Midwifery for Pregnancy

In the United States, women’s birth choices were once limited to an obstetrician or a knowledgeable family doctor. In recent years, midwifery has become another alternative for women with low-risk, uncomplicated pregnancies. Midwifery for pregnant women can enhance the quality of care for women and their families. Research has shown that team midwifery care is associated with increased satisfaction before, during and after birth.

What is Midwifery?

Midwives strive to return a sense of normalcy and joy to the childbirth process. A midwife is a knowledgeable and experienced person (usually a woman) who helps a woman have a healthy, normal pregnancy and give birth to a healthy baby. A good midwife provides education, counseling and support before, during and after birth. About 96% of births assisted by certified nurse-midwives occur in hospitals.

Pregnancy, childbirth, and breastfeeding are normal body functions. Midwives approach these processes as normal life events rather than potential medical emergencies. A midwife's education emphasizes that pregnancy and birth are normal, healthy events until proven otherwise. They believe that labor and delivery works best with the least interference. Midwives view their role as supporting the pregnant woman while letting nature take its course.

Who would benefit from Midwifery?

A midwife can be an excellent choice for maternity care for women who are healthy and expect to have a normal pregnancy. Midwives have found that encouragement, massage, relaxation, laboring in water, changing positions and other approaches are often very effective.

The Midwive 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.

Who should not use Midwifery for Pregnancy?

Midwives are trained to recognize complications early and refer women for appropriate obstetrical care. Midwifery is not advisable for women with higher-risk pregnancies.

Those who should not use midwifery for pregnancy include:

• Women expecting more than one baby
• Women with prior pregnancy complications
• Women with gestational diabetes
• Women with high-blood pressure
• Women with chronic health problems of any kind before pregnancy

Women with any of the above should discuss their options with their primary health care provider or an obstetrician. Certified nurse-midwives, who practice in major medical centers and work very closely with obstetricians and perinatologists (specialists in high-risk pregnancy), may accept patients with some risk factors. But midwives in solo practice or who practice in limited medical facilities generally do not.

Choosing a Midwife

Midwifery works best when there is a close relationship between midwife and client. Interview your midwife and decide whether you are comfortable with her style, skills and abilities. If your midwife doesn’t have a practice agreement with a doctor, be sure to find out what will be done in case of any complications.

As with any other obstetrical practice, midwives meet with an expectant mother once a month initially, then every two weeks closer to birth, and finally every week during the last month of pregnancy.

Types of Midwives

There are three types of Midwives:

Certified Nurse-Midwife
Certified nurse-midwives (CNMs) are licensed healthcare practitioners educated in the both disciplines of nursing and midwifery, and are certified by the American Midwifery Certification Board.

Certified Midwife
A certified midwife (CM) is an individual educated in the discipline of midwifery who also possesses evidence of certification by the American Midwifery Certification Board.

Other Midwives
The overwhelming majority of midwives are either Certified nurse-midwives (CNMs) or certified midwifes (CMs). All CNMs and CMs have earned at least a bachelor's degree, while over 80 percent hold a master's degree or higher. A variety of titles are used to label midwifery practice so it can be confusing for consumers who want to determine just what qualifications have been met by their midwife. Some midwives are also called lay or empirical midwives, and obtain their training through a variety of routes.

Doulas

Another category of birth attendant, called a doula, is not a midwife, but may work in connection with a midwife. Doulas do not diagnose medical conditions or give medical advice. The doula's role is to provide physical and emotional support to women and their partners during labor and birth. A doula offers information, assistance and advice on topics such as breathing, relaxation, movement and positioning. Doulas do not perform clinical tasks such as vaginal exams or fetal heart rate monitoring.

Individuals who plan to use the services of a doula will generally visit with the doula for an introductory visit to get a feel for the doula’s personality and delivery style. In addition, they will usually have at least one “dry run” visit about 2 weeks before the due date. Labor and delivery positions, breathing techniques and birth plans are discussed during this time.

Special Considerations for Midwifery

• Standards for the education and practice of midwifery may vary. Carefully evaluate the credentials of your potential midwife. Choose a well-educated provider who allows direct access to medical care if needed.

• Be aware that while midwives practice in many settings, including hospitals, it is still rare to get the Midwives Model of Care in a hospital setting. Typically, the most likely place to receive the Midwives Model of Care is in your home or a free-standing birth center.

• 33 states mandate private insurance reimbursement for nurse-midwifery services, and Medicaid reimbursement is mandatory in all states.

• Some midwives see patients who are beyond childbearing years. Regular yearly checkups and guidance through the normal physical and emotional changes of menopause are other services that some midwifery practitioners provide.

Additional Resources

Midwives Model of Care Brochure from Citizens for Midwifery.

Satisfaction with team midwifery care for low- and high-risk women: a randomized controlled trial. Journal of Birth.. 2003 Mar;30(1):1-10.

The very oldest profession. Journal of Midwifery Today with International Midwife. 2006 Summer;(78):48-50.