How Does a Midwife Approach Pregnancy and Birth?
There are different educational paths that train midwives. Jeanne was trained as a registered nurse and was employed in labor and delivery units in Milwaukee, and LaCrosse Wisconsin as well as North Valley Hospital in Whitefish. She attended the midwifery educational program at University of San Francisco, San Francisco General Hospital. Her title is as a Certified Nurse Midwife (CNM) which means that she was educated in the two disciplines of Nursing and Midwifery. CNM’s have either a bachelors or masters degree, passed a national examination through the American College of Nurse Midwives and have a license to practice. Please visit the ACNM website for more information on CNM’s. http://www.acnm.org
A midwife's education stresses that pregnancy and birth are normal, healthy events until proven otherwise. Midwives view their role as supporting the pregnant woman while letting nature takes its course.
Midwives also focus on the psychological aspects of how the mother-to-be feels about her pregnancy and the actual birth experience. They encourage women to trust their own instincts and seek the information they need to make their own valuable decisions about pregnancy, birth, and parenthood.
Of course, many medical doctors (MDs) share these values. But an MD may be more likely to use preventative testing and medical technology — such as ultrasound, continuous fetal monitoring, and the option of pain medications during birth — as a standard part of care during pregnancy and labor.
High-risk pregnancies undoubtedly require this approach. But many midwives find it unnecessary for most uncomplicated pregnancies.
What Does a Midwife Do?
Midwives generally spend a lot of time during prenatal visits addressing a woman's individual concerns and needs, and will stay with her throughout labor. They encourage physical positioning during labor such as walking around, showering, rocking, or leaning on birthing balls. Midwives also allow women to eat and drink during labor.
Certified nurse-midwives who have hospital privileges and participate in hospital births may use some medical interventions, such as electronic fetal monitoring, labor-inducing drugs, pain medications, epidurals, and episiotomies, if the need arises. Currently, Jeanne does not have hospital privileges because of the loss of her supervising physician, Dr. Montgomery. However, this may be possible when a supportive physician is located at some undetermined point in the future. Only CNM’s are able to obtain hospital privileges.
Midwives of any licensing degree cannot perform cesarean sections (C-sections). If one were required, an obstetrician would have to perform your delivery. If any potentially life-threatening complications suddenly arose during delivery, midwives involve an obstetrician.
Certified midwives are trained in the neonatal resuscitation program (NRP) which educates the midwife to handle a situation where the baby may need medical assistance. In the event of sudden life threatening complications with your baby after birth, the midwife can stabilize your baby for transport to Community Medical Center where a pediatrician or neonatologist (an intensive-care specialist for newborns) is available. These situations may arise in approximately 1% of all births.
Is a Midwife Right for You?
Several studies have shown that midwife-supervised births produce excellent outcomes with fewer medical interventions than average (see articles under resources). Midwives' patients use electronic fetal monitoring less often and tend to have a reduced need for epidurals, episiotomies, and C-sections for successful deliveries. To some degree, this stems from the fact that midwives see only low-risk patients with uncomplicated pregnancies. But some researchers attribute the need for a minimum of medical intervention to the midwives' natural approach to the management of labor and delivery, which may reduce a woman's fear, pain, and anxiety during birth.
Midwifery is not advisable for women with higher-risk pregnancies. Those expecting
twins or multiples and those with prior pregnancy complications, gestational diabetes, high-blood pressure, or chronic health problems of any kind before pregnancy should discuss their options with their primary health care provider or an obstetrician. Certified nurse-midwives who practice in major medical centers and work very closely with obstetricians and perinatologists (specialists in high-risk pregnancy) may take patients with risk factors. But midwives in solo practice or who practice in limited medical facilities generally do not.
A major difference between doctors and midwives is the doctors' ability to intervene surgically when necessary, and to deal with complications that arise. Midwives can't perform C-sections and some can't administer drugs or anesthesia and do not manage high risk pregnancies. If you feel more comfortable having those options immediately available, a doctor may be the right choice for you.