Definition and Overview
A midwife is a licensed health care professional who specialises in the antenatal care of pregnant women, providing support throughout the pregnancy, during labor and even up to 28 days after childbirth. Midwives are experts in low-risk pregnancies and normal (vaginal) births. Should complications arise or in cases of high-risk pregnancies, they typically refer patients to obstetrics and gynaecologists (OB-GYN).
The recent years have seen a rise in the demand for midwives among pregnant women. The service they provide, particularly the support during the pregnancy and after delivery, makes them popular with women especially those who want a natural home or water birth. However, midwives can also assist in a hospital setting and can work together with the patient’s OB-GYN.
When preparing for a midwifery consultation, a woman needs to know that there are different types of midwives and these are the following:
Certified nurse-midwives (CNMs) are those who have finished a college/university nursing degree, licensed as a registered nurse (may have worked as a registered nurse), completed an additional 2-3 year midwifery education and passed a board certification exam. They often attend to patients in hospitals and are associated with OB-GYN clinics.
Certified midwives (CMs) have almost the same credentials as CNMs except that their primary degree is not nursing.
Certified professional midwives (CPMs) are independent licensed practitioners who usually deal with home births and are associated with freestanding birth centers.
Direct entry midwives (DEMs) are independent practitioners who have gained their midwifery accreditation through a career path other than nursing. They provide complete prenatal care and participate in home births or freestanding birth centers.
A midwifery consultation can be performed during the 4th month of pregnancy and may be done with several midwives until one who is a good fit, not just in credentials and experience, but also with the rapport and the connection with the mother, can be found.
Who Should Undergo and Expected Results
Pregnant women go through a midwifery consultation in the hopes of finding one that is a perfect fit for their pregnancy and childbirth needs. Generally, women who are looking for midwives fall under the following categories:
Those who prefer a natural birth – Midwives are experts at vaginal births and they are ardent believers in natural birth methods, which is why they are efficient with home births and even water births.
Those who want support during their labor – Generally, physicians and doctors don’t hold a patient’s hand throughout the birthing process. Midwives do. They are there to support the patient and provide a calming environment when the patient needs it.
Those who don’t want invasive birth practices – Some pregnant women prefer not to use obstetric interventions like pain medications and C-sections. Midwives use natural methods to alleviate pain like giving the mother a deep massage or a warm compress instead of an episiotomy (incision to enlarge the vaginal opening) as well as hot showers and baths for relaxing.
Those who need help after childbirth – First-time parents can feel overwhelmed when the reality sets in – that they have now transitioned from just a couple to being parents of a child or children in the case of multiple births. Midwives are trained to teach parents how to care for the baby, to counsel them on nutrition and exercise and to help them cope with the emotional pressure of parenthood.
Those whose pregnancy are considered low-risk – Women who have a healthy pregnancy may feel that midwives are the perfect choice since there are no serious complications to consider that may necessitate the need for a medical doctor. However, those with high-risk pregnancies may elect to have their chosen midwives work together with their OB-GYN.
How Does the Procedure Work
The first part of a midwifery consultation is choosing the perfect midwife. Patients should choose based on training and experience, ability to handle complications and emergencies and the exact services they offer during pregnancy, labor, childbirth and after delivery. Their ability to make the patient comfortable and at ease is a big plus. They must also have excellent communication skills to prevent any misunderstanding.
Once the mother has chosen her preferred midwife or midwifery team, then it’s time for them to focus on the following details:
Medical history and lifestyle – The midwife has to know all the relevant details about the mother, including previous pregnancies, history of diseases or genetic conditions, if either the mother or father smoke or drink alcohol and if there are medications currently being taken, among others.
Expected due date – The birthing date is the most important date in the mother and midwife relationship. It is the date when the baby is due and will be calculated based on the date of the mother’s last monthly period.
Labor and birth choices – The midwife/midwife team will discuss the pregnant woman’s birth options. Most of the time, they will choose natural birth because that is what they’re experts at. However, mothers can decide if they prefer to give birth at home, at a birthing center or a hospital. Water births are also an option.
Insurance information – Some midwives and their teams are covered under insurance policies. It is important to get this concern out of the way as soon as possible so that the mother can concentrate on the pregnancy and childbirth.
Contact information – It is important for the mother to have all the contact information readily available, whether for urgent and non-urgent concerns.
Possible Complications and Risks
During a midwifery consultation, especially the first one, there may be personality clashes or there is no immediate bond between the midwife and the mother. This happens if the mother is uncomfortable with the midwife or she’s not impressed with her credentials or she thinks her needs are not being understood by the midwife. The only solution is to find another, one that will be trustworthy enough to handle her pregnancy.
- Kilpatrick S, Garrison E. Normal labor and delivery. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.