Choosing a Midwife for Your Pregnancy and Delivery

Pregnancy and childbirth is a transformative journey filled with much planning and preparation. While most women choose to have their pregnancy and delivery managed solely by an obstetrician, or OB/GYN, in a hospital setting, others choose the care of a licensed midwife for a more holistic and natural approach to their pregnancy and birthing experience.

Although contemporary OB/GYNs perform a necessary role in the management of pregnancies and deliveries, especially high-risk pregnancies, most births are low-risk vaginal births without complications and can be managed safely and effectively by a midwife.

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A Brief History of Midwifery Care

Midwifery is one of the oldest professions in the world with historical records dating back to 1600 B.C. For centuries, older more experienced midwives passed their knowledge of maternity care and birthing down to younger midwives through an informal apprenticeship-like training. In turn, these younger midwives learned how to provide care for expectant mothers and deliver their newborns, then passed this working knowledge down to the next generation of midwives.

In Europe and the United States, midwifery-managed childbirth has had a long history, with midwifery the most common practice for management of pregnancy and childbirth during the American colonial era through the beginning of the 20th century in the United States. A more formal field of nurse-midwifery began in the 1920s and later, several non-nursing direct- entry certification pathways emerged in the 1980s and 1990s. Midwifery care decreased in the early 1900s as modern medical technology and hospitals became more advanced and population health became more institutionalized. The relatively new specialty of obstetric medicine (the American Association of Obstetricians and Gynecologists was formed in 1888) became more specialized and began to monopolize all aspects of childbirth. In Europe, the field of midwifery survived this transition into modern medicine; however, in America, midwifery practices slowly diminished. By 1950, 88% of births occurred in hospitals. By 1980 midwife-assisted births accounted for only 1% of births. There has, however, been a renaissance in midwifery care, with midwives attending almost 12% of all United States births in recent years.

Types of Midwives

Today, a midwife is a trained licensed professional who specializes in natural birth and provides a broad range of medical care and support for both mother and family in the pre-pregnancy period and throughout all stages of pregnancy, delivery, and postpartum, including the first year after birth. There are several routes to midwifery training and education: a Certified-Nurse Midwife (CNM) is the most common and is both an advanced practice registered nurse (APRN) and a certified midwife; a Certified Midwife (CM) is a direct-entry midwife who follows the same standards and principles as a CNM but is not a nurse; and a Certified Professional Midwife (CPM) is also a non-nurse, direct-entry midwife but has considerable clinical training outside of hospital births, with natural home births and freestanding birth centers.

Where Do Midwives Provide Care and Deliver?

While it’s common for some midwives (Certified Professional Midwives) to specialize in natural home births, which is a great option for many mothers, it’s important to know that there are other options for mothers who want to take a more integrative approach. Midwifery care can take place alongside doctors at freestanding birth centers and hospitals.

Freestanding birth centers are healthcare facilities that provide a unique home-like, non-medical setting for births but are not actually part of a hospital. They do, however, maintain partnerships with hospitals and doctors when more specialized care is necessary. Freestanding birth centers use midwives to attend to low-risk pregnancies while using the most natural approaches to assist in birth without being induced. They also use very little pain medication or no pain medication at all during the birthing process.

Women can get the same individualized approach with midwives who work with obstetric doctors in a hospital or a hospital-based birthing center (a place that aims to provide the same intimacy as freestanding birth centers). In fact, midwife-attended births occur in hospitals where midwives and OB/GYNs provide collaborative care for mother and newborn. With a hospital birth, midwives help comfort and ensure the mother’s chosen birth plan is followed and modified when needed. They are there alongside the mother-to-be to help guide labor with or without pain medication (midwives still provide care even when an epidural is chosen), assist with delivery, and provide postpartum care for mother and child during the hospital stay and when returning home. If a cesarean section is necessary, a midwife can still aid and support during surgery.

