Thursday, January 17, 2013

The Different types of Midwives

So I often get asked about the different types of midwives. Sometimes, I get strange looks when I tell people I'm a midwife. Unfortunately, in this day and age people still think that midwives are all the same. That we all deliver babies at home or that we have worse outcomes than medical doctors when the opposite is actually true. There are different types of midwives however. Just like there are different specialities of doctors. Before I start, I would like to say that midwife means "with woman." I believe all of us midwives have the best interest of the woman and her baby at heart although our levels of education and types of practice may differ. First off, there are Certified Nurse Midwives, which is what I am. We are midwives with a Master's degree in nursing and emphasis in midwifery. We have been registered nurses most of us with experience in the hospital setting in labor and delivery prior to going to a nurse midwife program. We first have to have a Bachelor's degree in nursing followed by acceptance to a Master's or doctorate program in midwifery. We are trained in natural childbirth as well as medical intervention childbirth when necessary with care being taken to fully understand women's individual needs and birth preferences. We also provide some primary care and gynecologic care as well such as pap tests, birth control and care of menstrual problems, etc. The majority of us deliver babies primarily in the hospital setting at 96%. We have arrangements with an obstetrician for emergencies and are under the same credenitaling and review process for hospital privleges as physicians are. We also carry malpractice insurance that typically only covers us for delivering babies in a hospital setting. Some CNM's also deliver in birth centers and at home.

The next type of midwife is a Direct Entry Midwife. These midwives primarily deliver babies at home or in birth centers. Many do have arrangments for OB back up if needed, but the majority do not have malpractice insurance and they will have you sign consents prior to your care having you acknowledge this. They do not have hospital privileges. Most of them have had some experience in assisting other midwives prior to going to training in midwifery. They do not have to be nurses prior to being midwives. They usually go through a midwifery training program that lasts about a year. They are licensed with the state and are accountable for their statistics in delivery, etc. The majority do a great job and have great outcomes. They are very suitable for low risk and completely natural delivery. They do not however have licensure to prescribe if emergency drugs or pain relief medications are desired. They are allowed to administer oxytocin and oxygen in emergencies and they must transfer their patients to the hospital if an emergency arises.

There are also lay midwives who get their training more apprenticeship like. Their experience and time of training may vary. They are much like Direct entry midwives in giving oxytocin and oxygen as needed and that they usually deliver at home or in a birth center, sometimes with a group of other similar midwives. Many have great outcomes as well as less intervention in many circumstances leads to better outcomes in low risk women.

On a side note, I'd like to say that 90% of home birth in low risk women go just fine with no complications. Statistically, midwives have lower incidence of cesarean section (because we don't stick with Friedman's curve for labor progress) and less interventions that could cause an emergency. We also rarely use vacuum extraction which increases risk of brain injury or shoulder dystocia. We rarely cut epiosotmies which decreases risk for third and fourth degree lacerations. Also, statistically midwives have bigger babies perhaps because of the stress on proper nutrition and weight gain that is within normal ranges for different size women. Overall, midwives have great outcomes and very personalized intuitive care:)