Midwives | What is a midwife & Should I use a midwife?


Midwives | What is a midwife & Should I use a midwife?

The midwife experience is usually very different than the traditional doctor experience.

Midwife means “with woman”.  Midwives are trained low risk pregnancy, labor & childbirth experts.

Some midwives do hospital births & many do birthing center births & home births. They give prenatal care, after birth care (postpartum care) & attend approximately 9% of births in the U.S. each year (that number is rising).

Midwives attend the majority of births in developed countries like: Israel, Sweden, France, Denmark, Spain, United Kingdom, Finland, Norway, Netherlands, Switzerland, New Zealand, Austria. In each of these countries, midwives attend over 70% & up to 100% of low risk births. These countries generally have the lowest Infant & Maternal mortality rates. The U.S. does not have one of the best Infant & Maternal Mortality Rates (we’re usually around 37th in the world). Up until the early 1900’s, midwives attended nearly all of the births in the U.S. 

There are 4 main types of midwives

Certified Nurse Midwives (CNM)- Have nursing degrees & midwifery education. They’ve graduated from a nursing program, a nurse-midwifery program and become certified after passing a test administered by the American College of Nurse-Midwives (ACNM).They can practice in hospitals, birthing centers & attend homebirths (it’s up to them to decide where). Most can prescribe medications. Often they work directly with OBs, in case complications require transfer to a hospital or C-Section surgery (from birth center or home births).

Certified Midwives (CM)- Have a background in a health related field (other than nursing) and attend a midwifery education program that is accredited by the American College of Nurse Midwives (ACNM).

Certified Professional Midwives (CPM)- CPMs are educated in midwifery and have passed a certification exam of the North American Registry of Midwives (NARM). Midwives certified with NARM are educated in core content areas, have hands-on clinical experience and have demonstrated their skills. CPMs are not nurses and do not practice in hospital settings.

Direct Entry Midwife (DEM)- DEMs are independent practitioners who are educated in midwifery through self-study, apprenticeship, a midwifery school, college or university midwifery program. They are trained to provide the Midwifery Model of Care to low risk pregnant women during out of hospital births.

Nearly all Midwives believe birth is a normal physiologic event. This belief is the backbone guiding the who/what/how/when & where behind their care. Midwives tend to focus more on “the whole” woman during pregnancy & birth (all the things that go into you becoming a mom, like: emotions, exercise, nutrition, stress, family dynamics, uterus, baby, etc.), whereas OBs generally focus more on your uterus & baby.

Most Midwives see the woman as the asset bringing baby into the world. Most OBs see ‘technology’ as the asset bringing baby into the world (from which they can manage a woman & the labor/birth process). 

Let’s be real. Some OBs function more like midwives & some midwives function more like OBs. “Date your provider” & ask around to figure out who they are (just like that high school crush). There is nothing more intimate than giving birth. You want to know who they really are & if you see eye-to-eye before you walk down the aisle (i.e. they catch your baby). tweet that

Midwives are highly skilled in low-risk normal childbirth. That’s what midwives practice every day. Sometimes, situations arise whereby a midwife needs to collaborate with an OB or possibly transfer care to a high-risk specialist at a hospital (usually OB or neonatologist- a neonatologist is a specialized OB for high-risk babies). 

Not all midwives have “ready access” to physicians. This is an important question to ask your potential midwife, “how do you transfer care to an OB? Do you have specific OBs you work with?”

*Quick Story- We knew a soon-to-be-dad who asked a ton of “what if” questions when interviewing a potential midwife. He wanted to get comfortable with how a “transfer of care” would actually go down & “when & why” she’d make the decision to transfer. He was reassured knowing she’d delivered over 3,500 babies, was conservative in assessing risk, knew her limits, and had great relationships with the OBs in the hospital. Having walked through different birth scenarios to learn how she thought, made decisions & approached potential complications, they felt super confident about choosing her as their midwife.

Not all midwives are alike. Some midwives are absolutely incredible- they’re skilled, are up on all the latest research & care enough to connect & listen to you. And some aren’t any of the above. Some make decisions for you & your baby based on opinion, not evidence (without informing you). You can find a great midwife by doing a little research on your own & asking good questions (we have some great questions in a link below that’ll help you get started).

This isn’t a surprise is it?

Every profession has a wide range of “quality” within their ranks. Midwives are no different. Some midwives would rather do nothing but care for mamas & catch babies, while others are ‘just there’.

