Demystifying Midwives

[doulala]

This is a helpful bit of info to differentiate between the kinds of midwives.

Demystifying Midwives

By Jacque Shannon-McNulty


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.

Copyright 2008 by Jacque Shannon-McNulty, all rights reserved, reprinted with permission

Jacque Shannon-McNulty is a doula, childbirth educator, mother of three and founder of Blissful Birth. She teaches childbirth classes and workshops and provides doula services in Chicago. http://www.blissfulbirth.com

Thank you, so much, Jacque, for sharing this very helpful info with us!   Much appreciated!!          :-D

[angiebug]

Feb. 4, 2008 at 6:40 PM I hired a CPM for my second birth.... and loved every minute of it. Wait a second, the pain was terrible, and we hadn't expected for an 11 and a half pound baby to come out of me, but it's okay. I am so glad that I did it. I wanted to hire her again for the third pregnancy, but she moved to Alaska. The experience was so much better than having a baby in the hospital for me. Thanks for posting!

[OliversMommy411]

Feb. 5, 2008 at 12:24 AM Thank you for the info!  I had a CNM but they did VBACs and women came to them just because of that.  Oliver was born in a hospital, but it was the best experience of my life.  I can't wait for more babies, but I don't know who will deliver them or where.

[sixzilliondots]

May. 13, 2008 at 3:06 PM This is very informative Thanks!

[mom_in_2004]

May. 13, 2008 at 6:40 PM

I wish I had the courage to hire a mid-wife.  I have a very low pain tolerance so I couldnt do the whole natural birth thing but the women who do are my heros let me tell you what.

[doulala]

Jun. 26, 2008 at 6:22 PM

HOW TO FIND A MIDWIFE 
http://www.midwife.org/find.cfm
http://cfmidwifery.org/find/index.aspx
http://birthpartners.com/
http://www.mana.org/memberlist.html 

Questions to Ask a Midwife
Experience

1. What is your general philosophy about pregnancy and birth?
2. Do you let us do whatever we want during labor? (Food, positions, water, etc.)
3. What is your education and training as a midwife?
4. How many years have you been practicing?
5. Are you a mother yourself? How old are your children now?
6. How were your babies born?
7. Do you work alone or with a partner or assistant? If you work with someone, what is their experience?
8. Do you participate in a local midwife peer review group?  How many meetings have you attended in the past year?
9. How many births have you attended as the primary caregiver?
10. What is your experience with breech births? How many have you attended?
11. What is your experience with twins? How many have you attended?
12. What is your experience with VBACS? How many have you attended?

Prenatal Care

1. How many births are you attending now? Do you have a maximum, and how do you manage to avoid too many commitments?
2. If I am planning a home birth, do you come to my home any time before I go into labor? Do you provide supplies or literature to help us prepare?
3. How often will I see you? What do your checkups consist of?
4. What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?
5. Do you require that I take a childbirth education class? Do you teach such a class?
6. Who takes over for you if you go on vacation or get sick?

Hospital and Obstetrician

1. Do you attend births in a birthing center, home or hospital?
2. How do you handle emergencies? Under what circumstances would you transfer?
3. What is your transfer rate?
4. Would you stay with me in the hospital?
5. Do you require that I see a physician during my pregnancy even if everything is all right?
6. Do you have guidelines or restrictions about who can give birth at home?
7. Under what circumstances do you induce labor with pitocin?
8. What is your protocol to induce labor naturally?
9. What is your c-section rate?
10. What is your episitomy rate?

General Labor

1. What kind of equipment do you bring to a birth?
2. Are you permitted to administer any drugs during labor?
3. How many people are allowed to be around?
4. When should I call you after my labor begins?
5. Do you wait until the cord has stopped pulsating before it gets cut?
6. Will you allow my partner to be as active at the birth as he desires?
7. How much time do you allow for the delivery of the placenta?

Financial Matters

1. What are your fees and what do they include?
2. Can you submit your charges to my insurance company?
3. What payment arrangements do you make?

The Baby

1. Have you ever had to resuscitate a baby?
2. Do you examine the baby after birth?
3. Do you give eyedrops or shots to the baby?
4. Do you have a pediatrician you work with or recommend?
5. Will you help me with breastfeeding?
6. How do you feel about circumcision?
7. How often do you come to see me after I give birth?
8. Do you provide or know of anyone who will help new mothers after birth?
   

