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Who Are Midwives?

In Europe, midwives assist at more than 70% of normal vaginal births. Though midwives have only delivered a small percentage of babies in North America, that percentage has been increasing since 1975. Today midwives are licensed to practice in most 50 states and provinces. Yet most aren't sure what they do, how they are trained, or if they're even available. Is a midwife a viable option for you?

Who Are Midwives?
The word "midwife" comes from Old English and means "with woman." Midwives have helped women deliver babies since the beginning of history. There are references to midwives in ancient Hindu records, in Greek and Roman manuscripts, and even in the Bible.

As early as 1560, Parisian midwives had to pass a licensing examination and abide by regulations to practice. Not all midwives had this level of education, however. English midwives received little formal training and were not licensed until 1902. America inherited the English model of midwifery.

Early American midwives usually learned their craft through apprenticeship and tradition. They remained ignorant of scientific advances in fighting infection through hygiene and drugs such as penicillin. By the early twentieth century, women and their babies were more likely to die under the care of midwives than under the care of doctors.

Around this time, American medical doctors began a campaign against midwifery in the press, the courts, and the Congress. They cited the poor outcomes for mothers and babies under the care of midwives. Today's research into the first few decades of the 20th century suggests that doctors may also have wanted a greater market share of the maternity business and did not welcome competition from midwives.

Whatever the doctors' motivations, the rate of midwife-attended births dropped during and after the campaign. In response to widespread criticism from the medical establishment, the first certified American nurse-midwifery school was founded in 1933. It aimed to incorporate the necessary medical training into midwifery's traditional approach to pregnancy and labor.

What Kind of Training Does a Midwife Have?
Midwives today come from a variety of backgrounds. The subtitle a midwife uses will indicate her education and training. Most American midwives are Certified Nurse-Midwives (CNMs). They have at least a bachelor's degree and may have masters' or doctoral degrees. They have completed both nursing and midwifery training and passed national and state licensing exams to become certified. They are licensed in every state and may work in conjunction with doctors. About 96% of CNM-assisted births occur in hospitals.

A Certified Midwife (CM) is not a registered nurse, but otherwise meets the same qualifications as a CNM. Because this certification has only existed since 1997, there are few CMs. Currently only the state of New York recognizes this certification as sufficient for licensing.

A lay or direct-entry midwife may or may not have a college degree or a certification. She may have trained through apprenticeship, workshops, formal instruction, or a combination of these. Not all states require her to work in conjunction with doctors, and she usually practices in homes or nonhospital birth centers. Not every state regulates direct-entry midwives or allows them to practice.

A Certified Professional Midwife (CPM) is certified by the North American Registry of Midwives after passing written exams and hands-on skill evaluations. Direct-entry midwives and CNMs can apply for this certification. They are required to have out-of-hospital birth experience, and usually practice in homes and birth centers. Their legal status varies according to state.

The Midwife's Philosophy
According to Lisa Summers, DrPH, a midwife and staff member of the American College of Nurse-Midwives (ACNM), a midwife's education stresses that pregnancy and birth are normal, healthy events until proven otherwise. A midwife views her role as supporting the pregnant woman while nature takes its course.

Midwives also focus on the psychological aspects of how the mother-to-be feels about her pregnancy and later on, the actual birth experience. They encourage women to trust their own instincts and seek the information they need to make their own valuable decisions about pregnancy, birth, and parenthood. Dr. Summers is quick to add that many medical doctors share these values. But an MD is more likely to use preventive testing and medical technology - such as ultrasound, continuous fetal monitoring, and the option of pain medications during birth - as a standard part of care during pregnancy and labor.

High-risk pregnancies undoubtedly require this approach. But many midwives find it unnecessary for most uncomplicated pregnancies.

What Does a Midwife Do?
Midwives generally spend a lot of time with a woman during prenatal visits addressing her individual concerns and needs, and will stay with her as much as possible throughout labor. They sometimes encourage physical positioning during labor such as walking around, showering, rocking, or leaning on birthing balls - recommendations not usually associated with a typical medical doctor. Midwives usually allow women to eat and drink during labor.

CNMs, like doctors, will use some medical interventions, such as electronic fetal monitoring, labor-inducing drugs, pain medications, epidurals, and episiotomies, if the need arises. A CM, CPM, or direct-entry midwife may not legally be allowed to use these techniques without a doctor's supervision. Birthing centers may or may not be equipped for these procedures. Midwives of any licensing degree cannot perform cesarean sections; if one were required, an obstetrician would have to perform your delivery. If any potentially life- threatening complications suddenly arose during delivery, midwives should also involve an obstetrician. Certified midwives are trained in basic life support for newborns and, in the event of sudden complications with your baby after birth, can care for the baby until a pediatrician or neonatologist (an intensive-care specialist for newborns) is available.


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