The term midwife reflects a philosophy of care–one that is directed toward women and their individual reproductive needs. A midwife usually offers a variety of options and seeks to eliminate or minimize unnecessary interventions.
The Midwives Model of Care represents this philosophy. The midwives model of care is based on the belief that pregnancy and birth are normal life processes. The midwives model of care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counselling, and prenatal care, continuous hands-on assistance during labour and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
What Is A Midwife?
A midwife is a health care professional who provides an array of health care services for women that can include medical histories and gynecological examinations, contraceptive counseling, prescriptions, and labor and delivery care. Providing expert care during labor, delivery, and after birth is a specialty of midwives that makes them unique.
What Services Do Midwives Provide?
The services of a midwife depend on the certification and licensing credentials obtained and the practice restrictions of each state. Because of the additional licensure in nursing, a nurse-midwife can offer the most comprehensive array of health care services to women.
These services include annual gynecological exams, family planning and preconception care, prenatal care, labor and delivery support, newborn care, and menopausal management. Midwives generally provide reproductive education in fertility, nutrition and exercise, contraception, pregnancy health, breastfeeding, and quality infant care. Midwives often function as a quality economical option for birthing care.
What Are The Different Types Of Midwives?
Midwives are qualified health care providers who go through comprehensive training and examinations for certification. The American College of Nurse Midwives (ACNM) and the North American Registry of Midwives (NARM) offer certification. The practice and credentials related to midwifery differ throughout the United States. Below is a brief description of each of type of midwife:
• Certified Nurse-Midwife (CNM): an individual trained and licensed in both nursing and midwifery. Nurse-midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.
• Certified Professional Midwife (CPM): an individual trained in midwifery who meets practice standards of the North American Registry of Midwives.
• Direct-Entry Midwife (DEM): an independent individual trained in midwifery through a variety of sources that can include: self-study, apprenticeship, a midwifery school, or a college/university program.
• Certified Midwife (CM): an individual trained and certified in midwifery. Certified midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.
• Lay Midwife: an individual who is not certified or licensed as a midwife but has been trained informally through self-study or apprenticeship.
A midwife attends childbirth, provides support during labor and delivery, and supervises the general care of women and children directly after birth. The term midwife, meaning “with a woman,” was first recorded in 1300. However, accounts dating to the second century confirm the role of midwives in the birthing process. Contemporary midwives provide care to women during normal pregnancies and deliveries and call on obstetricians or other physicians if complications develop. Midwifery is a professionally regulated field.
Midwifery provides continuous support to women with uncomplicated pregnancies during pregnancy and labor. Communication between midwife and the pregnant woman is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and most encourage family participation in the birth. They pay special attention to the cultural values and personal preferences of the women in their care.
Safety is also a priority in midwifery and studies show that outcomes are the same as physician-attended births. As part of their commitment to nonintervention, midwives do not advocate the use of pain medicationor invasive procedures during the normal birthing process. They encourage women to actively participate in the birthing process. Midwives provide health care education and emotional and social support. The continuous presence of a midwife during labor can reduce:
- The length of labor
- The need for pain medication
- The likelihood of forceps or other operative devices during delivery
- The possibility of cesarean delivery
There are two recognized types of midwives: direct entry midwives and nurse-midwives.
The credentials differ; however, certification requires that both types are trained in childbirth and committed to providing continuous care to women throughout childbirth. Midwives maintain working relationships with physicians in case of emergencies or complications.
Direct Entry Midwives
A direct entry midwife (DEM) enters the field of midwifery through an apprenticeship, community-based training, or a field other than formalized nursing education. They have a long-standing commitment to women’s health care and experience-based training. Most often, DEMs provide care to women giving birth at home.
During the past 50 years, many pregnant women have chosen obstetrics for their method of care and midwifery experienced a decline. Within the last 10 years, there has been a push to standardize the education of DEMs through certification and credentialing. Since 1996, DEMs can attain certification from the North American Registry of Midwives as “Certified Midwife” (CM), a professionally recognized title. Midwifery is currently experiencing an upswing in popularity.
