One of the funniest things I’ve noticed throughout my pregnancy is how little people know about midwives — especially young people who haven’t yet considered having children and older people who gave birth during a time when hospital births and obstetricians were pretty much the only option in the United States.
Midwives are still much less common than obstetricians in the United States — in 2003 only 8% of births were attended by midwives. That’s likely gone up in the past 7 years as natural birth has become increasingly popular, but the majority of births are still attended by obstetricians. This leads to a lot of misconceptions about midwives.
I don’t know if it’s because the word sounds New Agey or what, but when I tell people I’m seeing a midwife, they often make the following assumptions:
- I am planning a homebirth.
- I am somehow opposed to modern medicine.
- I’m taking a great risk with my health and the health of a baby by refusing the care of a doctor.
- I’m a crazy hippie lady who wants to give birth in a hut in the woods.
None of the above assumptions is true.
I’m sure most of you reading this are quite familiar with midwives and what they do, because I have smart readers. But I just want to clarify for my own sanity.
Midwives are modern care providers. They are highly educated nurse practitioners who happen to specialize in child birth and female reproductive health. Instead of medical school, they attend a graduate program in midwifery — a form of medical school condensed to include specialized education in caring for pregnant women and female reproductive health. Because they’re not learning a variety of specialties, their education is shorter, but still comprehensive.
Midwives typically have a different style than obstetricians. Because they are nurses and birth attendants, they often stay with patients throughout the labor rather than showing up to catch the baby at the end. (I’m sure there are obstetricians that also do this, but it’s less common.)
Midwives are also more likely to encourage natural birth practices such as unmedicated birth, but that doesn’t mean they’re not qualified or capable of administering pain medication during birth if you choose to have it. Choosing a midwife does not limit you to a natural birth, but if you want a natural birth, choosing a midwife can make it easier for you to achieve it.
Choosing a midwife also doesn’t mean you’ll be giving birth outside of the hospital. Most midwives have hospital privileges.
Midwives also deliver at freestanding birth centers and some do home births. Freestanding birth centers are sterile, modern medical facilities that are often dressed up to provide a more homey atmosphere than a hospital. They are not huts in the woods. Women who choose freestanding birth centers always have an emergency back-up plan in place to transfer them to a hospital in a hurry in the event of complications. However, complications are rare, because midwives generally only care for women with low-risk pregnancies.
Midwives cannot perform surgery, so if an emergency c-section is required, a surgeon will need to perform it. The good news is, all midwives are affiliated with obstetricians, which means there is likely a doctor on call within their practice who can take over if you become high risk or a c-section becomes necessary. Because they’re unable to perform the surgery themselves, midwives are less likely to push for unnecessary c-sections.
I don’t think home birth is for me, but I would have liked to use the birth center affiliated with my midwives’ practice. Unfortunately, it wasn’t covered by my insurance, so I’ll be giving birth in the hospital.
So you see, midwives aren’t just for crazy hippie ladies who want to birth in a hut. It’s just another option for prenatal care and delivery.
If you’re considering getting pregnant in the near future, and you’re not familiar with midwifery, definitely look into it as an option for you! I have been so happy with the care I’ve received from my midwives. It’s possible that you’ll decide to stick with an obstetrician for your prenatal care, but you should be aware of all of your options in case it turns out that a midwife would better suit your needs.
If you suffered complications during your birth and you’re facing a medical negligence claim, be sure to contact a lawyer as soon as possible.
I have to laugh because I think giving birth in a hut in the woods sounds beautiful! :) But, I know what you’re saying. I had a homebirth and people actually assumed it meant we were giving to birth without any preparation or willing to seek emergency help, that beyond a hospital , “safe birth” doesn’t exist. Which, as we all know, especially under a midwife’s care (whether in or out of hospital!), birth is absolutely safe and natural and actually, part of life.
Steph
What I mean when I say “giving birth in a hut in the woods” is exactly what you just said people assume about your home births — laboring in a primitive environment with no real medical care or preparation. Just because we choose a birth center or home birth with a midwife doesn’t mean we’re not getting proper care to ensure a safe birth for our babies! I’m sure a hut birth could be lovely as long as you’re close enough to a hospital to get there quickly if something went awry! :)
Oh come on — I think a hut in the woods in the winter sounds charming!
I do think it’s important for women who are seeking a midwife for the midwifery model of care to realize that some CNM’s really have highly medicalized attitudes, and there are also some OBs that have a midwifery mentality (like Dr. Bradley!).
The midwife who caught Johnny turned out to be much more intervention-friendly than I first realized. She wanted to do Cytotec to augment my labor because my water had broken, and contractions hadn’t yet started. I think other midwives would have given me more time before messing with me.
Also, I didn’t see much of her during my labor. It was mostly the regular nursing staff. I imagine this time, at a birth center, I will be seeing more of the midwife.
So I do think it’s good to interview the midwives and find out more about their styles when catching babies and stuff!
Oh and the pain meds that a midwife can administer are different than what an anesthesiologist can do with an epidural. Midwives can’t do epis but they can put meds in an IV for you or stuff. (I know you know all this Karen — just putting it out there for readers!)
