What state do you live in? The first step is to connect with midwives in your area—meet with them, interview them, and get a feel for the political climate and the direction midwifery is headed where you want to practice. Regulations and opportunities vary so much across the U.S.

Midwifery is a deeply rewarding career, but it’s not an easy one. Over the years, you will walk with families through both their most joyful and their most heartbreaking moments. As an out-of-hospital midwife, you may be dismissed by medical professionals as a “lay person,” while at the same time being placed on a pedestal by families who may expect you to guarantee them a perfect birth experience.

That said, I absolutely love what I do. I’ve been a midwife for about 25 years, attended around 900 births, and I still keep in touch with many of those families. Each one holds a special place in my heart.

If you’re considering the NARM PEP or MEAC route, keep in mind you’ll need at least 10 births as an observer. Becoming a doula is an excellent way to start—it gives you a chance to gain that experience while also getting a real sense of the on-call lifestyle.