Midwives: Pregnancy and Delivery

Midwives have been practicing since biblical times.  However, in the U.S., a woman's choice regarding prenatal care and delivery has historically been limited to a medical doctor.   In the past few years there has been an increase in the number of U.S. women who are choosing midwives as an alternative to traditional medical care..

There are plenty of things to consider during pregnancy such as when to start prenatal care and prenatal testing, selecting a doctor or midwife, choosing a hospital or birth center, and deciding who will be present during your baby's birth (family, friends, a doula).

Midwives have helped women deliver babies since the beginning of history and there are references to midwives in ancient manuscripts and in the Bible.  Even today midwives are the primary health care providers in most countries where birth is an integral part of family life and in Europe midwives assist at more than 70% of normal vaginal births.  The World Health Organization (WHO) declared in 1990 that birth was actually safer for mothers and babies when utilizing midwifery for pregnancy and childbirth. 

Research evidence indicates that midwives achieve the same outcomes as medical doctors and indicates 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 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.

Midwives generally spend a lot of time with you during prenatal visits addressing your individual concerns and needs, and will stay with you as much as possible throughout your labor. They sometimes encourage physical positioning during labor such as walking around, showering, rocking, or leaning on birthing balls.  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. 

Midwives today come from a variety of backgrounds and may be a Certified Professional Midwife or Certified Nurse-Midwife. Most American midwives are certified nurse-midwives (CNMs) who:

• have at least a bachelor's degree and may have masters' or doctoral degrees
• have completed both nursing and midwifery training
• have passed national and state licensing exams to become certified
• are licensed in every state
• may work in conjunction with doctors

The use of a midwife is not advisable if you have a high-risk pregnancy or a previous pregnancy with complications. One of the significant differences between a medical doctor and a midwife is the medical doctor's ability to intervene surgically when necessary. Midwives do not perform C-sections and some do not administer drugs or anesthesia.

The legal status of midwives varies from state to state. In many states, midwives' services are reimbursable through Medicaid and private insurance carriers.  You should check with your insurance company to see if a midwife's services are covered.