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When the Stork Is a Midwife

Nurse-midwives are better-trained and increasingly common today

The image of the midwife from medieval and pioneer times was not one to inspire confidence. But much has happened in recent years to professionalize the role of midwives in assisting childbirth, and today almost 1 in 20 births are attended by a registered nurse trained as a midwife. Kimberly Pool of the American College of Nurse-Midwives explains what a certified nurse-midwife can - and can't - do.

What types of midwives are there?

The two basic categories are nurse-midwives and lay midwives. Lay midwives are people who help women deliver their babies but are not necessarily nurses and differ widely in their level of education and experience.

Nurse-midwives are registered nurses who have completed additional training in obstetrics and gynecology. Often they are certified by passing a national exam administered by the American College of Nurse-Midwives. To qualify for the exam, they must spend a minimum of 18 months learning clinical midwifery skills and advanced obstetrics and gynecology for normal women, as well as newborn care and family planning.

What do nurse-midwives do?

By education and experience, a nurse-midwife is qualified to be the main caregiver for healthy women throughout pregnancy and childbirth, and to provide gynecological and family planning care throughout a woman's childbearing years. In 32 states they have the authority to write medical prescriptions.

The nurse-midwifery policy is to consult with a doctor when a condition arises in pregnancy or labor that is considered to be medically dangerous. In most cases, this means that the mother is not healthy, has high blood pressure, gestational diabetes, an abnormal metabolism, infections, or an improperly developed fetus or placenta.

Where do nurse-midwives deliver babies?

Many people envision a birth at home when they hear the word 'midwife.' But the vast majority of nurse-midwives work in hospitals - about 85 percent. Another 11 percent work in birth centers, and the remaining 4 percent attend home births.

What kind of backup do nurse-midwives have if something goes wrong?

Whether a problem is apparent during the first prenatal visit or does not arise until the final hour of labor, a nurse-midwife is taught to call in a doctor as soon as the woman's condition strays outside the boundaries of a nurse-midwife's expertise. The mother may be referred to the consulting doctor for medical care, or the physician and the nurse-midwife may co-manage the care, depending on what the complication is.

Are doctors always willing to work with nurse-midwives?

Not all doctors think highly of nurse-midwives, but as the number of certified nurse-midwives increases, this attitude is decreasing. A policy statement issued by the American College of Obstetrics and Gynecology and the American College of Nurse-Midwives states that the maternity care team should be directed by a qualified ob/gyn with written medical guidelines that define the individual and shared responsibilities of the doctor and nurse-midwife. These procedures include periodic and joint evaluation of services performed, including chart review, case review, patient evaluation, and review of data on the health of babies over time.

How do nurse-midwives differ from doctors?

Nurse-midwives are trained to treat normal, healthy women, and in that capacity they celebrate the normal. Doctors are trained to handle the emergency situation and because they have spent much more of their training on what to do if something goes wrong, they [may be] more likely to treat a normal pregnancy as if it were a high-risk situation waiting to happen.

Do nurse-midwives only deliver babies 'naturally'?

Nurse-midwives use technology when it is needed to learn something about the pregnancy that they otherwise would not know. During labor, nurse-midwives induce labor, break waters, start intravenous lines, use fetal monitoring equipment, and prescribe analgesics when it is medically necessary, thereby minimizing side effects and often ensuring that labor progresses more quickly.

What is the record for nurse-midwives delivering babies?

Over the years nurse-midwives have maintained a superb safety record. Research shows that pregnancy, labor, and delivery for a healthy woman is as safe with a nurse-midwife as with a physician. Studies have also shown that the rate of Cesarean sections, episiotomies, infant and maternal mortality, and low birth weight are often much lower than average among women being cared for by a nurse-midwife.

In fact, government reports have called for an increased use of nurse-midwives as a safe way to improve maternity care.

How does the cost of using a nurse-midwife compare with using a doctor?

Having your baby with a nurse-midwife usually costs less than obstetrical care with a physician in a hospital. The cost of midwifery care usually varies with the setting; most costly is a nurse-midwife in private practice with a hospital birth.

The least expensive is usually a home birth, which may cost a fraction of the price of a hospital birth. Birth centers fall somewhere in the middle. These differences may be significant or minimal; it all depends on the community.

Are nurse-midwives' fees covered by insurance?

All 50 states provide Medicaid reimbursement for nurse-midwifery care, regardless of whether the birth ocurs in a hospital, birth center, or home.

In 26 states, insurers are required to reimburse for nurse-midwifery care, although not necessarily in all possible birth settings.


They Stand and Deliver

A resource guide for those who are considering childbirth options

For more information on certified nurse-midwives:

American College of Nurse-Midwives
818 Connecticut Ave., NW, Suite #900
Washington, D.C. 20006

For information on lay midwives:

Informed Homebirth/Informed Birth and Parenting
P.O. Box 3675
Ann Arbor, MI 48106

National Association of Childbearing Centers
3123 Gottschall Rd.
Perkiomenville, PA 18074

Midwife Alliance of North America

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Updated on April 10, 1996