As a midwife one of the main questions I get all the time is “what is a midwife?”. As I am deepening my interest in fertility and subsequently infertility, people are even more confused as to where a midwife fits into the fertility picture. This post is to clear up any confusion about what a midwife is. I will also explain the role a midwife can play whether you are TTC naturally or undergoing infertility treatments.
What is a midwife?
In the United States, a licensed midwife is someone who has a master’s degree in midwifery and has passed the certification exam. Licensed midwives can be certified nurse-midwives (CNMs) or certified midwives (CMs). CNMs first went to nursing school and often practiced as a nurse before going back to school to become a midwife. This is the path I chose. I worked as a pediatric ICU nurse before going back to school for midwifery. CMs are not nurses first. However, they have master’s degrees. They take the same certification exam, and they have the same scope of practice.
Midwives train in primary care, gynecology, pregnancy and menopause. Therefore they have the same scope of practice as a women’s health nurse practitioner, but they are additionally trained in labor & delivery. Midwives primarily work in the hospital setting either for the hospital or for a private practice. Some midwives own and/or work in midwifery practices and some work in practices alongside doctors. Other midwives work in birth centers and then a few work in the homebirth setting.
How is a midwife different from a doula?
I get this question all the time! Doulas and midwives are not even close to the same thing. Doulas are very important supportive members of a birthing woman. But Doulas are just that- supportive members. Doulas provide emotional support, educational support, partner support and physical support. Women who desire a natural birth (without an epidural) often utilize doula . Doulas are in no way medical personnel. Midwives are responsible for the safety of the baby and mother. Midwives catch babies. When a woman is healthy and experiencing a normal labor and a midwife is present, a doctor does not need to be in the room.
How is a midwife different from a doctor?
Doctors (obstetricians) are trained to manage high-risk deliveries. They can perform surgeries (c-sections, hysterectomies, fibroid removals) and instrument deliveries (vacuum-assisted and forceps deliveires). They can manage complicated pregnancies and labors. Both midwives and doctors are trained to identify and handle emergencies. However, midwives are not trained to manage complicated pregnancies and deliveries. In midwifery practices, if complications arise that are out of the scope of midwifery, midwives will transfer care to obstetricians.
Midwives tend to be more holistic, allowing the woman to labor with fewer interventions. That being said, there are some obstetricians who practice more holistically than some midwives. Midwives can order epidurals. It is a common misconception that you can’t have an epidural if you go with a midwife. While she may be less likely to push an epidural on you, there is no reason a midwife can’t order an epidural (unless you are birthing at home or in a birth center where epidurals aren’t available).
What is the role of a midwife in fertility?
Midwives are often experts in natural fertility. Since midwives learn to trust the woman’s body and empower women to take control of their own bodies, midwives often turn to medical interventions last. If you haven’t started TTC, but you want to optimize your natural fertility, a midwife would be a great person to turn to. A midwife would also be a good person to turn to when you’re been trying for 6 months without success, but you aren’t ready to consider invasive testing or procedures. Midwives can check labs, review your charting, talk about your sex practices and assess for any obvious causes of infertility. Midwives can also perform intrauterine insemination (IUI) if desired.
Should I see a midwife if I became pregnant through IVF?
Absolutely! Even if your path to pregnancy was complicated, now that you are pregnant you are the same as everyone else. Many women like the change of pace from the high-tech, high-stress world of IVF, to the natural and supportive midwifery environment.
Of course, if you discovered medical issues during your infertility workup (such as lupus or diabetes) you may not be a candidate for midwifery care. But if after becoming pregnant, everything is normal, there is no reason you can’t see a midwife. In fact, a midwife could be a good option. Midwives tend to have more time to provide educational and emotional support. Each woman should do what feels right to you. All midwives and all obstetricians are not the same. And the provider one woman loves another might hate. The only way to know for sure is to schedule a visit. To learn more about preconception visits check out my article “The Preconception Visit“.