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Should You Use a Midwife?

Pregnant woman reading a magazine

Andrew Parsons

When Joanie Holmes, of Hooper, Utah, became pregnant, she started seeing an ob-gyn who'd been recommended by a friend. "But after two appointments, I switched to a midwife whom my mom had suggested," she says. "To my doctor, I was 'just another delivery,' but the midwife really took the time to get to know me and understand how I wanted to give birth."

While physician-attended births are still the norm in the United States, the number of babies delivered by midwives is on the rise. Today, midwives deliver more than 310,000 babies -- 7 percent of all births. That number has more than doubled since 1990.

Though the image of midwives is changing, lots of people still think of them as untrained "coaches" who deliver babies at home or who insist that you give birth without drugs. If that's been your impression, read on for four things you didn't know about midwives -- and why you may want to consider finding one for your next pregnancy.

1. Midwives have gone mainstream. Unlike doulas or birthing assistants, whose main job is to comfort a woman during labor, most midwives are medical professionals with varying amounts of formal training.

"When my friends found out I had a midwife, most of them assumed I was giving birth at home," says Jennifer Martin, of Eldridge, Iowa. "But my son, Jonathan, was born in a hospital." In fact, 97 percent of midwives practice in hospitals, according to the American College of Nurse-Midwives. Only about 2 percent deliver in birthing centers, and 1 percent in homes. Certified nurse-midwives can also administer labor-inducing drugs and epidurals.

2. Using a midwife is just as safe as using a doctor. Studies show that moms who use midwives have increased access to prenatal care, lower rates of cesarean births and obstetric interventions, and babies with higher birth weights. In addition, even home births for low-risk pregnancies using certified professional midwives are just as safe as low-risk hospital births, according to a study published in 2005 in the British Medical Journal. In Japan, Sweden, and the Netherlands, where midwives deliver almost all babies, infant mortality rates are much lower than in the U.S., according to the National Center for Health Statistics.

3. Midwives focus on physical and emotional support. A midwife makes sense for any woman who has a low-risk pregnancy, doesn't have serious health problems, and wants to be more in charge of her labor and delivery. Midwife literally means "with woman," and that's her greatest strength -- a nurturing, woman-centered approach. "My midwife listened to me and respected my input," says Eireann Kiley of North Adams, Massachusetts. "She really took the time to get to know me and my husband." Midwives are likely to spend more time with you than most doctors and offer both emotional and physical support during prenatal visits, labor, delivery, and the postpartum period. "Midwives are especially good at helping new moms with breastfeeding, handling anxieties, and improving nutrition," says David Katz, MD, director of the Yale-Griffin Prevention Research Center, in Derby, Connecticut.

4. Midwives favor less invasive birth practices. Though midwives will help administer pain medication if a mom wants it, they tend to favor natural methods to ease the pain of labor and delivery. For example, they might give a mom a deep massage or encourage her to use an exercise ball to feel more comfortable, a warm compress to help the area stretch naturally and avoid tearing, or even a Jacuzzi to relax. These techniques can prevent episiotomies (the cutting of tissue to widen the birth canal) and help nature take its course, says Shafia Monroe, founder of the International Center for Traditional Childbearing, in Portland, Oregon. In fact, recent national studies show that the cesarean-section rate for midwives is 11.6 percent, one third that of the national rate. Midwives also have more successful VBAC (vaginal birth after cesarean) rates than the national averages. All this means that women who choose midwives are more likely to have a natural vaginal birth and to recuperate faster.

CNMs (certified nurse-midwives) typically deliver in hospitals and birthing centers. These are registered nurses with advanced training in obstetrics and gynecology as well as specialized midwifery training; they've passed a certification exam and are licensed to practice in all 50 states. Many CNMs are employed by a hospital or work with a physician for consultation as needed. In most states, they can prescribe medication.

CM (certified midwife) is another credential from the American College of Nurse-Midwives. It doesn't require a nursing degree but, aside from that, certification is the same as that for a CNM.

CPMs (certified professional midwives) are accredited through exams by the North American Registry of Midwives, and their legal status varies according to state. They deliver babies mostly in homes or birthing centers.

"Lay" midwives -- caregivers who've had only informal training -- deliver babies without being certified by any national organization. Some states have very strict standards; others don't regulate midwives at all. (Check your state's laws regarding midwives at mana.org/laws.)

How to Find a Good Midwife

  • Ask your doctor, friends, relatives, other moms, or childbirth teacher for suggestions.
  • Check with your local hospital to find out which midwives, if any, deliver babies there. Make sure you check references and credentials before making a final decision.
  • The American College of Nurse-Midwives has about 6,200 practicing members. Visit midwife.org to find a registered nurse-midwife near you.
  • The Midwives Alliance of North America (mana.org) is a national organization that represents midwives. Go to its Web site or to midwifeinfo.com for lists of midwives, including those who do home births.

Insurance may cover a midwife.

Thirty-three states mandate that insurance companies in every state reimburse the cost of hiring a nurse-midwife, and most of the big health-insurance companies cover midwife services in every state. Check with your insurer to find out what your carrier allows.