Modern Midwives


 

WHAT is a Certified Nurse Midwife?

A certified nurse midwife (CNM) is someone who has a 4 – year college degree in Nursing and a Master’s and/or Doctorate in midwifery.  In order to practice in their state, they must pass a board certification and obtain an RN licensure as well as a midwifery licensure. In order to practice in a hospital, they must also obtain controlled dangerous substance (CDS) license.  In addition, they must register with the federal drug enforcement administration (DEA) and pass a rigorous vetting process by the hospital administration.

Over 94% of Midwifery attended births happen in a hospital. 

This is not your traditional homebirth midwife or apprentice/community trained midwife. A certified nurse midwife must undergo extensive education before presenting himself or herself to the board for examination. Once a midwife passes the certification exam, they then must undergo a thorough licensure process and an extensive vetting process by the hospital in which they work.

Midwives are known as one of the oldest professions in the known world. They have been around since the dawn of humankind assisting laboring women who give birth. It is only in the last 75 years as birth has moved from the home to the hospital that the extensive licensure and regulation of midwives has taken effect. While initially that shift from the home to the hospital did not bring an increase in better outcomes for moms and babies, in the last 30 years we have learned that hospital births decrease maternal and infant morbidity (home birth for the lowest risk of women is still considered safe by most).  With these recent changes, it is midwives that have better outcomes, higher breastfeeding imitation rates, and give women a better experience in the hospital.  They are able to do all of this without compromising on maternal and infant safety.

Midwives have:

  • Lower rates of cesarean birth
  • Lower rates of labor induction and augmentation
  • Significant reduction in the incidence of third and fourth degree perineal tears
  • Lower use of epidurals and regional anesthesia
  • Higher rates of breastfeeding
  • Lower than the national average rate for episiotomy (3.6% compared tp 25%)
  • Lower than the national average rate for primary cesarean (9.9% compared to 32%)
  • Higher than the natiaonl average for breastfeeding inititation (78.6% compared to 51%)

Many women have the assumption that midwives only deliver in the home or a birth center setting, when in fact, over 94% of midwifery attended births take place in the hospital setting.

In a systemic review that was published in 2011, looking at the health outcomes for midwives compared to their physician counterparts over a period of 18 years (1990-2008), this study discovered that midwives compare favorably to doctors.

Midiwfery care results in fewer cesarean births than physician care for equally low-risk women   

Additionally, mdiwives spend more time on prenatal education and preparation for labor, birth and the postpartum periods, as well as focus on the birth experience and patient satisfaction.  They do all of this without compromising on safety.  Certified nurse midwives working in a hosptial setting have a lower incidence of maternal and infant morbidity and mortality than other birth professionals.

Do midwives work together with doctors?

Midwives working in direct collaboration with a physician offer the best of both worlds. A woman and her family can have access to both a midwife’s expertise in how to avoid an unnecessary cesarean delivery, while having lower rates of intervention and increased rates of breastfeeding without giving up the expertise of an MD.  Many midwives work in practice with their collaborating physician and share patients or co-manage patients. This approach is seen by both the governing board for midwives and physicians as an ideal way to practice.

The American College of Obstetricians and Gynecologist and the American College of Nurse Midwives released a joint statement in which they said: “[We] affirm our shared goal of safe women’s health care in the United States through the promotion of evidenced-based models provided by obstetrician-gynecologists (ob-gyns), and certified nurse midwives (CNMs). Ob-gyns and CNMs are experts in their respective fields of practice and are educated, trained and licensed, independent providers who may collaborate with each other … Quality of care is enhanced by collegial relationships” between the two fields.

Midwives are trained to see pregnant women as healthy and pregnancy as a natural process whereas doctors are traditinally trained to treat illness and often see pregnancy as such.   This is why in having a collaboration betwene a physican and a midwife, a woman can be primarily treated by someone who sees pregnancy as a healhty state, but she is covered in case something does go wrong.

Times have changed for midwives. Midwives are more educated than they have ever been and more skilled than their precedcessors. They are working more and more alongside their physican counterparts in collaboration offering more options for women during pregnancy and birth. More options for birth leads to women becoming consumers in healthcare and demanding the changes they want to see.  Does a modern midwife equate to a better experience with better outcomes and the same saftey?  It sure seems that way.

This article was written by Kristin Mallon, CNM, MS, RNC-OB, a certified nurse midwife and founder of Mindful Midwifery in Hoboken and Hackensack New Jersey.  Kristin works in collaboration with Dr. Yaakov Abdelhak to create a “best of both worlds” model of pregnany care.  For more information about Kristin and her practice, see her website at www.njmidwifery.com

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