Midwife or Obstetrician?
In the United States, women's choices once were limited to an obstetrician or a knowledgeable family doctor. But now, midwives are another alternative for women with low-risk, uncomplicated pregnancies. So you're probably wondering whether you should choose an obstetrician or a midwife? The answer depends on your health and any risks to your or your baby, as well as your comfort level with a more traditional hospital birth, or your preference for a more natural experience.
If you're planning to get pregnant or just discovered you're expecting, one of the first things you want to do is begin your prenatal care. Now the question is whether you want to see an OB/Gyn (obstetrician/gynecologist) or a midwife throughout your pregnancy, delivery and follow-up care? Whether you choose an obstetrician or a midwife will depend on a few things, including what you want from your pregnancy experience, whether you or your baby have any health risks, if you prefer a birthing center or a hospital and, of course, what your insurance will cover.
Choosing an OB or OB/Gyn
You may already have an OB/Gyn that you are comfortable with. If so, this is a good time to talk with your doctor about your expectations for your birth experience, his or her approach to birth and any concerns you may have. If you're considering a midwife, this is also a great time to discuss any health risks you may have, and to create a backup plan in case of last minute changes or if the unexpected happens, such as the need for a c-section.
If you don't already have an OB/Gyn and would like to find one, you can start by asking your family doctor for suggestions. Friends and family members are also great resources, especially if they have an OB who has already delivered their children. Another resource may be your health insurance provider who can give you a list of OBs in your area that also accept your insurance. And, of course, you can always do an online search. Once you've made a list of doctors you'd like to interview, schedule an appointment to determine which doctor you're most comfortable with.
What Kind of Training does an OB/Gyn Have?
An obstetrician specializes in the female reproductive system with extensive training in pregnancy, labor and birth. To practice as an OB or OB/Gyn, the doctor must first be board certified. Board-certified obstetricians are required to complete an approved medical school and an additional four years of residency training in obstetrics, gynecology, gynecologic oncology, ultrasonography and preventive care.
Sometimes unexpected things can happen. One major advantage to choosing an OB is that you'll be delivering in a hospital. If something goes wrong or complications arise that require a c-section or other surgery being in a hospital means that the doctor has access to the necessary equipment and support. If your baby needs assistance, medical care from a pediatrician or neonatologist is also available at the hospital.
To help with your decision, you'll want to talk to the obstetrician about things that are important to you, like any risks you may have and the birthing experience available to you, such as a natural or reduced pain delivery. If you feel comfortable with your obstetrician and your options, this may be the choice for you.
Choosing a Midwife
If you're like many women today, you may want to have a more natural birthing experience without any medication. So you're probably wondering, "Is a midwife a good option for me?" In order to answer that question, it helps to understand what midwives are and how one can help you through childbirth.
The History of Midwives
The word "midwife" comes from Old English and means "with woman." Midwives have helped women deliver babies since the beginning of history. References to midwives are found in ancient Hindu records, in Greek and Roman manuscripts, and even in the Bible.
As early as 1560, Parisian midwives had to pass a licensing examination and abide by regulations to practice. Not all midwives had this level of education, however. English midwives received little formal training and weren't licensed until 1902. America inherited the English model of midwifery.
Early American midwives usually learned their craft through apprenticeship and tradition. They were not educated about scientific advances in fighting infection through hygiene and drugs such as penicillin.
Around this time, American medical doctors began a campaign against midwifery in the press, the courts, and Congress. They blamed midwives for the high rates of death among mothers and babies. Doctors also might have viewed midwives as competition.
Whatever the doctors' motivations, the rate of midwife-attended births dropped during and after the campaign. But that criticism from the medical establishment also prompted the foundation of the first certified American nurse-midwifery school in 1932. It aimed to incorporate the necessary medical training into midwifery's traditional approach to pregnancy and labor.
What Kind of Training Do Midwives Have?
Midwives today come from a variety of backgrounds. The subtitle a midwife uses will indicate the level of education and training.
Many American midwives are certified nurse-midwives (CNMs) who:
- have at least a bachelor's degree and may have a master's or doctoral degree
- have completed both nursing and midwifery training
- have passed exams to become certified and have fulfilled state licensing requirements
- may work in conjunction with doctors
Most births assisted by certified nurse-midwives occur in hospitals.
A certified midwife (CM) has also passed exams to become certified, but is not a registered nurse. Currently, only some states recognize this certification as sufficient for licensing.
A lay or direct-entry midwife may or may not have a college degree or a certification. Direct-entry midwives may have trained through apprenticeship, workshops, formal instruction, or a combination of these. They don't always work in conjunction with doctors, and they usually practice in homes or non-hospital birth centers. But not every state regulates direct-entry midwives or allows them to practice.
A certified professional midwife (CPM) is certified by the North American Registry of Midwives after passing written exams and hands-on skill evaluations. They're required to have out-of-hospital birth experience, and usually practice in homes and birth centers. Their legal status varies according to state.
What's the Midwife's Philosophy?
A midwife's education stresses that pregnancy and birth are normal, healthy events until proven otherwise. Midwives view their role as supporting the pregnant woman while letting nature takes its course.
