If you’ve seen any of Hollywood’s portrayals of a midwife in action, your mind may conjure up many images: people bustling about for boiling water and bed sheets, mom-to-be writhing away in pain and the confident and caring midwife, solely and solidly in charge. Most of those images have no basis in reality. In fact, there are a lot of misconceptions and a general lack of awareness about midwifery and its role in prenatal and postpartum care. So, we’ve asked a midwife about her profession so that you can make an informed choice!
What’s the difference between having a midwife for prenatal care versus having an obstetrician? Do woman select both or just one?
Midwives are medical care providers; therefore, women can select either a midwife or an obstetrician for prenatal care. When women get pregnant, they see a provider throughout the entire course of their pregnancy. Pregnancy, on average, spans 40 weeks. At the beginning of the pregnancy, a woman will see a provider every four weeks. Once she reaches the third trimester (28 weeks), she’ll start going every two weeks. At 36 weeks, she will start seeing her provider weekly. Therefore, a woman will typically have anywhere between 10 and 15 prenatal visits. This includes collecting vital signs and ordering labs and ultrasounds.
Midwives and OBs both address all physical aspects of pregnancy. Midwifery care goes a step further and addresses the whole person, asking Mom how she’s doing emotionally and spiritually as well as physically because all those things impact pregnancy and birth. That’s the biggest difference between OB care and midwifery care.
Can midwives order labs and ultrasounds?
Yes. In Florida, midwives are licensed by the Florida Department of Health as medical care providers. In this capacity, a midwife is responsible for the medical outcome of her patients. Therefore, she conducts diagnostic testing, takes measurements and monitors the vital signs of both the mother and her baby.
What are other differences between the services provided by an OB and a midwife?
Working with a midwife is more personal and holistic; she works from a wellness perspective versus a medical mindset. In other words, she attempts to prevent problems. A midwife talks to the mom-to-be about nutrition, hydration, exercise and mental health. When you hire a midwife, you develop a personal relationship over the course of 40 weeks.
Midwives are experts in natural, physiologic birth. They see hundreds of women give birth without medication or intervention, so that’s their area of expertise. Obstetricians are surgeons. That’s their area of expertise. When a midwife comes to the home, she monitors the labor, which consists of assessing the wellbeing of both mother and baby. She supports the woman emotionally, spiritually and physically: squeezing her hips, rubbing her back and making sure she’s eating and drinking. She’s there with her the entire labor. Once the baby is out, she stays a minimum of three hours monitoring vitals, getting the baby to nurse, nourishing Mom and monitoring her before she leaves.
Obstetricians are not with the mother for most of the labor. They come in when it’s time to push the baby out, and they rely on monitors and nurses to tend to these patients. A midwife tends to her patient from the beginning of pregnancy and the first prenatal visit, through the entire labor and birth and for postpartum care. This is vastly different than the limited face-to-face time with an obstetrician.
What is the difference between an independent midwife and a midwife who works from a birth center?
A birth center takes on a larger number of clients each month and tends to have multiple midwives caring for their patients. While the education and wellness mindset are still present, they may not be able to provide the same type of personal attention as a home birth midwife practice. Additionally, while in labor, the midwife on call may have more than one patient to tend to, therefore dividing her attention. When you have a home birth midwife, you receive her undivided attention.
An independent midwife’s appointments are often an hour long each, so time and personal attention are the biggest differences. This gives the midwife a chance to get to know her client well, and the time to ask questions about how’s she’s sleeping and eating, if she’s exercising and if she’s experiencing any emotional issues. Often a midwife becomes a woman’s confidant if she’s struggling with her mate, her other children or life in general. She’ll ask all the questions that medical care providers in a clinical setting don’t have the time to ask. All those “little things”—and the highly personal relationship that ensues—add up to a much more comfortable pregnancy.
When you hire a midwife, must you have a home birth?
Some midwives deliver in birth centers, and some deliver in the hospital. Those are typically certified nurse midwives, and they tend to share call with multiple midwives as well as obstetricians, and be bound by the policies of the hospital which may differ drastically from the home birth and birth center setting. Independent midwives conduct home births.
During a home birth, at what point might you need to go to the hospital?
A midwife’s job is to make sure pregnant women stay healthy and low risk. Her monitoring procedures ensure this from the first prenatal visit throughout the labor process. Problems that would indicate a need to be transferred to a hospital include, but are not limited to, abnormal bleeding, elevated blood pressure that does not normalize with IV hydration or other measures, abnormal fetal heart rate or any indications of unwellness in the mother or baby.
Midwives don’t see these problems very often because they work with a healthy, low-risk population, and provide comprehensive prenatal care. Therefore, going into the birth process, Mom is healthy, and most healthy women can have babies at home without issue. The most common reason for transfer is a first-time mom whose water breaks first and whose labor is not progressing normally. Then she’ll go into the hospital for evaluation. A typical rate of transfer is less than ten percent of patients. If you were wondering, contrary to Hollywood’s stereotypical depiction of childbirth, a woman’s water does not always break first, signaling the arrival of the baby. The water can break as the baby is coming out or the baby can be born in the bag of water.
What is the difference between a doula and a midwife?
