You’ll make many labor and delivery decisions during pregnancy:
Where to give birth.
What kind of birthing experience you want.
Which type of health care provider you want to guide your pregnancy and birth.
Choosing a prenatal care provider is an important decision. And although many women are familiar with OB/GYNs and their role in prenatal care and childbirth, not many are aware of the capabilities of midwives.
Before you go picturing a birth that resembles something you saw on “Little House on the Prairie” or “The Handmaid’s Tale,” we’d like to set the record straight. Midwives — health care providers who specialize in pregnancy, childbirth and postpartum care — deliver approximately 12% of all babies born in the United States. And with an impressive satisfaction rate at that.
To help us learn more about midwives, we turned to MU Health Care certified nurse midwives Lori Anderson, Jill Fuert, Shalisa Henson and Veronica Kloeppel.
Together, they debunked common myths about midwives:
While most midwives have some training, they don’t all have the same credentials or level of formal training.
Types of midwives include:
Midwives can deliver babies in your home, a birthing center or a hospital. But data shows that nearly 90% of the births attended by midwives involve CNMs or CMs, and almost all those births occur at hospitals.
Certified nurse midwives deliver low-risk babies at hospitals just like OB/GYNs do. They coordinate with a physician if the delivery requires something beyond their scope of care, such as cesarean delivery (C-section) or other surgery, or vacuum- or forceps-assisted delivery.
In many hospital networks, including MU Health Care, CNMs only deliver babies in hospitals. They are on-call seven days a week, just like other obstetrics providers who deliver babies.
Midwives do view health and pregnancy holistically. CNMs have a philosophy that is more complicated than that. They believe:
As trained nurses with clinical experience, CNMs perform all the same prenatal care as OB/GYNs, including ultrasounds, bloodwork and testing. During labor, they perform whatever medical interventions are necessary or requested.
Whether you’re hoping for a low-intervention birth experience — a natural birthing experience that includes no medication and minimal medical intervention or technology — or prefer an epidural, CNMs can provide that. They will respect your plan. They can also pivot and make changes before and during labor if that plan should change.
Nurse midwives take a slightly different approach to labor than most OB/GYNs. They don’t perform very many vaginal exams and avoid continuous fetal monitoring. They encourage laboring females to be out of bed, active, eating and drinking whenever possible to help get the baby in a good position. They tend to spend more time with their patients during labor, monitoring the progress of labor visually (following the patient’s cues) and by cordless monitor (so laboring patients are free to move around).
Inducing labor (using medication or other techniques to start labor) at 39 weeks may reduce the risk of C-sections and health concerns in first-time, low-risk pregnancies. And more than 25% of pregnancies involve induction.
CNMs follow evidence-based recommendations and regularly perform elective labor inductions — mainly because they tend to work with lower-risk pregnancies. They help their patients decide whether an elective induction is the right choice for them and their baby.
Many people mistakenly believe that once you deliver a baby via C-section, then all subsequent deliveries must also be C-sections. But approximately 14% of people who have had a previous C-section deliver vaginally, with the rate increasing every year.
Vaginal birth after C-section (VBAC) is successful for more than 60% to 80% of people who try it. CNMs have an expert understanding of the labor process and can lead you through a trial of labor after a cesarian birth. If you do end up needing a C-section, doctors are standing by and ready to assist.
CNMs work with people from adolescence through adulthood. In addition to pregnancy, birth and postpartum care, they manage almost all aspects of women’s health, including:
CNMs partner closely with OB/GYNs. They follow established guidelines that determine when it’s best to provide care together and when to transfer the patient’s care completely — typically in a high-risk situation.
The term “midwife” means “with-woman.” Certified nurse midwives take that name seriously, providing patient-centered health care for each and every patient.
