For most women, a childbirth provider is synonymous with an obstetrician, but that wasn't always the case. Women have sought the wisdom and support of midwives for millennia. Today, as more women explore natural birth options, soon-to-be mothers are again turning to midwifery care. Today's midwives are skilled medical providers who offer women compassionate, patient-centered care. If you are considering a midwife, here's how to make an intelligent choice.

Midwives: Homebirth, Hospital Birth, or Birth Center?

If you're considering a midwife, you also need to consider where you would like to give birth. Some midwives can only deliver a baby at a hospital. Others offer deliveries only at home or at out-of-hospital birthing centers. Before you spend precious time and energy getting attached to a midwife, do some research about where you want to give birth, then find a midwife who aligns with that goal.

The Importance of Care Philosophy

Women often select midwives because they hope to have a drug-free birth, but that’s not all that midwives offer. The midwifery model is more patient-centered, which means you can expect your provider to spend more time with you, ask you lots of questions, and explore how lifestyle issues affect your health. Thus many women choose midwives even when they want a medicated birth.

Talk to your midwife early about their care philosophy. Not all midwives are supportive of completely unmedicated births, and some work under doctors who require them to recommend a very particular model of attention.

Here are some questions you might ask your midwife to help you determine whether they are a  good fit:

  • How do you feel about unmedicated birth? What about medicated birth? When would you recommend a particular approach to birth?
  • Can I decline routine procedures? What will happen if I do?
  • If I am high-risk, can you continue treating me?
  • Will you support me if I want to get pain medication or pursue routine hospital procedures?
  • Are there procedures you cannot perform?
  • Can you still attend my birth if I have an emergency?
  • Do you work with a doctor who supports your care philosophy?

Supervision and Emergency Back-up

No matter how healthy you are or how much you want to have an unmedicated birth, pregnancy is an unpredictable process. If you experience a complication or a medical emergency, you should be confident that you will have excellent care. If your midwife works under a doctor, you should meet them several times to ensure this is someone with whom you feel comfortable. If your midwife does not operate under the supervision of a doctor, ask them what would happen in the event of an emergency. Would they be able to remain with you? Do you trust the doctor who would replace them? Is there a clear plan in place? If you’re unsure about the emergency plan, consider choosing a different provider.

Understanding Midwife Training

For centuries, midwives have been lay women with lots of experience and wisdom. Today, most midwives are highly trained professionals. A certified nurse-midwife (CNM) is a nurse with a master's degree who is licensed to care for pregnant and laboring women. A CNM's training is comparable to that of a nurse-practitioner or other advanced-practice nurses, and many have hospital privileges.

A certified practical midwife (CPM) is a midwife who has extensive hands-on training, but no formal training as a nurse. Many states do not license CPMs, but some do. CPMs can only attend homebirths and most partner with a doctor or CNM, who can provide care in the event of a life-threatening emergency. 

Who Should Consider a Midwife?

Midwives serve women of all ages and backgrounds, and many women enjoy working with midwives precisely because of the sensitivity and attention they offer to individual needs. Most women can use midwifery care, but women with high-risk pregnancies or a history of complications may only be able to use a midwife who is supervised by a physician. Ask your midwife if anything might prevent you from continuing under their care.

Many women see childbirth as a major life event. Midwifery care treats this event as a life transition. Honor your decision to use a midwife by taking time with your choice, asking lots of questions, and trusting your gut.