Evolution and current status of direct-entry midwifery education, regulation, and practice in the United States, with examples from Washington State.

This paper describes the re-emergence of direct-entry midwifery in the United States, and focuses specifically on the over 1,000 midwives nationwide who are licensed in the 16 states where direct-entry midwifery is legal and regulated, and/or certified by the North American Registry of Midwives; it does not focus on direct-entry midwives or nurse-midwives who are certified by the American College of Nurse-Midwives Certification Council, Inc. Professional developments of direct-entry midwives are highlighted, including the establishment of core competencies and articulation of values, the creation of a certification process, and development of education program accreditation. The current status of licensed midwives in Washington State, where state policies have supported the development of direct-entry midwifery and the integration of direct-entry midwives into managed care systems, is presented as one example of the evolution of professional direct-entry midwifery in this country.

Unlicensed midwifery practice in Washington state.

We examined the role of unlicensed midwives in Washington State by questioning mothers of infants born out-of-hospital with an unlicensed person in attendance. Only a small proportion of the state's births (0.11 percent) were attended by unlicensed midwives.