Facts vs Myths (Midwives)

Today Jaelin and Andie talk about the difference between midwives and OBs and the differences of the different midwife certifications.

Points from the Midwife Monday Video:

Midwives and Obstetricians are often misunderstood with the shroud of myth and bias of their professions.  Because the two professions have commonalities in caring for women during pregnancy and birth, lines blur and misunderstandings erupt from potential clients.  So, let’s clear up that confusion first.

The main difference between midwives and OBs is midwives are experts in uncomplicated, low-risk women while obstetricians are experts in high-risk women and surgery.

Now onto what we really want to discuss - Midwives!

On our big, beautiful globe, over 80% of the living population have been born with the attendance of midwives. In a majority of the developed industrialized nations, midwives help with about 70% of births. Historically and traditionally, midwives were the care providers for moms and babies.

The upsurge and regrowth in midwifery is not a trend.  Midwives have always been. Medicalized birth is the trend. Midwives are trained providers who offer women and families their expertise on pregnancy, labor, birth, postpartum, and breastfeeding. They use their skill to support and empower women and families.  It is based on individualism and unique holistic care. It’s important to note that in the entire world, all the countries with the best statistics for moms and babies use midwives.

In 1979, a Social scientist and sociologist named Barbara Katz-Rothman found a definition for maternal care.  Specifically, she pointed out the difference in the medical model and the midwifery model of care.

The Midwifery Model of Care and the Medical Model are on opposite ends of a spectrum.

The midwifery model views birth as a normal and healthy part of a woman’s life.  It focused on high touch and low tech with less intervention.  It focused on evidence based care, informed consent, and shared decision making.

Midwifery care tends to be more nurturing and is built on a relationship.  Those pillars come from monitoring holistically, education and counseling, and referring women for specialized attention when the need arises. Research shows that the Midwifery Model is responsible for less traumatic births, fewer surgical births, and less birth injuries.

Because there are various settings midwives practice in, it only makes sense that that model can work in all of those settings whether it be at the hospital, home, or birth centers.  Right now there are about 15,000 midwives in America, but only about 10% of birthing families use midwives. Countries that are using midwives are the countries with the best maternal and fetal outcomes, yet America, who tends to use midwives less than the rest of the developed world, does not. Here we are with one of the worst rankings for moms and babies.

Let’s put two and two together.  Who are these 15,000 midwives? Here’s where it gets confusing again.  We all (midwives) have these initials after our names that stand for what kind of training we had or what kind of schooling we attended. When we strip that away, we all stand as one. We are midwives.

That would be lovely, but unfortunately we have initials.  So, what do they mean exactly.  There are Nurse Midwives, CNMs. The C standing for Certified.  What that boils down to is they are midwives with a nursing background.  CNMs have master’s degrees in midwifery and are Advanced Practice Registered Nurses.

The general public sometimes carries a bias that CNMs are more medicalized.  The hurtful term “medwife” is even thrown around. It’s an awful way to describe the profession. Here’s why.  It further divides a very small community of people who are all fighting for the same thing -Empowering families to have ownership over their health and improving outcomes for mommas and babies.  They follow the midwifery model.

The medwife myth is rooted and we have to let go of it. I noticed the MANA site says CNMs training is hospital based, but that is not true either, and perhaps fuels the misconceptions.  It is true that most CNMs practice in the hospital, but we cannot take a term that is meant to be negative and blanket it on the entire profession. Its really unfair and it hurts my feelings.

We realize it’s a controversial issue and draws lines in the sand.  We don’t want lines. Lets build build beautiful sand castles together instead! I trained in home birth, a birth center, and a hospital.  My intentions were always to offer out of hospital options for families. Our scope of practice allows us to practice in all three of those settings, true, but my heart is in homebirth. We are also full care providers and have prescriptive authority, which means we can write prescriptions.  It does not mean we do it often; it just means we can.  Perhaps that adds more fuel to the “medwife” fire.  I consider it a very rarely used tool in my tool box.

Some other initials you may have seen are CM or CPM.  These are direct entry midwives who are trained and use the midwifery model.  Usually, you see them in out of hospital settings and without a nursing background.  A Certified Midwife usually has a degree in the health field but not in nursing.  They also complete a master’s level midwifery program.

More commonly seen in Texas and America, are CPMs, professional midwives. This avenue puts its focus on out of hospital birth. Their training and schooling keys in on providing care to families in birth centers and homes.

No matter the initials, laws differ from state to state, and all midwives should be practicing the midwifery model of care.  Here’s what it boils down to - The nations with the lowest morbidity and mortality statistics for babies and mommies are those in which midwifery is seen as a perk and is utilized. The midwifery model focuses on high touch, less intervention, low-tech, tons of caring, and a relationship that ends in better outcomes for low risk women.

Andie WyrickComment