Here is a quick summary of common titles, roles, and general backgrounds of various kinds of midwives and adjacent birthworkers.
Certified Nurse-Midwife (CNM) is a person who has completed a graduate or post-graduate degree in midwifery after obtaining a nursing degree. In most states, they can work in all birth settings, with or without physician oversight depending on the state, and they can typically provide preconception, peripartum, and early newborn care, as well as well-person care. These providers are typically required to maintain a professional nursing and midwifery license in the state(s) they practice in.
Certified Midwife (CM) is the same as a CNM, but they have an undergraduate degree in something other than nursing. In most states, they can work in all birth settings, with or without physician oversight depending on the state, and they can typically provide preconception, peripartum, and early newborn care, as well as well-person care. These providers are typically required to maintain a professional midwifery license in the state(s) they practice in.
Certified Professional Midwife (CPM) is a type of direct-entry midwife who has completed an academic midwifery program and an apprenticeship, typically with a senior midwife or midwives, or at a birth centre/clinic run by midwives. Upon completion of their program and apprenticeship, they pass an exam proctored by the North American Registry of Midwives (NARM) to gain their CPM credential. In many states, they can work at birth centres, birth houses, and in the homes of clients. Most provide preconception, peripartum, and early newborn care, with some also providing basic well-person care. In some states, they are required to maintain a professional license and in a few states, they are required to maintain collaborative agreements with physicians.
Direct-Entry Midwife (DEM) is a type of midwife who may have completed an academic midwifery program, engaged in independent study, or some combination of the two. They will have also completed an apprenticeship with a senior midwife or midwives, or at a birth centre/clinic run by midwives. In some states, these midwives may or may not be licensed or regulated and typically only practice out of birth houses or the homes of their clients (though they may be permitted to attend births in birth centres in some states). Depending on their training and experience, they might provide preconception, peripartum, and early newborn care, with some also providing basic well-person care.
In some states, they are required to maintain a professional license with or without collaborative agreements with physicians), while in others they may be unlicensed and unregulated, or possibly illegal. Some may choose to not certify or become licensed out of philosophical, political, spiritual/religious, or cultural reasons.
DEMs may utilise different titles depending on where they live, how they were trained, or based on the community/communities they serve. Some of these titles can include:
Direct-Entry Midwife (DEM)
Lay Midwife – though many DEMs refuse this label and see it as pejorative as it implies they have had no training or midwifery skills.
Community Midwife – some credentialed midwives also use this title to indicate that they provide out-of-hospital peripartum care.
Traditional Midwife (TM)
Christian/Plain/Amish/Spiritual/Religious Midwife– may carry a different, specific title depending on the faith or spiritual community they serve.
Partera/Mormusti/Agbẹbi/מילדת/etc.– names/titles depend on the specific cultural or indigenous group the person serves and they may hold these cultural titles with or without also holding credentials or licenses that carry Western/legal titles as well.
Traditional Birth Attendant (TBA) also sometimes called a Birth Attendant or Traditional Midwife, is a person experienced in the indigenous cultural and spiritual practices around pregnancy, birth, and early newborn care of the communities that they serve. They are typically found in parts of the world that Western Society labels as “developing”. They may or may not have any formal training, may have apprenticed, or be self-taught. The World Health Organisation recognises that TBAs are necessary in many locations and communities in order to mitigate high peripartum & neonatal mortality and morbidity rates where there is a lack of access to obstetrical care.
Licensed or Registered Midwife (LM/RM) are specific labels applied by certain states who license and regulate non-nurse midwives. An LM/RM may hold or not hold any other credential such as CPM.
Midwife Assistant is a person who has been trained by a midwife, a midwife group, or by a midwife assistant program to assist a midwife. They can typically be found assisting midwives that attend births in clients' homes, birth houses, and occasionally at birth centres. They perform tasks like setting up/breaking down the birth space, cleaning up the birth space, charting, checking vitals, and assisting the midwife during emergency situations like postpartum haemorrhage or neonatal resuscitation. A midwife assistant may or may not also be an advanced apprentice with the midwife that they are assisting.
