Midwives offer pregnant women a wealth of benefits that traditional obstetricians cannot match. From personalized care to more natural approaches to childbirth, midwives can provide the support and guidance expectant mothers need during this important time in their lives. If you are pregnant, or are thinking of becoming pregnant, it is worth considering a midwife as your primary healthcare provider.
But first, how do I know all of this? Hi — I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have worked at hospitals that had midwives, as well as hospitals that did not have midwives and I have seen a great variety in both types of care — so I’m a good one to answer this.
What is a midwife and what do they do
Midwives are highly trained and experienced healthcare professionals who provide care and support to women throughout their pregnancy, labor, and delivery. Midwives are also trained to provide postpartum care, and can offer guidance on breastfeeding and newborn care. In addition to offering physical care, midwives also provide emotional support to expectant mothers and their families.
Different types of midwives
There are three main types of midwives: certified nurse-midwives (CNMs), certified professional midwives (CPMs), and direct-entry midwives (DEMs) — sometimes also called “lay midwives”.
CNMs are registered nurses who have completed additional training in midwifery. They must pass a national exam administered by the American College of Nurse-Midwives in order to be certified.
CPMs are trained in midwifery through various sources, including apprenticeship, self-study, or a midwifery school. CPMs must meet the standards set by the North American Registry of Midwives in order to be certified.
DEMs are independent midwives who have trained through self-study, an apprenticeship, or a midwifery school.
The type of midwife you choose will likely be based on your personal preferences and the availability of midwives in your area.
However, this article will only speak to certified nurse midwives. They are the only ones allowed to practice in the hospital and they are the only ones that I have had experience with.
This isn’t to say that homebirth isn’t a viable option, but it is not something I have experience with.
Also, many midwives deliver in birth centers (including CNM’s) and that too is not an area that I am familiar with. I, personally, believe that midwife care in the hospital offers the best of all worlds and I would hope that it becomes more popular among pregnant patients.
Tip: I have worked with a variety of midwives and some are just as “medical” as “doctors” and some doctors are as “crunchy” as midwives — so it REALLY depends on your provider, but these are some generalities on how they view birth.
Fact: 9.8% of deliveries in 2019 were done by a CNM in the us (from my birth statistics page)
I have a whole podcast episode where I review the different people who can deliver your baby:
The Benefits of Having a Midwife
1. Personalized care
One of the most significant advantages of having a midwife is the level of personal attention and care you will receive. Midwives get to know their patients on a personal level, which allows them to provide individualized care. This level of personalized care is often not possible with traditional obstetricians who often have large patient loads.
The reality is that midwives often have much less overhead, and much less debt from schooling, so they can spend more time with patients, and learn more about YOU. This is a HUGE benefit to them.
Although, this isn’t true in all practices — some see just as many as physicians.
BTW, just because you have a midwife doesn’t mean you wouldn’t benefit from a childbirth class. The Online Prenatal Class for Couples is a great compliment to both OB or midwife care.
2. More natural approaches to childbirth
Many midwives take a more natural approach to childbirth, which can include the use of water during labor, walking during labor, and avoiding unnecessary interventions such as episiotomies. These more natural approaches can lead to a shorter labor, less pain during labor, and a quicker recovery after delivery.
In general midwives are just taught to take a more natural approach in school as they are dealing with more low-risk patients. Whereas, OB’s are taught to take a more “medical” point of view as they often have higher risk patients that require more monitoring.
Before we get into the next benefits I want to place a caveat in your mind. Midwives have lower-risk patients, and if they find that a patient is higher risks, or turns higher risk they will recommend that patient seek care with an OB. That means their patient population is very different than the average obstetricians, which definitely throws off the studies below. Higher risk patients often require more interventions…. Just something to know.
If you’re looking for studies that prove some of the benefits below — I liked this one, and it does seem to only compare “low-risk” patients.
3. Increased likelihood of having a vaginal birth
There is evidence to suggest that midwife-attended births are more likely to result in a vaginal birth, as opposed to a cesarean section. This is significant because vaginal births carry fewer risks than C-sections and usually result in a quicker recovery for the mother.
However, often midwives transfer care to an OB if a cesarean section is indicated.
Midwives are not able to perform a cesarean section (they can sometimes assist, but they can’t be the lead surgeon). So, any patient who has a cesarean section is delivered by an obstetrician.
4. Fewer interventions during labor and delivery
Midwives are less likely to use interventions such as epidurals, forceps, and vacuum extractors during labor and delivery. These interventions can increase the risk of complications for both the mother and the baby.
However, in many places midwives aren’t allowed to use these types of interventions without an OB present (because, in case it went to a cesarean section the OB would be need to be there ASAP).
