Choosing A Midwife - A Primer for Moms-to-Be

Choosing A Midwife - A Primer for Moms-to-Be 1If you are a mom-to-be, you have many choices ahead of you - not only about what car seat to choose and what to do after maternity leave - but also about the "big day."

The two choices that will especially set the stage for your birth experience are the birth environment (hospital, birth center, or home) and the care provider (OB, Family Physician, or Midwife) that you choose.
Choosing A Midwife - A Primer for Moms-to-Be 2
I had the pleasure of interviewing Leslie Ludka, the Senior Technical Advisor for the American College of Nurse Midwives, about common questions and concerns related to choosing a midwife.

ME: What training/education do midwives have?
LUDKA: All Certified Midwives (CMs) and Certified Nurse Midwifes (CNMs) have earned at least a bachelor's degree, and more than 70 percent hold at least a master's. Furthermore, CMs and CNMs must graduate from a nationally accredited education program, pass a rigorous national certification exam, and be licensed to practice. You can read more about midwives here.

ME: What is the advantage of having a midwife?
LUDKA: Midwives listen to women and we are experts in normal childbirth. Normal childbirth does not mean that your birth cannot include anesthesia or an epidural if that’s what you choose. We believe that birth is a normal process; that a healthy woman’s body can conceive, carry, & birth a baby. Pregnancy is not a disease. But we also know that pregnancy can become high risk.

In fact, the bulk of midwifery training is aimed at recognizing the red flags that signal high risk. We are able to order all the same standard testing that physicians order during a pregnancy. We use the same quality labs & technicians. Nurse-midwives always work in consultation and collaboration with a physician who is available to care for those women who have a pregnancy that becomes high risk.

Midwives are educators. We will spend the time that you need to teach you everything we possibly can about your body & your pregnancy. Childbirth is one of the most amazing experiences of our life. Midwives want you to empower you with information so that you are able to make the decisions that are right for you along the way. As you make your own informed decisions about your body, your pregnancy and your baby’s birth, we will walk beside you during this miraculous journey to be your guide and your advocate.

ME: Is using a midwife a safe option for me and my baby?

LUDKA: Certified nurse-midwives caring for low-risk women improve the infant mortality rate in both hospitals and birth centers when compared to physicians caring for equally low-risk women.

In one study, birth certificate data were examined for all singleton vaginal deliveries between 35 and 43 weeks. After adjusting for socio-demographic and medical risk factors, the outcomes for physicians and nurse-midwives were compared:

  • 33% lower risk of neonatal mortality with CNM-attended births;
  • 31% lower risk of low birth weight babies with CNM-attended births;
  • 19% lower infant mortality rate for CNM-attended births.

This nationwide study supports the findings of other studies that women receiving care from certified nurse-midwives have excellent birth outcomes.

ME: Will most insurance companies pay for a midwife-assisted birth?
LUDKA: Yes, most private insurers reimburse for certified nurse midwife services, and many state laws mandate third party private insurances reimburse for midwifery care.

ME: Is it possible to have a midwife attend my birth at a traditional hospital or do midwives only attend births at birth centers/homes?

LUDKA: 97% of all births attended by nurse-midwives are in the hospital. Approximately 2% are in birth centers & 1% in the home.

ME: What is the future of midwifery? Is the practice growing or shrinking?
LUDKA: Midwifery is growing in the US. Births attended by nurse-midwives have doubled since 1990. In addition nurse-midwives are primary health care providers who care for women throughout the life span. In the beginning, nurse-midwives cared mostly for the underserved populations of the US. Soon, highly educated, privately insured woman began to see the outstanding outcomes for underserved women cared for by midwives. They also began to understand that nurse-midwives provide care that is centered on the individual woman with a focus on education.

ME: How can I find a midwife in my area?
LUDKA: You can find a midwife near you on the ACNM site.

* For more information about midwives, check out
* If you live in the Boston area, you may want to consider attending the ACNM-sponsored Women's Health Expo on May 24th, 2008.
* If you are interested in becoming a midwife, you can learn more about the career on the ACNM site.

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5 comments on “Choosing A Midwife - A Primer for Moms-to-Be”

  1. Thank you to everyone who left comments about direct-entry midwives. I certainly didn't mean to exclude anyone and perhaps I will spotlight direct-entry midwives in the future so that moms-to-be can learn more about what differentiates the two. Thanks again!

  2. The Midwives Association of North America (MANA)website also has a midwife locator option in the resource section of their website if you are interested in finding a direct entry midwife The National Association of Certified Professional Midwives (NACPM) also seeks to increase women's access to qualified direct entry midwives

  3. FYI, ACNM will also be hosting a "becoming a midwife" forum on Sat. May 24 along with the Women's Health Expo. It will offer a chance to talk with student nurse-midwives and practicing nurse-midwives as well as hands-on experiences that simulate things that nurse-midwives learn in school.

  4. My CNM interfered (and I trusted her), and I ended up with a cesarean. I'm not saying it was her fault, but what she did certainly didn't help. I would use a midwife again though. Actually, I hope that I'll be able to have my baby at home. CNMs won't do that in my area, but we have many excellent direct entry midwives (CPMs) in town.

    Thank you for posting your interview!

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