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Do You Need a Midwife?

Top questions and answers about midwife-assisted delivery

Published on: June 26, 2018

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When I got pregnant with my first child, I knew that even the best-laid birth plans could easily go awry. Still, I made a birth plan anyway, hoping for a natural delivery with as few interventions as possible.

With that goal in mind, I decided to pursue a midwife-assisted delivery instead of a traditional OB/GYN one: Hospital midwives are linked to lower C-section and episiotomy rates, and they’re also known for supporting alternative pain relief options, like nitrous oxide and water therapy.

I found a midwifery practice affiliated with a local hospital (no, I didn’t want a home birth) and, after months of attentive prenatal care, had the exact delivery experience I wanted. I’ve had two more babies since then and never regretted my choice to use a midwife.

If you’re wondering whether a midwife-assisted delivery could be a good fit for you, too, here are some things to know.

Who are midwives?

There are several different kinds of midwives with varying levels of training and education.

Certified nurse-midwives (CNMs) are the only kind of midwives licensed to practice in all 50 states. They are educated in both nursing and midwifery, with graduate degrees from accredited programs and are recognized as primary care providers.

Certified midwives (CMs) receive similar training, but do not hold nursing degrees.

CNMs and CMs are usually employed by hospital-affiliated group practices or on-site OB/GYN departments. If you’re interested in a midwife-assisted delivery at your preferred hospital, information on the practitioners available to assist you during labor should be listed on the hospital’s website.

Certified professional midwives (CPMs), on the other hand, typically work as solo practitioners attending home births or at independent birthing centers. CPMs are not required to have graduate degrees and undergo a different certification process from CNMs and CMs, but they receive an extensive education in managing out-of-hospital births. Licensing rules vary state to state.

If you think a CPM is a better fit for you, you can find one by searching the web for practitioners in your area, meeting with staff at local birthing centers or asking your favorite parents group for recommendations.

What is the midwifery model of care?

Contrary to the popular stereotypes, midwifery practice is not rooted in herbs, healing crystals or meditation. It’s evidence-based care centered around patient education and autonomy.

“Midwives give their patients information so they can make their own informed decisions,” says Michelle Collins, a certified nurse-midwife and director of the nurse-midwifery program at Vanderbilt University. “It’s very individualized, and we focus on empowerment of women as partners in their healthcare.”

What do they do?

CNMs and CMs care for women’s health needs throughout their whole lives, from the onset of menstruation all the way through menopause. In addition to providing prenatal care and delivering babies, they also perform annual gynecological exams, treat common health issues like menstruation disorders and postpartum depression and even care for babies in the first 28 days of their lives.

The care provided by CPMs is typically limited to pregnancy, labor and postpartum care, as they are not primary care providers. However, a hallmark of all midwifery care is the belief that pregnancy and birth are innately normal — not abnormal — functions.

“We look at them as normal unless they prove otherwise,” says Collins. “During labor, women should be able to eat, get in the tub or shower and stay home as long as they feel comfortable. Labor shouldn’t be induced for non-medical reasons, and we advocate for no interventions in the absence of complications.”

What does a midwife-assisted delivery look like?

All three of my deliveries felt like dramatically different experiences, but my midwifery care was always the same: encouraging, patient and cooperative. My birth plans never included epidurals, though my midwives would have supported me if I had changed my mind.

“Delivering with a midwife is very individual — some patients want an epidural right away, while others want a natural delivery,” says Collins. “The misconception is that midwives don’t use pain interventions, but it’s really whatever a woman wants as long as she’s been informed.”

Who is a good candidate for midwife-assisted deliveries?

In the past, women with serious medical conditions or high-risk pregnancies (such as multiple births) were advised to stick with OB/GYNs. Today, Collins says, those parameters are changing. Many hospitals and universities are developing collaborative models of care, where a patient can see both a midwife and a perinatologist — or some other specialist — at the same appointment.

Collins also notes that your preferred delivery setting — not your overall health — is now the biggest determining factor in whether a midwife can deliver your baby.

Home birth midwives and birthing center midwives have stricter criteria than hospital midwives because of their more limited access to resources. They may not accept patients with certain risk factors (like women who have smoked or have higher BMIs), but hospital midwives have more flexibility.

What else should you consider?

Since choosing a midwife-assisted delivery typically means foregoing care with an OB/GYN, you should consider it carefully. I didn’t have any complications and wasn’t considered high-risk with any of my pregnancies, so CNMs managed all of my prenatal care and hospital deliveries; I never saw an OB/GYN. This would also be true for home births as well as prenatal care and delivery at a birthing center.

Collins strongly recommends that anyone considering a midwife-assisted delivery think about the type of birth experience they ultimately hope to have because every practice will have a different approach.

“Ask about the options available during labor and delivery. Ask if your midwife does office visits while also being on call for deliveries. Ask if your midwife will end her shift after 12 hours regardless of where you are in the labor process, or if she’ll stay with you until you have delivered,” says Collins. “You have to decide what’s important to you.”

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