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The Institute of Medicine and the National Commission to Prevent Infant Mortality praise the contributions of certified nurse-midwives in reducing the incidence of low-birth-weight infants and call for their increased utilization, and the new federal Health Care Reform Act strengthens the legitimacy of certified direct entry midwives.
Is it safe to go with a midwife?
Yes, as long as you have no pregnancy complications or risk factors for birth complications. For 60 to 80 percent of low-risk pregnancies, it may be even safer to go with a C.M. or a C.N.M. than with an obstetrician. That’s because midwives use less fetal monitoring and over-diagnose fetal distress less often, which means fewer interventions, such as C-sections and forceps- or vacuum-assisted deliveries. Studies show that C.N.M.-attended births are associated with 31 percent fewer low-birth-weight babies and 33 percent less neonatal mortality.
If you have certain health risks, including obesity, diabetes or hypertension or are carrying multiples, you might still qualify for midwife care, but only if it’s coordinated with an OB. If you want to give birth at home, make sure your midwife has protocols for a quick transfer to a hospital in case of an emergency.
How do costs and care compare with those of obstetricians?
Midwifery care can cost less overall, but C.N.M.s are sometimes paid similar rates as OBs. Insurance companies currently pay for most C.N.M. services, and under the new federal health care legislation, certified D.E.M.s will also be covered.
As for whether the midwife you see for prenatal visits will deliver your baby, it’s the same as if you were seeing an OB. “Many private practice midwives make a special effort to be at their own patients’ births, even when they share call with partners,” says Karen Parker Linn, a C.N.M. in Portland, Ore. In shared practices, several midwives work together. Patients see different ones during pregnancy and deliver with whomever is on call, though midwives sometimes come in for patients with whom they’ve formed a special bond, Linn adds.
Do doctors respect midwives?
Most hospital-based midwives are well-respected by OBs. Out-of-hospital midwives? Not as much. Most out-of-hospital births are safe, but when trouble arises and patients are transferred to hospitals, doctors sometimes feel like the clean-up crew for high-risk deliveries.
“Midwives are fantastic options for low-risk women,” says Kathleen Harney, M.D., chief of obstetrics for Cambridge Health Alliance and the C.N.M-managed Cambridge Birth Center in Massachusetts. “Their philosophy and training are more focused on birth as a healthy, natural process. Doctors are trained to think something adverse may happen,” she explains. “The truth is somewhere in between. Working in concert with midwives reminds OBs not to be overly interventionalist.” .
5 questions to ask a midwife
1. What is your training, experience and certification, and do you have references?
2. Where do you deliver—at home, in a birth center and/or in the hospital?
3. What percentage of your prenatal patients do you actually deliver yourself?
4. For an out-of-hospital birth, what’s your emergency backup plan?
5. Do you take medical insurance?