Midwives: Pregnancy and Delivery

In the United States, a woman's choice regarding prenatal care and delivery has traditionally been limited to an obstetrician or a knowledgeable family doctor. In the past few years many women are choosing midwives as an alternative.

There are plenty of decisions to consider during pregnancy. Opting for prenatal testing, selecting a doctor or midwife for your baby, whether to deliver in a hospital or in a birth center, setting, and deciding who will be present during your baby's birth (family, friends, a doula) are among the more challenging decisions you'll need to make.

The following information, adapted from the websites listed at the bottom of the page, deals with midwives.

The word "midwife" comes from Old English and means "with woman." Midwives have helped women deliver babies since the beginning of history.  There are references to midwives in ancient Hindu records, in Greek and Roman manuscripts, and even in the Bible.

Midwives are the primary health care providers in most countries where birth is an integral part of family life. Countries with the highest rate of midwifery care also have the best outcomes for mothers and babies. The World Health Organization (WHO) declared in 1990 that birth was actually safer for mothers and babies when utilizing midwifery for pregnancy and childbirth.  In Europe, midwives assist at more than 70% of normal vaginal births. But most Americans are not sure what they do, how they are trained, or if they are even available.

What's the Midwife's Philosophy?

Midwifery is based on a strong belief in partnership with childbearing women and respect for birth as a normal life event. Midwives view their role as supporting the pregnant woman while letting nature takes its course.  Midwives strive to empower parents with knowledge and support their right to create the birth experience which is best for them.

Midwives focus on the psychological aspects of how the mother-to-be feels about her pregnancy and the actual birth experience. They encourage women to trust their own instincts and seek the information they need to make their own valuable decisions about pregnancy, birth, and parenthood. Of course, many medical doctors (MDs) share these values. But an MD is more likely to use preventive testing and medical technology, such as ultrasound, continuous fetal monitoring, and the option of pain medications during birth, as a standard part of care during pregnancy and labor. High-risk pregnancies undoubtedly require this approach. But many midwives find it unnecessary for most uncomplicated pregnancies.

What Kind of Training Does a Midwife Have?

Midwives today come from a variety of backgrounds. The subtitle a midwife uses will indicate the level of education and training. Most American midwives are certified nurse-midwives (CNMs) who:

Midwives generally spend a lot of time with a woman during prenatal visits addressing her individual concerns and needs, and will stay with her as much as possible throughout labor. They sometimes encourage physical positioning during labor such as walking around, showering, rocking, or leaning on birthing balls - recommendations that are not usually associated with a typical medical doctor. Midwives also usually allow women to eat and drink during labor.

Certified nurse-midwives, like doctors, will use some medical interventions, such as electronic fetal monitoring, labor-inducing drugs, pain medications, epidurals, and episiotomies, if the need arises.  Midwifery care involves judicious use of technology. Women avoid the risks, discomfort, and disruption that unnecessary procedures impose, yet have the opportunity to use available technology if needed.  Certified midwives are trained in basic life support for newborns and, in the event of sudden complications with your baby after birth, can care for the baby until a pediatrician or neonatologist (an intensive-care specialist for newborns) is available.

National research shows that midwives achieve the same outcomes as physicians without disrupting the natural birth process as often. Research also shows that midwives have reduced cesarean section rates by more than 50% with no compromise in safety. In fact, care from midwives has significantly lower rates of induced labor, episiotomies, and forceps births. Midwives are most actively involved in a woman's preparation for childbirth. That kind of support reduces the length of labor, avoids unnecessary interventions and improves birth outcomes. Midwifery care is proven to be safe.

Is a Midwife Right for You?

Several studies have shown that midwife-supervised births produce excellent outcomes with fewer medical interventions than average. Midwives' patients use electronic fetal monitoring less often and tend to have a reduced need for epidurals, episiotomies, and cesarean sections for successful deliveries. To some degree, this stems from the fact that midwives see only low-risk patients with uncomplicated pregnancies. But some researchers attribute the need for a minimum of medical intervention to the midwives' natural approach to the management of labor and delivery, which may reduce a woman's fear, pain, and anxiety during birth.

Midwifery is not advisable for women with higher-risk pregnancies. Those expecting twins or multiples and those with prior pregnancy complications, gestational diabetes, high-blood pressure, or chronic health problems of any kind before pregnancy should discuss their options with their primary health care provider or an obstetrician. Certified nurse-midwives who practice in major medical centers and work very closely with obstetricians and perinatologists (specialists in high-risk pregnancy) may take patients with risk factors. But midwives in solo practice or who practice in limited medical facilities generally do not.

The major difference between doctors and midwives is the doctors' ability to intervene surgically when necessary. Midwives can't perform cesarean sections and some can't administer drugs or anesthesia. If you feel more comfortable having those options immediately available, a doctor may be the right choice for you.

Most health insurance plans cover midwifery care, including Medicaid/DSHS, Group Health, Regence and other major insurers.