When a woman learns that she's pregnant, she'll be faced with several decisions. One of the first decisions will be choosing a medical professional to help guide her through pregnancy and childbirth.
At Drexel Obstetrics & Gynecology, patients can choose a traditional OB/GYN doctor or a certified nurse-midwife. We believe there's a right medical professional for every woman. There are many misconceptions out there about midwives, so Drexel Medicine's Laniece Coleman, DNP, MSN, MA, CNM, director of nurse-midwifery services, answers some common questions to help you decide if a midwife is the right fit for your care.
What is a certified nurse-midwife?
Certified nurse-midwives are registered nurses who return to school to earn a master's degree in nursing. They provide a full range of care to women from their teenage years through menopause and beyond.
What are some of the services they provide?
The care they provide may include general health care (vaccinations, health screening and promotion, smoking cessation, urinary tract infections, etc.), annual gynecological exams (pap smears, breast exams, referrals for mammograms), family planning services, sexually transmitted disease diagnosis and treatment, diagnosis and treatment of minor gynecological issues (yeast infections, vaginitis), pregnancy/labor/birth/postpartum care, and menopause care.
In addition, they are licensed to write prescriptions. The certified nurse-midwife's care is based on scientific evidence and professional standards, influenced by an understanding of the normal events in a woman's lifespan.
What is the benefit of using a midwife?
Certified nurse-midwives view themselves as a woman's partner in care, not just her provider of care. Our mission is to educate women about their bodies, their health and their options so they can make the best decisions for themselves based on their needs, desires and values. Certified nurse-midwives are less likely to use medical interventions when things are progressing in a typical fashion. They are often more open to and experienced with alternative and non-pharmacologic therapies for coping with labor and menopausal symptoms.
Can high-risk patients use a midwife for childbirth?
The vast majority of women have healthy pregnancies and births that a certified nurse-midwife can provide care for independently. Some women also have chronic health problems like asthma and thyroid disease, which would not prevent them from being cared for by a certified nurse-midwife as long as their chronic disease remains stable throughout their pregnancy. Some women have chronic health conditions or develop minor pregnancy complications that would require a certified nurse-midwife to review the woman's condition with an OB/GYN and make a plan of care for the future. In many cases, these women can continue their care with a certified nurse-midwife without any problems.
Occasionally, a chronic health or pregnancy condition may become serious enough that a certified nurse-midwife may need to refer the woman to an OB/GYN for continued care. In Pennsylvania, all certified nurse-midwives are required to have "practice guidelines" established with the OB/GYNs they work with to guide in the decision-making process. The good news is that even if a woman has a condition that prevents a certified nurse-midwife from providing care to a woman independently, often a certified nurse-midwife can still be involved in some aspects of her care, including providing emotional support, advocacy, referrals and more.
How are midwives trained and regulated?
In the United States, certified nurse-midwives are nurses that obtain a master's degree from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education. They must pass a national certification examination to receive the professional designation of "certified nurse-midwife." Once a nurse-midwife is "certified," licensure can be obtained at the state-wide level. In the Commonwealth of Pennsylvania, nurse-midwifery licensure if obtained through the Medical Board. Just like OB/GYNs, certified nurse-midwives must renew their licensure every two years, take continuing education courses, pass examinations to renew their certification and have malpractice insurance. In addition to a nurse-midwifery license, certified nurse-midwives must maintain an active registered nurse license and a nurse-midwife prescriptive authority license in the Commonwealth of Pennsylvania. Many certified nurse-midwives also have Drug Enforcement Agency (DEA) licenses that are obtained through the federal government.
What are some of the biggest misconceptions about midwives?
- If I see a midwife, I won't be able to get an epidural. Although certified nurse-midwives are experts in providing care to women who choose to use non-pharmacologic methods to cope with labor, many of the women we care for still choose to use IV medications and/or epidural anesthesia. A certified nurse-midwife's goal is to make sure you are educated about your options and to support your decisions.
- Midwives only attend home births. Although the vast majority of home births are attended by midwives, this is still a very small number. Over 95% of births attended by certified nurse-midwives are in hospitals.
- Midwives have no formal education. There are several types of midwives in the United States. At this time in the U.S., a certified nurse-midwife is required to have a master's degree and pass a national certification examination.
What should women look for/ask when choosing a midwife?
We are all unique human beings with different preferences and priorities for our health and our care. There is no one perfect provider for all women. A woman should think about the care experience she would like. She should gather a list of questions to ask a midwife that will help her decide if this provider is the right fit for her. Is the provider's interaction style comfortable for you? Do you have similar philosophies about the use of medications, medical tests and alternative therapies? Is the provider easy to reach in case of emergencies? Are you comfortable with the provider's collaborative physicians in case you need more complex care? Does this provider accept your insurance? These are all questions you should consider and ask when considering a midwife.