What's a Midwife and what do they do?

What is a midwife? Glad you asked! There are different types of midwives and in this post we break down each type, what they do and why they're important to the world of birth.

As an expecting parent or someone thinking about having kiddos one day, we know the pool of advice can be deep. There’s a whole slew of information out there that can feel overwhelming. At Mina, we like to dig in, research, and weigh all the options.

We're pretty good at putting in hours researching the type of car we’re going to purchase, or obsess over consumer reports to determine which vacuum does the best job, but often research around birth options is overlooked. And in the US, most families simply go to the hospital closest to their home without realizing, there are other excellent and safe options. Understanding those options is important; there's mounting evidence showing that where you give birth, and the provider you choose affects your birth experience, your baby’s experience and both of your health outcomes. Also, your first birth experience can significantly affect future births.

Choosing a midwife for your birth is one incredible option for birth. Most people have probably heard of a midwife, but they don't know exactly what a midwife does or what benefits they bring to birth. Maybe their mind goes straight to "Call the Midwife," and they think that it's a practice from the past or are only for hippy or homeschool families.

What is a midwife?

But the truth is, midwives are incredibly trained and skilled medical professionals that are experts in pregnancy, birth and postpartum and they provide care for clients across all family spectrums. Midwives can provide care in the clinic for all prenatal appointments and can attend births in a hospital, birth center, or at home. Some also offer family planning services which can include annual exams (even basic well-person care — you don’t have to be pregnant!).

Midwifery care typically leans toward

1) physiological birth (birthing person-led, with freedom of movement, and limited interventions like episiotomies, epidurals or medication)

2) evidence-based birth (birth care that is based on the most up to date evidence for best care during birth). There are different types of education and certification for a midwife.

Certified Nurse Midwife (CNM)

A Certified Nurse Midwife is a registered nurse that has also graduated from an accredited midwifery program and passed the American Midwifery Certification Board exam. All 50 states allow CNMs to practice. Certified Nurse Midwives primarily work in hospitals and free-standing birth centers. Their scope of practice is similar to a medical doctor. They can provide general well-person care (like annual physicals and general health), as well as care throughout pregnancy and birth. Contrary to popular belief, these midwives can prescribe some medication and even work with patients who are planning to get an epidural. Midwives are generally with their patients throughout labor and birth.

Certified Midwife (CM)

A Certified Midwife is not an RN but has a bachelor’s degree in a health field and has completed an accredited midwifery program as well as passed the National Certification Exam in Midwifery. There are a few states that allow a CM to practice.

Certified Professional Midwife (CPM)

A Certified Professional Midwife is not an RN but has experience and training in childbirth, including out-of-hospital settings. These midwives have passed a national midwifery exam and have spent time apprenticing with a practicing midwife. There are few states that allow a CM to practice.

How is the Midwifery care model different than Obstetrician (OB or Ob-Gyn) care?

Midwifery model is birthing person-led. This model sees birth as a normal physiological event that needs very little intervention and should be supported rather than managed. There is freedom for the birthing person to do what feels right for them during labor and birth, which can include movement, eating, drinking, being in water or other methods to help with labor. This model also recognizes that only sometimes birth needs interventions and the midwife can assist the birthing person in some of those interventions or by calling for the assistance of an Obstetrician when deemed necessary.

Obstetrics see birth as a medical event that needs to be managed, which can include episiotomy, forceps-assisted birth, birth augmentation, epidural or cesarean birth. Often this model is medically-led care rather than patient or birthing person-led care.

Do Midwives and Obstetricians/Ob-Gyns work together?

Yes, absolutely! Most midwives at a hospital are overseen by an OB-Gyn, and they can be called in to assist a midwife's birth team if complications arise that require immediate medical interventions. They can perform cesarean births and other complicated operations that can occur such as placenta accreta, or retained placenta, where the placenta needs to be surgically removed.

Birth Center and Home Birth midwives are highly skilled individuals that also follow the Midwifery Model of Care. Most freestanding birth centers have state-of-the-art medical equipment and are very well prepared to care for birthing people and their newborns. Home Birth midwives bring medical equipment to each birth to care for the birthing person and baby. Midwives that work in this capacity have relationships with hospitals in case birth would turn into a medical event and a transfer is needed.

However, research shows that planned out-of-hospital births are just as safe as hospital births, but also come with the added benefit of less: episiotomies, forceps and vacuum assisted births, less births being induced by Pitocin, less pain medication used and a far less rate of cesarean births.

Birth options include:

  • You have many options: 
  • Hospital with an OB/Ob-Gyn, Certified Nurse Midwife, or Family Practice physician
  • Freestanding birth center with a Certified Nurse Midwife or Certified Professional Midwife
  • Homebirth with a Certified Professional Midwife or Certified Nurse Midwife

So, in summary…

The style of care and approach to childbirth can vary with where you birth your baby and the type of provider you choose. While these descriptions are broad generalities, and care can vary from one specific provider to the next, they can provide a starting point to research what may be the best fit for your family. It’s important to understand your options to understand what provider and birthplace aligns with your birth goals. The way you choose to bring your baby into this world is 100% YOUR CHOICE. It’s a beautiful time of life, and meeting your little one face-to-face should be one of the most amazing experience in life. We hope this resource helps provide a snapshot of the different care available, and aims you in the direction that works best for you, your baby, and your family.

Help Us, Help Families.

Did you know that the doors you walk through on the day you give birth can greatly affect the experience you have during and after birth? Some birthplaces are more family-led, baby-friendly places, and some tend toward more medicalized birth experiences. It also can be a determining factor in the chances of having an unplanned cesarean birth. Some hospitals and providers simply are more prone to lean that way if a delay or complication arises.

We love babies, and know that sometimes a surgical birth may be the healthiest way for you to meet your little one. BUT the frequency of unnecessary cesarean births is high in our nation (which can bring more complications, especially if it isn’t medically necessary). Knowing your hospital’s record and those of your provider (and their associated provider group that may share on-call shifts), as well as what style of care your provider and hospital provides, is important so you can be prepared and make informed decisions.

We’re creating an amazing, grassroots way to look at birthplaces. It’s a way to help growing families determine where they want to give birth to their little ones, based on the reviews from other families. It’s also a place where you can share the experiences you’ve had with providers and birthplaces. If you’re new to the birth world, taking a minute to read through the places listed on our site may help in your future birth experience. If you’ve already had a birth experience, writing a review of birthplace(s) and provider(s) with which you’ve had an experience can greatly help other expecting parents find a place to meet all their wants and needs.

We know families deserve the very best, and we want to help provide that for you; gleaning wisdom from others is one of the best ways we can think of to achieve that goal. Please help us in that endeavor.

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