There are a lot of misunderstandings out there about midwives. I had a very well-educated relative that was shocked to learn that most home birth midwives carry things like oxygen, fetal heartbeat monitors, and medicines to stop excessive bleeding at birth. I’m pretty sure that a lot of people, when they think of midwives, imagine some kind of Earth mother with braided hair and essential oils. And for SURE, if you want a midwife stamped from that mold, you can find one, and she would probably be awesome. But the main difference that I have seen between the midwifery model of care and the medical model of care is that from the midwifery point of view, birth is a normal physiologic process that normally goes well and sometimes needs medical help, and from the medical point of view birth is a delicate process that will probably go wrong and turn into an emergency at any moment if the provider doesn’t take charge and manage things from the start. There are different kinds of midwives who practice in different kinds of settings, and it’s good to understand the differences.
Certified Professional Midwives
Certified Professional Midwives, or CPMs, are the ones that most people are really talking about when they mention midwives. They are trained for and attend home births. They are experts in out-of-hospital birth. They know all kinds of things about how to help labor progress and how to manage when things aren’t going so well in labor. Very importantly, they are trained to know when a mother would be safer in a hospital setting and needs to transfer from a home birth to have a hospital birth. This doesn’t mean that the home birth has been a failure. A certain percentage of births will need medical intervention that can’t be given at home, and so a certain number of transfers from home to hospital should be expected.
When midwifery legislation was up for a vote in Alabama (and I have seen this in other places, too) CPMs were mistakenly (whether honestly or dishonestly) called “lay” midwives, implying that anyone could decide to be a midwife, watch a few YouTube videos on the birthing process, and open up practice. But the CPM credential is earned only after a lengthy process of education, apprenticeship, and sitting for an exam by NARM, the North American Registry of Midwives. In Alabama, to be licensed, a CPM must also meet the additional requirements of the “Midwifery Bridge Certificate,” which requires even more education.
In Alabama, licensed CPMs are only permitted to attend the births of babies who are not multiples, not breech, and whose mother has not had a previous cesarean. They do not give mothers pain medications or epidurals, so a mother wanting a home birth with a CPM is a mother planning to use non-medical methods (like water) to cope with the pain of labor.
Certified Nurse Midwives
Certified Nurse Midwives, or CNMs, first become credentialed as nurses, and then take additional training to become a midwife. Not surprisingly, since they are nurses, they usually work in more medical settings, like hospitals. In some states, CNMs are able to practice somewhat independently, the way Nurse Practitioners do. But in Alabama, they must practice under the supervision of a doctor.
The nearest CNMs to our area (at least those who catch babies) are in Montgomery and Columbus, and lots of mothers drive to those two cities to receive midwifery care in a hospital setting. Because they practice in a hospital, their care is more like that of an OB/GYN, and there are more options for things like medical pain relief in labor. But usually, CNMs are willing to do birth with fewer interventions and restrictions than many OB/GYNs.
There are other kinds of midwives, like traditional midwives who are more common in areas where there is not as much access to medical care and who pass knowledge about birth from midwife to midwife, and “underground” midwives, who practice here in a more traditional way and who choose not to be regulated by examinations or licensing. But most of the midwives you will encounter in our part of the world fall into the CPM or CNM families.
So Why Choose a Midwife?
I’ll start by saying that midwives aren’t for everyone. By definition, they are experts in “normal” birth, meaning that some medical situations fall outside of their range of practice. Mothers with high risk pregnancies typically need the greater monitoring and skill range offered by an OB/GYN. In fact, in most of Europe, this is how maternity care is managed: low risk mothers with uncomplicated pregnancies are cared for by midwives, while only those facing special circumstances or complications would need the more advanced care of a doctor.
But in our system, which operates differently, why would a woman seek out a midwife? Well, most of the people I know who have chosen a midwife wanted a provider who would take a more hands-off approach, only intervening if there was a problem. They also wanted a caregiver who would remember that the mother is the one in charge of decision-making.
Why Choose a Home Birth if You Can Have a Midwife in a Hospital?
There are a few reasons. One comes down to having more control over how you are cared for. Do you want to labor and/or give birth in a tub? There are few hospitals in Alabama and none in our area who allow that. Do you want a provider who will monitor your baby’s heartbeat without asking you to get out of the shower? A home birth midwife is a good choice.
Usually, mothers who seek out a home birth want as few medical interventions as possible, only those truly necessary to keep birth safe. And many women feel safer at home than in a hospital setting.
Planned home birth is actually very safe for low-risk mothers, but one thing that makes it as safe as possible is when doctors and nurses do not stigmatize home birth and make transfers from home to hospital as seamless and easy as possible, without shaming the mother for her choice of home birth or treating the midwife as some kind of inferior caregiver.
It’s important to choose a provider that “matches” your philosophy of birth, so that you can feel confident in the recommendations they make for you, and for some people, that means choosing a midwife. Let me tell you a story about myself that illustrates this.
I chose a Certified Nurse Midwife for my third birth after having two births with OB/GYNs. My first two births went pretty well. I was able to meet my most important birthing goals. But I always, in all of my conversations with my doctors, felt like I had to be on my toes, ready to get into a bit of a debate, in order to do things the way I wanted. I knew I had to be on my guard during my birth in case my doctor suggested something I wasn’t sure I needed. I didn’t have bad experiences, but I didn’t feel fully supported.
When I was ready to have my third baby, I decided to make a change, and I went instead to a group of Certified Nurse Midwives who practiced in a hospital in another city. And something really neat happened. Every time I had a topic to discuss with them at an appointment, something that I did or didn’t want, they would say, “Actually, that’s how we always do things.” All the things I wanted were the default way of practicing for those midwives. I didn’t have to feel on my guard, I didn’t have to be prepared for debate. And it was WONDERFUL. I had found providers who matched my birth philosophy.
I want to also say that there are some midwives who practice more in the medical model (some call them MEDwives), and there are also doctors who practice more like a midwife. This isn’t meant to be a “midwives are good and doctors are bad” thing. The point is for each person to find the care provider who is the best fit for THEM.
Would you choose a midwife for your care? Did you have a midwife as your provider for your birth? Tell me what you think!
