As a child, I learned that doctors delivered babies. When I got a little bit older, I learned these doctors had a fancy name, a specialization: they were obstetricians. It wasn't until decades later that I learned about midwives! While midwives and OBs share many of the same duties, the histories of the two practices are drastically different from one another. Today, midwives are still pushing for the legal right to practice medicine in certain states. So what is a midwife? What do midwives do beyond catching babies? And why do some states essentially ban midwifery?
The History Of Midwifery
Midwifery has probably been happening, in some form, since the beginning of human history. In ancient Egypt, midwifery was recognized as a career dominated by women. During birth, midwives would help women into a good labor position on different styles of birthing chairs or stools. After birth, midwives care for both mother and baby. It's clear that midwives were culturally significant in ancient Egypt.
Women continued to help one another through the centuries until midwives hit a major snag in the 18th century. Surgeons and midwives were locked in conflict. In some ways, this conflict continues to this day. Most surgeons were males, and these medical males looked down upon the more "folksy" aspects of the practice of midwifery. Eventually, doctors pushed for regulatory control in North America. Their standards excluded midwives who had been practicing for decades and made it extremely difficult for women to pass the collective knowledge from one generation of midwives to the next.
By mid-19th century, midwives had begun to regain some of their footing in the U.S. Some consider Ina May Gaskin to be the mother of modern midwifery. She established a birthing center on a farm in Tennessee called..."The Farm". When Gaskin was rising to prominence, the cultural zeitgeist was ripe to grasp onto the idea. Since the 1960's, midwifery has continued to rise in popularity.
Today, midwives can be divided into several categories, based primarily on the years of education and certifications required to practice.
- Certified Nurse-Midwife (CNM)
- Certified Midwife (CM)
- Certified Professional Midwife (CPM)
- Direct-Entry Midwife
- Lay Midwife
Most midwives practicing in the United States have a bachelor's degree and work as a nurse while completing a certification program.
What Midwives Can Do For Pregnant Moms
Midwifery practice can be described as "low-tech, high-touch." While midwives can use all of the same diagnostic and monitoring tools as obstetricians, they are more likely to rely on clinical experience and first-hand patient observation. Generally, midwives are less likely to push for interventions during labor. Of course, midwives can prescribe pain relief measures during labors - so you don't have to give up on your epidural dreams if you'd like to work with a midwife!
Women with normal pregnancies can be seen by midwives; high-risk pregnancies "risk out" to obstetricians. Because they're generally working with "normal" birth scenarios, midwives sometimes partner with obstetric practices. This way, midwives can call in an obstetrician for expert consultation or assistance as needed.
What Midwives Are Not Allowed To Do
Because midwives do not attend a formal medical school program, they cannot perform surgery. Some midwives assist obstetricians in the operating room, as they are nurses and focused on reproductive and sexual health. Another exception: midwives are legally not allowed to use vacuums or forceps in an assisted delivery. The assumption is this: if midwives only oversee patients with average pregnancies, they won't need to use surgical or manual assistance to deliver.
Midwives Provide Care Before, During, And After Birth
While obstetricians and midwives provide care to mothers during pregnancy and labor, most medical care and supervision ends there. Some midwives, however, provide care to both newborn baby and mother after birth. Immediately after birth, midwives perform Apgar tests to determine the baby's health. Before releasing mother and baby to go home, midwives provide a recommended treatment plan.