Today, Francie Likis, Certified Nurse-Midwife and editor in chief of Journal of Midwifery & Women’s Health, joins us to talk about the confusion of midwifery here in the US. While this topic doesn’t, at first glance, pertain to all readers, we know that the fact that one third of all births are delivered via Cesarean section and one fourth of all births are induced is an interesting topic of conversation. Plus, have you noticed this topic coming up more in the news lately with all the attention that our national healthcare policy is receiving?
There is no question that the trend line for women seeking midwifery care is up, with the percentage of vaginal births attended by nurse-midwives increasing by 21% over the past decade. In talking about this, Elizabeth and I discussed how we both chose different paths for the birth of our children, three each. Elizabeth used a midwife and I used an OBGYN. Both of us are happy with our experiences and felt cared for throughout our pregnancies and the births of our children. However, there seems to be an abundance of confusion for many people concerning the medical qualifications required to become a certified nurse-midwife. We are thrilled to have such an expert as Francie join us today.
This week, more than 1500 midwives are in Nashville for the American College of Nurse-Midwives Annual Meeting. When I say I am a certified nurse-midwife (CNM), these are some of the reactions and questions I get:
“So you do home births?” Some midwives do attend births at home, as well as in birth centers outside of hospitals, but the vast majority of births attended by nurse-midwives (more than 95%) occur in hospitals. There are other types of midwives, including certified professional midwives who primarily attend home births. I am focusing on nurse-midwives in this post because as one, I know the most about them, and the majority of midwives in the United States are nurse-midwives. We are licensed and can write prescriptions in every state.
“What if women want drugs or need a cesarean?” Midwives offer a variety of pain relief options from relaxation techniques to epidurals. Our goal is to give you information about your options so you can choose what you want. Midwives work collaboratively with obstetrician-gynecologists who are experts in high-risk, medical complications and surgery, so that these services are available if the need arises. Midwives do not perform cesareans.
“Do midwives just deliver babies?” Nurse-midwives provide health care to women through all stages of life from adolescence beyond menopause, including gynecologic and primary care in addition to prenatal, labor and birth, and postpartum care. We can prescribe medications and order medical tests. Also, you’ll often hear midwives say we attend births or catch babies rather than deliver them, because we believe mothers do the hard work of delivering their babies.
“What are your qualifications?” CNMs are nurses with advanced education, which is usually a master’s degree and sometimes a doctorate. We must pass a rigorous national certification exam and are required to complete continuing education to maintain our certification. Midwives approach health care using science and research evidence.
“Is midwifery care safe?” Decades of research have shown that midwives provide high-quality care with excellent outcomes that are comparable to, or in some studies better than, those of obstetrician-gynecologists. Compared with women of the same risk status cared for by physicians, women cared for by nurse-midwives have lower rates of cesarean birth, forceps or vacuum birth, labor induction, episiotomy, and third and fourth-degree tears, and higher rates of breastfeeding. Infant outcomes, such as Apgar scores and admissions to the neonatal intensive care unit (NICU), are similar for physicians and nurse-midwives. Women also report very high satisfaction with the personalized care midwives provide.
“What is the midwifery philosophy?” Generally speaking (because there are as many philosophies as there are midwives!), midwives believe that women’s life events such as puberty, birth, and menopause are normal physiologic processes. When complications in these processes arise, interventions should be used appropriately and judiciously. Midwives provide women with information to make informed decisions and encourage women to actively participate in their health care. Midwifery and medical models are complementary, with overlap in knowledge and skills.
“It seems like so many of my friends got induced or had cesareans. Is that true everywhere?” The US cesarean rate is nearly 33% and rose by 60% from 1996 to 2009. More than one fourth of pregnant women have their labors induced. The US spends more than other countries on health care, yet our maternity outcomes are some of the worst among developed countries. Cesareans, labor induction, and other interventions are definitely needed at times, but they have associated risks and should be used prudently. Wanting to avoid unnecessary use of these interventions is one of the reasons women seek midwifery care. Interestingly, a new national study (Childbirth Connection), that is the third in a series, found that the proportion of mothers who agree somewhat or strongly that birth is a process that should not interfered with unless medically necessary has risen from 45% to 58% over the past decade.
Several months ago, I read an article in the Tennessean in which there was a comment about how women spend so much time planning their weddings, yet so little time planning their births. I have thought about that many times since reading it and believe this is a very true and important point. Whether you’re pregnant, menopausal, or just need a routine exam, it is important to choose your health care provider carefully. Midwives are an option that I hope you will consider now that you know more about us.
To learn more about midwives, visit www.ourmomentoftruth.com.
To find a midwifery practice near you, visit http://www.midwife.org/.
Thank you, Francie!
Francie is the editor in chief of the Journal of Midwifery & Women’s Health, the official journal of the American College of Nurse-Midwives, and a Senior Investigator for the Vanderbilt Evidence-Based Practice Center at Vanderbilt University Medical Center. She is pictured here with her beloved nieces whose births are her all-time favorites.