Call the Midwife: Understanding a Midwife’s Role in Pregnancy Care

Certified nurse midwives encourage each individual woman to participate in decisions and be a partner in their prenatal care & delivery so they can leave the hospital a healthy mom, with a healthy baby, and a satisfying birth experience.

Both OB-GYNs and midwives provide personalized advice to help pregnant women understand what’s in store for them and their baby. Our nurse midwives pride themselves on providing personalized prenatal care and education to patients in the prenatal period. Our far-reaching goal is to ensure a positive pregnancy and birth experience because it helps women grow into confident mothers.

While most people recognize that midwives have some role with delivering a baby, after that their understanding frequently gets much fuzzier. To clear the confusion, let’s break down my role as a certified nurse midwife (CNM) in pregnancy care.

Related reading: Pregnancy Labor and Delivery Blog

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What is a midwife and a certified nurse midwife (CNM)?

Midwives have a solid medical background for caring for women during pregnancy and childbirth, but also for women’s gynecological care as whole.

Most midwives in the United States are registered nurses (RN) who have at least a Master of Science in Nursing (MSN) with training in labor and delivery. For example, after completing my Bachelors of Arts in international development, I did my graduate training at Yale University. First, I became a nurse, then the subsequent two years I completed my Masters of Science in Nursing, in the nurse-midwifery specialty.

All certified nurse midwives (CNMs) have a Masters of Science in Nursing and licensed nationally through the American Midwifery Certification Board, which issues board exams and requires ongoing medical education and recertification throughout our professional career.

Midwives do not perform surgery, so in instances where a surgery is required, like a cesarean section, CNMs collaborate with our physician colleagues who do the surgery. Midwives often accompany patients into the operating room either to assist with surgery, or to serve as a support person for the patient and her family member.

Like OB-GYNs, midwives provide personalized pregnancy and delivery care with attention to the health of both mom and baby. It is our nursing background and focus on patient and family education that sets us apart from our physician colleagues.

I spend a significant amount of time educating patients about the journey of childbearing, ways to stay healthy and managing common gynecologic complaints. I take an active role in preparing expectant parents for labor and newborn care after delivery. Medical care as a whole relies on algorithms and guidelines however, nurse midwives recognize that every patient is an individual and we pride ourselves on engaging patients in shared decision-making, recognizing that the pregnancy and birth is unique to each woman.

CNMs and nurse practitioners are really the foundation of the clinic for patients and staff. We care for women across the lifespan. Because of our education and wellness focus, we have slightly longer visits and enjoy helping patients understand their bodies and treatments.

When caring for especially complex patients or conditions that require surgery, I collaborate with my physician colleagues to prepare the woman for surgery.

Electing to see a midwife during pregnancy care is a personal and empowering decision. We can help you make that decision.

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The role of a midwife during labor and delivery

Childbirth is very personal, and the journey is somewhat different for each woman.

At the end of the day, I see pregnancy more as a state of health rather than a medical issue. As such, the midwifery care model recognizes pregnancy and birth as a normal process that often requires little intervention.

This means that during labor, a midwife may encourage labor and birth per a woman’s chosen birth plan (bed, bathtub, birth ball, etc.) and generally avoids intervention with medication or other things like breaking the bag of waters unless there is a clear reason to do so.

Having said that, women who have their babies with midwives often choose to use pain medication, epidural anesthesia and may have their labor induced if medically necessary.

However, my job is not to “tell” a patient what she “should” do. At the end of the day this is her pregnancy, her experience and I want to support her in that unique journey.

I want a mother walk away from a birth feeling like a real participant in the decision process, and to help her grow as a confident mother.

For this reason, providing expert care focused on education and patient involvement prenatally, during labor and delivery, and after birth is what draws women and families to midwifery care.

A look after pregnancy to postnatal care and beyond

Though a woman’s first experience with a midwife is often during pregnancy, many choose to continue seeing a midwife long after. This is particularly true in the postnatal care period, which is generally the period just after birth and through the first six weeks.

Because we focus on whole-patient wellness, we enjoy helping women understand their bodies and treatments throughout their lifespan.

The same skills that I use when caring for pregnant women also helps me assess, diagnose and treat women with gynecologic or sexual concerns. This can range from placing IUDs (intrauterine devices), managing gynecological complaints, menopause, sexual pain, and more.

Outside of prenatal visits, I am the co-director of the CU’s Women’s Sexual Health Consultation Service. With my colleague Helen Coons, Ph.D.,  we provide evidence-based multidisciplinary care to improve sexual satisfaction for women across their lifespan.