Pregnancy and childbirth are beautiful experiences. They can become more beautiful if you stay comfortable and confident, and that you can be with the care and guidance of a medical professional, be it a doctor or a midwife.
If you are looking for one-on-one interaction and a personalized experience, a midwife should be the right option. This MomJunction post helps you understand in detail about midwives, what they do, and how they add a personal touch to your pregnancy experience.
Who Is A Midwife?
A midwife is a trained healthcare professional, who assists women in every aspect of pregnancy, from gynecological examinations and prenatal care to labor and delivery. A midwife also addresses the health needs during contraceptive counseling, prescriptions, and annual checkup (1).
Midwives are ideal for women who want minimal medical intervention, and those who have no complications in their pregnancy. They may not be suitable if your pregnancy is complicated or you are having health concerns or carrying multiple babies.
Where Do Midwives Practice?
Midwives work in various setups, including birth centers, obstetrician’s consulting rooms, hospital maternity units, community health centers, midwifery group practices and at private homes. You can select the midwifery services based on how and where you plan to deliver the baby.
Most of the midwifery services are covered under health insurance schemes provided by the government. You may also get a rebate from your private health insurances.
Types Of Midwives
Midwives are categorized based on the different levels of training they take. Also, the practice and credentials of a midwife may differ from state to state. Following is a brief description of each type of midwife in the US (2) (3):
- Certified nurse midwives (CNMs): They are registered nurses trained in both nursing and midwifery. They are advanced practice nurses and hold a master’s degree from an accredited Nurse-Midwifery program. They offer prenatal, birth, and postpartum care along with woman care throughout the life cycle.
- Certified midwives (CMs): They do not hold a nursing degree but are otherwise similar to CNMs. Only a few states, including New Jersey, New York, Maine, Delaware, Missouri, and Rhode Island, permit CMs to practice.
- Certified professional midwives (CPMs): They are trained in midwifery and pass a competency test held by the North American Registry of Midwives (NARM). They work independently with women delivering in birth centers or at home. They offer prenatal, birth, postpartum and well-woman care.
- Direct entry midwives (DEMs): They are independent practitioners who have learned midwifery through study school, apprenticeship, or a college program. They offer complete prenatal care and attend births in birth centers or at home.
- Lay midwives: They are not certified or licensed but go through informal training through apprenticeship or self-study. They help with deliveries in birth centers or at home.
The certifications might vary but the basic services provided by them are similar.
What Does A Midwife Do?
Role during pregnancy:
Midwives offer prenatal care. You may also employ them while consulting an obstetrician during your routine appointments. They may team up with another midwife or a doula to:
- Check the fetal growth, position, and health
- Offer support and advice
- Help with hospital bookings, regular checkups, and tests
- Prepare you for labor and birth
During labor and birth
Midwives help you throughout labor and birth. They:
- Offer information, emotional support, and encouragement.
- Monitor your labor signs.
- Monitor your progress and suggest ways to make labor easier.
- Arrange a doctor when needed.
If it is an uncomplicated birth at a birth center or a public hospital, your midwife will assist during both the labor and birth. An obstetrician will be available in the case of complications. In a private hospital, the obstetrician is present along with the midwife.
If you have planned for a home birth your midwife will alone manage the whole labor process. But this is not advisable because:
- You may not have any specialized medical help on hand if you have any unforeseen complications.
- Midwives cannot give epidural injections, and it can only be given in the hospital by an anesthetist.
After the baby’s birth
The midwife offers the needed care for both you and the newborn. Postnatal care by the midwives includes:
- Training you in breastfeeding and settling your newborn.
- Administering pain relief.
- Teaching you how to change the nappies and bathe the baby.
- Carrying out tests such as newborn screening.
After you go home from a birth center or the hospital, the midwife may make a visit. If it is a home birth, you will have everyday visits at least for a few days. Some midwives might advise over the phone.
Benefits Of Using A Midwife
One of the main reasons women employ a midwife is to experience natural childbirth. Most women, who had a midwife, had (6).
