Selecting the right person to care for you during pregnancy, labor, and delivery would logically require someone who can give you undivided attention. Studies have indicated that having a skilled midwife in attendance can reduce the likelihood of cesarean section, minimize the need for medical interventions, and lower the chances of infection and maternal death. However, what exactly does a midwife do, and is it necessary to have one? Discover more about the varying kinds of midwives and determine if employing one for your pregnancy and postpartum stage is suitable for you.
What Is a Midwife?
A practitioner of healthcare with a specialization in pregnancy, childbirth, after-birth care, and infant care is known as a midwife. Midwives may be employed at hospitals, birthing centers, or operate their own private practices and offer home birth services.
Jenna Benyounes, a certified nurse midwife and director of clinical talent acquisition strategy at Quilted Health, states that midwives offer comprehensive prenatal, birth, and postpartum care. They can act as the primary prenatal care provider as long as no complications occur outside the midwifery care scope. Depending on state regulations, many midwives are qualified to provide gynecological care, which may involve prescribing birth control, performing medical abortions, and giving fertility support.
While midwives are able to offer their services in various environments, the majority of certified nurse midwives (CNM) – approximately 94% – provide care in hospital labor and delivery units and are present for roughly 9% of all hospital births. Additionally, CNMs attend approximately 50% of home births and 40% of births that take place in birthing centers.
What Does a Midwife Do?
Midwives are of different types and therefore their level of care varies. Those with higher education, professional training, and credentials have a wider range of patients, including hospital settings, while those with less training can offer fewer services, including hospital-based practice. There are various services that midwives provide.
- Confirming and dating a pregnancy
- Prenatal care, including ultrasounds and some blood work
- Education and support for labor and delivery
- Attending to labor, birth, and newborn care
- Postpartum education, support, and care
- Providing education on nutrition, family planning (including birth control), lactation, fertility, and reproductive health
- Providing health screenings, including breast exams, pap tests, sexually transmitted infections tests, and exams for other infections
Understanding what education, training, and certification your midwife has is essential when considering what services they can provide.
Types of Midwives
Indeed, there exist various categories of midwives, all of whom possess certification and training for specific responsibilities. Emily Hoger, RN, CNM, a board-certified nurse-midwife at Keystone Women’s Care in Pennsylvania clarifies that lay midwives and certified professional midwives primarily oversee deliveries that transpire at home or in birth centers. Additionally, there are certified nurse-midwives (CNM) or certified midwives (CM) who may also attend home or birth center deliveries but are more commonly found conducting such procedures in hospitals.
In her explanation, Hoger points out that some midwives choose to operate outside of hospitals and may not pursue licensure, or it may not be mandatory under the laws of their state to attend home deliveries. The Midwives Alliance of North America has released data revealing that not all states offer midwives with licensure, which can restrict their range of services, such as working in hospitals, ordering laboratory tests, or prescribing medications. For states that do provide licensure, individuals who desire to become a certified nurse midwife must earn an academic degree and obtain licensure in both nursing and midwifery from their state.
The Difference Between a Midwife and an OB-GYN
The primary difference between an OB-GYN and a midwife lies in their educational background. As per Christine Armstrong, MD, FACOG, an OB-GYN with board certification in Manchester, Connecticut, an OB-GYN is a medical doctor who has finished a four-year course in medical school and a four-year residency program. In contrast, a midwife is a nurse who has completed two years of post-graduate studies, provided they are a CNM. A lot of practices have a collaborative approach where both midwives and physicians see all patients. However, in some midwife-only practices, physicians act as consultants for complex situations or any patients who need surgical attention.
Midwives have the ability to assist in delivering babies regardless of their level of expertise. Nevertheless, they lack the necessary training to administer epidurals, a task that only certified nurse anesthetists or anesthesiologists can perform. Additionally, midwives are not authorized to perform C-sections; however, they can provide support to a physician during the operation.
According to Benyounes, midwives possess specialized knowledge and skills in vaginal birth and are capable of delivering babies. However, they are not authorized to perform C-sections. In certain hospitals, CMs and CNMs may have the opportunity to assist OB-GYNs in performing C-sections. In situations where midwives are present during out-of-hospital births that require hospital transfer, they may offer emotional support to the mother during surgery. If a midwife is your provider at a hospital, and they are a CM or CNM, they can order pain medications such as epidurals. Therefore, if you desire an epidural during childbirth, you can request one.
Should I Hire a Midwife?
Selecting a healthcare provider during pregnancy is a crucial decision, and a midwife may not be suitable for every expectant mother. Nevertheless, midwives can provide comprehensive care throughout the prenatal, delivery, postpartum, and neonatal phases. Dr. Armstrong recommends that if you have an uncomplicated obstetric background, a midwife would be an ideal patient for you. By researching healthcare facilities in your vicinity, you can determine whether or not you are a good match for the service. Depending on the midwife, they might be able to manage patients with conditions such as diabetes and hypertension in collaboration with a physician.
If you decide to hire a midwife, make to ask a few important questions:
- Are they licensed and certified to offer midwifery services?
- What doctor and hospital do they practice?
- Will they stay with you during labor and delivery?
Low-risk pregnant individuals can receive personalized, one-on-one care from midwives, who may also provide educational support for labor, delivery, postpartum care, newborn care, and lactation. Midwives can work in hospitals, birthing centers, or homes, and their level of training and certification may vary depending on state laws. It is important to inquire about your midwife’s qualifications, including licensure, academic and clinical training, and certification, as well as the doctors and hospitals they collaborate with.