What is a Midwife and Why Do You Need One? (2024)
What we’ll cover in this post:
Hopefully by this time in your life you’ve seen a care provider for your routine gynecological needs. This person could either be a doctor or a midwife (yes, midwives do routine well visits, place birth control, and counsel you about treatment options!).
Then you get pregnant. Now what? Well, you have a few options!
If you start with a doctor:
If they are also an obstetrician (OB) assisting births, determine if they are a good fit for your needs and goals
If they don’t assist births, you’ll need to switch to another doctor or midwife
See if there are midwives within their practice that you connect with
If not, consider interviewing other midwifery practices to get a sense of what’s out there
If you start with a midwife:
Ask what hospitals/locations they have privileges at
Determine if they’re a good fit for your needs and priorities
If your pregnancy is higher risk, you may need to find an obstetrician
You may be wondering: “What is a midwife and why would you choose a midwife over an OBGYN?”
Knowing the difference between a midwife and an OB-GYN can really help you decide who you’d like on your team for the duration of your pregnancy and when you give birth. Let’s jump in!
What is a midwife? What is the difference between a midwife and an OB-GYN?
The definition of a midwife is: “A person trained to assist pregnant folks with childbirth”.
Midwives can deliver babies in various settings:
In hospitals
In birth centers
In homes
While a midwife and an OB-GYN share a lot of similarities, there are also quite a few differences.
Midwives and OB-GYNs are:
Both trained healthcare professionals
Care for patients during: Family planning, pregnancy, birth, and postpartum
Offer preventative care/screening services
Are able to prescribe medications when necessary
The differences between midwives and OB-GYNs include:
A completely different model of education and training
Midwives typically support a more uninterrupted, physiologic birth - offering more options, control, and freedom throughout pregnancy, labor, and birth
Midwives care for those with low-risk pregnancies, whereas an OB-GYN typically needs to be involved in any high-risk pregnancies
Midwives can assist with cesarean sections, but an OB-GYN needs to actually perform the surgery
Midwives can deliver babies in hospitals, homes, or birth centers, whereas OB-GYNs deliver babies in hospitals
Midwives tend to play a more active role for the duration of care - they are able to get to know their patients and spend more time with them
If you’re unsure whether you want an OB-GYN or a midwife to care for you throughout your pregnancy and birth, there are some questions you can ask:
Is your pregnancy considered high risk or low risk?
Are you planning a vaginal birth or cesarean birth?
Do you prefer an unmedicated labor/birth with little to no intervention?
Where would you feel safest when it’s time to give birth?
Models of care in pregnancy and birth
** Any provider, physician or midwife, can subscribe to either model of care and most land somewhere in between. Neither model is right or wrong. It is important to consider the things that matter to you. And it is also important to not to assume a provider's philosophies without asking them insightful questions, such as those listed in the resource section.
Medical model of care
These Providers:
Focus on the medical aspects of pregnancy, labor, and birth such as the potential risks and complications.
Focus on managing risks to try to prevent possible problems.
May have additional training that make them more skilled at dealing with medical complications.
May take charge of your care and treatment rather than expecting you to make all the decisions.
May have set plans for things like testing and follow up rather than presenting options for you to choose.
May primarily spend time evaluating the medical issues with less emphasis on individual education and personal needs during prenatal visits.
May be less likely to focus on providing emotional support.
Often place a high value on medications and technology.
Patient-Centered Model of Care
(May also be called the Midwifery Model of Care or Midwifery Philosophy of Care but is not exclusive to midwives)
These Providers:
Focus on treating you holistically as a whole person rather than focusing on specific medical issues.
Focus on preventing problems and anticipating potential issues.
Focus on educating you about all your options in a way you can understand and then encourage shared decision making.
Understand that informed consent requires education and the ability to say no.
Spend time assessing not only your medical needs but also your mental, emotional, and social needs as well.
Recognize that birth is a social (involving family and friends) and transformative event.
Often take part in equity support (care for diverse populations and backgrounds).
Understand that medications and interventions are useful tools when used appropriately.
Vulnerable populations, like people of color and families of lower income, may benefit even more from patient-centered care. However, access to a variety of care options in these populations can be limited. If you’re having a hard time finding midwives in your community, contact Big Push for Midwives.
Deciding who you want to choose as your healthcare provider can be a tough decision, but Motherboard has all of the up-to-date and evidence based information to help you make informed decisions.
Creating a Birth Plan through our Birth Plan App is simple and starts with helping you choose which healthcare provider is best for you!
Midwife’s role during pregnancy
The midwife’s role during pregnancy is similar to that of an OB-GYNs role during pregnancy. The midwife:
Offers prenatal care
Provides families with all of the necessary information to help make informed decisions regarding care, testing, treatments, medications (if necessary), etc.
If they are a CNM (certified nurse midwife) they can prescribe medications and treatment when necessary
Ensures the proper screening and testing is done throughout pregnancy
Monitors you to help predict and treat any complications that may arise
Midwife’s role during labor and birth
A midwife will provide care and support for the duration of a labor and birth.
