Midwives have cared for women during childbirth for thousands of years. The meaning of the word midwife is "with woman," and the midwife's role is to offer supportive care to the expectant mother. In general, midwives use fewer interventions than obstetricians and place greater trust in birth as a normal process. Although women in high-risk pregnancies should be under the care of a qualified obstetrician, midwifery is safe for most women experiencing normal pregnancies.
Types
There are two main types of midwive: certified nurse midwives and direct-entry midwives. Certified nurse midwives, or CNMs, practice under a doctor's supervision. CNMs must complete the equivalent of a master's degree in nursing and are state-licensed. Direct-entry midwives do not necessarily have a background in nursing or medicine. Many direct-entry midwives learn their practice through home study courses and extensive apprenticeships. There is no state licensing for direct-entry midwives, according to the North American Registry of Mdwives, which grants practitioners the designation of Certified Professional Midwife, or CPM.
Settings
Midwives can practice in a hospital, birth center or the patient's home. Certified nurse midwives practice almost exclusively in hospitals or birth centers, where they have more technology available and traditional medical care as backup. Direct-entry midwives practice most often in the patient's home, where they believe laboring women are most comfortable and the environment is safest for the baby.
Philosophy
Midwives often view pregnancy and childbirth considerably differently than obstetricians. While many obstetricians see childbirth as risky and believe in the need for technological intervention, the midwifery model trusts that the woman's body is capable of birthing naturally with only limited interventions. The obstetric model, which is also practiced by many CNMs, believes that a hospital is the most sterile environment for delivery. The direct-entry midwife model of care holds that home is a safer environment for healthy mothers and their babies, because they will be exposed only to familiar germs.
Maternal Care
Midwives act as supporters, rather than directors, for women during birth. The midwife monitors the mother's health to watch for any potential complications. Many midwives support laboring in water as a nonpharmaceutical form of pain relief, according to the website Easy Baby Life. They might use pain-relieving techniques such as massage, coached breathing and visualization. Some midwives, particularly direct-entry and CPMs, use herbs to help labor progress. Midwives also help to deliver the baby and may massage the mother's perineal tissue to avoid cuts and tears between the vagina and anus when the baby is born.
Neonatal Care
Midwives also focus on the baby. Midwives practicing in hospital settings probably have access to and use more technology to monitor the baby's health and deliver the baby, such as electronic fetal monitoring and vacuum extractors. Midwives practicing at home have fewer technological tools to measure the baby's health, but still have hand-held doppler monitors and stethoscopes to monitor the baby's heartbeat.
Warnings
Women with health problems should not seek the care of a midwife to deliver their baby. Women in high-risk pregnancies need access to greater medical technology during childbirth, in case an emergency should arise.
