What is a midwife, and what do they do?

Until recently, the only people who were delivering babies at Clements University Hospital were obstetricians. That changed this spring when we launched our new midwife program. Certified nurse midwives are now available 24 hours a day, 7 days a week in our Labor and Delivery unit.

Midwifery is a very old profession that has steadily grown in popularity in recent years. In 2013, more than 18,000 births in Texas were attended by a midwife or another person who is not a doctor.

But Mary Banner, CNM, one of our certified nurse midwives (CNMs), is quick to point out that she and her team are “not your granny’s midwives.” I’ve asked Mary to answer some common questions and clear up misconceptions about midwifery and what midwives really do.

Here are Mary's answers in her own words:

What is a midwife?

Many midwives provide care for women from adolescence through post-menopause. Our midwife team works with our obstetricians to care for women throughout pregnancy and during labor and delivery.

Many people don’t know that there are two kinds of midwives:

• Professional midwives (also called lay midwives) deliver at home and in birth centers. They are trained in childbirth and are required to pass an exam to be licensed, but are not required to have any medical training and cannot administer medication.
  
• Certified Nurse Midwives (CNMs) are highly trained and have extensive medical backgrounds. More than 80 percent of CNMs in practice across the United States practice in hospitals. Our team of midwives are all CNMs.

Approximately 95 percent of midwife-attended births in the United States occur in hospitals, and only 5 percent occur at home. Certified nurse midwives who practice in hospitals like ours must have a strong medical education and background. The minimum requirement is a Master’s of Nursing degree. The preferred requirement is a Doctorate of Nurse Practitioner (DNP). That means each of our midwives has at least eight years of medical education as a nurse and advanced practice nursing.

Midwives are sometimes confused with doulas. Midwives can provide prenatal care, co-manage deliveries with a physician and manage medical problems in the post-partum period, while doulas provide only non-medical support during labor, delivery, and post-partum.

Can I have an epidural if I use a midwife?

Absolutely. Our goal is patient satisfaction and safety, no matter what. We’ll do as much as possible to facilitate the kind of birth experience you want to have, whether it’s natural childbirth or with the aid of pain medication like an epidural.

Our team of certified nurse midwives is highly trained in the natural process of birth. All births that we manage are not “natural births,” of course, but we follow a natural process. We believe a patient should have pain medication if she wants it and she should be supported if she doesn’t.

We are trained in pharmacology, and we have prescriptive authority. We can write for and administer pain medications, including orders from the anesthesia department for epidurals. We’re not what your granny thought of as midwives: packing our little bags, boiling some water, and giving you a piece of shoe leather to bite down on for pain control! When you work with a midwife, you have a lot of options from position changes and birthing balls to pain medication.

How do midwives work with doctors?

The arrangement we’ve developed is the best of all possible worlds. The midwife team is on staff and we don’t leave the unit during our shifts. Our total dedication is to our patients.

When you come in to have your baby, there will be a Labor and Delivery nurse who takes care of you. If you’re at full term and you don’t have any problems, the midwife will be the next person to see you. You can talk with her about your birth plan, her medical experience, and how she’ll work with the physician to care for you and your baby during labor and delivery.

If you’re uncomfortable with using a midwife, no problem – the physician will manage all aspects of your labor and delivery. But honestly, that doesn’t happen very often!

If you choose to work with the midwife, she will manage your birth all day, straight through the delivery.

The midwife on duty partners with the physicians who are on call that day to take care of patients on the labor and postpartum floors. We run 24-hour shifts, and then we’re off the next day. It sounds crazy, but most of the time, the hours just fly by! It works for our team, and when it doesn’t, we can break the shifts down into 12-hour increments.

Our shifts start with a meeting between the midwife and doctor who are going off shift, and the midwife and doctor who are coming on. We meet to determine which patients will go to which care provider when it’s time for delivery. The midwife works with all of the patients whose regular physician isn’t on shift that day. The physician cares for the high-risk patients.

High-risk patients are women who have medical issues – diabetes, high blood pressure, twins, or any other kind of medical or obstetrical problem. The physicians manage high-risk patients’ care before and during labor, and we assist with the care of those patients through labor and delivery as requested by the obstetrician.

The physicians also perform all the C-sections, but the midwives at Clements are trained to act as surgery first assistants. A recent study suggests that hospitals that use laborists (physicians who have dedicated time in labor and delivery) and midwives to care for patients report fewer C-sections than those that don’t. Midwives are trained to work with patients to try to get vaginal births to happen, and we are able to spend time with patients to help them do that.

That’s part of why we work 24-hour shifts. We want to see the birth process through from start to finish with each patient whenever possible. We also want to ensure continuity of care. We want you to know who’s going to be in your room and who’s taking care of you. We want you to know us by our first names, and we’ll make sure you can get ahold of us when you need us.
During labor and delivery, we’re not just working with a patient, but with a family. We’re there to provide care and comfort, and we’ll support your birth plan as much as possible.

What if something goes wrong during delivery?

We are skilled in assessing a patient’s condition and trained to recognize possible childbirth complications. If a medical situation arises, we will immediately involve the doctor.

The midwife team will work closely with the physician to make sure we’re always on the same page about your care. Our ultimate goal is to get what you really want – a good birth experience and a healthy baby.

What if I don’t want to give birth in the hospital?

You may be planning a home delivery or want to deliver at a birthing center. What questions should you ask your midwife?

• What are your qualifications? We strongly urge you to work with a midwife who is certified to practice in Texas.
  
• Who is the physician that provides back-up? Find out which doctor the midwife will call with questions about your labor and delivery.
  
• What hospital will I be transferred to if there are complications? Have this conversation with your midwife before labor begins so you’re both prepared.
  

We know there are women in our community who are interested in working with a midwife, but they can’t have their babies at a birthing center or at home due to pregnancy complications, or they want the security of delivering their baby at a hospital. Now we can offer those women the support of a midwife along with the expertise of our physicians and specialists to handle all types of labor and delivery.

Mary and her team are a great addition to our practice, and we’re excited about the difference in perspectives and additional care they provide our patients. Every pregnant woman deserves supportive care, and that’s exactly what they get when midwives pair with physicians during pregnancy, labor, and delivery.