 

(Original Poster)

[doulala]

Dec. 17, 2008 at 6:00 PM

(midwives)  Woman's Way    and    Obstetric Way

 

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Women's Way of Birth	Obstetric Way of Birth
Cultural definition of birth
Social event Normal part of women's lives Birth is work by the woman and her family and kin The woman is a person passing through a major life transition	Potentially pathological process Illness Birth is work of doctors/nurses/midwives and other experts The woman is a patient
The setting for birth
Home or other familiar surroundings Informal system of care In a woman's home or near With other women of neighbourhood and family Continuity of care Woman free to change position and move about	Hospital, territory alien to the woman Bureaucratic, hierarchical system of care May be distant from woman's home Woman is separated from those close to her Discontinuity of care, e.g. shift changes/woman is moved from one room or one ward to another Woman may not be free to change position and move about
Caregivers: the support they give and the conduct of labour
Older and more experienced women who are themselves mothers See birth as holistic process Shared decision-making between caregivers and woman giving birth No class distinction between caregivers and woman giving birth Equal relationship Information shared Personal caring - longer, more frequent, and in-depth prenatal visits Often strong emotional support Verbal and non-verbal encouragement Familiar language and imagery used Empathy Cultural awareness because they are part of the same culture Awareness of spiritual significance of birth Believes in integrity of birth, uses technology if appropriate and proven	Young and older women who have often not themselves had babies, under direction of male obstetricians Trained to focus on medical aspects of birth Professional care that is authoritarian Often class distinction between obstetricians and patients Dominant-subordinate relationship Information about health, disease, and degree of risk kept secret Care depersonalized Little emotional support Lack of communication Use of medical language Threatening and often punitive behaviour, e.g. commanding, scolding, warning Little cultural awareness of rituals, beliefs, social behaviour, values Spiritual aspects of birth ignored or treated as embarrassing Values technology, often without proof that it improves birth outcomes
Techniques used
Skills to preserve the physiological progress of labour Usually intervention-free Comfort skill, e.g. massage, hot and cold compresses, holding Few resources to handle complicated obstructed labour	No skills to preserve the physiological progress of labour Obstetric intervention Drugs for pain relief Skills and resources to handle complicated and obstructed labour, e.g. intravenous fluids, oxytocin stimulation, surgery

 

http://www.moondragon.org/articles/comparison.html

(Original Poster)

[TheArtDisarray]

Dec. 17, 2008 at 6:04 PM

Thanks so much for the information. I had a midwife (CNM) with my daughter, and it was wonderful. I'm now pregnant with my son, and I'll be doing the same again.

[doulala]

Sep. 18, 2009 at 11:41 PM

Can't Say you weren't warned: Malpractice Ins for Midwives

Carla Hartley's blog on malpractice

(Original Poster)

[doulala]

Apr. 25, 2010 at 5:48 PM

High Tech Midwifery 

 by Carla Hartley

 

My work with Apprentice Academics brings me in touch with hundreds of midwives every year.  I am in a unique position to notice trends among midwives.  Over the past year I have observed a trend that is scaring me – more and more midwives are becoming “HIGH TECH”.  In the last few months I have talked with three beginning midwives who had never used a fetoscope in their training – only Dopplers.  I  know midwives who are “ordering” sonograms on a somewhat regular basis.  

Are midwives embracing technology out of a lack of knowledge of intrinsic dangers and potential risks?  Maybe it is a desire to do more in less time (which we can all identify with) but it should set off a warning bell somewhere in our subconscious that we have gotten off track.  There  is also the possibility that midwives lack confidence in their own diagnostic ability.  I am afraid, however, that the underlying reason could have a great deal to do with our desire to work with, and to be accepted by, the medical community.  In our attempts to seem less radical, less judgmental, and more cooperative, are midwives being seduced by technology?  It is not a desire to learn technical and medical information, or a wide variety of skills and services offered that makes a midwife a “Jr. OB” – it is a reliance on technology.  

I asked a large number of parents why they had chosen home birth with a midwife rather than a physician attended hospital birth.  The most frequent answers were: level of caring, amount of time spent together, lack of gadgets and machines.  I like those distinctions.  Rather than three unrelated comments, I see a definite relationship between them  I would like to see all three distinction preserved; compromising one may eventually compromise all.  Any unwarranted use of technology carries with it the risk of detachment from the client… and ultimately from the art.  The French doctor who invented the first stethoscope, Rene Laennec, is credited by the authors of Medicine on Trial, with the simultaneous creation of a separation of doctor and client – a symbolic act of distancing one’s self from the client that has become woven into medicine.  Midwives, on the other hand, have practiced in the opposite manner.  We attempt to draw closer to our clients during the relationship because we know it enhances the safety and because it is our way.  My fear is that as we use our hands and ears less, we will also use our hearts and minds less.  We will create a separation and will be at risk of losing something that is uniquely ours… that which defines a midwife as    

“with woman”.

(Original Poster)