What is a midwife and is their care right for you?

When you find out you’re pregnant you are faced with many choices. One of those choices is whether to have a physician or midwife care for you during your pregnancy and birth. Depending on where you live, you might think that only physicians care for women in pregnancy but, midwives are a safe choice for most women.

Jade Elliott sits down with certified nurse midwife, Emily Hart Hayes from Intermountain Healthcare , on this episode of the Baby Your Baby Podcast to discuss the philosophy of midwifery, what to look for and when you are considering who to care for you and your baby during pregnancy and birth.

In the U.S., certified nurse midwives and certified midwives attend 8 percent of births and the rate is about 12 percent if you look at just vaginal births. In Utah, midwives attend about 10 percent of births.

The philosophy behind midwifery

The word midwife means “with woman.” The midwifery model of care focuses on individualized care that is a partnership between the pregnant person and the provider. They focus on health, wellness, and prevention; and use interventions at lower rates when complications arise. Midwives approach pregnancy as a normal physiologic event in a woman’s life. While complications can arise, they are trained to identify and manage those complications, and refer or consult with physician colleagues when warranted.

The advantages of seeing a midwife

Typically, midwives allow more time during prenatal visits and can also provide additional support during labor and birth. Midwives provide the same prenatal screening tests physicians do, including lab tests, ultrasounds, blood pressure checks, and monitoring for complications. Midwives generally have the philosophy to use interventions judiciously. For example, they may not break your bag of waters to speed up the birth process as long as labor is progressing normally.

Midwives offer continuous labor support and that has been shown to decrease the chance of Caesarean section. Midwives will typically intervene as needed. They can prescribe medications and use medications to induce labor. They care for women who are laboring with or without epidural anesthesia for pain relief, and they may recommend a c-section be performed. Midwives generally don’t do a routine episiotomy or order a routine hydration IV, although an IV may routinely be placed for emergencies. They allow moms to eat and drink during normal labor if they desire.

There are many different types of midwives

There are many ways to become a midwife and the laws are different in different states. In Utah, Certified Nurse Midwives (CNMs) earn their bachelor’s degree and become registered nurses first, and then go on to receive a Master’s or Doctorate degree in nurse midwifery. The vast majority of CNMs attend births in the hospital. Some states also license certified midwives (CMs) who pass the same certification exams as CNMs but who have entered the profession from a non-nursing background.

In Utah, there are also certified professional midwives (CPMs) who see women at home or in birth centers for pregnancy and birth. Utah also has direct entry and unlicensed midwives who attend deliveries at home. In Utah, only certified nurse midwives have privileges at hospitals, and some CNMs also practice in and out of hospital settings.

If you are considering a midwife who practices outside of the hospital, learn about their certification and licensure, and find out what the conditions are for transfer to a hospital.

Look for a midwife with formal education that leads to state licensure

Nationally, 98 percent of certified nurse midwives deliver in hospitals. If you prefer to deliver in a hospital, find out if your midwife is licensed to do so. Ask questions, share your birth goals and health history to find a provider who can attend to your specific needs.

There are many studies that show that midwifery care for healthy pregnant women is as safe or even sometimes safer than physician-led care. From a health systems perspective, midwifery care is cost-effective, because it results in fewer unnecessary interventions such as Cesarean section. Preterm birth rates are also lower in women who receive their prenatal care from a midwife.

Midwives provide general women’s care and can manage some complications during pregnancy

Midwives may care for you if you have health problem that arises before or during your pregnancy, whether independently or jointly with an OB/Gyn or maternal fetal medicine specialist. They care for women with gestational diabetes and pregnancy induced high blood pressure, depending on the setting, and they can attend births for women who have had a previous Cesarean birth.

There are even midwives who work collaboratively with physicians who jointly care for women with high risk chronic conditions such as Type 1 diabetes, high blood pressure, or autoimmune diseases.

Midwives aren’t just for pregnancy and birth. You can also see a midwife for general women’s primary care and gynecological issues such as pap smears, annual exams, birth control and family planning, immunizations including the HPV vaccine, and breast exams. Midwives care for women throughout the lifespan, from puberty to menopause and beyond. And yes, there are some male midwives.

How are doulas and midwives different?

A doula offers guidance and help with your comfort during labor. A doula will provide physical and emotional support for you and your partner during labor and birth. A doula will also foster a positive environment and support good communication between you and your healthcare team.

A doula cannot perform clinical or medical tasks including taking blood pressure or temperature, checking fetal heart tones or adjust monitors, or do vaginal exams. A doula also cannot diagnose medical conditions or present your options for medical care.

To learn more about midwives or to find one in your area, click here.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.