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Midwife Q&A

Moms-to-be have a lot of decisions to make, starting with choosing a care provider. We spoke with Ellie Daniels, CPM, president of the National Association of Certified Professional Midwives, to find out what midwives do and how to choose the best midwife for your pregnancy and birth. 

What exactly do midwives do? Do you offer the same services as an OB/GYN?
Basically yes. Midwives by and large are experts in normal, low-risk pregnancy and birth, and oftentimes people think midwives are associated with a more natural approach to birth with less medical intervention. Midwives work in all kinds of settings, everywhere from the hospital, to birth centers attached to the hospitals, to freestanding birth centers to home births. A mom could pick a whole breadth of locations and find a midwife practicing in that setting.
Midwives do all of the prenatal care for moms. They do lab work. They can access testing and ultrasounds. They can monitor labor. They provide immediate newborn care as well as the care for women generally through the first 6 weeks of their postpartum time.

How does a midwife differ from a doula?
Doulas are birth companions. Sometimes they work a little prenatally and a little postpartum, but their basic focus is on labor support. There is great research supporting the effectiveness of having a doula for having your labor be shorter and greatly reducing the rates of cesarean section and intervention and labor relief. But doulas are not trained in all the medical and technical science and art of actually supporting a healthy pregnancy and a good labor. So in other words, doulas don't interpret lab work or palpate babies or listen to heart tones or know how to assess labor progress.

What about medically fragile situations or high-risk pregnancies? What do midwives do when a birth situation gets serious?
All midwives have ways in which they can either consult with medical care providers or collaborate with medical care providers or transfer care to medical care providers. I think one thing that is unique to midwives is that they are always working in a preventative model. At our practice, we offer something called complementary care. We see women who are planning a hospital birth with an obstetrician who come to us for care at the same time as they’re seeing the OB [because] they don't feel like they have enough time to talk about things like nutrition or body changes or how they can best prepare for breastfeeding or how they can prepare their toddlers to be a big brother or big sister. The focus in an obstetrician’s office is very much on the event of birth itself. [In midwifery care] birth is seen as a point in the whole childbearing year, which encompasses the whole pregnancy.
We do a lot of preventative care, education and preparation as well as mutual decision making with couples so both Mom and Dad get involved and feel empowered in their process. That’s a good way to ward off about 95 percent of the things that could happen. So many of the problems of pregnancy are largely nutritional in character. If we do consult with a medical person it is something that has truly propped up that was an unexpected event.
What questions should a mom-to-be ask a prospective midwife?
Where do you work? If she’s calling a nurse-midwife, they typically work in hospital settings or in birth centers attached to hospitals. If she’s not a certified nurse-midwife, is she a certified professional midwife [CPM]? CPMs typically work in home settings and in freestanding birth center settings and they are experts in out-of-hospital care. The mom needs to have an understanding of where she will feel most comfortable and where the setting will be most appropriate for her situation. Most of the time birth is a completely normal and natural event but there are of course a mom’s preferences and where she will feel most comfortable. For some people, that’s at home. For other people, that’s in a large hospital with an OB. That’s not about risk factors, that’s about comfort level.
She needs to find out whether she’s going to know that she can actually see that midwife for her prenatal course and also for her birth. Many midwives work in rotations with other practitioners. Sometimes you’re lucky to have five or six midwives working in a rotation, but you might not know specifically which one [will attend your birth]. In other settings, midwives work in rotation with doctors. If she has her heart set on a midwife, she might be unpleasantly surprised.
Once she’s figured out that, she wants to know about the skills and experience and education of her midwife. Is she credentialed? Is she licensed by her state? Oftentimes midwives come recommended by friends and family. It’s always good to have heard someone who’s had a positive experience with a midwife.
And then there’s the safety questions. What if something happens? What does that look like when we have to go to the hospital? Do you carry any medications? What equipment do you have?
Once a woman has chosen a midwife, what do the visits look like? Is the partner typically involved?
In our practice, typically we have 10–12 visits over the course of the pregnancy before the birth. We always welcome and encourage her partner to come along and we try to schedule such that people can work it out around their work. We really welcome siblings into the office. We enjoy getting to know the entire family. We have a luxury of a lot of nice time with people to get to know them and their whole selves and their whole family unit.
Early in one of the first trimester appointments, we typically are talking about different pregnancy screenings and lab works available and making referrals for those things. We have an affiliation with places that do ultrasounds. There’s really sort of a schedule of things that are presented as choices to the woman and her partner and her family.
They’re usually getting so much information in their visits. By the end of their pregnancy, they have a whole folder of information and handouts and a lot of pictures of their baby during the pregnancy.