- Fewer C-sections
- Reduced use of regional anesthesia
- Decreased rates of labor induction and augmentation
- Reduced risk of premature labor
- Decreased infant mortality rates
- Reduced risk of perineal tears
- Successful breastfeeding
- Increased satisfaction of care and well-being
In general, midwives help in having fewer medical interventions. In spite of their contribution, midwives may not be suitable for all women.
Not all women could enjoy the benefits of midwifery care.
- Women with high-risk pregnancies – those older than 35 years, obese, or who have diabetes, preeclampsia, hypertension, seizure disorders or other pre-existing illnesses – need medical interventions. The lone services of a midwife won’t be sufficient in such cases.
- Midwives are not trained to take up twin births, breech presentations or vaginal births after cesarean (VBACs). An obstetrician is necessary in such cases.
In situations like above, though a midwife cannot take it up alone, they can work in collaboration with the obstetrician to give you support and comfort during delivery.
Cost Of A Midwife
The cost of a midwife varies depending on where you live and the birthplace. A midwife’s fee usually includes prenatal checkups, birth and the postpartum visits. However, it is still less expensive than consulting an OB.
Some insurance plans cover the costs of a midwife while some don’t, especially if it is home birth. Some offer payment plans, sliding scales or reduced fee. It is, therefore, advisable to contact your insurance company before you plan to use a midwife.
Finding A Midwife
You can find a midwife through the following resources (7):
- Referral from your OB/GYN, the childbirth class instructor, doula, or friends and family
- Online directories
- Midwife certificate organizations
- Social networking sites
Get a list of references, and talk to them before choosing a midwife. Do not rush through the process; take time to decide as you are going to share the most precious moments of your life with her.
Next, we answer some commonly asked questions about midwife and their practices.
Frequently Asked Questions
1. What is the difference between a doctor and a midwife?
The main difference between a doctor and a midwife is the type of education they receive. The OB/GYNs specialize in pregnancy and birth from a medical school and are trained to perform surgery. They do not attend home births, and only a few go to birth centers. Midwives are trained to deal with pregnancy and birth but do not go to a medical school. Although they do not hold a doctor degree, they provide pregnancy and birth care.
Doctors can take up any pregnancy complication whereas midwives are specialized only in uncomplicated, normal and low-risk pregnancies (8).
2. What is the difference between a nurse-midwife and a doula?
Midwives and doulas seem similar as both help women through labor. However, their roles in the birth process are different.
A midwife is a healthcare provider who can replace OB and can deliver babies even at home whereas a doula cannot replace OB but can only provide physical, emotional and informational support during birth and postpartum (9).
3. Do midwives do C sections?
Midwives cannot perform C-sections, they can only assist the obstetrician in the operations theater.
4. Can I take the help of a midwife if I take an epidural?
Yes, your midwife can support you during and after epidural, and helps manage labor.
5. Do midwives perform ultrasounds?
No, midwives should not perform diagnostic ultrasounds. They can only recommend ultrasound scans as part of screening tests.
Whether to hire a midwife or not mostly depends on where you want to have your delivery. They are useful if you want to deliver at home or a birth center. It is most suitable for low-risk pregnancies.
Are you planning to hire a midwife during pregnancy? Let us know about your experience in the comments section below.
2. Comparison of Certified Nurse-Midwives, Certified Midwives, Certified Professional Midwives Clarifying the Distinctions Among Professional Midwifery Credentials in the U.S.; American College of Nurse-Midwives
3. Types of midwives; Oregon Midwifery Council
4. Kebe Y; The role of the midwife; Afr Health (1994)
5. Baeyens C and Johansson C; The role of midwife during pregnancy and childbirth; Rev Med Brux (2008)
6. Benefits of working with a midwife for your pregnancy & birth; North County Health Services
7. What does a midwife do; The University of Utah Health
8. What is the difference between an ob/gyn and a midwife; University of Utah Health (2016)
9. Midwifery FAQ; Obstetrics and Gynecology; University of South Florida
10. Nurse midwifery and birth center FAQ; UC San Diego Health