Monitrice is a person who provides educational, emotional, physical, and client-advocate support during late pregnancy, birth, and immediate postpartum in the same ways that a “doula” would. The difference is that most are either midwives or midwife assistants and offer certain clinical skills to their clients such as checking vitals and cervical dilation while they are labouring at home. They may or may not communicate this information with the client’s homebirth midwife before they arrive or with the client’s birth centre or hospital-based provider before transferring to give birth.
Doula is a person who provides educational, emotional, and physical support. If certified, they may or may not provide client-advocate support depending on their certifying organisation’s policies concerning advocating for clients. They may or may not be trained or certified by an agency, group, hospital, or organisation. They are employed by and serve the client, not the client’s provider; they answer to their clients, not their clients’ providers. There are many different kinds of doulas and some may provide all or a combination of services:
fertility – provides support for clients trying to conceive or navigating fertility treatment and options.
pregnancy/gestation/prenatal – provides support for clients during their pregnancy.
labour/birth – provides support for clients during their labour, birth, and the immediate postpartum period.
postpartum – provides support for clients during their postpartum recovery period, typically not beyond 12 weeks postpartum, though some provide periodic support up to a baby’s first birthday.
abortion – provides support for clients before, during, and after the termination of a pregnancy.
full-spectrum – provides support for clients regardless of the outcome of their pregnancy, be it birth, loss, surrogacy, adoption, or abortion.
bereavement – provides support for clients experiencing a pregnancy loss, stillbirth, or neonatal death, with some also providing care to those choosing abortion/medical termination.
adoption – provides support for clients (gestating person, adoptive person/s, or both) during the process of adoption.
sibling – provides support to clients by providing support to the client’s other children during labour, birth, and immediate postpartum periods, with some also providing periodic sibling care during the first few weeks postpartum to help with sibling adjustment.
(life) transition/gender – provides support for clients during gender transitioning, gender-affirming surgery recovery, or when transitioning into their menstruation or menopausal phase in life.
medical – provides support for clients navigating stressful or complex health situations and recovery periods.
death – provides support for clients and/or their families at the end of life.
Due to the etymology of the word “doula”, meaning slave or servant in Greek, many people who fill this role, especially those who are descendants of people who were enslaved and/or colonised, do not wish to embrace the sentiment of the word or use the title of slave or servant. Other terms that imply a person is fulfilling the role of a doula may include:
repro worker/reproduction professional
BirthKeeper/Birthkeeper* is a term coined by midwife Jeannine Parvati Baker (1949-2005) by combining Earth Keeper and Birth Worker. Inspired by her Indigenous (Shoshone/Newe)and Jewish roots, birthkeeping is a recognition that the health and stability of birth and of the Earth are inextricably linked. That to heal and preserve one was to heal and preserve the other. Advocating for autonomy, informed decision-making, physiological & non-managed birth, non-pathologising care, and honouring the ineffable are at the core of birthkeeping. “Healing the Earth, by healing Birth.”
*in recent years, there has been a growing number of people adopting the title of Birthkeeper and using it to describe their role at birth in addition to their title of doula or midwife, or the birth and ecological-related work that they engage in. Unfortunately, this term has been largely divorced from its original intent by many present-day “birthkeepers”.
It is no secret that JP Baker was a supporter of unassisted birth (birth with no attendant or assistance) and would likely be a supporter of the more recent trend of freebirth (birth with or without attendants or assistance, but with the birthing person’s full autonomy intact regardless of their informed birth choices). However, many “birthkeepers” are essentially attending “unassisted births” or “freebirths” as doulas who are cosplaying as midwives with little to no actual academic or skills training, without having apprenticed under a senior midwife, and without transparency around their lack of skills and knowledge when being interviewed by prospective clients. This trend is causing incredible trauma to families in many communities and further complicating the tenuous legal circumstances in which many Traditional and other community-based midwives already practice.
Let us not forget to acknowledge the damage done by many of these “birthkeepers” who are cisgender, heteronormative, white women, often misusing appropriated cultural practices of Indigenous, Black, and other People of the Global Majority, as well as other historically marginalised peoples.