The midwife’s role during labor and birth is to:
Provide support
Monitor you and your baby’s vital signs
Ensuring you are comfortable and will prescribe medication if needed/desired (if they are a CNM)
Assist you with the delivery of your baby and placenta
Assess and care for you and your baby during the immediate postpartum period
Midwife’s role after birth
Immediately after birth, your midwife will assess you and your baby. If you have any vaginal tearing that requires repair, your midwife will perform the repairs.
Your midwife will ensure you are not bleeding more than expected, you and your baby’s vital signs are stable, and that there are no immediate concerns. If any concerns arise, your midwife is capable of ordering and administering any necessary medications. If any concerns arise out of their scope of practice, they can consult an OB within the hospital system or, if you are at a birth center or home, they would recommend a hospital transfer when necessary.
Keep in mind that midwives who deliver babies at birth centers and within your home carry birth supplies, including life saving equipment and medications.
Once you are stable and receive stitches, if necessary, the remaining postpartum care you receive from your midwife will depend on where you give birth.
If you are giving birth in a hospital, the midwife will typically leave the room once any repairs are done. You will then be in the care of the nurses, who will call the midwife if they have any concerns. Throughout the remainder of your hospital stay, it is likely that you will see the midwife once per day until you are discharged home (usually 24-72 hours after birth).
Once you are discharged from the hospital, it is common to have a postpartum visit at your midwife’s office for a 6 week check up.
If you are giving birth in a birth center or at home, you will remain with your midwife for at least a few hours to ensure you and baby are both doing well. After about four hours or so, as long as you and your baby are settling in with no apparent issues, you will be given the option to leave the birth center or, if you’re at home, your midwife will go ahead and leave.
When you give birth at a birth center or at home, it’s common to have a sooner postpartum visit than the typical 6 week check up we see after a hospital birth. Every midwifery practice is different, so it’s important to ask this question when you are planning your birth.
In the home birth/birth center world, it is not uncommon for your midwife to come do a few postpartum checkups within your home throughout the first few weeks after you give birth.
Regardless of where you give birth, if you have any concerns within your postpartum period prior to your scheduled appointment, always call your provider.
Types of licensed midwives - eligibility and requirements
Although we hear the term “midwife” and assume they all have the same background, that is not the case. There are actually five different routes someone can take to become a midwife:
Certified Nurse Midwife (CNM) - They go to nursing school first and then get a Masters in Midwifery
Certified Midwife (CM)
Certified Professional Midwife (CPM)
Direct-Entry Midwife (DEM)
Lay Midwife
Keep in mind that some education and training requirements may differ by state and/or anywhere outside of the United States; these are qualifications/requirements within the United States.
Certified Nurse Midwives (CNM) and Certified Midwives (CM)
Certified Nurse Midwives (CNM) and Certified Midwives (CM) receive a high level of education and training to be able to care for patients throughout the entire lifespan; starting at adolescence. CNMs and CMs also care for pregnant folks for the duration of a pregnancy and throughout labor, birth, and the postpartum period.
These two types of midwives earn a graduate degree and have to pass a certification exam from the American Midwifery Certification Board (AMCB).
CNMs and CMs are both qualified to perform the same level of midwifery care. The main difference is that CNMs were nurses prior to attending midwifery school or received nursing education with their midwifery degree.
Certified Professional Midwife (CPM)
A Certified Professional Midwife (CPM) receives a certification from the North American Registry of Midwives (NARM). In order to qualify for this exam, a person must either apprentice with a qualified midwife for a certain amount of hours, complete a portfolio evaluation, or graduate from a midwifery program that is accredited by the Midwifery Education Accreditation Council.
The privileges of a CPM depends on the state they work in.
Direct-Entry Midwife (DEM)
Direct-Entry Midwives typically attend home births and births in freestanding birth centers. There is no national certification or licensing process required for DEMs, instead, each state sets requirements for any necessary licensing and education.
Lay Midwife
A lay midwife is a midwife who is not certified or licensed, but typically has some type of informal education, i.e. a former doula who received hands-on training from midwives they worked with in a birth center/home birth setting. Possible licensing requirements will depend on the state the lay midwife practices in.
The Takeaway
One of the most important decisions you’ll make once you find out you’re pregnant is who your provider will be. Will you choose a midwife or an obstetrician (OB)? What is a midwife?
A midwife typically follows a more holistic model of care. Midwives tend to favor more of an uninterrupted, physiologic birth and avoid any unnecessary interventions throughout the birth process.
Obstetrics is a surgical specialty, so OBs learn a totally different model of care and tend to see labor and birth as more of a medical “condition” rather than a natural physiologic process.
It’s important to remember that any provider, OB or midwife, can adopt any model of care. The best way to choose which provider is best for you is to discuss your birth preferences with your provider “candidates” to see who aligns best with your wishes.
Remember, it is your birth and you have the right to create the birth team you feel most supported and comfortable with.
🤍 The Motherboard Team
