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When planning for the arrival of a new baby, you’ll need to make countless decisions. But none may be as important as choosing the healthcare providers to support you through pregnancy, childbirth and the postpartum period.
One such provider could be a midwife. While midwives provide the majority of maternity care in countries like the U.K. and the Netherlands, in the United States, they attend just under 10% of births [1] Births: Final Data for 2019. National Vital Statistics Report. Accessed 7/24/2021. .
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A midwife is a type of healthcare provider that cares for a person throughout pregnancy, labor, birth and postpartum.
Like a physician, a midwife attends labor and delivery to safely bring a new baby into the world. In low-risk pregnancies, a midwife can autonomously deliver in a hospital, birthing center or a family’s home.
While preparing for the birth, expectant parents may discuss the interventions, medications, procedures and labor positions they’re most comfortable with, says Amanda Mondesir, a certified nurse-midwife (C.N.M.) in Westchester, New York. From there, she explains, a midwife works to accommodate their requests, as long as they fall within the scope of safe childbirth practices.
Midwives are guided by a philosophy that views childbirth as a normal part of life, says Mondesir. “In general, midwives believe in care that is holistic, woman-centered, individualized and personal, where women are co-facilitators of their own care,” she says.
There are three main types of midwives in the U.S., as outlined in the Journal of Midwifery and Women’s Health:
While we may think of midwives solely as helping to deliver babies, many provide a host of services. The services C.N.M.s and C.M.s provide fall into three categories:
While state laws vary, many hospital-based midwifery groups are required to have a collaborating physician in case high-risk situations arise. These providers are only called upon when necessary, such as to perform Cesarean sections, says Stewart.
Note that care and services provided by C.P.M.s differ, as they focus solely on maternity care.
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Midwives are trained to care for expectant parents with low-risk pregnancies, says Stewart. They may transfer people with high-risk conditions such as a twin gestation, an infectious disease or an underlying condition to a high-risk doctor, or collaborate with a physician for their care, Stewart says.
A midwifery practice may appeal to expectant parents with low-risk pregnancies looking for:
“Midwives tend to focus on care for pregnant patients who desire unmedicated, vaginal delivery,” says Stewart. She describes the model of care as less invasive than traditional care from an OB-GYN. Under the guidance of a midwife, for instance, Stewart says patients can expect fewer cervical checks meant to evaluate dilation and the progression of labor.
However, midwifery groups do typically see patients on a traditional schedule throughout pregnancy, and require bloodwork and two ultrasounds to check fetal development, she adds.
Midwives often are able to spend more individualized time with their patients than OB-GYNs do, says Mondesir. This time dedicated to patient care may result in greater communication between provider and patient. In fact, one study found that women who chose a midwife for prenatal care reported better communication than women cared for by other types of clinicians [2] Kozhimannil K, Attanasio L, Yang T. Midwifery Care and Patient-Provider Communication in Maternity Decisions. Maternal and Child Health Journal. 2015;19(7):1608–1615. .
Medical procedures such as C-sections and episiotomies are performed at lower rates when midwives manage patients’ deliveries, says Franka Cadée, Ph.D., the president of the International Confederation of Midwives, based in the Netherlands. The research agrees. Studies show lower rates of epidural use and surgical intervention under midwife care, while birth outcomes remain equal to those of doctor-led deliveries [3] Davis L, Riedmann G, Sapiro M., et al. Cesarean Section Rates in Low-Risk Private Patients Managed By Certified Nurse-Midwives and Obstetricians. Journal of Nurse-Midwifery. 1994;39(2):91-7. . “In most birthing scenarios, a midwife has the education and expertise to autonomously support a woman or birthing person through labor and childbirth,” says Cadée.
Most often, insurance coverage extends to midwifery care, so contact your insurance provider to determine your coverage. Online directories, such as the one by the American College of Nurse-Midwives, can help you find midwifery practices in your area.
Both C.N.M.s and C.M.s have a master’s in nurse-midwifery and are accredited by the American Midwifery Certification Board. C.P.M.s receive their accreditation from the North American Registry of Midwives.
When choosing a midwife, interview candidates to ensure they’re the right fit, recommends Mondesir. “There does not exist a more important nor relevant experience such as the birth of one’s child… trust this process to someone knowledgeable, kind, trustworthy and passionate about this work,” she says.
“As long as there are no high-risk conditions present in one’s history, most women are great candidates for midwifery-led care,” says Mondesir. “In countries like the U.K., whose birth outcomes are superior to our own, only high-risk women are seen by an OB [OB-GYN] and most other normal, low-risk women are managed by midwives.”
