In 2006 direct-entry midwifery was legal in 24 states, “alegal” (allowed without legal interference) in 17 states, and explicitly illegal in only nine states. In the past decade, more and more states have been legalizing direct-entry midwifery. The U.S. government recognizes the training for both nurse-midwives and direct-entry midwives and has authorized the Midwifery Education Accreditation Council to accredit midwifery schools and programs. Despite the current resurgence of midwifery in the United States, the fact that midwives were harshly persecuted for more than a century has left the profession with a legacy of public reticence and confusion that must be overcome. Many myths surround midwives, myths that are often reinforced by obstetricians who view them as competition. One is that midwives are not trained but are “hippy-dippy” lay women who attend only home births. Another is that midwives are religious zealots or witches who use magical potions. That nurse-midwives attend births only in hospitals is a common misconception, as is the idea that a midwife is a second-class doctor for women who can’t afford a real obstetrician. None of these ideas is remotely true. Science has proven that for attending low-risk births (that is, births without complications) , midwives are not second-class obstetricians, but rather obstetricians are second-class midwives. Generally speaking, a fundamental difference between midwifery care and physician care at birth has to do with control. Childbirth is a complicated physiological process regulated by the woman’s nervous system. Childbirth is not under the conscious control of the woman giving birth, but rather is directed by hormones and the parasympathetic portion of the autonomic nervous system. Anything that causes fear or alarm shuts down the parasympathetic system and fires up the sympathetic nervous system (adrenaline) . Any intervention that increases a laboring woman’s fear or anxiety will interfere with, slow down, or even stop the birth processes. A wise birth assistant, be it midwife, nurse, or doctor, knows how to facilitate these autonomic responses and not interfere with them. The key elements in the midwifery model of birth are normality, facilitation of natural processes (with minimal intervention) , and the empowerment of the birthing woman. Taking on the role of facilitator, midwives typically will reassure, calm, and encourage birthing women. Obstetricians, on the other hand, typically try to get the birth under their own control by overriding the natural processes with drugs and medical procedures and giving orders. The medical model and the midwifery model are essentially different ways of looking at women and birth. Doctors “deliver” babies and believe that having a baby is something that happens to a woman. Midwives assist at birth and believe that giving birth is something that a woman does. Midwives tend to believe that a woman giving birth needs to be the one making decisions about her birth experience. The woman giving birth needs to believe in her own body and feel responsible for her body, while at the same time letting go of the need to control what is happening, since she cannot. Another fundamental difference between midwives and doctors is how they view pregnancy and birth. Midwives understand that pregnancy is not an illness. They typically call the women in their care “clients,” not “patients,” since they are not sick and are not getting medical treatment. Though midwives know what can go wrong during pregnancy and birth and know how to identify problems early and to cooperate with doctors in managing complications, their focus is on birth as a life-enhancing experience. Although they believe it is essential to have medical assistance available when it is needed, they are trained to go beyond medical care and empower women to achieve their goals for themselves and their babies. Midwives trust in women’s bodies and their capacity to give birth successfully with little or no intervention in most cases. Obstetricians, on the other hand, tend to focus on what can go wrong during pregnancy and birth.

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