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WOMEN'S & CHILDREN'S | Family Maternity Center | Pregnancy Resource Center | Pregnancy Library | Birth Planning | Choosing a midwife: Some things to consider
Choosing a midwife: Some things to consider
Your choice of provider can influence your approach to birth and your birthing experience. Some women choose to have a midwife deliver their baby, with a doctor on call, in case of complications.
Midwife derives from Old English and means with woman. A midwife is used to refer to everything from a minimally trained birthing attendant to a highly trained medical professional.
Some view midwifery as a personalized, natural alternative to medical intervention and pain medication. Many midwives provide a full range of pregnancy-related services. One advantage to having a midwife is that more time is spent with patients on prenatal visits than is often spent by traditional practitioners. While most attend births in hospitals, they also deliver babies in birthing centers, and some attend home births.
Midwifery isn't for everyone, but the use of midwives is on the rise. In the United States, the number of women consulting nurse-midwives increased tenfold between 1975 and 1995. If you are more comfortable having a doctor care for you, you may want to choose an obstetrician or a family doctor to deliver your baby. If you have a chronic medical condition, are carrying more than one baby, or your pregnancy is high risk, consulting with with a physician with specialty skills appropriate for your condition or trained to deal with high-risk pregnancies. However, healthy women with normal pregnancies who choose nurse-midwives often have excellent outcomes with fewer medical interventions.
Doctor, midwife: Is there really a difference?
There isn't always a clear distinction between the type of care you may receive from a midwife or from a physician. Some ob/gyns are flexible and open to a more natural approach to birth. Some midwives are more liberal about use of pain medication than others.
Statistics show that more and more American women are choosing midwives. According to the National Center for Health Statistics, there has been a steady rise in the number of midwives delivering babies in the U.S., from 3.7 percent of all births in 1989 to 7 percent in 1997.
Midwives generally fall into one of two categories:
- A certified nurse midwife (CNM) has a nursing degree, has practical experience as a labor and delivery nurse, and has demonstrated competence through at least one year of midwifery training. CNMs also have to pass a certification exam given by the American College of Nurse Midwifery on the graduate level and must have a license to practice in most states. When they attend a birth (which may be in a hospital birthing center or, if allowed by law, the mother's home), they have to have a medical doctor on call for backup, in case complications develop.
- Lay midwives may not have a nursing degree and their training varies from person to person and state to state. Some states maintain license requirements for lay midwives. In these states, the midwife is not allowed to practice in a hospital, but third-party reimbursement may be provided for home-birth with prenatal and postpartum care.
There are tremendous differences in training and skills among lay midwives. Since lay midwives may not be required to have backup from a medical doctor, information should be gathered about the management of complications that may occur. Lay midwives may not have had any formal training other than the attendance at births with other unlicensed midwives.
Professional labor assistants can be a doula, midwife, nurse, or other trained to help during delivery. Doulas provide support and encouragement to laboring patients, but do not make medical decisions. Doulas work with doctors, nurses, and midwives as part of a team. Considering a midwife?
Start by asking the following questions:
- What training has she had?
- What certification or licenses does she hold?
- What is her philosophy about childbirth?
- How many births has she delivered as the primary provider?
- How are high-risk situations managed?
- What kind of prenatal services are included and what are the fees?
- Is back-up available from a credentialed medical doctor?
Date last reviewed: October 2002.
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