One hundred years ago, most children were born at home. Now, an overwhelming majority of childbirths in America take place in a hospital. Yet, this trend is coming full-circle, as an increasing number of women are opting for a more natural birthing experience, either at home or in a birthing center, under the supervision of a certified nurse-midwife (CNM). In fact, in 1989, about 3 percent of births were attended by midwives. By 2013, this number had climbed to almost 9 percent. It is noteworthy that in England more than half of all childbirths take place with a midwife as the lead care provider.
A non-medicated, minimally invasive labor and delivery with a midwife in attendance has a number of pros and cons – let’s find out what they are.
Midwives
A certified nurse-midwife (CNM) is a highly trained health professional who cares for pregnant women, providing prenatal care, assistance during labor and delivery, and postpartum care. Midwives complete a bachelor’s program in nursing requiring 2-4 years of study and then gain experience as a registered nurse. As of 2010, aspiring nurse-midwives must first earn a master’s degree (MSN) and become certified by the American Midwifery Certification Board before they can begin practicing.
Advantages of a Midwife-Attended Birth
- During prenatal visits, a midwife is usually able to spend more time with the pregnant woman than a doctor. A midwife’s approach tends to be more casual with a focus on developing a personal relationship with the patient. This helps make the pregnancy and birth experience more relaxed. Doctors tend to be straightforward and professional.
- Midwives are trained to be vigilant for anything that falls outside “normal” and requires more specialized care.
- Midwives offer a more holistic approach to pregnancy and childbirth and can answer questions related to nutrition, exercise, relationships, emotions, breastfeeding, and parenting.
- Other than pregnancy and childbirth, midwives can provide comprehensive care to women of all ages. They are trained to conduct annual gynecological checkups, order lab investigations, and prescribe medications including birth control.
- Midwives encourage a more natural management of labor pain such as massage, relaxation, showering, switching positions, or walking around.
- Midwives tend to be more judicious in the use of medical interventions (for example, continuous fetal monitoring during labor).
- Midwives typically offer more one-on-one care during labor and delivery and have a more hands-on approach at all stages of the pregnancy.
- A midwife may be able to offer a planned home birth or a relaxing water birth.
- More than 30 percent of all babies are born by Cesarean section in the United States, which is substantially more than the WHO-recommended target of 10-15 percent. Midwives are more likely to let labor progress naturally and less likely to recommend surgery and unnecessary interventions.
- Studies have shown that for low-risk pregnancies, maternal and fetal outcomes are equally good and midwife care is as safe as care from a physician.
Disadvantages of a Midwife-Attended Birth
- Midwives carry only basic tools and cannot offer ultrasound or anesthesia, for example.
- Midwives are not qualified to manage high-risk pregnancies or any acute problems or complications that may occur during childbirth. If complications should occur during labor and delivery, the patient will be forced to seek emergency care from a doctor or care provider she is not accustomed to.
- Obstetricians are best qualified to manage multiple births (twins, triplets), breech presentation, women with prior Cesarean sections, women with prior still births or other pregnancy-related complications, and women with other comorbid medical conditions such as high blood pressure and diabetes.
- Midwives are not qualified to perform Cesarean sections, should one become necessary emergently during labor.
- Obstetrician-attended births in hospitals can make pregnancy and childbirth safer in a number of ways including genetic testing, induction of labor, and IV antibiotics.
- Some health insurance companies do not cover midwifery services.