Midwifery Tenets

The International Confederation of Midwives states its philosophical tenets as follows:

  • Pregnancy and childbearing are usually normal physiological processes.
  • Pregnancy and childbearing is a profound experience, which carries significant meaning to the woman, her family, and the community.
  • Midwives are the most appropriate care providers to attend to childbearing women.
  • Midwifery care promotes, protects, and supports women’s human, reproductive, and sexual health, and respects ethnic and cultural diversity. It is based on the ethical principles of justice, equity, and respect for human dignity.
  • Midwifery care is holistic and continuous in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological, and physical experiences of women.
  • Midwifery care is emancipatory, as it protects and enhances the health and social status of women and builds women’s self confidence in their ability to cope with childbirth.
  • Midwifery care takes place in partnership with women, recognizing the right to self-determination and is respectful, personalized, continuous, and non-authoritarian.
  • Ethical and competent midwifery care is informed and guided by formal and continuous education, scientific research, and application of evidence.

Wiseman Health Take-Home Advice

While we understand that pregnancy and delivery choices are highly individualized, it’s important to consult with qualified healthcare professionals to help you make an informed decision about whether a home birth, birthing center, or hospital birth is right for you and your family. High-risk pregnancies or pregnancies that will need more invasive medical interventions are best managed by a medical doctor.

  • Integrating midwifery care with your OB/GYN is an option. If you are interested in working primarily with a midwife for a birth at a freestanding birth center, ask how they integrate doctors into their care, and if you are interested in working primarily with a doctor, ask how they can incorporate a midwife in a hospital setting. Midwives and physicians can work together to help provide you with the birthing plan that’s right for you. There are many OB/GYNs who respect midwives and will work together to provide an integrative approach to maternity care and delivery.
  • Midwifery is safe and effective. Understanding the data of midwifery-assisted labor and delivery births versus obstetric labor and births in a hospital is important when making an informed decision about maternity care and delivery in a hospital setting. One such study concluded that “greater integration of midwifery care into maternity services in the United States may reduce intervention in labor and potentially even cesarean delivery, in low-risk pregnancies.”  Substantial evidence from the United States and around the world support that midwives are safe, effective, efficient, and provide high-value, patient-centered care. According to the American College of Nurse Midwives, women cared for by Certified Nurse-Midwives compared to women of the same risk status cared for by doctors alone, had:
    • Lower cesarean rates
    • Lower rates of labor induction and augmentation
    • Significant reduction in third- and fourth-degree perineal tears
    • Less use of regional anesthesia (e.g., epidural)
    • Higher rates of breastfeeding
  • Midwifery care is usually the least expensive option for childbirth, and it may be covered under your insurance plan. Even with insurance, many plans have high deductibles, so in cases like this midwifery is typically less expensive because midwives are usually able to safely avoid unnecessary procedures and interventions, along with costly hospital stays. The average cost of a vaginal birth in a hospital to insurance companies is roughly 3–5 times more than the average cost of a midwife-led home birth or in a freestanding birth center. When you look at this total cost reduction on our health care system, along with the positive experience and health outcomes commonly found with midwives, it makes sense to rethink our approach to midwife-directed care and integrate it into our broader healthcare system and follow the lead of many countries around the world.
  • If you are interested in a home birth, we highly recommend learning more from Monika Stone CPM, LM. Her book Why Choose Home Birth: Yes, It’s an Option, and Yes, It’s Right for Women Today provides a wealth of knowledge about what today’s home birth looks like.
  • Another insightful read is Ina May’s Guide to Childbirth. Long considered the nation’s leading midwife, Ina May Gaskin shares her thirty plus years of  practicing this female-centered model of care.

Why Choose Home Birth: Yes, It’s an Option, and Yes, It’s Right for Women Today by Monika Stone

2019, November. Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/31599830/#:~:text=Compared%20with%20obstetricians%2C%20midwifery%20patients,(aRR%200.57%3B%2095th%25%20CI

A Brief History of Midwifery in America. OHSU Center for Women’s Health. https://www.ohsu.edu/womens-health/brief-history-midwifery-america

International Confederation of Midwives: ICM Philosophy of Midwifery Care

https://www.guirguisobgyn.com/blog/5-benefits-of-midwife-care

Mook, B. (2023, January 17). 5 Takeaways on Midwifery’s Past, Present, and Future. https://news.cuanschutz.edu/nursing/5-takeaways-on-midwiferys-past-present-future#:~:text=Currently%2C%20there%20are%2013%2C500%20certified,small%20number%20of%20births%20overall.

Feldhusen, A. E. The History of Midwifery and Childbirth in America: A Timeline. https://www.midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/