You’re building a relationship with the person who’ll be there for you in one of the most important moments of your life. Do you know them at all? Do you even like ‘em? Are they answering your questions or blowing you off?

Things moms like about midwife care:

  • It’s personal- pregnancy visits are longer than most OB visits (i.e.-60 mins vice 15 mins).
  • It’s very individualized & focused on learning what a Preggo’s goals are, then supporting those goals. 
  • Relational & nurturing. 
  • It’s holistic. This means care focuses on “all” the factors that affect your pregnancy & birth, like: emotions, exercise, nutrition, stress, family dynamics, and who you are as a whole person (rather than just a uterus), etc. 
  • Midwives providing out of hospital care carry a bag of medical supplies to manage complications (different midwives carry different things). 

Some things they might carry are:

  • Your medical records 
  • Oxygen 
  • Pitocin & Methergine 
  • IV ‘stuff’ 
  • Amnihook-
  • Fetal scope or Doppler (listen to baby’s heart beat) 
  • Blood pressure cuff & stethoscope 
  • Thermometer 
  • Sterile gloves 
  • Sterile birth pack 
  • Scissors, hemostats, cord clamp 
  • Ambubag 
  • Catheters 
  • Herbs, oils, aromatherapy 
  • Sterile stiches kit & Xylocaine- to numb for tear or episiotomy 

Some things moms don’t like about midwives:

  • They don’t have an MD at the end of their name. (quite a few midwives do have PhDs or Doctor of Nurse Practice (DNP) doctorate degrees) 
  • The possibility of transferring care for pregnancy or labor complications. 
  • Some midwives don’t have hospital privileges 
  • Some midwives only attend births in hospitals / some midwives only attendbirths at home or inbirth centers. 

Evidence based facts about Midwives:

A study comparing outcomes between Certified Nurse Midwives (CNM) & Physicians from 1990-2008 shows Certified Nurse Midwives had: lower rates of C-Sections, Induction, Epidurals, Episiotomies, fewer vaginal tearing (3rd & 4th degree) & higher Vaginal Birth After Caesarian (VBAC) rates, lower level of admission to NICU & higher level of breastfeeding. Evidence here.

A study done with 12,276 women concluded “Midwife-led care confers benefits for pregnant women and their babies and is recommended. Several benefits for mothers and babies, and had no identified adverse effects.” Main benefits were: fewer interventions, higher chances of vaginal birth & breastfeeding, increased sense of control during labor & birth, and labor care provided by someone the mom already had a relationship with. Evidence here.

The World Health Organization says “Midwives are the most appropriate primary health care provider to be assigned to the care of normal birth.” Evidence here.

There’s no disrespect for Physicians here. Both midwives and Physicians can be exceptionally skilled providers giving you Evidence Based Care for you & your baby. Many of us don’t hear anything about midwives- we don’t even know they exist. 

All the current research, the evidence, the history & world health institutions (World Health Organization & even the American College of Obstetricians and Gynecologists themselves) clearly show Midwives are safe & skilled providers for low-risk pregnancies & births.

Give midwives a look and see if they’re right or wrong for you. If you don’t even consider them, it’d be like buying the first and only wedding dress you tried on. You may end up wondering what better fitting options exist.

To Sum it up for ya…

Midwives offer safe care for women with low-risk pregnancies & births. Midwives might be perfect for you, they might not. Look at your personality, what you want & need out of care to find the type of provider who can work the hardest to support your needs.

And talk with moms who’ve had both traditional OB care and Midwifery care, they’ll help paint you a clear picture on the differences of each.

What if you could hear one mom compare, in detail, her different pregnancy & birth experiences using both a Midwife & an Ob/Gyn? She also reveals what she’d do differently next time. Check out this interview to get that.  

And download our “Make an Ask of Your Pregnant Self Question Guide” that’ll lead you in finding the best ‘provider fit’ for you.

Midwifery Care

  • Women are the asset 
  • Labor & Birth is a normal physiological process 
  • Focus on Prevention through Health & Wellness resulting in Lower rates of Interventions 
  • Care is Individualized & Personal 
  • Mother gives birth 

Traditional OB/GYN 

  • Care Technology is the asset 
  • Labor & Birth is dependent on technology 
  • Focus on actively Managing potential Complications resulting in Higher rates of Intervention 
  • Care is Standardized & Routine 
  • Doctor delivers baby

“Midwives offer evidence-based health care services. In today’s world of high technology, midwifery services provide the individualized care women need.”  Doug Laube, MD, Former President, American College of Obstetricians and Gynecologists   click to tweet

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