When planning for the birth of a new baby, there are many options and decisions that soon-to-be new moms need to make. One of the most important decisions is choosing a healthcare provider during your pregnancy. One type of provider 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. Midwives are normally used by those who choose to have a planned home birth.
Are There Risks Associated With Using A Midwife?
While midwives provide the majority of care in countries like the U.K. and the Netherlands, midwife-led home births account for only about 10% of births in the United States. (https://www.forbes.com/health/family/what-is-a-midwife/)
While in recent years, more families have sought out a more holistic, non-hospital location for giving birth and for the care provider, such as a home birth using a midwife, the complications of giving birth outside of a hospital have their own risk factors and cause concern.
Midwives consult with OBGYNs, 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.
CASE STUDY: Recent Midwifery Medical Malpractice Case At Zarzaur Law
In a recent medical malpractice case, the firm handled an expecting mother who enrolled the services of midwives for an out-of-hospital birth. The risks of this pregnancy and labor included:
- Advanced maternal age
- Absent collaboration with a physician with admitting privileges at a hospital in the immediate area
- Incomplete emergency backup plan
- Pregnancy extending to late-term and post-term (41-42 weeks)
- Meconium stained amniotic fluid
- Arrest of cervical dilation, with the ultimate outcome resulting in severe medical complications for the laboring mother and intrauterine fetal demise.
If you would like more information on the particular case or have had a similar, complicated experience, please reach out to the firm at zarzaurlaw.com or call us at 855hirejoe.
Why Would You Use A Midwife Instead Of A Doctor?
Many women choose a midwife over a doctor because they want additional emotional support before, during, and after delivery. A midwife will get to know you, your family, and your preferences over the course of your pregnancy. Midwives also allow for a planned home birth in Florida.
What Are The Possible Risks Of A Planned Home Birth?
Most pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures, and nervous system disorders than planned hospital births.
There are several factors that might reduce the risks of these problems, including having:
- Assistance from a certified nurse-midwife
- Access to a doctor who specializes in obstetrics
- A plan for transportation to a nearby hospital, if needed
It’s important to talk to your health care provider before you make a decision about a planned home birth. For some people with certain health conditions, as well as those who have never given birth before, the risks of a planned home birth may be higher than they are for others.
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, but 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.
- CPMs (certified professional midwives): CPMs work in birth centers or at home.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.
The Differences Between A Midwife And An OB-GYN
OB-GYNs and midwives both provide great pregnancy care and safely deliver babies. But there are some fundamental differences.
OB-GYNs and midwives have different credentials and educational backgrounds.
While OB-GYNs and midwives are part of the same specialty area, the training, education requirements, and credentials they hold are different.
OB-GYNs are medical doctors
An OB-GYN (which is short for obstetrician-gynecologist) is a medical doctor who specializes in women’s reproductive health, as well as pregnancy care and delivering babies. They’re also surgically trained and can perform cesarean sections (C-sections) when necessary. You may already have visited an OB-GYN for your annual well-woman’s visit.
When it comes to training and education, OB-GYNs complete four years of medical school, a four-year residency program, and a three-year fellowship.
Board-eligible vs. Board-certified OB-GYNs
OB-GYNs – like other medical doctors – can also pursue certification from the American Board of Obstetrics and Gynecology (ABOG) after they’ve completed their residency and gotten their license to practice. Board-certification is optional but a mark of distinction, implying that a doctor has gone above and beyond the minimum standard of education in their field.
The path to certification requires passing a qualifying exam, preparing an extensive case list demonstrating expertise in multiple categories, and then passing a certification exam. At HealthPartners, all our OB-GYNs are board-certified.
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:
- There is less chance of induction or assisted delivery.
- Cesarean delivery is less likely.
- Reduced use of epidurals or other medications.
- There is less risk of third and fourth-degree perineal tears.
- More flexibility for home births.
- You have greater control over your care.
Midwives are typically not trained to perform surgeries. Midwives will refer people to OB/Gyns if their pregnancy or birthing experience becomes complicated or high-risk.
Should You 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.
The links below provide information on midwifery practices and licensed midwives in the state of Florida.
Florida Rule 64B24-7 Midwifery Practice >
Florida Statute Chapter 467 Midwifery >
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 You 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 kinds of tests or screenings do you perform during pregnancy?
- Does insurance cover any of the cost?
- Do you work with any local Ob/Gyns?
If Necessary, Prepare To Go To A Hospital
Make the following preparations for a smooth transition to a hospital, if you need it:
- Discuss with your health care provider the symptoms that might mean you’ll have to go to a hospital. Talk about how that fits into your birth plan.
- Make sure you have access to transportation. Ideally, your home or other birth location is within 15 minutes of a hospital with 24-hour maternity care.
- Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly moved to the hospital and treated, if necessary.
The links below provide important information with regards to emergency backup plans and agreements for midwives in the state of Florida.
Florida Department of Health Emergency Plan for Licensed Midwifery >
Florida Department of Health Collaborative Management Agreement >
Hospitals or certified birth centers are the safest settings for delivery. However, you have the right to make an informed decision about where you prefer to deliver your baby. Keep in mind that life-threatening problems can occur during labor and delivery. In those cases, the need to take you and your baby to a hospital could delay care. That could put your lives at risk. Understand the risks and benefits of a home birth before you make a decision about where to deliver.
Sources:
https://my.clevelandclinic.org/health/articles/22648-midwife
https://www.healthpartners.com/blog/midwife-vs-obgyn-whats-the-difference/
https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/home-birth/art-20046878
Florida Rule 64B24-7 Midwifery Practice
https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B24-7
Florida Statute Chapter 467 Midwifery
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0467/0467.html
FL DOH Licensed Midwifery
https://www.floridahealth.gov/licensing-and-regulation/midwifery/index.html
FL DOH Emergency Backup Plan For Licensed Midwifery
FL DOH Collaborative Management Agreement