Kacie – I agree that interviewing is really important, because you could end up with a midwife who isn’t necessarily natural birth friendly.
Also: My point on pain meds is that midwifes are qualified to administer the same pain relief medications as obstetricians. Obstetricians can’t administer epis, either! Whether you choose an OB or a midwife, you’ll still have to wait around for an anesthesiologist if you want an epidural. So choosing a midwife doesn’t change your access to pain meds if you want ’em.
Thanks for your input! And I’m glad your new midwives aren’t so intervention happy!
I love this post. I definitely got the “taking a great risk” response when I would tell people I was using a midwife. I had a great experience with mine, even though she didn’t actually catch my baby, I think her encouragement through my prenatal care made a difference. I hope to use her again with the next kid, and I hope it works out that she catches the baby too.
The wife and I recently watched a series about a birthing unit in the NHS in the UK and it was very interesting. They do things completely different in the UK. Most birthing units are pretty much run by Midwives who are there for the entire process. There’s only a doctor involved if there’s a problem – and it would have to be a serious one. It was nice to see that a midwife stays with the woman the whole time during labor.
They also do something kind of strange – they give women laughing gas to help them breathe and relax – it comes out of the wall and all women take it.
I think it needs to be made clear that you are talking about CNMs (Certified Nurse Midwives) who are highly trained and licensed. In some states anyone can call themselves a midwife, and I think that’s where a lot of people get their stereotypes about midwifery, and in those cases you can be taking a huge risk with your and your baby’s life. In Indiana only CNMs are allowed but a quick google search comes up with several “midwives” who have no official training and are operating illegally.
Corinne, It is not only CNM’s who have training. There are Certified Professional Midwives who also have training, but who didn’t become nurses first. Quite a few states have licensing requirements for them and it is legal for them to attend home births. This varies from state to state.
Some midwives have this training and a great deal of experience, but live in states where the state does not recognize the training. Anyone who wants to use such a midwife should find out what her qualifications and experience are, for sure. But just because someone isn’t licensed doesn’t mean she doesn’t know what she is doing.
If a CPM moved from a state which licenses her to one which doesn’t, would she thereby become unqualified?
There are risks in all birth settings, and people who practice dangerously no matter what initials they have after their names!
Susan Peterson
Great explanation, Karen.
I agree with Corinne, you are just talking about CNMs. But I also agree with Susan, CPMs are licensed in many states and not “illegal”. Most providers who practice as midwives, whether a CNM or CPM, have training in childbirth and obstetric emergencies.
Current CNM student,
Carla
Its so weird to see how different the US is from other countries. I am currently pregnant and living in Australia. In Australia, you have gov’t healthcare…which means you can have all of your dr. visits and the birth covered 100% and not pay a penny, but you see a midwife. Sometimes I think they are even better than OBs. When I tell people in the states I am planning a natural water birth in a birthing centre with midwives, they think I am crazy!! It’s the norm here. Why would you pay $3-5K to give birth with an OB, when you can do it for free with a midwife? So here in Oz, people see Midwives as equals, not as less superior than a OB. I say, good luck with YOUR birth…it’s yours and your hubby’s…it’s not anyone else’s to judge or tell you what to do.
Amy – It seems that attitudes about midwives are also much different in the UK. Midwives are much more common there, as well. I’m not sure where the idea that midwives are inferior came from in the United States, but it’s prevalent here.
I saw an OB for the first half of my pregnancy and switched to a midwife for the second half. Obviously, I can’t judge all care providers based on this limited experience, but I will say that I definitely have preferred the care I received from my midwives over the care I received from an OB. Based on this experience, I would certainly say midwives are better.
Are u kidding – people from the 60’s, 70’s and 80’s were all having home births. But what about those of us with high risk pregnancies. My first birth – swallowed meconium – couldn’t breathe.
My second delivery – I hemorraghed, lucky me my third delivery was vaginal breach. Sorry I’ll take a doctor and a hospital anytime
I really appreciate this post! I can’t believe how many people have asked me if I am having a homebirth when I tell them I am with a midwife. I just explain that my birth with Libbie was really scary and I don’t want to repeat that.
I actually thought all midwives were super natural-birth friendly. Mine is not, really. Not that’s she against it–she is just not crunchy granola, like I expected her to be! I should have interviewed some people, but went by a suggestion instead.
Great post! I love the idea of a midwife, but I’m staying with an Ob because I had one pregnancy that ended on the high-risk side of things. Luckily, my experience has included two really great Obs–and neither were opposed to natural births. They were both very supportive and let me make the decisions necessary.
~Carla
Great post! I had an OB who at first was hesitant about natural birth, but was won over by the end and had a wonderful birthing experience. I have had dozens of insensitive comments about “opposing” modern medicine and why I would “choose to go through the pain.” I was saddened that I had to have an emergency C-section with my second pregnancy, but my twins were very pre-term and complications were snowballing. I still encourage women to think about what THEY want and make educated choices. I always say if you choose epidural, OB’s, hospital, home birth, or midwives, just make sure it’s YOUR choice, not what you have been TOLD to do. Thanks for the shoutout to those who opt to take an active role in their childbirth experience.