The Nurse-Midwife Option
Perhaps one of the first decisions you will make after finding out you are pregnant is “who will I see for prenatal care and where will I deliver my baby?” One increasingly popular option is the Certified Nurse Midwife (CNM). While there are several types of “midwives,” the focus of this article will be on the Certified Nurse Midwife.
Certified Nurse Midwives are health care practitioners with bachelor’s and master’s degrees in nursing who specialize in women’s health care particularly during the childbearing years. Certified Nurse Midwives are certified by the American College of Nurse Midwives after completing an accredited master’s program and passing a national exam. Once certified, the Certified Nurse Midwife must maintain her certification every five years through a continuing education program.
In 2006 (the last year that statistics were available) in the state of Colorado, 10.5 percent of all births were attended by Certified Nurse Midwives. You can find Certified Nurse Midwives in hospital-based practices, at a freestanding birth center, or in private physician practices where births are attended in a hospital setting. In most cases, families that choose the midwifery option will never see a physician during their prenatal care or delivery. Their midwife will offer all the same screening and testing that is the standard for prenatal care and attend the birth. Insurances cover midwives the same as they cover physicians so the cost is not different based on provider. The difference is in the approach.
The Certified Nurse Midwife is trained to approach prenatal care, delivery and the postpartum period as wellness care. Most people have 13 to 14 prenatal visits. Typically, the first obstetrics visit happens around 6 to 8 weeks of the pregnancy. While a Certified Nurse Midwife introduces you to the practice, gives you a brief overview of what testing will be recommended during your prenatal course and often performs a physical exam to ensure that any health concerns can be addressed from the beginning of the pregnancy. Some practices will also do an ultrasound at this first visit to verify your due date. Visits are then every month until 28 weeks then every 2 weeks from 28 weeks to 36 weeks then weekly the last month of the pregnancy.
Women have been giving birth since the beginning of time and need support and information. During the prenatal visits, Certified Nurse Midwives will offer nutritional counseling, and exercise recommendations. They will talk about fetal development, physical discomforts that may occur, listen to the baby’s heartbeat, try to assess the baby’s position and answer any questions that may come up. They will guide you toward appropriate childbirth education classes, help you pre-register at the hospital and let you know your options while in labor.
Many people may have the impression that if they choose a “midwife,” they have to deliver at home and cannot have pain medication. Ultimately, Certified Nurse Midwives are advocates of choice. It is their responsibility to provide you with information that will promote your relaxation and peace of mind about delivering your newborn and building a family. During prenatal visits, Certified Nurse Midwives listen to your hopes and fears about birth and try to provide you with resources to help you have the optimal birth experience. If that experience means having a few contractions at home then getting to the hospital and getting an epidural as soon as active labor ensues, that is what will be supported. If that experience means needing support and encouragement to stay at home for several hours of contractions then arriving at the hospital in active labor and proceeding with an unmedicated delivery, then that support will be offered.
While most prenatal care and births are uncomplicated and do not require medical intervention, Certified Nurse Midwives are trained to know when help is needed and when a pregnancy may fall out of their scope of practice. All Certified Nurse Midwives work with consulting physicians that can be called in if a pregnancy becomes complicated by preterm labor, high blood pressure, gestational diabetes or a handful of other complications that warrant more intense medical support. If during a labor, it becomes necessary for a cesarean section, a physician is called in to perform the surgery and in many practices the Certified Nurse Midwife will serve as the first assistant still able to provide support during the birth.
Pregnancy and birth are pinnacle events in a woman’s life and warrant care that recognizes that. In “Heart and Hands: A Midwife’s Guide to Pregnancy and Birth,” Elizabeth Davis so eloquently writes that “the midwife must keep her senses ever alert, the parameters of safety ever in mind, and then stand back, let birth happen, and gratefully bear witness.”
For more information about where you can find a CNM in your area, contact the American College of Nurse Midwives at www.midwife.org.
