Summary List Placement
Midwives are trained and certified healthcare professionals who are experts in obstetric, gynecological, and primary care, says Sascha James-Conterelli, DNP, a midwife at Yale Medicine.
They are caretakers of mothers and their newborns during pregnancy, labor, and the postpartum period, among numerous other abilities. In fact, midwives attend approximately 10% of all births in the U.S.
Midwifery is focused on supporting normal physiologic births (i.e. normal, vaginal births rather than cesareans) and providing individualized care that is congruent with the person’s culture, beliefs, and health goals, says Michelle Telfer, DNP, a practicing midwife and an assistant professor of midwifery at the Yale School of Nursing.
According to the U.S. National Library of Medicine, midwifery has helped improve healthcare services for women and people with vaginas in rural and inner-city areas and should be given a larger role in healthcare. A 2020 study found that midwife-assisted births could cost an average of $2,262 less than physician-assisted births.
Here’s a guide to understanding the important medical and cultural role midwives play and if one is right for your reproductive needs.
What’s the difference between a midwife and a physician?
While there are different types of midwives, the most common are certified nurse midwives who are registered nurses with an additional midwifery certification and anywhere between six to 10 years of education.
According to Telfer, there are three designations of midwives in the U.S.:
- Certified nurse midwives (CNMs): This is the largest group, consisting of registered nurses who go on to complete a master’s degree and national certification in midwifery. CNMs are recognized in all 50 states.
- Certified midwives (CMs): CMs are not nurses, but they are required to complete a master’s program and national certification in midwifery. CMs have all the same abilities as CNMs but are not currently recognized in all 50 states.
- Certified professional midwives (CPMs): CPMs follow an apprenticeship model and are certified by a national certification. Their legal status varies from state to state.
Midwives’ roles often intersect with those of an OB-GYN physician; however, it’s important to note that unlike physicians, midwives are not surgeons, so they cannot perform surgeries like c-sections without the supervision of an OB-GYN.
Depending on the institution, some midwives may assist in more complicated births or even in c-sections. Midwives are also more geared toward handling normal pregnancies. You may therefore prefer an OB-GYN over a midwife if you require a c-section or have a complicated pregnancy.
Here’s how midwives compare to OB-GYN physicians, according to Telfer:
(CNMs and CMs)
|Philosophy||Have a medical approach and rely on interventions where required||Support physiologic births and use as little intervention as possible||Support physiologic births and use as little intervention as possible|
|Medication (like birth control)||Can prescribe medications||Can prescribe medications||Cannot prescribe medications|
|Laboratory tests||Can order laboratory tests and bloodwork||Can order laboratory tests and bloodwork||Cannot order laboratory tests and bloodwork|
|Physical exams||Can perform physical exams||Can perform physical exams||Can perform physical exams|
|Normal pregnancies||Can handle normal pregnancies||Can handle normal pregnancies||Can handle normal pregnancies|
|Physiological delivery||Can deliver babies physiologically||Can deliver babies physiologically||Can deliver babies physiologically|
|Delivery location||Can assist with hospital deliveries||Can assist with hospital, home and birth center deliveries although most deliveries are usually in the hospital||Can assist with home or community deliveries|
|Complicated pregnancies||Can manage complicated or high-risk pregnancies||Need to consult with OB/GYNs on complicated or high-risk pregnancies||Need to consult with OB/GYNs on complicated or high-risk pregnancies|
|C-section surgeries||Can perform surgeries||Cannot perform surgery, but may be trained to assist physicians in surgery||Cannot perform surgery|
|Epidural||Can order epidurals, which are typically administered by anesthesiologists||Can order epidurals, which are typically administered by anesthesiologists||This is not an option with home or community births|
|Labor experience||Usually spend less time with the laboring person||Spend more time with the laboring person, offering support and comfort||Spend more time with the laboring person, offering support and comfort
Are midwife deliveries safe?
Midwives often work closely with OB-GYN physicians and consult them when someone who is pregnant or in labor requires surgery or more specialized care, says Telfer.
Midwife-assisted deliveries are considered to be safe, especially for people with low-risk pregnancies. A large 2015 study found that people with low-risk pregnancies were not very likely to experience serious adverse events, like uterine rupture or admission to intensive care, if they opted for midwife-assisted deliveries.
However, you may want to opt for an OB-GYN (either as your primary healthcare provider, or secondary provider who will co-manage your pregnancy with your midwife) in the event of:
- A breech baby, which means the baby is positioned feet-first rather than head-first
- A chronic illness or other conditions like diabetes or high blood pressure
- Multiple births, like twins or triplets
- Previous c-section surgeries or pregnancy complications
Is a midwife cheaper than a hospital?
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The cost of opting for a midwife is similar to that for a physician, according to James-Conterelli. She says most midwives accept insurance; however, some prefer private pay only.
Opting for a midwife or a home birth can be considerably cheaper overall however, according to Telfer, because midwives usually:
- Use fewer interventions, making the delivery less expensive
- Have lower rates of cesarean surgeries, which are the main contributor to delivery costs
- Have lower preterm birth rates, reducing the probability of neonatal care
- Are less likely to induce labor, which can cause complications and result in longer hospital stays for you and your baby
According to Telfer, a hospital-assisted vaginal birth costs around $9,000, whereas a home birth assisted by a midwife costs around half that. She says a cesarean surgery can add around $3,000 to the cost. Exact costs can vary by state, midwife, hospital, and medical issues or pregnancy complications.
Midwife services are usually covered by insurance plans; however you should definitely check whether your specific plan:
- Covers midwife services
- Has any certified nurse midwives as in-network providers. Otherwise, if they are out-of-network providers, you’ll have to pay more from your own pocket
- Covers your preferred birthing option, like home birth, for example
Midwives are trained medical professionals who deliver babies and provide other types of pre and postnatal healthcare.
Midwives take a personalized, physiologic approach to healthcare, helping improve the quality of care and reducing the costs associated with it.
You can find a midwife through the American College of Nurse-Midwives’ website or through your primary care or OB-GYN physician.
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