This article is from the Midwifery FAQ, by cnmpat@aol.com (Pat Sonnenstuhl) with numerous contributions by others.
Lay Or Empirical Midwives, also referred to as direct entry midwives,
obtain their training through a variety of routes. This category may also
include very experienced and well trained midwives who practice in
states where there is no reciprocity for the license they already have,
such as Oregon, where certification is not required unless one wants to
get medical funds for low income clients. This category does not exclude
nurses from its ranks. (Sharon Hodges-Rust). These might also be
midwives who have chosen not to become licensed or certified for a
variety of reasons, ranging from the lack of experience necessary for
licensure to not wanting to work under any type of mandated protocols or
guidelines. Some are part of a religious group, and practice only within
a specific community. In some areas they cannot charge for their
services, and can be prosecuted for doing so.
Community-based midwives have been providing care for pregnant women across
North America for many past years. Currently there are two to three
thousand independent midwives in the US alone. There are many types of
providers providing prenatal care and birthing assistance in the United
States: Midwives with different sorts of titles and qualifications,
Physician Assistants, Family Practice or General Practitioners, and
Obstetricians. As you can imagine, the process and outcome of a birth
will be different, depending upon the provider chosen to assist the
birth.
 
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