Midwives Care for Women During All Phases of Life, Before, During and Beyond Pregnancy

Many women may have heard of midwives, but have never been to see one and wonder whether to have an OB/Gyn or a midwife provide care for her during pregnancy and childbirth. In Utah, midwives attend about 10 percent of births, which is slightly higher than national rates.

People also may not know that certified nurse midwives deliver babies in hospitals and can also care for women not just through pregnancy and childbirth, but during all phases of a woman’s life: from puberty to menopause and beyond.

“Midwives provide general women’s preventive and primary care, including things like annual well woman exams, pre-pregnancy health check-ups, immunizations and prescriptions, breast exams, pap smears and gynecologic, menstrual cycle or menopause concerns, and family planning services such as IUDs and other birth control. Midwives can also be primary care providers and refer to physicians in other specialties such as cardiology, orthopedics, gastroenterology, etc., said Leah Moses a a certified midwife with Intermountain Layton Hospital.

During pregnancy, midwives provide the same prenatal visit schedule as obstetricians, including lab tests, ultrasounds, blood pressure checks, and monitoring for complications.

The philosophy behind midwifery

The word midwife means “with woman.” The midwifery model of care focuses on individualized care that is a partnership between the woman and the provider. Midwives focus on health, wellness, and prevention; and use interventions at lower rates.

“Midwives approach pregnancy as a normal physiologic event in a woman’s life and believe women’s bodies have the innate capacity to give birth. While pregnancy and delivery complications can sometimes arise, midwives are trained to identify and manage complications as a team with obstetricians and maternal fetal medicine colleagues,” said Moses.

The advantages of seeing a midwife

The job of an obstetricians and a midwife is very similar, to help a woman have a safe and healthy pregnancy and delivery. However, midwives usually take a little more time for education in prenatal visits and provide more hands-on support during labor and birth.

“Midwives generally have the philosophy to use interventions judiciously. For example, they usually encourage spontaneous labor rather than elective inductions without a medical reason, or choose not to break the bag of waters to speed up the birth process in a normal labor,” said Moses.

Midwives follow these and other evidence-based guidelines such as avoiding episiotomies except in rare emergencies, delaying cord clamping and encouraging skin to skin contact with the newborn at delivery. Some midwives offer water labor and delivery.

Labor can be a sometimes long and physically demanding process, so a midwife will usually encourage changing positions often and eating and drinking during labor as needed.

“In the hospital, women always have the option of an epidural or an unmedicated labor. Midwives are known for continuous and creative labor support, which has been shown to decrease the chance of Caesarean section. They care for women who are laboring with or without epidural anesthesia for pain relief,” said Moses.

Statistics show most pregnancies are normal and most deliveries are low risk

National statistics show that 97 percent of the time, babies are born normal and healthy. The US HealthyPeople2020 initiative estimates that about 85 percent of pregnant women enter labor at “low risk”, meaning very few medical problems. While complications can arise in pregnancy and birth, they are not the norm.

“Midwives are a safe choice for most women and interest in them is increasing. In most other countries, including Europe, midwives are the first option for all almost all women and attend the vast majority of deliveries,” said Moses.

When risks or serious complications arise, midwives can work in partnership with physicians

Midwives also care for women who have health problems that arise before or during pregnancy. Women may see only a nurse midwife, or both a midwife and an OB/Gyn and occasionally need a maternal fetal medicine specialist. Midwives work collaboratively with physicians to jointly care for women with high-risk chronic conditions such as Type 1 diabetes, high blood pressure, or autoimmune diseases. Every woman’s medical history and each pregnancy is unique, so it’s a good idea for women to consult with their provider about specific risks or complications.

Midwives attend births for women who’ve had a previous Cesarean birth, sometimes referred to as VBAC or vaginal birth after Cesarean. In following obstetric guidelines, in rare circumstances midwives may recommend a repeat Cesarean section. Midwives usually stay with the woman in the operating room as support, and in some hospitals specially trained midwives are the second surgeon performing the Cesarean section with the obstetrician.

There are many studies that show that midwifery care for healthy pregnant women is as safe or sometimes even safer than physician-led care. Midwifery care is cost-effective, because it results in fewer unnecessary interventions such as Cesarean section. Preterm birth rates are also lower in women who receive their prenatal care from a midwife, partly due to the extra education midwives offer to help women achieve their best health.

There are different types of midwives

There are many types of midwives across the country, laws governing midwifery practices differ across states. In Utah, certified nurse midwives (CNMs) earn a bachelor’s degree in nursing, although many never practice as a nurse, and must hold a Master’s or Doctoral degree with a residency and qualify for a DEA license. Nationally, 98 percent of certified nurse midwives deliver in hospitals. In Utah, only certified nurse midwives have privileges at hospitals but they can also practice in birth centers.

Look for a midwife with formal education that leads to state licensure

“If a woman prefers to deliver in a hospital, it’s important to find out if her midwife is licensed and has privileges at the hospital she prefers. When looking for a provider, it’s a good idea to ask questions, share health history and birth goals to find a provider who has the skills and resources to address her specific needs,” said Moses.

If a woman is considering a midwife who practices outside of the hospital, it’s best to learn about the midwife’s experience and licensure and understand her relationship with and conditions for a transfer to a hospital should complications arise.

Matching a woman’s personal preferences and birth goals along with her individual health needs with a chosen provider and the location she will deliver can give her a sense of reassurance and create a more satisfying experience.

Midwives in hospitals are a good resource for women who are considered generally low risk, want options for labor support and desire personalized care throughout their pregnancy and beyond into primary care, annual exams and overall personal wellness.

Intermountain Midwife Locations

In Utah, Intermountain Healthcare has midwives at locations near Intermountain Medical Center, and Alta View, Riverton, and Layton Hospitals and at West Valley Clinic. For more information, visit https://intermountainhealthcare.org/.

About Intermountain Healthcare

Based in Utah with locations in seven states and additional operations across the western U.S., Intermountain Healthcare is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,800 employed physicians and advanced practice providers, a health plans division with more than one million members called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information, see Intermountain Healthcare.