By and large, moms-to-be rely on the expertise of an OB for prenatal care, but in recent years, a growing number of expectant women are asking midwives to take the lead.
As a doula, I intrinsically respect a woman’s choice and the individual nature of each birth experience. I myself birthed one of my children in a hospital and one at home, and both experiences were amazing in their own right. What I will say of midwifery care, in particular, is that it felt like working on my own project under the guidance of extremely knowledgeable peers—I called the shots but valued their presence and expertise as care providers, and to an extent, friends. I keep in touch with my midwives on Facebook, via email and every year around my son’s birthday. I can’t say the same of the OB who delivered my daughter; I met her while pushing, was in the same room as her for about 30 minutes and never saw her again. This isn’t to say this is the norm or that one way is better. But it is to say that midwives are pretty darn special. If midwifery care calls to you as part of a birth plan, even a little bit … listen!
The Basics of Care
The art of midwifery dates back thousands of years, across many cultures. The official term comes from Old English and means “with woman.” (Males, though a rarity in the profession, are also called midwives.)
The modern midwife is a skilled professional who has been through some form of training, usually a lengthy apprenticeship and likely a formal certification program.
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However, it’s worth noting that there are a few paths to midwifery and, therefore, different types of midwives. For example, you can be a certified professional midwife (CPM), certified nurse midwife (CNM) who are registered nurses, certified midwife (CM), non-credentialed traditional midwife, licensed, unlicensed or a combination of several of these.
What’s more, who can legally oversee births varies from state to state. Generally speaking, CPMs are autonomous and specialize in out-of-hospital births. CNMs and CMs work in a variety of birth settings, including hospitals, clinics and birth centers, as well as in home-birth care.
What seems almost universally true of all midwives is their devotion to pregnant women. They view women’s health wholly—mental, emotional and physical—and rely on truly getting to know each person in order to provide the best possible care. They’re extremely available, present and patient by nature, and come to each situation with a large skill set, well-crafted intuition and a passion for what they do.
“Each midwife has a different story,” says Susan-Rachel Condon, LM, co-founder of River & Mountain Midwives and Hudson Valley Midwifery Center in Kingston, New York. “For me, the best part of my job is bearing witness to the hard work women do. The work impacts women on every level—social, cultural, physical, emotional, spiritual. Each woman deserves to have an informed and nonjudgmental ally. That’s me.”
How Midwives Differ From OBs
On a fundamental level—for a normal, low-risk pregnancy—midwives are not all that different from healthcare providers in obstetrics. Both are trained in labor and delivery. Both are present at the moment of birth. Both perform immediate postnatal procedures for the mother and infant.
But looking closer, you’ll notice some key contrasts. Obstetricians have completed medical school, and choosing an OB/GYN means you will be delivering in a hospital setting. (Your prenatal visits may also be held in a hospital setting.) Midwives have a more holistic approach to health care and often a strong leaning toward natural childbirth. They see birth as a natural, empowering experience. OBs, on the other hand, might view delivery from the lens of a medical procedure and be more apt to utilize interventions or pain medication, such as an epidural.
That said, midwives aren’t only for women who wish to birth their babies without meds (though many favor alternate pain management techniques). In fact, some work in tandem with OBs. A midwife is medically minded when she needs to be and carries standard birth equipment, including IV and suturing supplies. It’s worth noting, however, she’s not able to perform a cesarean, so an OB will need to take over should you require a C-section.
With far fewer patients than OBs, midwives make themselves readily available to their clients and are more actively involved in the birthing process, offering physical and emotional support along the way. When the time comes, a midwife is on-call 24/7. If a mom has a question or concern, she can ask her specific caregiver directly … even at 2 a.m.
Midwives’ accessibility stretches to general care as well. A midwife spends an average of one full hour with a woman during a prenatal checkup. During this visit, the midwife and client will talk about everything—stress, diet, relationships, emotional history. Assessments and recommendations are made not from a routine checklist but a deep understanding of the individual woman.
This level of care continues into labor, birth, postpartum care and beyond. Home-birth midwives will visit the family several times after birth to assess to postpartum health, weigh the baby and provide breastfeeding assistance.
Although clinic and birth center midwives don’t necessarily visit the home, they do follow the spirit of the midwifery tradition as well.
Nicole Capehart, mom in Albuquerque, New Mexico, gave birth twice in a hospital setting—once with an OB and once with a midwife from a midwifery clinic. “I loved every bit of my experience with my midwife,” she shares. “I think what I loved most was that she listened. She took me seriously and took my opinions into consideration when something didn’t feel right. I wasn’t just another patient to check off her list. She empowered me to have the best birth possible.”