Midwives have been around for centuries, and historically, it was common practice for midwives to attend most births. Although today more than 90 percent of women opt for an obstetrician-gynecologist (OB/GYN) or another physician during pregnancy and at birth, some prefer the type of care that comes with choosing a midwife.
So when is hiring a midwife a good option, and is it something you should consider? If you’re thinking about a midwife instead of a doctor, this guide can help you decide.
What is a midwife and what does a midwife do?
Midwives provide pre- and postnatal care to pregnant moms as well as attending births and offering breastfeeding and nutritional support. They tend to focus on low-risk, low-tech births for moms-to-be who want to try to avoid surgical intervention, epidurals, pain medications and/or drugs that induce labor.
Is a midwife a doctor?
No, a midwife is not a doctor. While licensed and certified midwives are highly trained, they cannot perform cesarean sections on their own. They can prescribe epidurals and labor-inducing drugs, but they are less likely to do so compared to doctors.
While midwives can attend low-risk births without a doctor present, in the event of a complication like an emergency C-section, they'll have to get an on-call physician to perform the surgery. In some states, midwives must work in a collaborative practice with a doctor, and in others they can work in a solo practice.
What are the benefits of having a midwife?
Midwives are a good choice for moms with low-risk pregnancies and for women who want a home birth, a birthing center delivery, a birth without epidurals or labor-inducing drugs, or a water birth. (That said, midwives sometimes do use drugs that induce or augment labor.)
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Like other practitioners, midwives are just as concerned about their clients' mental health as they are about their physical health. They focus on breastfeeding and lactation support before and after baby's arrival, and often place particular emphasis on healthy eating during and after pregnancy.
Is a midwife right for you?
It’s best to talk to your health care provider and make a decision together that’s best for both you and your baby.
But if your pregnancy is classified as low-risk by your practitioner, you haven’t dealt with any complications (like preeclampsia or gestational diabetes, among others) and you really want a low-tech birth, a midwife might be a good choice for you.
How much does a midwife cost and is it covered by insurance?
Midwives can range from $2,000 to $6,000 in cost depending on where you live. Insurance should cover care by most midwives, but talk to your provider to make sure. While the majority of health plans will pay for midwife deliveries at hospitals, they may not cover home births or those that take place at birthing centers.
That said, birthing centers and midwives tend to charge less than hospitals and OB/GYNs.
Do midwives do C-sections or offer epidurals?
Midwives cannot do C-sections without a doctor present.
Midwives can refer a patient to an anesthesiologist for an epidural (though many women who choose a midwife would prefer to give birth without any pain medications).
They do not, however, actually perform epidurals. You'll only be able to get an epidural if you're delivering in a place with anesthesiology available (like a hospital), not if you're at a birthing center or at home.
How can I find a good midwife?
The best way to find a good midwife is to do your research. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend choosing a midwife who's licensed by your state and certified by the American Midwifery Certification Board. Not all are.
Ask your friends (or your What to Expect group), get a referral and meet with midwives before deciding which one is best for your family.
Are there any risks or downsides to hiring a midwife?
If your last birth was high-risk, required a C-section, you’re having multiples or your health care provider considers your pregnancy high-risk, having a doctor present may be necessary. It can be stressful (and sometimes dangerous) to move from home or a birthing center to a hospital because of a birth complication or to switch mid-pregnancy because a complication arises.
What’s more, for some moms, having a doctor on hand at a hospital provides some peace of mind in case something does go wrong.
How do you become a midwife?
Midwives fall into four categories: certified nurse-midwives (CNMs), certified midwives (CMs), certified professional midwives (CPMs) and direct-entry midwives.
Nurse-midwivees (CNMs)
A CNM is a registered nurse with a graduate degree in midwifery who's certified by the American Midwifery Certification Board (AMCB) to perform births in all 50 states and Puerto Rico. Most midwives in the U.S. are CNMs.
Certified midwives (CMs)
A CM has an undergraduate degree (but not in nursing) and a graduate degree in midwifery, and is also certified by the AMCB.
Certified professional midwives (CPMs)
A CPM will either apprentice or take professional courses before being certified by the North American Registry of Midwives (NARM). Although a CPM can provide pregnancy and postpartum care, she or he cannot prescribe most medications. Most CPMs work in homes or birth center practices.
Direct-entry midwives
A direct entry midwife is not a nurse but has either gone to a midwifery school, or has had an apprenticeship or other training. Often, a direct entry midwife may also be a CM or a CPM, but that isn’t always the case. Direct entry midwives cannot perform births legally in all 50 states.
Midwives perform low-risk births with the goal of reducing surgical intervention and providing mom-centered care. But just remember that no matter what kind of practitioner you choose, birth plans are not set in stone, and whatever your birth goals, your baby-to-be may have a different plan in the works.
Whether your child's birth is attended by a doctor in a hospital, a midwife at home or another combination, all that matters is that both you and your baby are happy and healthy when it's all over.
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