Doulas are not medical care providers. They provide emotional support, comfort measures, education and advocacy. They may offer massage or heat packs. Doulas may also assist the partner or care for the other children. During pregnancy they may run errands and do cooking or household chores.
Is it dangerous to have a home birth with a midwife?
When a midwife arrives at a home birth, she’s not toting a drum and candles; she’s coming with emergency medical equipment. Included is oxygen to support Mom if she needs it during pushing or in the unlikely need for resuscitation and medications to manage hemorrhage (of which there is a very low risk) and IV fluids if the mother needs a little support. She also has sterile instruments and suture materials if the mother has a laceration that needs repair.
Note, midwives cannot use Pitocin to augment or induce labor, only to control bleeding after childbirth. That said, they do have herbs and midwife tricks to help with labor, if needed. Many midwives have working relationships with OBs who are available by phone if needed and to call in prescriptions if natural methods are not working. For example, if a patient is not responding to treatment for a urinary tract or vaginal infection, an antibiotic can be called in.
What postpartum support does a midwife provide?
Postpartum care looks vastly different with a midwife versus an obstetrician. Typically, when a woman gives birth in a hospital, she gets discharged with very little education about how to care for herself and her newborn. Her next visit with her OB doesn’t happen for six weeks, and that’s just for her own care, not the baby’s.
Midwives leave about three hours after the birth, check in every 12 hours and then return to visit the mom and baby within 24 to 48 hours. After that, they’re a phone call or text away until their next in-person visit at two weeks and then again at six weeks. Postpartum care is much more comprehensive with a midwife. Midwives are very mindful of the breastfeeding relationship, ensuring that Mom is having a good experience, and that the baby is gaining weight. They’re also alert to signs of postpartum depression and anxiety disorder. These conditions are real, but midwives rarely have moms with chronic issues, because Mom knows she’s got somebody just a text or a phone call away if she’s struggling, and she’s followed very closely.
Mom is also educated about good nutrition, especially restoring all the reserves she has lost because of pregnancy. Holistic measures, supplements, exercise and nutrition all help women who experience a rocky postpartum period. With close support, midwives help women avoid getting any further down the hole.
Midwives talk to their clients about family planning (not getting pregnant again too soon) and pelvic floor therapy. It’s a myth that women should expect incontinence after delivery. Midwives focus on getting their clients’ bodies in the best shape to avoid issues later. Incidentally, in Europe, it’s normal to send women to pelvic floor therapy before they have babies, so they know how to protect their pelvic floor and how to exercise their pelvic floor to reduce the likelihood of injury.
How long after the birth do you retain the services of a midwife?
The final postpartum visit is usually around six or eight weeks after birth, but the personal relationship forged with a midwife usually lasts months, if not years, after the baby is born.
Are the services of a midwife covered by insurance?
The financial agreement is between the midwife and her client. The client can seek reimbursement from her insurance company. Since 2020, there has been an uptick in people seeking home births. As a result, more and more people have been successfully reimbursed by their insurance companies. The rate for a licensed midwife in the Central Florida area (all prenatal care, the delivery, postpartum care and 24/7 support) is $8,000 on average. A normal vaginal delivery in a hospital and a 48-hour postpartum admission can run between $40,000 and $50,000 in addition to the obstetrician’s prenatal care that is usually around $5,000. So that’s a minimum $55,000 that the insurance company must reimburse.
More consumers have been pushing their insurance companies to reimburse for a midwife, pointing out that it is much more economical. Some insurance companies want to keep their customers happy and agree to it. Insurance companies do contract with midwives in birth centers, because they look at that arrangement like a group of providers, but solo midwives have a hard time getting contracts. And even if they did, the insurance companies don’t typically agree to pay them for all the time they put in.
What do I say to my friends and family that say I’m crazy to want a home birth?
That point of view usually comes from lack of education. It’s not general knowledge that home birth midwives are medical care providers with extensive training. A common misconception is that the woman in labor has never met the midwife that shows up at her door. Many people don’t realize that midwives conduct prenatal care and do extensive monitoring up to and throughout labor and delivery.
What is placenta encapsulation?
This may seem weird, but it’s something that has gained in popularity and appears to be beneficial because women are reporting good outcomes. Once a woman births her placenta, it is washed, drained of as much blood as possible, and then cut it into pieces. It is then dehydrated and ground into a powder and put it in capsules, which the mother consumes.
Humans are one of the only mammals that doesn’t consume their placenta on a regular basis; however, traditional uses do exist. The benefits reported have been: good milk production, mood stabilization and lower rates of prolonged postpartum bleeding. This seems to be because the placenta is rich in nutrients. Forty-eight hours after birth, a woman’s hormones usually shift dramatically. Consuming placenta capsules seems to stabilize hormones. In Western medicine, placenta encapsulation has been gaining popularity over the past twenty years. In fact, if the placenta is requested at the hospital, nobody bats an eyelash anymore.
Special thanks to midwife extraordinaire, Rhonda Huggins, of A Positive Beginning Midwifery for her contribution to this article. Contact her at (407) 476-9009 or visit https://apositivebeginningmidwifery.com/
