Demystifying Midwives: everything you need to know about midwives

[babonwy]

Midwifery is enjoying an explosion of popularity with moms-to-be. More and more women are choosing to give birth with midwives. The term “midwives” used to be a one size fits all label for a woman helping another woman give birth naturally. In the United States, however, there are now several classifications of midwives, making it finding the right midwife complicated for even the savvy mom-to-be.

Choosing the right kind of midwife is critical to assuring that you have the best birth experience possible. Every birth is unique and every mom-to-be has different needs in pregnancy and birth. Understanding the differences between different types of midwives will go a long way to helping you to choose the right midwife for your pregnancy and birth.

All midwives have a number of commonalities; these characteristics in general are what distinguish the care that midwives provide from a doctor’s care. Midwifery literally means “with woman” and is a holistic, woman-centered care philosophy. Midwives spend more time in prenatal appointments with their clients than most doctors do. Midwives are trained to prevent many common pregnancy complications through preventive care practices. Midwives spend time educating their clients about nutrition, exercise and stress reduction to help maintain healthy pregnancies. Midwives tend to be less interventive, relying less on technology and more on personal care to attend to the needs of their clients. Midwives also tend to provide more individualized care, offering more flexibility and open discussion of your personal preferences and your birth plan.

Certified Nurse-Midwives are nurses who continue on to complete an advance practice graduate degree program in midwifery. Certified Nurse-Midwives (CNMs) are trained in hospitals and generally practice within the medical system. CNMs attend just over 10% of births in the United States, according to the American College of Nurse-Midwives, and 96% of CNM attended births are in hospitals. Though most CNMs have never witnessed birth outside of a hospital, a small number of CNMs attend births at independent freestanding birth centers and a handful attend homebirths.

Certified Nurse-Midwives often work in teams with physicians and are required to have physician back up. This enables easy continuity of care should your pregnancy or birth develop problems. Conversely, it can add some extra restrictions for a CNM to practice under physician supervision. Due to medial malpractice insurance restrictions, hospital policy or rules laid down by supervising doctors, many CNMs are unable to attend VBAC births (Vaginal Birth After Cesarean), even healthy and uncomplicated VBACs. Most CNMs are unable to attend breech births or twin births in hospitals, though some are able to at birth centers and at home. In hospitals, some CNMs can even attend births where a mother chooses to use an epidural or other medication, though most CNMs prefer to practice with a focus on natural childbirth.

Certified Professional Midwives are apprentice-trained midwives (direct-entry midwives) who have completed the certification process through the North American Registry of Midwives. CPMs practice holistically outside of the medical system, they are not dually trained in the medical system and nurses and they usually practice independently, without physician supervision. This freedom from institutional restrictions enables many CPMs to provide individualized care without blanket risk-out protocols. Many CPMs attend healthy VBAC births and some very experienced and specially trained CPMs even attend healthy, uncomplicated twin births and breech births.

CPMs are experts in homebirth. The credentialing process for CPMs is the only educational route that requires homebirth experience to achieve certification; no CNM or MD program has this requirement, and the vast majority of CNMs and MDs have never even witnessed an out of hospital birth. With this extensive training and specialized experience in homebirth, CPMs are uniquely qualified to attend homebirth. CPMs tend to embrace waterbirth as a healthy birth option and support their clients who are interested birthing in the water. CPMs have a strong working knowledge of gentle, natural healing modalities like herbs and homeopathy. CPMs act as guardians of the natural process of pregnancy and birth. They are trained to detect problems before they occur and to manage emergencies during birth. When they can’t prevent a pregnancy or birth complication, they refer their high-risk clients to a physician.

Direct-Entry Midwives are apprentice-trained non-nurse midwives and receive their training from more experienced midwives. DEMs are midwives who have not undergone the certification process that CPMs have. They may be highly skilled and well-trained, or they may be less experienced. Because the term direct entry midwife encompasses such a wide array of midwives with very different types of training and experience, it is up to the mom-to-be to ask many questions, check referrals and carefully assess the individual training and experience of a DEM.

Direct-entry midwives and even Certified Professional Midwives are sometimes referred to in the media and by physician groups as “lay midwives.” This term is essentially pejorative, and is not a professional classification of a certain type of midwife. Other kinds of midwives, such as traditional midwives, granny midwives, traditional birth attendants or independent midwives also are types of direct-entry midwives.

Licensed Midwives are usually CPMs or other direct entry midwives who have passed a licensure exam and have received a license to practice midwifery in their state. While many states do license CPMs and DEMs, several still have not enacted licensure legislation. The qualifications for the LM credential vary from state to state.

