What Is a Midwife?
If you’ve just found out you’re expecting, congratulations! You’ll have tons of decisions to make over the next nine months, but one of the most important is whether you’ll opt for an ob-gyn or a midwife for your prenatal care and eventual delivery. Most women are pretty familiar with the type of care to expect at the OB’s office. But what is a midwife? What does a midwife do?
Many women tend to think of midwives as playing a supporting role in the pregnancy and childbirth experience, similar to doulas or lactation consultants. But a midwife is, in fact, a professional trained specifically in assisting women with every aspect of pregnancy, from prenatal care to delivery. What’s more, her job doesn’t necessarily end with pregnancy. You can see your midwife for just about all your women’s health needs, including your annual exam, contraceptive counseling and prescriptions.
Most importantly, a midwife helps a woman achieve a satisfying birth experience, and provides support during the labor and birth to attain this goal. Sarita Bennett, DO, CPM, vice president of Midwives Alliance of North America, says, “In the midwifery model, it is more of a shared decision-making model with the provider educating and supporting, while the client has the ultimate control over what happens to her and her baby.” Midwives often lend a more personal touch to the pregnancy experience compared to OBs, emphasizing the physical, emotional and social needs of patients.
There are many types of midwives, all with different levels and types of education. Here’s a quick summary—though, it’s worth noting that different states may have different sets of regulations for each type of midwife.
• Nurse-midwife (CNM): A certified nurse-midwife is a registered nurse who has topped off her nursing degree with a graduate-level nurse-midwife degree program, which includes a combination of training in obstetrics and gynecology and midwifery; a nurse-midwife has also passed an exam administered by the American Midwifery Certification Board.
• Certified Midwife (CM): A certified midwife is a non-nurse who has taken a graduate- level midwifery degree program and also passed the certification exam.
• Professional Midwife (CPM): A certified professional midwife is a midwife who has met the certification requirements of the North American Registry of Midwives.
• Direct-Entry Midwife (DEM): A DEM can be a CNM, CM or CPM; this term describes midwives specializing in home and birthing-center births.
• Lay Midwife: Lay midwives have informal training, such as an apprenticeship.
Whom you choose to deliver your baby and where is in many ways up to you—whether it’s a certain type of midwife, an OB, or a combination. “It’s another take along the theme of reproductive choice,” points out Jaime Knopman, MD, a New York City-based ob-gyn and cofounder of Truly, MD.
There are many benefits to using a midwife, assuming that the woman is healthy and has an uncomplicated birth. In these low-risk cases, Bennett says, “midwifery care results in fewer c-sections, fewer interventions, more successful breastfeeding and, overall, more families who are less likely to be traumatized by their care.”
According to the American College of Nurse-Midwives, women would typically find that, with a nurse-midwife-assisted labor and birth, they have a greater sense of control. Midwives, in general, end up using fewer technological or medical interventions than an OB, but they’re also able to recognize possible complications and bring in the help of an OB when necessary.
Chances are, you can find a midwife to assist you wherever you choose to deliver. In 2014, about 3 percent of births attended by a midwife were at home. The benefits of giving birth at home are clear: You’ll deliver in a familiar setting, surrounded by whomever you choose, with no medical intervention. However, there can also be serious risks: Complications or emergencies that arise cannot be immediately treated, and pain relief is not available, even if you change your mind at the last minute.
Birthing centers offer flexible, comfortable settings with fewer rules and regulations than hospitals. For instance, continuous fetal monitoring is generally not practiced in birthing centers. Moms are allowed to get up, walk around and explore different birthing positions. And birthing centers often allow more family members to attend the birth than a hospital would.
Many midwives in the United States, however, practice within a hospital system. Here, women can get the best of both worlds: the experience of a midwife-assisted birth along with the reassurance of a medical setting, should it become necessary.
Not all women are good candidates for midwifery care. The conventional route works best for those with high-risk pregnancies. This might include, for instance, women who are age 35 or older or obese; or women who have preeclampsia, diabetes, hypertension, seizure disorders, or other pre-existing medical conditions, explains Knopman.
“Midwives have to follow rules in the state that licenses them,” Bennett says. “Most don’t allow [midwives to handle] twins, breeches and sometimes VBACs (vaginal births after cesarean).” In those cases, using an OB (who has undergone four years of medical school in addition to four years of a residency program, plus a board-certification process) would be most prudent or, in fact, necessary.
But that doesn’t mean that you can’t have a midwife attend your high-risk delivery alongside a physician. Often, in situations like these, midwives collaborate with physicians and provide comfort and support to the mother during delivery. If a woman in the care of a midwife runs into significant medical problems, the physician will step in. This often occurs when a c-section is necessary, since midwives are not able to perform surgery, which is the most notable difference between a midwife and an ob-gyn.
Wondering how a doula differs from a midwife? According to DONA International , the certification board for doulas, a doula is “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.” In short, doulas support the mother and help her labor and delivery go as smoothly as possible, similar to a midwife. But the biggest difference between a doula vs midwife is that a midwife is trained to provide end-to-end care independently for the mother and baby during pregnancy and birth, while a doula always takes a supporting role, providing comfort and assistance where necessary.
All things considered, delivering with a midwife will likely be less expensive than delivering with an OB, regardless of the setting. That’s because midwives charge less for their services than OBs do. Costs vary greatly depending on where you live and your birth situation, says Ashley West, communications specialist at the American College of Nurse-Midwives.
When it comes to figuring out whether your midwife’s services will be covered by insurance, things can get a bit murky, especially when you factor in where you’d like to give birth. Most insurance plans will cover the cost of a midwife in a hospital setting. However, if you opt for a home birth with the assistance of a midwife, the midwife’s fee may be an out-of-pocket expense. Many insurance companies won’t cover home births, because they consider home births too risky. However, midwives often offer payment plans and sliding fees, and are willing to accept most insurance plans, including Medicaid. So be sure to contact your insurance company as early as possible in your pregnancy.
Published October 2017