Midwife

What is a midwife?

Midwives are healthcare providers who deal with pregnancy, childbirth, newborn care and postpartum health. Some midwives provide routine reproductive care like pelvic exams, Pap tests, or counseling on birth control. Midwives tend to be more holistic and supportive of natural approaches to pregnancy and birth. People often choose a midwife when they know they want a nonmedicated birth or want to give birth at home.

Midwives are usually not physicians. They often work alongside obstetricians and gynecologists (Ob/Gyns) in a hospital to ensure you have access to any care you need. A midwife is recommended when your pregnancy is low-risk or if you have only mild complications.

Pregnancy and labor are very personal experiences. You have a choice about the kind of care you’d prefer. That’s why it may help to know the differences between midwives and Ob/Gyns.

What does a midwife do?

It depends on their credentials, certifications, schooling and where they practice. Certified midwives and certified nurse midwives can offer the most services. Midwives who aren’t certified offer fewer services.

Some of the health services a midwife may provide include:

• Prenatal appointments and routine pregnancy monitoring.
• Ultrasounds and prenatal blood work.
• Attending to birth and newborn care.
• Postpartum care.
• Educate on nutrition, lactation, fertility and other aspects of reproductive health.
• Birth control and family planning.
• Pap tests and breast exams.
• Screenings for sexually transmitted infections (STIs) and other vaginal infections and diseases.

A certified nurse midwife can practice at hospitals, clinics, birth centers or your home. Midwives who are not certified are limited in where they can practice. It’s best to ask your midwife what credentials they have and ask your hospital or birth center what the regulations are for midwife care.

What are the different types of midwives?

There are a few different types of midwives:

• Certified nurse midwives (CNMs): CNMs have completed nursing school and have a graduate degree in midwifery. In addition to pregnancy care and delivery, they can provide general reproductive care, prescribe medication, order lab tests and diagnose conditions. They’re qualified to work in hospitals, homes and birth centers. CNMs are certified by the American Midwifery Certification Board. They work in all 50 states and the District of Columbia.
• Certified midwives (CMs): CMs have a master’s degree in midwifery, except they haven’t completed nursing school. CMs have an undergraduate degree in something other than nursing. They’re certified by the American Midwifery Certification Board and can prescribe medications. CMs are only licensed to practice in a few (nine) states.
• Certified professional midwives (CPMs): CPMs work at birth centers or homes. They have completed coursework and are certified by the North American Registry of Midwives. CPMs aren’t licensed to practice in all states and can’t prescribe medications.
• Unlicensed or lay midwives: These midwives don’t have certification or a license to practice. They are either self-taught or have received some other type of training which could include an apprenticeship. Unlicensed midwives work almost exclusively in homes.

Are midwives doctors?

Most midwives aren’t doctors. Some earn doctorates in nursing practice.

What is the difference between an Ob/Gyn and a midwife?

Ob/Gyns and midwives differ in their schooling and approach to care.

Midwives are highly supportive and take a more natural approach to pregnancy and childbirth. They view pregnancy and birth as a natural process instead of a condition that needs managed. They tend to be more open to nontraditional approaches to labor and delivery. People may want a midwife for a more relaxed birthing experience.

Midwives didn’t attend medical school and can’t provide all of the same services as an Ob/Gyn. They can’t treat high-risk pregnancies or complications during delivery. Obstetricians can manage complications using medical or surgical interventions that aren’t available to midwives.

That’s not to say Ob/Gyns won’t offer supportive and personalized care or be open to alternative approaches to your care. If you are unsure, you should meet with both providers to see who fits your personality and your desires for pregnancy and delivery.

Is a midwife better than an Ob/Gyn?

It’s a personal preference. Some people prefer midwives, and others prefer Ob/Gyns. A midwife is typically only recommended for low-risk pregnancies. Most pregnancies in the United States are low-risk. Some advantages of using a midwife are:

• Less chance of induction or assisted delivery.
• Less chance of cesarean birth.
• Reduced use of epidurals or medication.
• Less risk of third and fourth-degree perineal tears.
• More flexibility for home births.
• You have greater control over your care.

Midwives typically are not trained to perform surgeries. Midwives will refer people to Ob/Gyns if their pregnancy or birthing experience becomes complicated or high-risk.

Should I have a midwife?

A midwife might be for you if you have a low-risk, routine pregnancy and if you desire a more personalized relationship with your provider. If you have a health condition that could complicate your pregnancy or delivery, close collaboration between your midwife and obstetrician is ideal. Some of these conditions include:

• High blood pressure.
• Diabetes.
• History of seizures.
• Previous high-risk pregnancies.
• Expecting multiples.

If you decide to use a midwife, we recommend finding one who’s licensed and certified to practice in your state.

Are there risks to having a midwife?

Midwives consult with Ob/Gyns, maternal-fetal medicine specialists and other healthcare providers to mitigate risk in your care. Working with a midwife who attends births in a hospital setting is usually recommended if you are worried about delivery. This can give you the safety net you’re looking for if a complication arises.

What’s the difference between a doula and a midwife?

The word doula means “female helper” in Greek. A doula is a person who has training in the support of labor and birth. They can help you manage contractions, get you ice water to sip on, suggest new labor positions and act as your cheerleader. They have no medical training. The care they provide is emotional and informational, not medical.

Do midwives do c-sections?

Midwives can’t perform c-sections, but they can assist in them. If you require a c-section, a collaborating physician will be called on to assume care.

Do midwives give epidurals?

Some midwives can prescribe epidurals, but midwives can’t give epidurals. They consult with an anesthesiologist or a certified registered nurse anesthetist (CRNA). Anesthesia providers are typically available in hospital settings only.

What questions should I ask before choosing a midwife?

A lot of people interview potential midwives to make sure they feel comfortable with them prior to beginning services. Some questions you should consider before choosing a midwife are:

• Where will I deliver my baby?
• What kind of training do you have?
• How long have you been a midwife?
• How many births have you attended?
• What are your philosophies or values when it comes to childbirth?
• What kind of tests or screenings do you perform during pregnancy?
• Does insurance cover any of the cost?
• Do you work with any local Ob/Gyns?

A note from Cleveland Clinic

Midwives can be a great addition to your reproductive care team, especially during pregnancy and childbirth. They are ideal for low-risk pregnancies and births or when you’re looking for a more natural approach to your care. Not all midwives are the same. When looking for a midwife, check their certifications and what settings they’re licensed to practice in. Be sure that they have healthy relationships with a physician partner. Whether you decide to use a midwife, Ob/Gyn or a combination of both, your healthcare providers will work together to help you achieve the best possible outcome.