What is a Midwife?
by Alicia Huntley, CNM, MSN
"Midwife" is a word that comes from the old English words mit wif, literally "with woman." A midwife is a person who is "with woman," especially during the period of pregnancy, birth, and caring for the newborn. Some people also use the word midwife as a verb, meaning to help give birth, as in "She 'midwifed' the project." The things that midwives do is called "midwifery" (pronounced mid-whiff-err-ee).
There are many types of midwives throughout the world. The World Health Organization recognizes the importance of midwives in promoting the health of women and babies throughout the world and strongly encourages that midwives be the primary health care providers for pregnant women throughout the world. Midwives are specialists in normal pregnancy and women's health care. Obstetricians and gynecologists are specialists in surgery and illness, and are not the appropriate care providers for healthy women experiencing normal pregnancy (although they can do an adequate job if there are no midwives available).
Throughout the world, midwives fall into three general types. First, there are the midwives with formal training (either in a school or apprenticeship, who have met a specific standard for education and experience) but are not trained in the discipline of nursing. This is the system primarily used in the Netherlands, Denmark, and some other European countries. These are professional midwives. Then there are the nurse-midwives, midwives who have taken a course in midwifery after completing the usual course for professional nurses in their country. Finally, there is the traditional birth attendant, or indigenous midwife. This is a midwife who practices primarily within the contours of a traditional ethnic or cultural group, who may or may not have any formal training or education. These midwives are found throughout the world, and are quite common in rural areas of Latin America, Africa, and the third and fourth worlds.
In the United States, all three basic types of midwife co-exist. Certification exist for the nurse-midwife and the professional midwife. All 50 states license nurse-midwives. Professional midwives are licensed in many states, and there is a move for licensure in many more. A few states offer licensure for traditional birth attendants, or allow them to practice under limited conditions. Some states consider the practice of midwifery to be the practice of medicine, others do not. It can be very confusing for the consumer, and things change frequently. But certification (CNM, certified nurse-midwife, or CPM, certified professional midwife) is evidence that the midwife has attained competency in various areas considered "core competencies" for midwifery practice, and has passed a standardized examination on these topics. Certification also indicates that the midwife has attended at least 30 (and often many, many more!) births under supervision.
Midwives practice in a variety of settings. Traditional birth attendants usually attend women at the women's homes (or other culturally designated birth place). Professional midwives in the USA usually practice at home or in birth centers. Nurse-midwives practice primarily in hospitals and birth centers, although an increasing number of them are now attending births at home. Midwives usually have some kind of arrangement to transfer care to a surgeon or physician if the woman develops a complication during pregnancy, labor, birth, or the time after birth. Certified nurse-midwives in the United States also provide well-women care and family planning services in some settings.
What makes care with a midwife different? Since midwives are specialists in normal pregnancies, they are not bored by all the 'routine stuff' of pregnancy. They often take more time in a prenatal visit (20-30 minutes as opposed to 5 - 10 minutes for a 'belly check'). They have a strong commitment to keeping things normal, so they will often ask questions about how you are feeling, how you are eating, what's going on in the rest of your life. These are not to be nosy, but rather to help you identify areas where you can help yourself to have the healthiest possible pregnancy and birth experience. Midwives tend to see prenatal care as a partnership between themselves and the pregnant family, and the family is the senior partner in the firm.
In labor, midwives usually provide not just medically oriented care but also labor support. This may include things like showing you (or your helpers) ways to cope with pain, like getting into water, changing positions, massage techniques. In some ways, the midwife is like a tour guide, there to point out the signposts as you journey from pregnancy to birth, and also to keep you from going the wrong way on a one way street or otherwise getting into trouble in unfamiliar territory. The tour guide doesn't tell you what country to visit, just how to get around once you get there. The midwife helps you to get the best birth you can with what you are given in the way of labor, baby, and so on. But you are also expected to do your part, to give birth rather than being delivered.
Does this mean that midwives never intervene? No, midwives will sometimes intervene, but more often to get things back on the track of normal. Sometimes a mom can wander off the path and get stuck in the mud, and then the midwife's job is to help the mom figure out how to get back on track. Sometimes this may mean using drugs or technology, like ultrasounds or I.V. s. Rarely do midwives use these as 'routine', rather the need for, benefits of, and potential risks of the interventions are discussed with the mom and her family.
Does having a midwife guarantee that everything will go perfectly? Again, the answer is no. Birth is a natural process, and just like everything else in life, sometimes things go awry. Wearing a seat belt doesn't guarantee that you won't get hurt in a car accident, but it certainly improves your chances. Looking both ways doesn't guarantee that you won't get hit by a car crossing the street, either! Sometimes, despite everything, it just doesn't go right. Babies are born with birth defects, or prematurely, or even sometimes die. Moms get sick, get high blood pressure, or bleed too much. Good care, like you get from a midwife, helps reduce the chance that you will have a serious problem, but there are no guarantees in life. Midwives recognize this, and are prepared to help you deal with whatever life sends you. Since their training emphasizes looking at the whole person, body, spirit, and psyche, they are often uniquely able to help if you do have a problem.
To summarize, there are many sorts of midwives practicing in the world today. They are available in a variety of settings, and there is probably one or more available to you wherever you live. As specialists in normal birth, they are able to care for around 90% of pregnant women, and may even by able to cooperate with a specialist in the care of complicated pregnancies. The personalized care they provide has been shown to improve outcomes for both mothers and babies in numerous studies. Many moms are also happier with midwives because of the attention given to the routine and possibly boring (to anyone who isn't pregnant!) changes that happen during pregnancy. Care with a midwife is, for most women and their families, a very positive experience.
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