October 24, 2023
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:
Myth: All Midwives Are Equally Qualified
While most midwives have some training, they don’t all have the same credentials or level of formal training.
Types of midwives include:
- Certified nurse midwives (CNMs) are licensed registered nurses (RNs); many are also nurse practitioners (NPs). They have a graduate degree, complete clinical work and have passed a certification exam. CNMs can work in all settings, including hospitals.
- Certified midwives (CMs) have graduate degrees, complete clinical work and earn certification like CNMs. But they are not licensed RNs. CMs can get licensed in certain states — though Missouri is not one of them.
- Certified professional midwives (CPMs) must complete training requirements but do not need an advanced degree to earn a certification. They do not have hospital privileges and tend to work in birthing centers or deliver babies at home.
- Traditional or lay midwives may have an informal education but have not attained certification or a license related to midwifery.
Myth: People Only Use Midwives for Home Births or in Birthing Centers
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.
Myth: Midwives Do Everything Naturally and Don’t Believe in Epidurals or Pain Medicine
Midwives do view health and pregnancy holistically. CNMs have a philosophy that is more complicated than that. They believe:
- Birth is a natural and healthy process that doesn’t necessarily require medical intervention.
- Patients have the right to determine and actively participate in their health decisions.
- Clinical practice should reflect scientific evidence and what’s medically best for the patient.
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).
Myth: Certified Nurse Midwives Cannot Do Labor Inductions
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.
Myth: You Can’t Use a Midwife if You’ve Already Had a C-Section
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.
Myth: Midwives Only Work With Pregnant People
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:
- Birth control medication and IUD placement
- Menopause and related issues
- Menstruation and heavy periods
- Screenings for sexually transmitted diseases (STDs), cervical cancer (Pap smear) and breast cancer
- Vaginal health, which may include concerns about sex, discharge or pain
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.
Next Steps and Useful Resources
