How to choose a midwife

In observance of the International Year of the Nurse and the Midwife, a certified nurse-midwife explains the different options among the profession
January 21, 2020

In a global initiative to recognize the vital role nurses and midwives play in providing health services, the World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife. Nurses and midwives account for nearly 50 percent of the global workforce, according to the World Health Organization, and provide essential health services well beyond the walls of a traditional health care setting.

You would be hard pressed to find someone that hasn’t been seen by a nurse, whether through an emergency room visit, a scheduled surgery or to stay up-to-date on their immunizations. And everyone knows a midwife delivers babies. Is that all they do, though? And are they all nurses? Texas A&M College of Nursing’s Robin Page, PhD, APRN, CNM, assistant professor, speaks to the different certifications, what they mean to patients and how to make an educated decision when choosing a midwife.

What is a midwife?

“There are different kinds and models of midwifery that offer varying levels of education and experience,” Page said. “The primary differences are related to the certifications a midwife carries based on higher education, and not all midwives are nurses.”

In its most basic definition, a midwife is someone trained to assist a woman in childbirth, but certified midwives can have a much wider scope, encompassing a full range of primary health care services for women from adolescence to post-menopause.

The two most widely accepted credentials are certified midwife (CM) and certified nurse-midwife (CNM). Both are obtained through the American Midwifery Certification Board (AMCB) and require graduation from a nurse-midwifery education program accredited by the American College of Nurse-Midwives (ACNM) Accreditation Commission for Midwifery Education (ACME).

A certified midwife holds a graduate degree from an accredited college or university—not necessarily in nursing—with required health and science courses as part of their midwifery program.

A certified nurse-midwife holds both a bachelor of science and master of science in nursing degree from an accredited college or university, maintains licensure as a registered nurse and, across each state, has the authority to prescribe medications and obtain the CNM licensure. Furthermore, CNMs are advanced practice registered nurses (APRNs), which also includes family nurse practitioners, clinical nurse specialists and nurse anesthetists.

Benefits of selecting a midwife for childbirth

“One of the main reasons women choose to have a midwife is because they want more personalized attention,” Page said. “During labor and delivery, a midwife is more likely to remain alongside the mother throughout the entire labor and birthing process.”

There is also greater opportunity for an expectant mother to form a bond with a midwife because all prenatal, labor and delivery, and post-partum care, including the first 28 days of a healthy infant’s life, can be provided by the midwife. Some patients may find comfort in this type of personalized care.

It is also common for those expecting to take finances into consideration. Many turn to midwives and home births in search of a less costly alternative to hospital care, but Page cautions this can be a misguided expectation.

“Choosing a midwife is not an incentive to save money because the cost is actually similar to other health care providers,” Page said. “However, you could potentially reduce cost in facility expenses if you choose a home birth or a birth center.” This is making the assumption the mother and unborn child are most likely to deliver without medical intervention.

“If parents are looking to go with a midwife, the mother will be screened by that midwife to identify any risk factors,” Page said. These risk factors can include previous cesarean sections, preeclampsia, cardiac disease, high blood pressure and diabetes.

Even with the most thorough screening, sometimes interventions are still needed. Midwives are trained, equipped and prepared to handle unexpected emergencies. There are varying models within midwifery but often a physician capable of performing a c-section, or other necessary surgery, is on-call. In some instances, a birthing center or midwifery practice may operate within a hospital.

Choose what’s right for you

Because there are many factors to consider, expectant parents should independently research birth options before making a decision. Page recommends using the American College of Nurse-Midwives as a respected and reliable resource that includes information about each type of midwife.

“It’s important to remember that different types of midwives bring a variety of strengths to the table,” Page said. “Asking questions about experience in relation to education and credentials can help determine the optimal birth plan to ensure the comfort and safety of the mother and her child.”

Nursing graduates and midwifery

Graduates of the Texas A&M College of Nursing undergraduate and graduate programs interested in becoming a certified nurse-midwife have an opportunity to pursue the CNM certification. As an accredited college by the Commission on Collegiate Nursing Education (CCNE), Texas A&M nursing students continue to maintain a 99 percent pass-rate of the NCLEX-RN® licensure exam and meet the higher education requirements set by the AMCB to seek the additional midwifery curriculum needed to earn certification.

Kala McCain Author

— Kala McCain

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