Midwives have been here for ages, and in the past, it was standard practice for midwives to help with the pregnancy and birthing process. Although now, over 90% of women choose an obstetrician-gynecologist (OB-GYN) through pregnancy and at birth, some might choose the mom-centered care that includes getting a midwife.
So when is accepting a midwife a good option, and is it something you should consider? If you’re considering hiring a midwife, this guide can help you decide.
What’s A Midwife And What Does A Midwife Do?
Midwives offer pre- and postnatal care to pregnant mothers in addition to performing births and providing breastfeeding and nutritional assistance. They tend to concentrate on low-tech, low-risk births for moms-to-be that wish to attempt to avoid pain medications, surgical intervention, epidurals, and/or drugs that induce labor.
Is A Midwife A Physician?
No, a midwife is not a physician. While certified and licensed midwives are highly trained, they cannot perform cesarean sections by themselves. They can prescribe labor-inducing drugs and epidurals, but they are less possible to do so compared to doctors.
As midwives can serve low-risk births without a doctor present, in the event of a complication. Like an emergency C-section, they will need to find an on-call physician to do the surgery. In certain states, midwives should work in a collaborative practice with a physician. In others, they could work in a solo practice.
What Are The Advantages Of Having A Midwife?
Midwives are an excellent choice for mothers with low-risk pregnancies and for women who want a home birth, a birthing center delivery, natural birth without epidurals or labor-inducing medications, or water birth.
Midwives are often just as worried about the mental health of mothers as they are about her physical health. They are also more likely than physicians to concentrate on breastfeeding and lactation support before and after baby’s birth, and often place special importance on healthy eating during and after pregnancy.
Is A Midwife The Best Choice For You?
It is advised to consult with your healthcare provider and make a decision together that is ideal for both you and your baby. However, if your pregnancy is classified as low-risk by your physician, you have not dealt with complications (such as gestational diabetes or preeclampsia, among others), and you want a low-tech birth, a midwife may be an excellent choice for you.
What Are The Midwife Charges And Is It Covered By Insurance?
Midwives can vary from $2,000 to $6,000 in cost based on where you reside. Although insurance policy covers most midwives, you should consult with your insurance provider to make sure. While most of the health plans cover midwife births at hospitals, they may not include home births or those that happen at birthing centers. That said, midwives and birthing centers tend to charge less than OB-GYNs and hospitals.
Can Midwives Do C-Sections Or Provide Epidurals?
Midwives cannot perform C-sections without a doctor present. But, midwives can provide epidurals, though many women who choose a midwife would instead give birth with no pain medications.
How Do I Find The Perfect Midwife?
The best way to discover a good midwife is to do your own research. Request your friends, take a referral, and engage with midwives before determining which one is most suitable for your loved ones. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend choosing a midwife who is licensed by your state and accredited by the American Midwifery Certification Board.
What Are The Risks Or Drawbacks To Hiring A Midwife?
If your last birth was insecure, required a C-section, you have multiples or your medical care provider recognizes your pregnancy high-risk, using a physician present might be necessary. It may be stressful (and sometimes dangerous) to move from house or a birthing clinic to a hospital due to a birth complication or to change mid-pregnancy because a complication occurs. What is more, for some mothers, having a physician on hand at a hospital provides some reassurance if something does go wrong.
What Schooling And Certifications Are Required To Become A Midwife?
There are four categories of Midwives:
- certified professional midwives (CPMs),
- certified midwives (CMs),
- direct-entry midwives, and
- certified nurse-midwives (CNMs).
A CNM is a designated nurse with a graduate degree in midwifery who is certified by the American Midwifery Certification Board (AMCB) to assist with births in Puerto Rico and all 50 states.
A CM has an undergraduate degree (although not in nursing), certified by the AMCB, and a graduate degree in midwifery.
A CPM will either take licensed courses or is an apprentice before being accredited by the North American Registry of Midwives (NARM). Even though a CPM can offer pregnancy and postpartum care, she (or he) can’t prescribe most medicines. Most CPMs work in houses or birth center practices.
