Midwifery & changes in
North American birth
Awareness about choices in childbirth in the USA and the popularity and number of so-called out-of-hospital birth in this country received a huge boost with the inception of the Internet. Easy access to information and independent films and documentaries such as "The Business of Being Born" (2008) provided eye-openers and positively impacted families' birth decisions. When COVID (2020) turned everyone's world upside-down, we experienced yet another surge of awareness..
The number of Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM) is growing in response to the demand for better birth, but can hardly keep up. The majority of CPMs are independent practitioners specifically trained in out-of-hospital settings (home, free-standing birth centers). In 2025 there were approximately 2700 actively practicing CPMs in the US. Certified Nurse Midwives (CNMs) are medically trained and primarily work in hospital group and birth center settings (13,000 active licenses in 2020); few CNMs are cross-trained to do home births.
Did you know that in developed nations with the best birth-outcomes midwives greatly outnumber obstetricians? Sadly, in the USA the opposite is true, yet we spend more on maternity care than any other developed nation in the world!
We still have a long way to go before all US families that desire a midwife can secure one, and before all hospitals achieve Baby-Friendly status and demand safe, evidence-based care in their birthing suites, but at the very least we can say that the current state of birth in most areas of the USA is much improved compared to the late forties - seventies when all US births took place in hospitals. Back then, babies were born to doped-up mothers who had no support or say at all while enduring high-intervention deliveries that left them cut, stitched, and traumatized or without any recollection at all.
The notion that the birth experience belongs to the mother and her baby and that it should be protected from unnecessary interventions and possible harm is finally gaining ground. Parents are now asserting themselves by researching, interviewing midwives and touring birthing centers, realizing that they need to actively participate and take responsibility for their prenatal care and birth choices if they want to achieve the best possible outcome for themselves and their offspring.
Another forward trend we've seen are childbirth preparation classes developed by women. These courses are often comprehensive, teaching relaxation and immersion methods, explaining anatomy and physiology, how to support a healthy pregnancy, the stages of labor, coping skills, breastfeeding and early post partum challenges - all through insight and respect for processes of normal childbirth - an excellent prep fit for any birth setting.
The state of South Carolina grants a license to Certified Professional Midwives to practice midwifery independently. Licenses are renewable every two years provided all required re-certifications, and continued education hours are fulfilled. The CPM credential is renewable every three years. SC Licensed midwives work within the guidelines of SC Regulations for Licensed Midwives (SCDHEC 60-24) and must carefully screen prospective clients: a good candidate for midwifery care and a planned home- or birth center birth is in robust health without a complicating medical history, and takes responsibility for their choices in pregnancy and birth, in collaboration with their chosen midwife.
Having one's baby out of hospital with a Licensed Midwife is a viable option for SC families, and we are doing our very best to respond to the growing demand for our services.
Web Links
Palmetto Association of Licensed Midwives
Midwives Alliance of North America
The North American Registry of Midwives
South Carolina Dept of Health & Environmental Control - Midwives Regulation 60-24
Good Reads
Ina May's Guide to Childbirth - Ina May Gaskin
Heart and Hands - Elizabeth Davis
Mama Natural - Genevieve Howland
Jessica Mitford - The American Way of Birth
Active Birth - Janet Balaskas
Videos
the business of being born statistics
The number of Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM) is growing in response to the demand for better birth, but can hardly keep up. The majority of CPMs are independent practitioners specifically trained in out-of-hospital settings (home, free-standing birth centers). In 2025 there were approximately 2700 actively practicing CPMs in the US. Certified Nurse Midwives (CNMs) are medically trained and primarily work in hospital group and birth center settings (13,000 active licenses in 2020); few CNMs are cross-trained to do home births.
Did you know that in developed nations with the best birth-outcomes midwives greatly outnumber obstetricians? Sadly, in the USA the opposite is true, yet we spend more on maternity care than any other developed nation in the world!
We still have a long way to go before all US families that desire a midwife can secure one, and before all hospitals achieve Baby-Friendly status and demand safe, evidence-based care in their birthing suites, but at the very least we can say that the current state of birth in most areas of the USA is much improved compared to the late forties - seventies when all US births took place in hospitals. Back then, babies were born to doped-up mothers who had no support or say at all while enduring high-intervention deliveries that left them cut, stitched, and traumatized or without any recollection at all.
The notion that the birth experience belongs to the mother and her baby and that it should be protected from unnecessary interventions and possible harm is finally gaining ground. Parents are now asserting themselves by researching, interviewing midwives and touring birthing centers, realizing that they need to actively participate and take responsibility for their prenatal care and birth choices if they want to achieve the best possible outcome for themselves and their offspring.
Another forward trend we've seen are childbirth preparation classes developed by women. These courses are often comprehensive, teaching relaxation and immersion methods, explaining anatomy and physiology, how to support a healthy pregnancy, the stages of labor, coping skills, breastfeeding and early post partum challenges - all through insight and respect for processes of normal childbirth - an excellent prep fit for any birth setting.
The state of South Carolina grants a license to Certified Professional Midwives to practice midwifery independently. Licenses are renewable every two years provided all required re-certifications, and continued education hours are fulfilled. The CPM credential is renewable every three years. SC Licensed midwives work within the guidelines of SC Regulations for Licensed Midwives (SCDHEC 60-24) and must carefully screen prospective clients: a good candidate for midwifery care and a planned home- or birth center birth is in robust health without a complicating medical history, and takes responsibility for their choices in pregnancy and birth, in collaboration with their chosen midwife.
Having one's baby out of hospital with a Licensed Midwife is a viable option for SC families, and we are doing our very best to respond to the growing demand for our services.
Web Links
Palmetto Association of Licensed Midwives
Midwives Alliance of North America
The North American Registry of Midwives
South Carolina Dept of Health & Environmental Control - Midwives Regulation 60-24
Good Reads
Ina May's Guide to Childbirth - Ina May Gaskin
Heart and Hands - Elizabeth Davis
Mama Natural - Genevieve Howland
Jessica Mitford - The American Way of Birth
Active Birth - Janet Balaskas
Videos
the business of being born statistics
