Midwives: Another Option for Pregnancy Care

In the U.S., formal training for midwives began in 1765. Most women were resistant to this, particularly as men usually taught the classes. Prior to the 1800s, midwives were the predominant choice for childbirth. This shifted as wealthier families began using doctors and midwives were only used by people who could not afford a physician. By the 1960s, about 97% of births were attended by a physician in a hospital setting. Things began to shift again in the 1970s with the women's lib movement; some women asserted that childbirth was a natural process and did not require a hospital or physician.

The specific services a midwife provides depend heavily on licensing and credentials as well as the state where the midwife is practicing. Highly trained and licensed midwives play an essential role in the ongoing management of women's health and can perform regular gynecological exams, manage prenatal care, provide support during labor and delivery, and help older women manage menopause.

Certified Nurse-Midwives are registered nurses who go on to pursue higher education in midwifery. This involves intense hospital-based training as well as extensive classroom education. They need a least a bachelor's degree, but some states require a masters-level education for certification. Certified nurse-midwives can work in a hospital setting, but is it within their scope of practice to provide care anywhere.

There are two types of certified midwives. The first, most commonly given this designation, must have a bachelor's degree in a health-related field and then receive masters-level training and certification in midwifery. The second type is a certified professional midwife. This is a unique certification because it requires knowledge and experience in settings outside of a hospital. Training primarily focuses on working in birth centers and assisting with home births. These practitioners may also work under a physician in an office or clinic, providing maternity care.

Some midwives practice without completing the same formal education as certified midwives. Direct-entry midwives train in midwifery schools or attend a college-level midwife program. They do not complete masters level classes and might not obtain a bachelor's degree. Lay midwives receive no formal training and are not licensed or certified. Instead, they receive informal training through apprenticeships or self-study.

This depends on a midwife's certification. Certified nurse-midwives work alongside and collaborate with physicians. Pregnant women wishing to work with a midwife, who are planning to give birth in a hospital setting, will likely work with a certified nurse-midwife. Certified professional midwives work primarily in birth centers or clinics. Direct-entry midwives are not licensed or certified and are usually found assisting in home births.

Midwifery has been practiced around the world for centuries, if not millennia. In modern times, however, the practice has become more regulated, particularly in the U.S., though licensing and certification still vary from state to state. Certified nurse-midwives can practice in all 50 states, though some require the direct supervision of a physician. Certified midwives and certified professional midwives can practice in some states but not in others. Only a handful of states allow the practice of unlicensed midwives.

Certified nurse-midwives begin their relationship with expectant mothers during prenatal visits. They monitor the progress of the pregnancy, the growth of the fetus, and the health of the mother. When a woman goes into labor, a certified nurse-midwife is at the bedside, ensuring a safe delivery. Some states require these practitioners work under a physician while others allow more independence. In the case of cesarian births, a certified nurse-midwife collaborates with the doctor but will not perform the procedure.

One of the main reasons women choose to work with a midwife is their traditional approach to childbirth as a natural process. This type of care has many benefits. Studies show births attended by midwives are at a lower risk of requiring cesarian sections, have decreased mortality rates, decreased risk of premature birth, less severe perineal tears, and increased satisfaction of the birthing experience.

One important thing to keep in mind is that some pregnancies have complications that require interventions outside a midwife's expertise. It is worth considering that one of the reasons the statistics for midwife-attended births are so favorable is because they were normal, healthy pregnancies without much risk of complications. In the hospital setting, nurse-midwives are part of an integrated care team. If complications arise or if the pregnancy is high-risk, qualified physicians are on hand to intervene.