Nurse-Midwifery Care
Safe, Effective, Soothing
by Mary Anne Diamond CNM, MSN

And it came to pass, when she was in hard labor, that the midwife said unto her, fear not. Genesis 35:17

Midwife means "with woman". It comes from an English translation of the German word "mit wife" and for many centuries has been used to describe the individual who was "with women" in childbirth. Midwives have been the primary caretakers of birthing women and their newborn babies throughout history. The oldest known reference to midwives can be found in the Old Testament, in the book of Genesis.

The certified nurse-midwives of today are health care professionals who specialize in the care of women throughout their life cycle as well as through pregnancy and birth. Nurse midwives believe that birth is a normal physiologic event that affects the whole family. They believe that birth is best assisted by a supportive environment in which unnecessary interventions are minimized, and where the emotional and physical support of the mother is maximized. Nurse midwives include the woman and her family in a "partnership" of prenatal care that includes education about nutrition, exercise, and good health habits that will promote the healthiest pregnancy and birth possible.

There are currently over 5,000 nurse midwives practicing in the United States, and they deliver over 200,000 babies a year. Although most of the babies delivered by nurse-midwives are born in a hospital, midwives also attend births in birth centers and in the home. Some midwifery practices provide services in a combination of hospital, birth center and home-births. All nurse-midwives are registered nurses who have completed rigorous, advanced training in one of 50 accredited schools, have successfully passed a national certification exam, maintain state licensure, and demonstrate continued competency through participation in continuing education.

Nurse-midwives practice in collaboration with physician colleagues. Every nurse-midwife is required by state licensing and by professional definition to have a collaborative agreement with a "back-up" physician. This midwife-physician relationship provides a good combination of care — a midwife who excels in promoting and maintaining health and a physician to manage any medical complications that may develop. Nurse-midwives in Pennsylvania are eligible for full insurance reimbursement, including private insurance, HMO's, Medicaid and Medicare.

The safety of midwifery care has been established by a large body of research. In 1998, the National Center for Health Statistics released its findings that the risk of infant mortality occurring in the first 28 days of life was 33% lower for births attended by certified nurse midwives. It also found that the risk of a low birthweight infant was 31% lower. A survey published by the Public Citizen Research Group found that the cesarean section rate for certified nurse-midwifery practices attending hospital births was 11.6% — half the overall cesarean rate for the United States. These outcomes were achieved with a substantially lower use of drugs, anesthesia and episiotomy.

The safety of free-standing birth center care has also been clearly demonstrated by research. Most notably a study was published in the New England Journal of Medicine in December, 1989 which examined over 11,000 births in 84 birth centers and revealed a cesarean section rate of 4.4% and an overall infant mortality rate of 1.3 per 1,000 births (as compared to a national infant mortality rate of over 9 per 1,000 births in 1989).

The prenatal care provided by your midwife will include regular office visits to assess your blood pressure, weight, urine, fetal heart rate, and fetal growth and well being. Your midwife will review your obstetrical and medical history and do a physical exam to detect any problems that could affect your pregnancy. Prenatal testing will be explained thoroughly and provided when appropriate. Each visit will include time for your questions and to discuss nutrition, exercise, the emotional and physical changes of pregnancy, preparation for labor and birth, and infant care.

When labor begins, your midwife will continue to assess both you and your baby's well being, as well as labor progress. You and your support persons will be involved in all decision making. The focus will be on facilitating the normal birth process, as well as assisting you in achieving the birth experience you desire. Nurse-midwives are knowledgeable in pharmaceutical as well as non-pharmaceutical methods of pain relief in labor. You will be encouraged to utilize position changes, massage, back rubs, showers, and even jacuzzi baths to manage your progress through the birth process. Light fluids and nutrition will be encouraged to maintain labor energy. During the delivery of your baby, the midwife may use warm compresses or gentle massage to help your perineum gently stretch and minimize the need for an episiotomy.

After delivery, the midwife will assist you in establishing your choice of infant feeding, monitor your recovery, and prepare you for your return home as a new mother and family. Nurse-midwives are breastfeeding experts and will provide the education and support you need to establish a great breastfeeding start with your baby.

Your postpartum care will include a checkup between 4-6 weeks after delivery when the midwife will evaluate your healing, discuss and provide family planning options, and review diet, exercise and other health issues. Your healthcare relationship with your midwife can continue long after the birth of your child. Nurse-midwives provide well-woman care, which includes annual exams, pap smears, breast exams, and normal gynecological care.

Nurse-midwives are caring, competent healthcare providers, who are dedicated to providing the best possible care to women and their families. Experience for yourself the historic midwifery commitment to truly be "with women".

Editorial provided by Mary Anne Diamond CNM, MSN, The Birth Center in Bryn Mawr, Pennsylvania.