Why Choose a Midwife?
I’m a planner. I can’t help it. I’m one of those people who enjoy making a list and then checking things off of it.
So when I prepared to get pregnant for the first time, I asked my family care physician during my yearly physical what I should do to prepare for pregnancy, and if she had any advice for me. She was quick to recommend starting to take a prenatal vitamin as soon as I ceased birth control. Her other piece of advice surprised me though.
“I would advise seeing a midwife as opposed to an ob-gyn.”
“Really?” I questioned. “What’s the difference?”
“Their care is more personal, much more relaxed than most ob-gyns,” she responded. “When I was in my residency, I learned a lot more from the midwives than the doctors. The midwives were more willing to take their time with their patients, and with me. The midwives were much more willing to work with the natural process of pregnancy and birth.”
And since my doctor was not only my physician, but also my friend; when that pregnancy test read positive, I sought out the care of a midwife. I’ve always been thankful for that little conversation.
What is a Midwife?
A midwife is a skilled professional with unique expertise in supporting women and their families through a healthy pregnancy and birth. They offer individualized care, education, counseling, and support to a woman and her infant through the entire process of pregnancy and birth.
The World Health Organization states that “midwives are the most appropriate primary health care providers to be assigned to the care of normal birth.”
Midwives work with individual women and their families to meet their unique physical, emotional, and social needs. When an area of expertise is needed outside the midwife’s training, she will refer the woman to another health care provider for the additional consultation or care.
Although major midwifery organizations are united on the definition of a midwife and the type of treatment they provide, this does not mean every person calling themselves a midwife actually provides this type of care. Individuals seeking midwifery care should go into their first meeting with specific questions ready for their prospective caregiver.
The Midwives Model of Care (http://cfmidwifery.org/mmoc/) is based on the belief that pregnancy and birth are normal life processes, not diseases or sicknesses to be monitored.
“The Midwives Model of Care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
Copyright © 1996-2004,
Midwifery Task Force
All Rights Reserved
Are There Different Kinds of Midwives?
Midwives do vary in the skills, qualifications, education, legal status and places where they can assist women in giving birth. Knowing what kinds of midwives there are will help you ask the right questions, know what will best meet your needs, and pick the right midwife for you. It’s important to remember that not all midwives practice the Midwives Model of Care.
"Two broad categories of midwives exist in the United States: nurse-midwives and direct-entry midwives. Nurse-midwives are educated in both nursing and midwifery, while direct-entry midwives focus their professional preparation on midwifery alone. … In order to practice as a nurse-midwife, one must be a certified nurse-midwife (CNM)." From, "The Future of Midwifery," a Joint Report of the Pew Health Professions Commission and the University of California, San Francisco Center for the Health Professions, April 1999.
Certified Professional Midwives, or CPMs, are most often direct-entry midwives who have completed all the requirements for CPM credentialing. Other direct-entry midwives (who are not CPMs) may have met the requirements for certification in their state or even practice without outside certification. Some states license direct-entry midwives; in other states they practice but are not regulated by state government; and in some states, practicing midwifery is actually illegal.
Direct-entry midwives mostly attend births outside of hospitals, such as home births or at birth centers. Almost all direct-entry midwives practice exclusively in these situations.
Certified Nurse Midwives, or CNMs, on the other hand, attend mostly births in hospitals, although some do work in birth centers and very few in individual’s homes. CNMs are trained in nursing and midwifery; they must pass an examination for certification by a national board.
You cannot choose a midwife based on title alone. Just because a midwife lacks national certification does not mean she lacks adequate knowledge, skill, and experience. On the other hand, not all those who go by the title of “midwife” have met a certain set of criteria or practice the Midwives Model of Care. Before choosing your caregiver, meet with her in person and be sure she is able to provide the type of care you seek.
Advantages of Midwives
A new study from the University of Washington of more than 1,300 low-risk pregnant women, published in the March issue of the American Journal of Public Health, concludes that the patients of certified nurse-midwives are likely to endure fewer obstetrical interventions than patients cared for by obstetrician-gynecologists and family practice physicians.
Worldwide, midwives attend over 70% of births. In this approach to pregnancy and birth, the United States is far behind. Midwives in Ireland, Scotland, and England deliver more than 65% of all babies, and the proportions in Denmark, Sweden, Norway, Finland, and Germany exceed 85%. These countries have fewer obstetrical interventions than the US, as well as lower maternal, neonatal, and infant mortality rates and higher rates of breastfeeding.
Many experts agree that midwives are more knowledgeable than doctors when it comes to breastfeeding. And while doctors may have the advantage when it comes to medical intervention and procedures, midwives are often more informed and practiced in natural intervention- such as perineal massage instead of an episiotomy- and are much more willing to “let nature take its course” when it comes to labor and delivery, rather than over managing.
