Expectant parents should inquire about the education and licensing status of a midwife, to make the best match between parents and caregiver. Expectant parents should make sure that the midwife is licensed to practice in the state, holds a current certificate from the American Midwifery Certification Board or the North American Registry of Midwives, and has completed an accredited midwifery education program. Several types of midwives exist, including certified midwives, direct-entry midwives and certified nurse-midwives. A nurse-midwife is a nurse who holds a bachelor's degree or higher, has completed a midwifery training program, and has passed national and state licensing exams to become a certified nurse-midwife. Each state licenses nurse-midwives, but the licensing status of the other types of midwives varies from state to state.
The experience of the midwife should be taken into consideration. Not only should expectant parents ask about how long the midwife has been practicing and the number of births attended, but also about statistics regarding the birthing experience. Parents should ask the midwife about the rate of vaginal and cesarean deliveries, the rate of episiotomies and epidurals and the rate of induced labor. Midwives cannot perform cesarean sections so if expectant parents opt for a c-section or if an emergency c-section is required, a medical doctor will need to perform the operation. Additionally, only certified nurse-midwives can use electronic fetal monitoring, administer labor-inducing drugs and pain medications, and perform episiotomies. Asking for statistical background will give expectant parents insight into the midwife's experience that has created a type of "norm" that the midwife expects. If this norm does not match with the birthing plan of the parents, the midwife may not be a good fit for the couple. For example, if the midwife has a high rate of epidurals and the parents want a natural drug-free birth, the midwife may not be a correct fit for this particular couple.
An important factor to consider when using a midwife is the comfort level of the expectant parents. If the parents are not comfortable with the midwife, the birth will not be an ideal experience. Parents should make an ideal birthing plan and ensure the midwife will help facilitate that plan. If the prospective midwife does not fully support the ideal birth plan of the parents, it may be time to seek a different midwife.
When using a midwife, expectant parents and the newborn child may not have immediate access to resources needed in case of an emergency. Midwives often help with home-births where the technology and resources of a hospital setting are unavailable. Safety considerations that should be factored into the decision to use a midwife include the possibility of postpartum hemorrhaging, requiring a transfusion of plasma; complications arising from the position of the baby in the birth canal; and the delayed discovery of birth-related complications. If any of these medical issues arise during a birth that does not take place at a hospital, the mother and newborn may have to wait 20 minutes or more to get an ambulance to a hospital. Before deciding to use a midwife, and when considering home-birth in particular, safety issues and possible emergencies need to be considered and planned for.