Midwives also focus on the psychological aspects of how the mother-to-be feels about her pregnancy and the actual birth experience. They encourage women to trust their own instincts and seek the information they need to make their own valuable decisions about pregnancy, birth, and parenthood.
Of course, many doctors share these values. Doctors often use preventive testing and medical technology — such as ultrasound, continuous fetal monitoring, and the option of pain medications during birth — more than midwives do. While high-risk pregnancies certainly need a more intense approach, many midwives feel that most uncomplicated pregnancies do not need as many interventions.
What Does a Midwife Do?
Midwives generally spend a lot of time during prenatal visits addressing a woman's individual concerns and needs, and will stay with her as much as possible throughout labor. They sometimes encourage physical positioning during labor such as walking around, showering, rocking, or leaning on birthing balls. Midwives also usually allow women to eat and drink during labor.
Certified nurse-midwives, like doctors, may use some medical interventions, such as electronic fetal monitoring, labor-inducing drugs, pain medications, epidurals, and episiotomies, if the need arises. However, a certified midwife, certified professional midwife, or direct-entry midwife may not legally be allowed to use these techniques without a doctor's supervision. And birthing centers may or may not be equipped for these procedures.
A major difference between doctors and midwives is the doctors' ability to intervene surgically when necessary and to deal with complications that arise.
Some midwives can't administer drugs or anesthesia. And no matter what licensing they have, midwives cannot perform cesarean sections (C-sections). If one were required, an obstetrician would have to perform your delivery.
If you feel more comfortable having those options immediately available, a doctor may be the right choice for you.
Certified midwives are trained in basic life support for newborns and, in the event of sudden complications with your baby after birth, can provide some care for the baby until a pediatrician or neonatologist (an intensive-care specialist for newborns) is available.
Is a Midwife Right for You?
Several studies have shown that midwife-supervised births produce excellent outcomes with fewer medical interventions than average. Midwives' patients use electronic fetal monitoring less often and tend to have a reduced need for epidurals, episiotomies, and C-sections for successful deliveries. To some degree, this stems from the fact that midwives see only low-risk patients with uncomplicated pregnancies.
But some researchers attribute the need for a minimum of medical intervention to the midwives' natural approach to the management of labor and delivery, which may reduce a woman's fear, pain, and anxiety during birth.
Using a midwife without an obstetrician is not advisable for women with higher-risk pregnancies. Those expecting twins or multiples and those with prior pregnancy complications, gestational diabetes, high blood pressure, or chronic health problems of any kind before pregnancy should discuss their options with their primary health care provider or an obstetrician. Also, if any potentially serious complications arise during delivery, midwives should involve an obstetrician.
Certified nurse-midwives who practice in major medical centers and work very closely with obstetricians and perinatologists (specialists in high-risk pregnancy) may take patients with risk factors. But midwives in solo practice or who practice in limited medical facilities generally do not.
What if Something Goes Wrong?
Midwives are trained to recognize the signs of trouble in pregnancy and labor. If a complication develops at any time, the midwife should consult a doctor. If your midwife doesn't already have a practice agreement with a doctor, be sure to find out what will be done in case of a complication.
If you plan to deliver at a non-hospital birth center or at home, an emergency back-up plan is especially critical. If you must go to the hospital, your midwife will go with you and will continue to support you throughout your labor.
But it's a good idea to get answers to these questions:
- Who will back up the midwife in case of a problem?
- What training or equipment does your midwife have to handle emergencies?
- How far will you be from the nearest hospital?
- Do they have fail-safe transportation?
Finding a Midwife
You can decide to use a midwife at any time during your pregnancy. Women often turn to midwifery a few months before their due dates, when they begin to seriously consider their birth plans.
To evaluate your medical needs, most midwives will request that you bring your prenatal care records to your first meeting. Few midwives will accept a patient well along in pregnancy unless she has had adequate prenatal care.
Interview a prospective midwife carefully. Investigate the midwife's background, certifications, experience, back-up practitioners, and ability to handle emergency procedures. Because you'll be closely involved, make sure your personalities mesh. Do you feel comfortable with the midwife? Can you talk easily?
To locate a midwife, ask your obstetrician-gynecologist (OB/GYN), family doctor, and friends for a referral.
What is the Difference Between a Midwife and a Doula?
The terms midwife and doula may seem like the same thing, but other than the fact that they both help women through childbirth, they're actually quite different. A midwife provides prenatal care, labor and delivery management, postpartum care and other health care services. A doula, on the other hand, is more like a labor and delivery coach. While doulas don't provide health services, they do provide parents with additional services and support during labor and/or in your baby's first days at home.
There are three types of doulas: the birth doula, the antepartum doula, and the postpartum doula. The birth doula will help you know what to expect, helps to ensure your birth experiences and wishes are met, and even helps make you more comfortable during labor. An antepartum doula specializes in helping expectant moms cope with high-risk pregnancies, helping both parents understand what to expect and providing physical and emotional support during stressful times. Postpartum doulas help new parents adjust to life with baby, offering tips on infant care and ways to manage the sometimes overwhelming stress that comes from having a newborn.
The Choice is Yours
There are many birth options available today. Your decision will most likely be based on things like cost, insurance coverage and ultimately and the type of experience you want and are most comfortable with.
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