A direct-entry midwife is not a nurse but has either gone to a midwifery school or has had an apprenticeship or other training. Often, a direct entry midwife may be a CPM or a CM, but that isn’t always true. Direct entry midwives cannot perform births lawfully in all 50 states. Most of the midwives in the U.S. are CNMs.
Low-risk births are performed by midwives to reduce surgical intervention and provide mom-centered care. But do not forget that regardless of what sort of practitioner you choose, birth plans aren’t set in stone.
Whatever your birth purposes, your newborn might have a different strategy in the works. Whether your child’s birth is accompanied by a doctor in a hospital. A midwife in your home or something in between attends your child’s birth.
All that matters is that you have a happy, healthy baby when it is all over.
Barriers To Midwifery Care
Midwifery care is often challenging to get, even for those who need it.
Midwives aren’t as easily available or allowed as part of the obstetric practice in some states and regions. By way of instance, there are now just about 12 CPMs and 16 CNMs authorized to practice in the whole state of Alabama.
State-by-state law also limits midwifery practice for CPMs and CNMs. This can make it more challenging for midwives to do their jobs. For customers to understand midwives’ roles and select them as providers.
For those who want to use midwives out of the hospital, barriers can be even higher. Some insurance, including Medicaid, will not cover out-of-hospital birthing choices, including birth facilities. These out-of-pocket costs are not feasible for many families.
Midwives And Women Of Color
Cultural competency is also a problem. A serious lack of midwives of color makes it less probable that women of color will access midwifery care.
Presently, black women in the USA are a few times more prone to die in the perinatal period than white women. As per the March of Dimes, they are 49% more likely to give birth prematurely.
This inequality may be because suppliers may undervalue the pain of black patients or remove their symptoms. Serena Williams is a good example. She needed to ask her physicians to test for blood clots after the cesarean birth of her daughter in 2017.
Midwifery care could make an improvement in birth experiences for black women. Yet it can be near impossible for black women to find midwifery providers who look like them.
Racha Tahani Lawler, a black CPM who has been practicing for 16 years, concludes that there are less than 100 black CPMs in the whole nation. As of 2009, 95.2% of CNMs identified as Caucasian.
Many of the Lawler’s clients are not aware of midwifery or home birth options, she says until they have a terrible experience. “The catalyst for many black folks is, ‘I do not like the way they’re treating me,’ or ‘I feel like I’m being harmed in my appointments, ‘” she says.
A mother in Los Angeles, veronica Gipson, chose home birth with Lawler following three birth experiences at hospitals that she believed disrespectful, racialized, and disappointing. However, she came to Lawler with only around a month left in her fourth delivery. Lawler worked with her to set care and a payment method.
Gipson says it was more than worth it. However, she was at first intimidated by the cost of home birth midwifery: “It is so helpful to have somebody who looks like you and knows you. It is a priceless relationship, a bond, and a feeling. I’m not only rooms 31 at the hospital — I am Veronica when I am with Racha.” Gipson has because she had Lawler accompany the birth of her fifth child.
The Future Of Midwifery In The USA
Health specialists say midwifery could be a viable alternative to help solve a range of ills from the American maternal health care system, such as:
- Making maternity care less costly
- Helping to address the plight of the dwindling numbers of motherhood care providers
- Reducing the maternal mortality rate
There’s a long way to go before midwives are completely and successfully integrated into the U.S. health care system.
Vedam believes it will take a systems-level collaboration before midwifery is both approve and incorporate. “Healthcare administrators, health policymakers, researchers, providers, the public — everyone will have to work together.”
But customers with resources or accessibility to healthcare coverage can, however, choose by trying midwifery care. Making it obvious that they want midwives in their communities, adds Vedam.
“Studies show us that midwife care is the most reliable care for a low-risk woman. So, if you wish to have that normal experience, seek a midwife that will work with you to get you the attention that you want.”
And if that day of complete acceptance ever comes, there is a good chance American mother and babies may be in better care.