Another advantage of midwives is the beauty of women caring for women. Of course, many women are also OB/GYNs, but the ratio of women to men is far more extreme in the former profession, as male midwives account for only about 0.3% of the profession. Not to say that male doctors (and female) can’t do a magnificent job as well, but who can understand the aches, pains, and worries of a pregnant woman quite like a woman who has been pregnant. Who can soothe and encourage a laboring mother better than a woman who has been through labor? A beautiful advantage of midwives is that they have “been there, done that”.
Midwives are extremely involved in the labor and delivery process, sometimes not leaving the mother during the entire process. They are trained to recognize any signs that deviate from the normal processes, and will consult with a physician who may or may not become involved in the delivery process, if need be.
Midwives view pregnancy and birth as natural processes of life, rather than sickness to be treated. They actually have an entirely different mindset toward the process of bringing babies into the world. The difference is that specialists in hospitals are always sensitive to possible problems, they are trained with this mindset and it is how they are expected to perform. First and foremost, they view their patients as clients. Decades of observation show that this translates to earlier intervention in the natural progression of pregnancy and birth. In nations where births are generally overseen by doctors, more births are induced and more interventions (such as vacuum and forceps) are used.
Midwives are trained to support the mother through pregnancy and birth, and not to interfere in the normal process unless necessary. Their aim is to let the birth process remain as natural as possible. They view their patients primarily as pregnant women with no complications. This is true even with midwives who work in hospitals.
One major advantage of midwives, not yet discussed, is cost. This is an area that cannot be overlooked- or overemphasized- for many people. While midwives working through hospitals charge the same amount as the OB/GYNs; independent midwives, delivering in homes or birth centers, charge far less. Total cost of prenatal care and delivery vary greatly from midwife to midwife and depending on where you live, but you can expect the cost of a midwife to often be less than half of what you would pay a doctor. This can be an extremely important advantage to someone who is paying most of their fees out of pocket or does not have insurance.
A midwife supports a pregnant woman before, during, and after the birth of her baby. She takes charge of the care of both mother and baby, and offers the mother and her partner education and encouragement. Midwives have the knowledge to do necessary examinations, give advice, as well as refer women to an OB/GYN or other specialist when needed.
A midwife is more than a medical specialist; she is also a coach during pregnancy and birth. Midwives are a source of endless information and wisdom. She can even become a friend, and thus make the difference between a good or bad birth experience.
Disadvantages of Midwives
The greatest disadvantage of midwives is that they are unable to offer the medical intervention that a doctor can. If an issue occurs and medical involvement is needed, such as a prescription or an emergency birth situation, a midwife would have to refer her patient to a doctor. If you are birthing at home or an independent birth center and an emergency arises while you are laboring, you would be transported to a hospital and your midwife would accompany you. Her role would change to that of a doula in such a situation. Midwives are trained to handle normal, low-risk pregnancies and births. So if you have no previous medical conditions, and hope to have as natural a birth as possible, a midwife is a valuable option.
Even though there is more that unites the profession of midwives than what divides, an individual midwife’s opinion can vary greatly from one to the next as to the extent of medicine’s role in birth. As with any other provider, you should interview your prospective caregiver and be prepared with questions so that their belief system is similar to your own.
Midwives only deliver babies at home
There are a wide variety of midwives, and although many do deliver babies in patients’ homes, there are also midwives who work in- or own their own- birth centers, as well as those who work in a hospital setting alongside OB/GYNs.
Midwives don’t allow any pain relief.
Midwives are qualified to administer drugs and perform medical procedures, but most are not routine in midwifery care. Midwives choose to first educate and encourage their patients to use other natural and proven forms of pain relief. Less natural forms of pain management are only used at the mother’s request.
Midwives only take care of pregnant women
CNMs provide preventative healthcare to women in general, from gynecological exams through pregnancy and childbirth and even into menopause.
Insurance won’t cover midwives
All major insurance companies and Medicaid cover midwifery services. As with finding a doctor, just check with your insurance provider for a list of midwives in your area they insure.
Midwives aren’t safe.
Numerous of scientific studies published in leading medical journals have shown that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with lower rates of medical interventions. Midwives have a lower rates of pregnancies ending in cesarean sections or pre-term birth than doctors.
Doctor or Midwife?
Doctor or midwife? A woman seeking care during pregnancy could absolutely find an entire range of caregivers: from highly intervening doctors, to doctors who are less intrusive and behave more like midwives, even to midwives who practice much more like a traditional doctor. The choice you make will come down to your personal preferences, hopes for your own pregnancy and labor, and the risk factor of your pregnancy. Doctors and midwives both offer exceptional professional care. The two professions often work side-by-side to provide mother and baby with the best possible experience and outcome.
If you have no major illnesses or conditions, and have had normal pregnancies in the past- it is definitely beneficial for you to give both doctors and midwives careful consideration.
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