There is a growing trend in North America among women to choose a midwife as their primary care giver during their pregnancy instead of a medical obstetrician. What is a midwife, you ask? Well, a midwife is a person, almost always a woman, who has been trained to help women give birth as well as look after her from the beginning of her pregnancy to six weeks after she has given birth.
Some women worry that a midwife cannot take care of them as well as a doctor. This is not true. Even the World Health Organization has recognized the importance of midwives, noting that women who give birth with a midwife often have shorter labor times and usually don’t need as much medication.
A Short Midwife History
In many parts of Europe, using a midwife has been common practice for a long time, while in the rest of the world, a midwife is much more likely to be by your side during birth than a doctor, especially if you live in a rural area.
Midwives have been attending births throughout history and are even mentioned in the Bible. In the past, midwives had no formal training, gaining their experience from “on-the-job training” instead.
However, because of changing societal ideals, by the beginning of the 20th century, the number of pregnancies assisted by a midwife began to decline dramatically in the United States. Many women began to believe that having their baby in a hospital with a doctor was much safer than at home with a midwife. This change marked a shift away from viewing childbirth as a natural process and towards regarding it as a medical problem that could only be treated by highly trained professionals. This resulted in the profession of midwives being almost completely eliminated from the United States.
In the 1960s, there was a growing movement among women to regain control of their bodies. One important aspect of this was their right to choose how to give birth. Women did not want to be knocked unconscious or strapped to a delivery table during labor, which was far too common back then. Along with women’s demands, there were nurse-midwives who had become common fixtures in many hospitals. Since nurse-midwives had been trained in an academic setting, educational standards began to be set, thereby giving the profession more legitimacy. These two factors coupled together meant that midwives were making a comeback in America.
Nowadays, midwives are increasingly becoming a fixture in prenatal care in North America. Education requirements for midwives have evolved to reflect the knowledge midwives need to become accredited. A midwife today must have a number of years of formal classroom training as well as practical training before she can be accredited and allowed to practice. Midwifery is no longer an illegal activity, which means that women all through Canada and the United States can benefit.
Midwife vs. Doctor
Many women choose to use a midwife rather than a doctor because of the difference in practicing philosophy. The Canadian Association of Midwives sums up the basic principles behind midwifery very simply:
We believe in a primary care model of midwifery that is community-based and collaborative. This model is founded upon principles of woman-centered care, informed choice, continuity of care and choice of birth place.
Midwives believe in allowing women to make informed decisions regarding their pregnancies. They feel that births do not have to take place in a hospital. They also believe that the whole family should be involved in a pregnancy rather than just the pregnant woman and her health care provider. Midwives look to support you through your pregnancy and provide you with information so that you can decide what you think is best for you and your pregnancy.
Midwives look to incorporate modern medical knowledge with traditional methods of dealing with pregnancies and birth. Having a pregnancy looked after by a midwife means that you are treated as a person experiencing a normal part of life, not as someone who has a medical condition. While all this sounds very nice, there are obviously some differences between a midwife and an obstetrician.
One of the main differences between a midwife and a doctor, aside from philosophy of care, is training. A midwife is trained to deal with women who are having a normal, uncomplicated, low-risk pregnancy. If there are any complications with your pregnancy, or if any develop while you are pregnant and under the care of a midwife, you will be referred to an obstetrician.
However, midwives have been trained to deal with all facets of prenatal, antenatal and postpartum care. Just like an obstetrician, your midwife will be with you right from the start of your pregnancy up until six weeks after you give birth. Even if you need to be transferred to an obstetrician during your pregnancy, many midwives will continue to see you in order to provide emotional support.
Another difference with midwives is that women receive much more personalized care. Most midwives work independently with a group of other midwives (usually known as a midwife collective). Some midwives work in birthing centers while others are based out of a hospital. If you go for an appointment at your midwife’s collective or birthing center, you will probably notice that it has more of a warm, family-oriented atmosphere than a sterile medical feel. Midwives encourage their clients to come to their appointments with family members and friends and have appointment rooms large enough to accommodate everyone. In some parts of the world, midwives will even make the trip to your home for your prenatal check-ups. Your postpartum appointments will almost always take place in your home (if you want). Plus, midwives make sure they deal with any concerns you have about your pregnancy, whether it is medical or emotional. They are happy to have a long appointment with you in order to ensure that any issues you are dealing with have been resolved.
Midwifery in the United States
Certified Nurse Midwife
The level of care that you receive from your midwife is dependent upon how much training she has received. Always ask the midwife what certification she has. In the United States, there are two types of midwives: a certified nurse-midwife (CNM) and a direct-entry midwife. A CNM is a registered nurse who has also taken a graduate-level midwifery program. To be given the title of CNM, the nurse-midwife must also be registered with the American College of Nurse-Midwives. This is a regulatory board in the U.S. who accredits midwifery education programs and establishes the standards of clinical midwifery practice.
