Thursday, April 19, 2012

What is a Midwife?

When you hear the phrase, “I see a midwife for my pregnancy” or “My baby was delivered by a midwife” what images come to mind? Do you imagine that the woman delivered her baby at home…in the water…without pain medication? When informing my family that I was pursing advanced nursing education to become a midwife, I experienced similar questioning. I was frequently asked questions about my future practice as a midwife and will never forget one question from my brother, “So a bunch of women have your phone number and then when they start labor they will call you and you will go meet them in their bathroom?” To me this question seems silly and the answer seems straightforward but there are three different types of midwives in the United States who attend around 11 percent of vaginal births both in and out of hospitals so it is not surprising that many people are unclear about the role of a midwife and their scope of practice.

Certified Nurse-Midwives (CNMs) and Certified Midwives (CM) attend the majority (90%) of midwife attended births in the United States. More times than not, mention of using a midwife during childbirth is associated with delivering at home without medications when in reality, the majority (96.1%) of births attended by midwives take place in hospitals with less than 2% taking place at home. CNMs are also able to prescribe medications including epidural anesthesia in all 50 states. The majority of births that take place at home are attended by Certified Professional Midwives (CPMs) whose educational background and scope of care differs from CNMs. This seems to be the scenario with which most people are familiar and thus the word midwife is more commonly associated with out of hospital birth.

CNMs are registered nurses, many of whom have previous nursing experience in labor and delivery, who have pursued advanced nursing education in nurse-midwifery and obtained either a master’s or doctorate degree. These providers then pass a national certification exam and have a license to practice midwifery in their state. Currently, CNMs have legal authority to practice in every state in the US.

CNM’s are considered independent healthcare providers. They care for low risk women during pregnancy and childbirth and are advocates for minimizing intervention during this normal process. These midwives are also skilled at recognizing complications that may arise during pregnancy and have a relationship with a physician to co-manage women needing more specialized care. Though true emergencies are relatively rare during childbirth, CNM’s are experienced at handling these situations and ensuring the safety of both mom and baby. The relationship that CNM’s have with a physician ensures a seamless transition of care should a situation arise that is outside of the CNM’s scope of care, such as birth by C-Section. Many CNM’s have expanded their scope of practice to include first assisting during C-Sections, which means that they would still be present and help during the birth.

Midwives trust birth and honor the normalcy of reproductive events in low risk women. Pregnancy and childbirth are life events that can be empowering and joyous experiences for women and families. Midwives provide current information, listen to women, and work with them to navigate through the events surrounding childbirth. Midwives also strive to ensure a positive birth experience by exploring a woman’s individual desires for birth. This may include specific wishes for the environment such as music or aromatherapy, minimizing the amount of technological intervention at birth, having a birth photographer present, or having her partner or family participate in the birth. While CNM’s may prescribe medications, including epidural anesthesia during labor, they are also supportive of some women’s desire for an un-medicated birth and are skilled at various non-pharmacologic pain management techniques.

The word midwife means “with women” and midwives provide care to women across the lifespan. In addition to providing care during pregnancy, birth, and postpartum, CNMs care for women throughout the lifespan from adolescence through menopause. These services include gynecologic care, annual exams (including breast and PAP screening) and family planning. Whether you are a woman who is pregnant or someone who is interested in birth control options, a CNM is a skilled healthcare provider and can be a valuable resource for women’s health needs.

Learn more about midwives at

Rachel Zimmer, DNP, is a Certified Nurse Midwife who cares for patients at Texas Health Harris Methodist Hospital Hurst Euless Bedford.

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