. When they aren’t, turf conflicts and unclear handoff protocols can create gaps in care.
In practice, the division often works like this: midwives manage low-risk labors and births independently, consult with the on-call obstetrician when something falls outside normal parameters, and transfer care entirely when surgical delivery or complex medical management is needed. The goal is to keep the midwife’s approach intact for straightforward births while ensuring immediate access to higher-level intervention when the situation calls for it.