Direct Entry Midwife
A direct-entry midwife is a person who does not have any training as a nurse, only as a midwife. A CNM is more likely to work out of or with a hospital and is also allowed to prescribe medication. A direct-entry midwife is more likely to work in an independent collective of midwives and will assist in homebirths and births in birthing centers. However, she cannot prescribe medication. Direct-entry midwives should also be certified, preferably by the North American Registry of Midwives (NARM). If a direct-entry midwife has been certified by NARM, then she may prefer to use the title of “Certified Professional Midwife” or CPM.
Midwifery in Canada
In Canada, midwives fall under the singular classification of midwife. Unlike the United States, who have a national governing board, standards for midwifery in Canada are maintained provincially by the College of Midwives. Legislation regarding the practice of midwifery is also dealt with provincially. As a result, access to a midwife is not equal throughout the country. In New Brunswick and Prince Edward Island, for example, midwifery is not regulated which means that practicing midwives do not have any hospital privileges and women who want to use a midwife must pay for it themselves (in provinces like Ontario and British Columbia, the cost of a midwife is covered by the provincial health care system). Regardless, midwives in Canada do need to be registered, preferably with the College of Midwives in their province.
What to Ask Your Midwife
When you meet with a midwife for the first time, you might want to ask her some questions to make sure that she is someone you want to have looking after you. You should definitely ask if your midwife is accredited and by whom. This will help ensure that she has received the proper training and can provide you with a high level of care. Also, ask how long they have been practicing, as this will give you an idea of how much experience they have.
Additionally, it is important to inquire about the midwife’s philosophy of care. While most subscribe to a more personalized method of care, there can still be variations in how each midwife practices.
If you already know what kind of birth you would like to have, or are thinking about an alternative birth, discuss this with your midwife. Not all midwives have hospital privileges, in which case a hospital birth would not be possible if that is what you wanted.
If you were thinking about having a water birth, it would be wise to bring this up since not all midwives have experience with this type of birth or feel comfortable with it. While most midwives encourage family participation in the pregnancy care, some midwives may discourage having family around for the labor. If it is important to you to have your family with you when you give birth, ask your midwife about this. Perhaps it is simply the location of your birth that will prohibit your family from attending, not the midwife, in which case you may have to reconsider where you give birth.
It is essential to remember that not all pregnant women can be looked after by a midwife. Ask what eligibility requirements your potential midwife has to help determine whether or not you can actually use her services. Also, consider the cost of the service. In the United States, costs can vary among midwife collectives and birthing centers, so it is worth doing some research into the price. Don’t forget to check with your insurance company to see if part or all of the services are covered.
In Canada, most provinces cover the cost of having a midwife. In other countries, the cost of a midwife may or may not be covered. Be sure to ask regardless of where you live.
Giving Birth with a Midwife
Now, you may be wondering how your birthing experience will be different if you use a midwife instead of a doctor. One big difference is that midwives will attend to a homebirth while most doctors won’t. Many women find the home birth experience to be a much more tranquil and enjoyable experience than a hospital birth. Women get to give birth in a familiar setting, surrounded by people they know and aided by someone who has their best interest in mind. Find a midwife who embodies these values for you.
A midwife will encourage you to do what feels best for you, whether you want to walk around, get into the shower or use some heat compresses to deal with the pain. Midwives also do not set you to a time limit when you are in labor. Many doctors will let you try to give birth vaginally for a set amount of time before they decide to perform a cesarean. Since midwives encourage vaginal births, no time limits are enforced which means fewer unnecessary cesareans are performed.
In fact, women who give birth with a midwife often have less medical interventions. Other benefits to giving birth with a midwife include fewer complications with both you and your baby.
However, you do not have to have a homebirth with a midwife. Midwives will also attend to births in hospitals and birthing centers (most birthing centers are staffed primarily by midwives but have obstetrical backing). Even if you give birth in a hospital or birthing center, a midwife will still encourage you to deal with any pain you experience in a natural way rather than injecting you with drugs. They will also do their best to make your experience as calm and tranquil as possible.
Midwives feel that their role in a birth is to assist the women in labor. As a result, many midwives will not use the term “deliver” since they feel that this refers to them doing all the work, not you. Instead, many midwives prefer the term “catch” meaning that they will catch your baby when it comes out of you or has been delivered by you. Also, some midwives will refrain from announcing the sex of your baby, a common practice in many hospital delivery rooms. Instead, they will let you announce whether you have had a girl or a boy. Because midwives take a more passive role in the birthing process, many women feel empowered by the control they are able to wield.
Revision date: July 9, 2011
Last revised: by Sebastian Scheller, MD, ScD