Direct entry midwives may have completed apprenticeships with midwives and/or physicians, performed independent studies, and/or completed midwifery school. To attain Certified Midwife status, they must also:
- Complete prerequisite health science requirements
- Graduate from an accredited, university-affiliated midwifery education program
- Earn at least a baccalaureate degree
- Successfully complete the national certification exam
The American College of Nurse-Midwives (ACNM) developed the requirements to guarantee competency for CMs. CMs are held to the same standards for practice, philosophy, and code of ethics as certified nurse-midwives. The certification examination is the same as for certified nurse-midwives and is administered by the ACNM Certification Council (ACC).
CMs practice independently, at medical clinics, or at hospitals as physician assistants. As a relatively new profession, CMs are not recognized by every state. Insurance providers may cover their services and many CMs have a sliding scale.
Nurse-midwives are registered nurses who have completed accredited midwifery programs. Once certified, they are certified nurse-midwives (CNMs). Nurse-midwives can write prescriptions and provide a variety of care, including:
Nurse-midwives collaborate with physicians, especially in problem pregnancies. In general health care, nurse-midwives work with other medical professionals to provide comprehensive health care resources. When additional medical advice or surgical care is needed, they refer women to the appropriate physician.
The philosophy of nurse-midwifery is based on providing health care to women, while acknowledging and respecting their needs. They encourage patient education, active participation, clear communication between the provider and the woman, and an individualized health care experience.
Perhaps the best-known facet of nurse-midwifery is the commitment to facilitating uncomplicated pregnancy. Nurse-midwives provide information about different types of care available and encourage women to enhance their pregnancy by being involved. Nurse-midwives advocate birth education, natural childbirth, and the participation of the entire family. They rely on technology only when it is medically necessary. Thus, cesarean sections and episiotomies are less common when care is provided by a CNM.
The tradition of nurse-midwives has existed since the 1920s and the American College Nurse-Midwives (ACNM) formed in 1955 to oversee the development of the field. The ACNM has defined the criteria for nurse-midwifery. Nurse-midwives receive education and training in nursing and midwifery and must be licensed. The requirements for certification are similar to those for certified midwives.
To become a Certified Nurse-Midwife (CNM), candidates must successfully complete these requirements:
- Completion of an accredited nursing program
- Licensure as a Registered nurse
- Satisfactory completion of a program in nurse-midwifery from an accredited institute
Once a candidate meets these requirements, he or she can take the national certification examination administered by the ACNM Certification Council (ACC). After passing the exam, the candidate receives nurse-midwife certification. Because state licensing laws vary, there may be additional requirements.
The National Center for Health Statistics reports that in 1998, 277,811 births were CNM-attended in the United States. CNMs usually work in private physician practices, hospitals, clinics, free-standing birth centers, and health departments. They may have their own private practices and occasionally attend home births. All states mandate Medicaid reimbursement and most require private insurance reimbursement for nurse-midwifery services.
Where Do Midwives Practice?
Midwives believe in facilitating a natural childbirth as much as possible. Accordingly, it is common to receive care from a midwife in a private and comfortable birthing center or in your own home. Because of their professionalism and expertise, midwives are often part of a labor and delivery team associated with the local hospital. You can choose to use the services of a midwife whether you elect to give birth at home, a birthing center, or at a hospital.
What Are The Benefits Of Using A Midwife?
One of the main reasons that women elect to use a midwife is to experience childbirth as naturally as possible.
Available options is another benefit associated with having a midwife. Midwives often offer payment plans, sliding fees, and are willing to accept most insurance plans including Medicaid.
According to the doctoral research conducted by Peter Schlenzka, the choice of using a nurse-midwife and natural delivery can result in the following benefits:
- Lower maternity care costs
- Reduced mortality and morbidity related to cesarean and other interventions
- Lower intervention rates
- Fewer recovery complications2
Electing to use a nurse-midwife is appropriate for low risk pregnancies which constitute 60 to 80% of all
pregnancies. In Schlenzka’s review of over 800,000 births, he reports there are no advantages of a standard obstetric hospital approach over a nurse-midwife setting inside or outside of the hospital.
What Are The Concerns Related To Using A Midwife?
Low risk pregnancies make up 60 to 80% of all pregnancies. This means that between 20 to 40% of pregnancies could have potential complications. There are times when either the mother or the baby will require medical interventions that are outside the scope of services offered by a midwife. Midwives routinely consult with obstetricians, perinatologists, and other healthcare professionals and will refer women to appropriate medical professionals if complications arise.
If complications are anticipated, it is recommended that women elect a hospital setting with more convenient access to obstetricians, primatologists, and other professionals trained to deal with complications affectin