In a recent Breath of Life birth story, when asked what she would want to tell new moms about her experience with her midwives, Natalie Roper said:

They provide the knowledge, comfort, and guidance needed, which is particularly critical when your birth isn’t going as you had planned or expected. When things get tough–and they will–a midwife will give you the strength and encouragement you need. When I felt like I couldn’t do it, my Breath of Life midwife gently encouraged me and believed in me-—“You can do this!”  And she was right.

An increasing number of women are choosing midwifery care for their pregnancy and birth. When you’re pregnant there are so many decisions that go into preparing for your new baby and life as a parent. Some of those questions may revolve around whether or not to use a midwife.

When it comes to choosing someone to care for you during your pregnancy and beyond, what do you need to know about hiring a midwife? We’ve broken down some of the most common questions moms have when they are considering this option.

What is a Midwife?

There are  3 main types of midwives in the United States.  Let’s break it down a bit for you.

Certified nurse-midwives (CNMs)  – Midwives who have a college degree in nursing and a master’s degree in nurse-midwifery. CNMs are registered nurses (RNs) who have graduated from an accredited nurse-midwifery education program and passed a national certification exam. They must have a license to practice midwifery in the state where they work. CNMs work in all health care settings including hospitals, birth centers, and offices or clinics. CNMs provide general women’s health care throughout a woman’s lifetime, and they can prescribe most medications.

Certified midwives (CMs) – Midwives with a bachelor’s degree in a field other than nursing and a master’s degree. They have the same midwifery education and pass the same national certification exam as CNMs. CMs must have a license to practice midwifery in the state where they work. CMs provide the same services and work in the same settings as CNMs. Not all states license CMs.

Certified professional midwives (CPMs) – Midwives who may have apprenticeship training, or they may graduate from an accredited formal education program. CPMs take a national certification exam that is not the same as the one CNMs and CMs take. The health care services provided by CPMs are not as broad as those of CNMs and CMs. CPMs provide pregnancy, birth, and postpartum care for women outside of the hospital—often in birth centers and homes. CPMs are not able to prescribe most medications, and they do not work in hospitals.

Most of the midwives in the United States are CNMs. CNMs are licensed in all 50 states. Not all states license CMs and CPMs.

What Services Does a Midwife Perform?

Midwives have helped over 300,000 women give birth each year in the United States, but are more than birth experts. Depending upon which type of midwife they are the services they provide may include:

  • Prenatal care to mother and baby
  • Non-stop support during pregnancy, labor, and delivery
  • Guidance to mom through the birthing process
  • Postpartum support
  • Care for the new baby
  • Annual Well Woman exams
  • Birth control planning
  • Menopause counseling and care
  • Health counseling

Do Midwives Only Help with Home Births?

You’ll find midwives serving women in birth centers, hospitals, and at home. In fact, most midwife births are in hospitals. There’s a growing number of OB-GYNs and midwives partnering to provide care for moms-to-be. This gives moms-to-be more options. Read Kerri Shaw’s birth story about how she decided between using a midwife at a hospital birth or at a birth center.  

What are Some Benefits of Choosing a Midwife?

The word “midwife” literally means “with woman,” which is perfect, when you consider how much you need someone to be on your side during pregnancy, delivery, and postpartum care.  There are many benefits of choosing a midwife, but we’ll share six things that resonate with most women.

  1. Midwives believe pregnancy and birth are normal, natural experiences, and not a medical situation to be managed.
  2. Midwives focus on creating a healthy, safe experience, as well as empowering the birthing woman.
  3. Midwives are experts in knowing the difference between normal changes that occur during pregnancy and symptoms that require extra attention.
  4. The use of midwives has been shown to improve birth outcomes, including

5. Midwives see their patients as partners in the process, giving the mom a more active role in her birth experience.

6. Midwifery care reduces interventions as well as complications ultimately reducing costs in all settings.

Breath of Life recently participated in a Government Study about birth centers that show favorable results for both birth centers and midwifery care. If you haven’t seen that study, you can view it here.

Can I use a Midwife if I am Considered “High Risk”?

Very few pregnant women are unable to have their baby with a midwife in the birth center. Age is not a risk factor, neither is infertility nor is a history of miscarriages. A midwife can manage most of the common pregnancy complications. Check your state regulations, as some states require that women who plan to deliver out-of-hospital be medically low-risk and be expected to have an uncomplicated birth.

The following conditions would place a woman in the “higher-risk” category, according to most state regulations. In these cases, it would be best to choose a CNM or CM who works with a physician and give birth in a hospital:

  • Chronic High Blood Pressure, pre-eclampsia in current pregnancy
  • Heart Disease
  • Kidney Disease
  • Diabetes*
  • Multiple Pregnancy (twins or triplets)
  • 7 or more childbirths
  • History of Placental Abruption

*Note: Gestational Diabetes in a prior pregnancy does not automatically exclude you from consideration for a birth center birth.

What if I Have a Complication During Pregnancy or Labor?

You’re in good hands. Midwives work with doctors who specialize in illness during pregnancy. If you have a medical problem during pregnancy or complication during labor, your midwife will work with a doctor to make sure you get the best and safest care for you and your baby. There should be a hospital transfer plan should complications arise during your labor and delivery.

Your midwife will also work with other health care providers: nurses, social workers, nutritionists, doulas, childbirth educators, physical therapists, and other specialists to help you get the care you need. In addition, your CNM/CM can prescribe medicine and order treatment for any common illness that you might have during pregnancy.

Will a Midwife Allow the Use of Pain Medicine During Labor?

There are options for pain management. If you want or need pain medicine during labor, your midwife will provide you with choices so you can decide what is right for you.

Should I See A Midwife If I Am Not Pregnant?

It’s a great idea, actually! Many women go to their CNM or CM for annual check-ups, family planning, and to receive wellness care. A midwife can answer questions about all the methods of birth control, help you decide what is best and safest for you, and prescribe it for you. They can also perform women’s well-checks and help with any health concerns that are specific to women.

What Questions Should I ask a Midwife?

There are numerous questions you should ask your potential midwife before making a decision to hire her. These are some of the questions you should consider:

  • Is she licensed in your state?
  • What are her credentials?
  • How much experience does she have?
  • How many births has she attended as a midwife?
  • Where does she do her prenatal visits? (at her home, an office, or a birth center?)
  • Does she have a back-up midwife if she’s unavailable?
  • Can you meet her back-up midwife?
  • How often does she monitor mom and baby?
  • Will she help you develop a birth plan?
  • What are the fees for her services?
  • Is she available the month you are due?
  • Will she attend the birth?
  • How long do her appointments usually last?
  • Will she stay will you after labor and delivery?
  • Is she CPR certified?
  • Has she ever had to resuscitate a baby?
  • What would she do in the event of an emergency?
  • What will she do if two clients are in labor at the same time?
  • How is she contacted?
  • Does she work with student midwives in her practice?
  • How will your partner be included in the visits and birth?

You may not think some of these questions are not a cause for concern or you may have additional questions. Ask what is important to you before you meet with your prospective midwife. That way you can make the best decision for you.

This is by no means an exhaustive list of questions moms have or a complete guide to hiring a midwife. If you would like to speak with someone at Breath of Life to find out if using a midwife is right for you, we would love to hear from you. Contact us for additional resources or for help being pointed in the best direction for you.