The term midwife reflects a philosophy of care; one that is more specifically directed at the woman and her individual reproductive needs. A midwife usually offers a variety of options and seeks to eliminate or minimize unnecessary interventions. This philosophy of care is represented by the Midwives Model of Care:
The midwives model of care is based on the fact that pregnancy and birth are normal life processes. The midwives 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 attention1
What is a midwife?
A midwife is a healthcare professional that provides an array of health care services for women that may include medical histories and genealogical examinations, contraceptive counseling, prescriptions, and labor and delivery care. Providing care during labor, delivery and after birth is a specialty of midwifery that makes them unique experts.
What services do midwives provide?
The services of a midwife depend on the certification and licensure credentials obtained and the practice restrictions within each state. Because of the additional licensure in nursing, a nurse-midwife provides the most comprehensive array of healthcare services to women.
These services include: annual gynecological exams, family planning and preconception care, prenatal care, labor and delivery support, newborn care, and menopausal management. Midwives generally provide reproductive education directed at fertility, nutrition and exercise, contraception, pregnancy health, breastfeeding and quality infant care. Midwives often serve as a quality economical option for birthing care.
What are the different types of midwives?
Midwives are qualified health care providers that go through comprehensive training and examinations for certification. Certification is offered by the American College of Nurse Midwives (ACNM) and the North American Registry of Midwives (NARM). Below is a description of each of the types of midwives:
- Certified Nurse-Midwife (CNM): an individual trained and licensed in both nursing and midwifery. Nurse-midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives. Certified Professional Midwife (CPM): an individual trained in midwifery and meets practice standards of the North American Registry of Midwives.
- Direct-Entry Midwife (DEM): an independent individual trained in midwifery through a variety of possibilities that include: self-study, apprenticeship, a midwifery school, or a college/university program.
- Certified Midwife (CM): an individual trained and certified in midwifery. Certified midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives. Lay Midwife: an individual who is not certified or licensed as a midwife; however they are trained informally through self-study or apprenticeship. The practice and credentials related to midwifery may differ throughout the United States. The American Pregnancy Association encourages you to inquire about the training, certification and licensure of any person practicing midwifery services.
Where do midwives practice?
Midwives believe in facilitating a natural childbirth as much as possible. Accordingly, it is common to receive care from a midwife in a private and comfortable birthing center or in the comforts of your own home. Because of their professionalism and expertise, midwives are often part of a labor and delivery team associated with the local hospital. You may choose to use the services of a midwife whether you elect to give birth at home, a birthing center, or in a hospital.
What are the benefits of using a midwife?
One of the main reasons that women elect to use a midwife in their home, at a birthing center or in the hospital is to experience the childbirth process as naturally as possible.
A focus on options is another benefit associated with electing midwifery care. Midwives often have payment plans, sliding fees, and accept most insurance plans, including Medicaid.
According to the doctoral research conducted by Peter Schlenzka, an election to use a nurse-midwife and natural delivery may result in the following benefits:
- Lower maternity care costs
- Reduced mortality and morbidity related to cesarean and other interventions
- Lower intervention rates
- Fewer recovery complications2
Electing to use a nurse-midwife is appropriate for low risk pregnancies which make up 60 to 80% of all pregnancies. In Schlenzka’s review of over 800,000 births, he reports there are no advantages of an obstetric hospital approach as compared to a nurse-midwife setting inside or outside of the hospital.
What are the concerns related to using a nurse midwife?
Low risk pregnancies make up 60 to 80% of all pregnancies, which means that between 20 to 40% of all other pregnancies anticipate a potential complication. There are times when either the mother or the baby will require medical interventions that are outside the scope of services offered by a nurse-midwife. Midwives routinely consult with obstetricians, perinatologists, and other healthcare professionals and will refer women to the necessary medical professionals if complications arise.
If complications are anticipated, it is recommended that women elect a hospital setting where there is easier access to obstetricians, perinatologists, and other experts prepared to deal with a variety of complications related to either the mother or the newborn baby.
Choosing a hospital setting does not necessitate the utilization of every medical intervention available. You may still consult with your health care provider about options related to your delivery. Having a nurse-midwife as part of your delivery team should still be an option. The primary concern is to make sure that you are in a setting that enables your delivery team to address any complication that may arrive.
1Collaborative statement created by Midwives Alliance of North America, the North American Registry of Midwives, the Midwifery Education Accreditation Council and Citizens for Midwifery.
2Schlenzka, Peter, “Safety of Alternative Approaches to Childbirth,” Department of Social Work and Sociology, Ferrum College, 1999.
Reprinted with permission from American Pregnancy Association