5. Lower rates of inductions and C-sections
Midwives are less likely to induce labor or recommend a C-section. Inductions and C-sections can increase the risk of complications for both the mother and the baby.
But again — very often both of these happen on higher risk patients who are already seeing OB’s.
6. Continuity of care
Having the same care provider throughout your pregnancy, labor, and delivery can provide much-needed continuity of care. This continuity of care can help to reduce stress and anxiety during what is often a very emotional and stressful time.
Seeing a familiar supportive face that you’ve known for your pregnancy can be HUGE in labor.
However, not all midwife practices only have a few midwives. You may build a relationship with one, and you may not. It’s important to ask at your visits what the likelyhood is that you’ll have built a relationship with the provider you delivers you.
7. Emotional support
In addition to providing physical care, midwives also provide emotional support to expectant mothers and their families. This emotional support can be invaluable during pregnancy, labor, and delivery.
I love this aspect, and I find this to be true VERY often of midwife-centered care. They really are there to support you.
8. Fewer postpartum complications
There is evidence to suggest that midwife-attended births are associated with fewer postpartum complications, such as hemorrhage and infection. This is significant because these complications can lead to a longer hospital stay and a more difficult recovery for the mother.
A Note From Hilary:
I actually do find that midwives most often aren’t as quick to turn to medical interventions like forceps, cesareans, inductions, episiotomies etc. So, while the studies could be skewed, I do think this is true. However, it really depends on YOU and YOUR cirucmstances, as well as your midwife.
How to Find a Midwife in Your Area
If you are interested in finding a midwife in your area, the best place to start is by asking your obstetrician or other healthcare provider for a recommendation. They may even have midwives in their own practice. Many large OB practices have midwives on staff (and then they can easily advance you to an obstetrician if nescessary)
You can also search the directory of the American College of Nurse-Midwives or the Midwives Alliance of North America.
Another place to start is your insurance providers. Midwives should be covered just like an OB through your insurance.
What to Expect During Your Prenatal Appointments With the Midwife
When you visit the midwife for your prenatal appointments, she will conduct a physical exam, order routine blood work and urine tests, and assess the baby’s heartbeat. She will also ask about your medical history and any concerns you have about your pregnancy. These appointments are typically 30-60 minutes long.
They do much of the same testing as OB’s including lab work, ultrasounds, measuring the fetus, feeling your abdomen, and checking baby’s heart rate with a doppler. Good prenatal care is the same for OB’s or midwives.
I just find that midwives spend more time, and are a bit more personable than OB’s (speaking in generalities).
Questions to Ask the Midwife Before You Hire Them
Before you hire a midwife, it is important to ask them some questions to make sure they are the right care provider for you. Some questions you may want to ask include:
1. Who is in your practice (who will you be seeing)
2. How/Who do you transfer care to an OB if that becomes necessary?
3. At what point am I required to see an OB with your care?
4. What is your policy on inductions and C-sections?
5. Will you be delivering me or another provider? How often are you delivering in the hospital (if that is important to you).
6. What is your policy on call hours? Is there always someone available to take my call?
7. What is your favorite part about your job?
In general you’re seeing how open they are to answering these questions, and how much they seem to enjoy what they do. Midwifery can have a high burn out rate, so be aware of if they are enjoying what they do.
The Cost of Hiring a Midwife
The cost of hiring a midwife will vary depending on the services you require and the geographical location. In general, midwives charge between $2,000 and $4,000 for their services. However, insurances should cover a midwife just as they would an OB. In general, the cost for a midwife is a bit less than an OB (although not always true).
Important Points About Midwives
I am a HUGE fan of the midwife model of care. I honestly believe more Certified Nurse Midwives would solve a lot of our problems in the US.
It is unfortunate that all midwives are called the same thing. Be aware that Certified Nurse Midwives often have a doctorate (yes, you could call them doctor, but the OB’s don’t like that). Your mom or friends might be concerned that you’re planning a home birth when you say you are seeing a midwife — but assure them that it is a VERY safe method of care and VERY different from home birth.
Ok, now that you’re educated on the differences between them — make sure you’re also considering how YOU will get educated. It’s still important to take a prenatal class. The Online Prenatal Class for Couples starts at just $35 and can be done on your own timeline in just a few hours. It is also taught by a very experinced RN. Use coupon code PREGNURSE to save 10% today.
And, if you’re not quite sure you’re ready for that whole thing, check out the free lesson from it. It’s your first step toward getting in the driver’s seat of your birth.
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice. She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
As an evidence-based prenatal educator Hilary has delivered thousands of babies and has educated hundreds of thousands of parents from a diverse patient population to help them have a confident birth.