While many midwives are deeply committed to the Midwives Model of Care, some midwives practice with more of a medically-inspired model of care. Do your research. Ask lots of specific questions. Check out referrals. Most importantly, trust your instincts. Only you can decide which midwife best suits your needs.

Whatever your birth plan entails, if you would like to experience your birth as a healthy, natural, joyful life transition, a midwife is a great choice to support and care for you through your pregnancy and birth.

(From the website www.naturalfamilyonline.com

Tags: midwives, natural birth, pregnancy, childbirth

Add A Comment

[TJSMOM91804]

Jul. 3, 2009 at 3:23 PM

It was a CNM that played "God" the night my son was born & she did NOT call the real dr in. Thanks to her, my son will NEVER lead anything near a normal life. Children with severe brain damage since birth don't a any chance a real future. I just wish SHE was the one who has to pay every day of her life like TJ has to.

[babonwy]

Jul. 4, 2009 at 10:26 AM

I understand that you and your son where Hurt, But its a Rare one and you SHOULDNT scare other mothers away from midwives...You had a (RARE) bad one and I  Know that what she did was wrong but Smear HER name....Not the names of all Midwives.

A doctor Killed my Nephew...I don't blame all doctors for it.

(Original Poster)

[TJSMOM91804]

Jul. 5, 2009 at 7:10 PM

I'm sorry for the loss of your nephew & I'm not out to scare anyone. I just think that everyone should also know that a midwife is NOT a dr & cannot do surgery if it's an emergency situation. Had the midwife I had who actually represented herself as a dr called in a real dr then a c-section would have been done & my son would not be the way he is. Yeah, there was a lawsuit & she lost but all of the $$ in the world will NOT bring my son's brain back. She is still practicing (no skin off her nose) & my son is the one paying for HER mistake. A newborn can do more than my son can do & he will be 5 yrs old in Sept.   I will undoubtedly have to bury my son before he ever reaches the teenage years & the "midwife God" will still be practicing.  I know not ALL midwives are like her but EVERYONE should still have a backup plan in case of a dire emergency. 

[babonwy]

Jul. 6, 2009 at 12:01 PM

you stated things Right there that would have been Red Flags for most people!!!!

For one She CANNOT represent herself as a doctor, yet alone get away with it (Where did you find her?)

Did you Research her? Get back up opinions? Even check old newspapers and news sites for articles about midwives in the area?

I would have dropped her in the beginning, Any Midwife Claiming to be a doctor (I am sorry but you had to know she wasn't a Doctor!) Should be a Huge Red flag that she cant be trusted.

....And I never met someone Without a Backup plan!

I am going to stop responding after this, I know its Just a raw nerve with you so I see no point in going further...But Its a FACT that Midwives have fewer cases of emergencies, fewer C/S, and few Cases of Death for mothers and babies....Midwives are the BEST option...But No one should be without a back up plan...

And NO ONE should just Pick a Midwife without researching her and getting some impute from former clients.

(Original Poster)

[babonwy]

Jul. 6, 2009 at 12:03 PM

Did you even Read the Post? Or just put you bad experience?

(Original Poster)

[TJSMOM91804]

Jul. 6, 2009 at 1:18 PM

When we got to the hospital we were told that DR B would be right with us. No one ever called her a midwife & the office where my ob was had a large number of drs working there. I did not see every one of them during my pregnancy so I did not even know she was not a dr. She was the one on call that night. Yeah, I did read the post & it is very informative, but I still believe that as you said, everyone should have a backup plan. I'm not putting you down & I'm sorry if you found my replies offensive. I understand that you are very outspoken regarding your choices & no one can fault you for that. I just think that everyone should also know that there are risks involved in ANY situation (midwife or dr assisted delivery). Hope whatever your future is, doesn't involve a brain damaged child. It's a lot harder than anyone could ever imagine.   Be calm & stay strong. You have a lot of wonderful beliefs & don't let anyone change you.  Bye.

[babonwy]

Jul. 11, 2009 at 5:46 PM

I do have to say....

SHE CANT WORK UNDER THE NAME OF A DOCTOR....IF YOU HERE OF PEOPLE USING HER TELL THEM TO RUN!

(Original Poster)

[eema.gray]

Jul. 14, 2009 at 12:23 AM You know, it's funny that TJSmom brought this up. The hospital everyone assumes I'll birth at actually calls its attending midwives "nurse-doctors." Craziest, most misleading thing I've ever heard. In our area, it might be a push back against the overwelmingly conservative nature of the place by trying to show that these women do have a great deal of medical education. But they're midwives, not doctors and I think "nurse doctor" is a rather misleading term.