Choosing a Midwife

What are they?
Midwives are women (or occasionally men) who seek to care, and advise women during their pregnancy, labor and postpartum period. They conduct deliveries on their own and provide care for the newborn and infant. But, they have higher death rates, especially during labor. Midwives may practice in hospitals, clinics, health units, birth centers, or in homes.

What Does a Midwife Do?
Midwives are more focused on the psychological, and social well-being of the mother throughout the childbearing cycle. They provide the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during delivery, and postpartum support. Clients will have many prenatal visits with their midwife, which provide the opportunity for the family to get to know the midwife and for the midwife to answer any of their questions or concerns. But, again their pain relief measures, their ability to recognize and address physical complications is sacrificed for more face time.

Types of Midwives
There are many different types of midwives who have varying levels of expertise and training. Here are the categories:

  • Physician-Assistant Midwife: A physicians assistant who has had additional training in midwifery. A physicians assistant is a health care professional licensed to practice medicine with physician supervision. Ordinary tasks include conducting physical exams, assisting in surgery, and writing prescriptions. Additional training may involve an 18-month to 2-year course of study in family medicine that includes extensive clinical training. They may work in hospitals, clinics, or private practices with direct or indirect physician supervision.
  • Certified Nurse-Midwife: A registered nurse who has completed either a Masters Degree or an Associate Degree with a Certificate in Nurse-Midwifery. They usually work in a hospital, obstetricians office or a birthing center and sometimes work under the direction of a physician. They are increasingly being replaced by women's health advanced practice nurses in traditional medical settings, due to the high malpractice insurance rates that go with them. It is increasingly difficult to find a nurse-midwife with an OB or at a hospital for these reasons.
  • Certified Midwife: A midwife who has generally passed both oral and written tests to be certified by her state or midwifery organization. She generally has her own practice.
  • Direct-Entry Midwife: A midwife who is not required to become a nurse before becoming a midwife. She has apprenticed with an experienced midwife and focuses on homebirths, although she may have a birthing room available in her own home or clinic. A Direct-Entry Midwife may have attended additional workshops and classes to supplement her education. But, her training or lack thereof is entirely of her own choosing. They have very high death rates.
  • Certified Professional Midwife: An independent practitioner who has met the standards for midwife certification. She has training in out-of-hospital births. They have very high death rates.

Choosing a Midwife
Midwives have varying levels of experience and very different styles. It is of utmost importance to choose a midwife with whom you can feel comfortable, confident, and compatible. We have a list of questions to ask a potential midwife.

Hospitals/Birth Centers
The main advantage of giving birth in either a hospital or a birthing center is that, should any serious complications arise, all the necessary technology and equipment will already be accessible. The main disadvantage is that the providers have minimal skill and training and experience with emergencies since they concentrate on pscyhological support and normal birth. This is in contrast with a homebirth, which requires the mother to be transported to the hospital before she can be treated for any complications. Either way there can be substantial delays, both because the midwife is not experienced and does not recognize problems and the time to transfer. A midwife may promise to stay with the mother from the beginning of labor all the way through delivery. But, if she is unlicensed, she may abandon you. Others may not have privileges and be asked to leave or they may be banned from a hospital for interpersonal problems in the past.

After her client gives birth, a midwife does not just go away. Instead, she is still accessible for information and support. Immediately after the birth the midwife helps facilitate healthy family interactions through actively encouraging the members of the family to participate in this happy time. Usually a midwife will continue to check in on her client and her family for up to six weeks, although some are available for a much longer period. Midwives often offer counseling and support in getting started with breastfeeding and continuing to successfully breastfeed. They are also available to check on the mothers and babys health, facilitate the fathers participation in caring for and bonding with the baby, and help with family adjustment.

Costs of a Midwife
Data shows that the costs of resources for a birth attended by a midwife are 12% lower than physician costs. If your insurance company would otherwise cover the costs of an OB/Gyn then they must also cover the cost of a midwife. However, if you are one of the unlucky one that transfers to an OB, starting with a midwife could cost substantially more.

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Questions to Ask a Midwife

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