Midwives in the Mainstream
More women want hands-on healthcare
By: Jan Jarvis
Some women want a Jacuzzi. Others prefer having a birth ball handy. And many simply want all of their relatives by their bedside.
More and more mothers-to-be are having babies their way, with the help of a midwife who is there to do as much or as little as the woman wants.
Although midwives have been delivering babies throughout history, their role has evolved over the years. Gone are the days when midwives worked only in homes, helping women have babies the natural way. Today the practice has expanded to include birthing centers and hospitals.
In Texas, only certified nurse-midwives — who represent the majority of practitioners — are allowed to deliver babies in a hospital. Certified nurse-midwives must have a bachelor’s degree and complete an accredited nurse-midwifery program. In 2006, there were 15,679 births attended by certified nurse-midwives in Texas.
In Tarrant County, midwifery has been growing steadily for more than a decade with the biggest growth over the last six to eight years, said Sharon Lloyd, a certified nurse-midwife with the Midwife Center, which opened in January at Baylor All Saints Medical Center’s Andrews Women’s Hospital.
Midwifery programs are a way for hospitals to balance the high-tech world of medicine with a more natural, hands-on approach to healthcare.
“We basically provide something that technology can’t,” Lloyd said. “We listen, we laugh and we cry with you.”
Harris Methodist Fort Worth, which began offering midwifery services in 1995, now has five certified nurse-midwives. Baylor’s new Midwife Center has four. There are also 19 Tarrant County midwives listed on the Association of Texas Midwives Web site, including licensed and lay midwives.
The new Midwife Center offers women choices about how they deliver their babies.
“They can sit in the shower or rocking chair until it’s time to deliver,” Lloyd said. “Not every birth requires high technology, but we’re glad it is available if needed.”
The profession has seen a lot of growth, as the public has learned more about the role of midwives and as women seek out a more holistic, family-centered approach to healthcare, said Kathleen Donaldson, a certified nurse-midwife with UNTHealth who works with Harris Methodist Fort Worth Hospital.
“The more women are educated, [the more] they are not just settling for the status quo for their women’s wellness examination and childbirth experience,” she said.
Here, we answer 10 vital questions about midwives today:
What is a midwife?
Midwives are trained to support a woman during her pregnancy, childbirth and the postpartum period.
They see labor as a natural process for healthy women.
How long have midwives practiced in the United States?
Native Americans had midwives in their tribes. Midwives also played an important role in the colonies. But over time the practice faded away. In 1915, 40 percent of all births were attended by midwives. By 1935, the number of had decreased to 10.7 percent. Nurse-midwifery never went away entirely, but it wasn’t until the 1970s that the profession experienced a rebirth. Today, midwives serve in cities and rural communities throughout the country. In Texas hospitals, nurse-midwives have hospital privileges, but most work with obstetricians who can step in if there is a medical emergency.
If you choose a midwife for birthing, when do you begin working with her?
A woman should begin seeing a midwife as soon as she knows she is pregnant, or sooner. Nurse-midwives also provide routine gynecological care.
What are the different types of midwives?
Certified nurse-midwifes must have a bachelor’s degree and complete an accredited nurse-midwifery program. They can practice in hospitals, are licensed in all states, can prescribe medications and are certified by the American College of Nurse Midwives.
Certified professional midwives are trained in midwifery and meet practice standards set by the North American Registry of Midwives.
Direct-entry midwives include those who are licensed and lay midwives. They are trained through self-study, midwifery school or apprenticeship. They often practice in homes or birthing centers.
What are the advantages of having a certified nurse-midwife attend a birth in the hospital?
The environment is close to being at home but within the confines and safety of a hospital, Donaldson said. Women who deliver with a nurse-midwife have more choices, including labor positions and IV use during labor. A midwife typically uses natural methods, such as backrubs, to curb pain.
Half of the women who choose a nurse-midwife decide against having an epidural, according to Nancy Jo Reedy, director of midwifery services for the Midwife Center at Andrews Women’s Hospital. A woman who decides against having an epidural, which typically confines them to a bed, can walk around, shower or be with family while in labor. Often they want to hold the newborn immediately. Others want to deliver their placenta on their own.
What are some of the differences between a midwife-attended birth and a physician-attended birth?
A midwife will stay by the woman’s side throughout the delivery. They are generally able to spend more time with their patients and sit by a woman’s bedside during labor, Reedy said. Their role is to provide support throughout labor and delivery.
Women who deliver with the help of a midwife are less likely to have a Caesarean performed than women whose delivery is physician-assisted. Caesareans were uncommon in the United States until the 1980s, but today about 30 percent of women have the procedure. The rate of C-sections for midwife-attended births is 4.8 percent lower than for births attended by a physician.
Why would a woman want to avoid a C-section?
For starters, a Caesarean is major surgery that requires cutting through tissue and nerves, Lloyd said. Vaginal births usually have fewer complications and a faster recovery time. Women are often up and moving around on the same day.
At the Andrews Midwife Center, fewer than 6 percent of women have an episiotomy, and less than 3.8 percent of babies are admitted to intensive care.
Why would a woman chose a midwife to deliver her baby?
When Otishae Womack, 20, was pregnant with her first baby she wanted to follow her sister’s lead and have a midwife attend the birth. The Fort Worth woman gave birth in February at Baylor All Saints Medical Center. Having a midwife available to answer questions and offer guidance made a big difference, Womack said. “I feel very comfortable knowing they are caring for me and my baby,” she said.
What do certified nurse-midwives do besides deliver babies?
Nurse-midwives take care of women throughout their life, Donaldson said. They can do everything from a young woman’s first pelvic exam to menopausal counseling. They also spend a lot of time on education and prevention of disease.
Do nurse-midwives and licensed midwives take insurance?
Most private insurance groups cover nurse-midwifery care. Nurse-midwives are eligible for Medicare/Medicaid reimbursement. Licensed midwives may be covered. Direct-entry and other types of midwives often work with people who have no health insurance. They charge a flat fee that is typically at least $5,000 less than a hospital birth.
How safe is a home birth?
Home births are considered safe for low-risk healthy women, and offer advantages including a lower risk of infection and unnecessary intervention. But they are not appropriate for those who have high-risk pregnancies, including women who are diabetic, have chronic high blood pressure or toxemia or have experienced preterm labor in the past.
The Midwife Center at Birthing facts
Midwives are mentioned in the Bible.
There was a midwife on the Mayflower.
The births of Queen Victoria and Prince Albert were attended by the same midwife.
The word midwife in Old English means “with woman.”
The word gravida, which means pregnant woman, was one of the most popular “special” words used at a recent international Scrabble competition.