What Exactly Does a Midwife Do?

As a midwife, I am often asked what exactly it is that I do?

Although the percentage is rising, only 10% of births in the United States are attended by midwives, so it’s not unusual to find myself explaining my profession. The term “midwife” is from Middle English and translates to “with (mid) woman (wife)” meaning a woman supporting a woman, and the vast majority of modern day midwives are still women.

Midwives are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care.

There are two types of midwife: Certified Nurse Midwife (CNM) and Certified Professional Midwife (CPM).

A Certified Nurse Midwife (CNM) is an advanced practice registered nurse in nurse midwifery, the nursing care of women during pregnancy and the postpartum period. A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM)  and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. In Texas, CNMs can practice in the hospital, clinic, birth center and out-of-hospital settings, while CPMs primarily practice in out-of-hospital settings such as birth centers and home birth.

So what does care with a CPM during the childbearing year involve?

It involves all of the standard clinical care provided by an OB: routine prenatal labs, monitoring of vital signs and urinalysis, monitoring of fetal growth and fetal heart rate and referrals for any necessary ultrasounds. The prenatal appointments fall at the same intervals as they do in an OB practice with visits once a month until 32 weeks and then bi-weekly until 36 weeks, at which point the visits become weekly. Ok, so how is it different? Each of those appointments is 45 minutes to an hour with the clinical portion only taking about 10 minutes. The remainder of the time is spent on education and informed choice, the cornerstones of midwifery care.

In addition to being trained to conduct comprehensive physical exams and order laboratory, screening and other diagnostic tests, midwives provide extensive health care education and counseling, as well as engage in shared decision-making with their clients and patients. Midwives are trained in normal physiologic pregnancy, birth and postpartum, and as a result, we focus on keeping pregnant women within the large spectrum of normal. Extensive nutritional counseling, discussions of exercise and encouraging a healthy mind-body connection are essential to maintaining the normalcy of a healthy pregnancy.

CPMs focus on family-centered maternity care by encouraging the participation of all family members in the formation of or addition to their family. Each prenatal visit involves education about topics such as: the best way to maintain a healthy pregnancy, what does birth look like/sound like/feel like, breastfeeding education and postpartum information. All of this education empowers women and their partners to make informed healthcare decisions about testing and treatment options, another crucial aspect of the midwifery model of care.

Relationship-based, truly personalized care

Most CPMs limit their practices to 3-8 births a month which allows them to develop relationships with their clients and the ability to offer truly personalized attention and care. I believe that this relationship helps build a solid foundation for the families in our care. Midwives’ holistic approach to care during the childbearing year includes the use of herbs and homeopathics and referrals to other holistic care providers such as chiropractors, acupuncturists, homeopaths and massage therapists. Because we are well trained in the natural, normal physiological processes of pregnancy and birth, midwives understand when it is necessary to collaborate and consult with an OB or other pregnancy medical specialist.

Births with a CPM in Texas are always out of the hospital and can occur in the home or in a free-standing birth center. Midwives cannot prescribe pain medication or use epidural anesthesia, but we can utilize IV fluids as necessary and carry prescription medications and all necessary equipment to manage neo-natal resuscitation and postpartum hemorrhages. We are skilled in managing normal labor and have many techniques and methods for helping a woman through the birth process with less than 10% of women transferring to the hospital during labor. The vast majority of those transfers are for first time mamas who have experienced a long labor and suffer from fatigue. During labor, midwives monitor the well being of mom and baby by regularly assessing maternal vitals and progression and intermittent monitoring of fetal heart tones with a Doppler.

We are skilled in managing normal labor and have many techniques and methods for helping a woman through the birth process with less than 10% of women transferring to the hospital during labor.

All of the prenatal education and relationship building leads to a mama and her partner who are well equipped to manage the hard work of labor. The midwife is present for the birth for the duration of the active phase of labor (and more or less time depending on the situation). She then stays for up to five hours after the birth to monitor mom and baby, only leaving when everyone is stable and well but remaining available by phone 24/7 in case of any issues. Studies confirm that midwifery care leads to fewer interventions and maternal and fetal outcomes equal to those in the hospital.

Postpartum care as a critical component in midwifery

Another added bonus of working with a midwife is that she is trained in well-woman and well-baby care during the postpartum period. Midwives generally make 2-3 visits to the home during the first week postpartum to assess the physical and emotional well being of both. This care is critical because it encourages the mother-baby bonding to continue by allowing everyone to stay at home during the magical first weeks. She then sees the family in her office at two weeks and six weeks postpartum. The last visit is always bittersweet because of the strong bond and relationship formed over the last months. It is not unusual to hear from a mama years after the birth just to check in or to ask a question about toddlerhood.

While most women come to midwives for clinical care during pregnancy and birth, they can return for well-woman care, preconception counseling and repeat birth services. As we say “Once your midwife, always your midwife.”

www.tandemmidwifery.com

2324 E. Cesar Chavez

Austin, TX 78702

512-537-9201

tandemmidwifery@gmail.com

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