There are two types of midwife in the United States:

**Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).

**Direct-entry midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry (non-nurse) midwives vary from state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.

"A midwife is…a health care provider and a doula is more of a childbirth coach. You might choose to have a midwife instead of an OB for prenatal care and to deliver your baby — midwives can deliver babies in hospitals, birthing centers or even in your home. A doula, on the other hand, doesn’t replace your healthcare practitioner but rather can add extra services, such as helping you with techniques to manage pain during labor and even providing support and help during baby’s early days." 

A midwife's main scope of practice is the health and well-being of the Mother and the Baby.  She is doing "watchful waiting" through the pregnancy and birth, ensuring that everything is proceeding and staying healthy and low-risk.  If things start to vary or complications develop, depending on the midwife and whether they are home- or hospital-based, they may encourage the family to seek co-care or transfer care to an obstetrician who is trained to manage pregnancy that is moving away from low-risk.  

The first study to compare birth outcomes between midwifery and obstetrical care was published in 1998.  Here are the conclusions:

"Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively."

~Excerpt from THIS article

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