Every now and again, a patient or their family will refer to me as “Doctor Robyn.” I’m always quick to correct them, “Oh, I’m not a physician. I’m a midwife. You can just call me Robyn.” Consequently, whenever I make a phone call to patients, I identify myself as “Robyn-the-midwife,” as though it is one word.
I’m very proud to be a midwife, and I have no desire to be a doctor. But many people do not understand what that term “midwife” really means. Most immediately assume that I deliver babies at home. I don’t, but many midwives do.
When I tell patients I work in a large university-based OB/GYN practice, they often ask if I’m a nurse practitioner (NP). I am, in fact, a women’s health NP (WHNP), but not all midwives are NPs. Although I’m certified as a WHNP, I do not currently hold an NP license, mostly because I am licensed as a Certified Nurse Midwife (CNM).
Within the field of midwifery itself, there is some confusion about what defines a midwife. CNMs are the most widely recognized type of midwife in the United States. But currently New York, New Jersey, and Rhode Island also recognize the certified midwife (CM) title. CMs are not nurses prior to attending midwifery school, but are certified and credentialed under the same exam and regulations as CNMs by the American College of Nurse Midwives (ACNM).
A Certified Professional Midwife (CPM) is credentialed under the North American Registry of Midwives (NARM) and is trained extensively in out-of-hospital birth. Lay midwife is a term that is broadly used for midwives who are not trained in a formal program by accredited schools, nor licensed or certified to practice. These midwives are usually trained through apprenticeships or self-study.
It is this identity crisis that often leads to confusion among health-care consumers and even other health-care providers about the role and abilities of midwives. Sometimes I think even some of my own family members believe that I am out in the woods casting spells rather than providing comprehensive medical and OB/GYN care to women across the lifespan.
The practice where I work employs a smart system in which the midwives attend most vaginal births. We also see a large proportion of low-risk obstetrical patients, perform annual well-woman exams and handle basic gynecology problem visits. This frees up physicians to perform cesareans, gynecology surgical procedures and care for higher-risk patients. It is a model of care that maximizes every clinician’s skill level and is designed to increase everyone’s productivity.
Despite the efficiency we enable, midwives often have to explain our training and qualifications to new patients. We need a clearer understanding of midwifery in the United States. If more of my colleagues in the medical profession acknowledged the integral role midwives in the care of women, it would help achieve this.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.