The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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Midwives are being “rediscovered” by growing numbers of pregnant women today. According to the National Center for Health Statistics, in 2006 (the most recent figures available), they attended a record-busting 317,168 births—7.4 percent of all U.S. births; 96.7 percent of them took place in hospitals, 2 percent in birth centers and 1.3 percent in homes. To help you decide whether to go the midwife route, here are answers to some of the most common questions.
What advantages do midwives offer?
The Midwives Model of Care views pregnancy and birth as normal events; as a result, midwives suggest and perform fewer interventions than are typical with most obstetric care. “Midwives focus more on nutrition and education,” says Judi Tinkelenberg, C.N.M., R.N., clinical director of Sage Femme Midwifery Service and Birth Center in San Francisco. “We do fewer routine, often unnecessary tests—for example, we don’t automatically do ultrasounds if they’re not needed. We make decisions with patients based on informed consent.” Midwives also spend more time with patients than most OBs do, which means they often offer more personalized care.
What exactly does “midwife” mean?
All midwives provide prenatal and postpartum care, attend labors and deliver babies. Some provide additional services, such as routine gynecologic exams and contraception care. But do your homework; anyone can call herself a midwife. Here are the distinctions:
• Certified midwives (C.M.) meet American College of Nurse-Midwives (midwife.org) requirements, but they do not need to be nurses.
• Certified nurse-midwives (C.N.M.) are nurse- practitioners who are certified by the American College of Nurse-Midwives.
• Certified professional midwives (C.P.M.) meet North American Registry of Midwives (narm.org) certification standards.
• Direct entry midwives (D.E.M.) are educated through self-study, apprenticeship, midwifery school or college- or university-based programs that don’t include nursing. They include certified midwives and certified professional midwives.
• Lay midwives are sometimes called traditional, unlicensed or “granny” midwives. These women are educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren’t certified or licensed.
• Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.
For more information on the different types of midwives, go to mana.org.
What’s the best kind of midwife?
That depends on whether you want a hospital or out-of-hospital birth, a low-intervention or medicated one. The most important thing is to make sure anyone you’re considering is qualified and experienced. “Direct entry midwives and certified nurse-midwives have different educational pathways, but they’re all well-trained and competent,” says Geradine Simkins, D.E.M., C.N.M., M.S.N., president of the Midwives Alliance of North America. Most C.N.M.s deliver in hospitals, while C.P.M.s have specific training and expertise in out-of-hospital births.