It is wonderful to have options, regarding how, where and with whom we give birth. In Northern Virginia we have many choices-- sometimes with confusing details and definitions. There are pros and cons to everything, and there is no "One size Fits All" perfect choice, as each family is unique. In addition to the traditional obstetrician-attended, in-hospital birth, here are some of the options "out there!"

Midwives
2 types of midwives are now licensed by Virginia. They differ in training and practice under different legal regulations:

Certified Nurse Midwives (CNM):
Certified by the American College of Nurse-Midwives (ACNM),
Formal university education in nursing and postgraduate degree in midwifery
May legally practice in all settings: home, birth center, hospital, clinic
Has license to prescribe most medicines
VA Law requires a CNM to have a collaboration agreement with a physician in case of complications
CNM's are employed by doctors, clinics, health systems and hospitals, or may be independent and self-employed,.
CNM's work within guidelines and limitations regarding their scope of practice,( for example, regarding twins, breech, high risk cases) because of their collaborative agreements and other institutional guidelines.
CNM certification includes competency in primary care and well-woman gynecology.
More info on CNM's: vamidwife.org or midwife.org

Certified Professional Midwives (CPM).
CPM certification is obtained through the North American Registry of Midwives (NARM) narm.org, that allows varied training routes, does not require formal education or degrees, but rather focuses on assembling a portfolio of required experience, competencies and learning, and passing a qualifying exam. CPM training occurs in out-of-hospital settings by the apprenticeship model. CPM's practice in homes or birth centers.
Currently Virginia CPM's do not have legal access to any prescription medications. This is an issue under study with the Virginia Department of Health Midwifery Board, in an effort to increase safety of birth in Virginia.
CPM's are not required to have any arrangements with physicians or hospitals.
CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings
For more info see: commonwealthmidwives.org

Birth Centers
There are no legal regulations regarding birth centers in Virginia, as long as local zoning rules are met. Voluntary national quality standards and accreditation do exist for Birth Centers through the American Association of Birth Centers, an organization committed to maintaining quality standards in birth centers around America. www.birthcenters.org.
2 AABC-accredited birth centers in Virginia include Birthcare and Women's Health: www.birthcare.org, and the Family Maternity Center of the Northern Neck. fmcnn.org.

Doulas
The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period. Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily. Midwives also fill many of these roles in their model of care.

Doulas are often chosen to help with hospital births, particularly by families who wish to avoid interventions and have committed labor support. Doulas are certified by a number of organizations, such as DONA,(www.dona.org), ICEA, and others. Doulas are not legally regulated health professionals, but rather have more a personal consultant role.
Mothers sometimes ask us at Loudoun Community Midwives whether a doula is needed or if the midwife fills this role. We reply that our CNM's are committed to bedside labor support for our clients.  We have a schedule ensuring that one of us is always available to be at the hospital for laboring women. We are skilled in labor support and guide your birth with respect for your unique wishes.

Q: What can a doula can do that Loudoun Community Midwives can't?

A:  If you plan to come to the hospital when your labor is more active, she can come to your home to help with early labor...she can be committed to one-on-one care for you. We promise to be at the hospital and checking on you often...but we may have more than one mother in labor, postpartum, or outpatient area. If you wish to have a doula with you and your family for the entire process, we entirely support the idea. Truly professional doulas are helpful, supportive, and never generate a spirit of competition or conflict with the midwives and medical staff.