We can talk about midwifery credentials and regulations (and those things are important!), but there are other things that are just as influential in a midwife's practice. Let's consider birth philosophy, relationships, & ethical practices. This gets us to the heart of an issue brewing within the profession of midwifery that few realize and even fewer understand until it is already too late: there is a vast array of beliefs and practices all of which fall under the umbrella of "midwifery".
Masquerading behind the title "midwife" causes much confusion for the consumer of midwifery and makes it quite difficult to "know what you're getting" so to speak. When the mask is removes, we see that some midwives are very responsible, highly educated, collaborate with hospitals when they are truly needed, and value the role of risk in their practice. They transfer fluently, without hesitation and don't take chances they don't need to take. In contrast, there are midwives who believe blindly that "birth works" and exercise that philosophy at all costs, without appreciation for the fact that sometimes women in labor need more help than they can offer. These midwives ignore warning signs, teach their clients to fear the hospital, and constantly put mothers and babies at risk to adhere to their own philosophy. They don't transfer willingly or fluidly (even though they may claim to do so), they take on risks they know they aren't qualified to handle, and take the chance that the outcome will be good. These are two very different ways of practicing midwifery. (Note: Being a nurse midwife doesn't necessarily mean the former.)
I don't think these two polarized philosophies are talked about, and they are certainly not clearly understood by the consumers - mothers and families. Every woman wants to believe her midwife is the responsible type, not the kind that would throw you under the bus for the sake of the "trust birth" mantra. Women who hire midwives are asking questions about credentials (I hope!), but how can we really know about what a midwife believes about birth and how these beliefs will impact us in a time of crisis? It is nearly impossible.
When you've had a terrible experience with a midwife and your baby is injured or dies, you start to question yourself and everything else around you. Then, and only then do you start to see that some of the fallout within the profession. You slowly stumble across stories of other mothers, their unfortunate outcomes, and start to talk to other midwives to gain perspective about what happened to you. Over time you come to understand how vast the gap really is among midwives within the profession and, most likely, you realize that you trusted someone who trusted birth to a fault . . . to the point that they sacrificed the safety of your baby and left you to pick up the pieces.
A close examination of the wide range of practices and beliefs within the profession needs to be considered. Women who are hiring midwives deserve consistency in caregivers across the profession. Hiring a midwife should mean something that is clearly defined and consistent in educational standards, scope of practice, and philosophy. The way it stands now, hiring a "midwife" is a blind game of Russian Roulette and families are paying the price.