Midwives, or nurse-midwives, specialize in women’s healthcare with a particular focus on the birthing process. “We’re providers of obstetric and gynecological care across the lifespan,” said Dr. Eileen Thrower, Chair of the Department of Midwifery and Women’s Health at Frontier Nursing University.
Given that the United States is facing a maternity healthcare provider shortage according to the American College of Nurse-Midwives (ACNM)[1], midwives and other health-care professionals are in high demand. In addition, maternal mortality rates in the United States are higher than many other developed countries which makes midwife services invaluable in improving maternal healthcare outcomes.
Studies show that low-risk pregnant women under the care of a midwife have lower rates of epidural use, Caesarean sections and other surgical interventions, while birth outcomes remain the same when compared to women that were not under midwife care. Thus, the role of a midwife can play an incredibly rewarding contribution to the maternal healthcare system.
Midwife job description
Do midwives deliver babies? Yes, but they also do much more than that.
Midwives provide healthcare to women from menarche (the onset of menstruation) to menopause (the cessation of menstruation) and beyond. Most often, they work in partnership with a patient’s physician to provide gynecological and obstetric care.
The pregnancies and births that they assist with are typically lower risk, though some midwives do specialize in higher risk pregnancies.
Main duties of a midwife
Some duties that midwives perform that can occur at any stage of a woman’s life include:
Perform health and laboratory screenings, annual patient exams
Provide physical, mental, genetic, and sexual health assessments
Diagnose and treat common medical conditions
Prescribe medication (yes, midwives in certain states can prescribe medication, but only if they posses the proper license)
Prescribe and administer comprehensive care for all contraceptive methods
Refer patients to other healthcare professionals if needed
Midwife services at each stage of childbearing
A midwife’s duties when caring for an expecting mother can be categorized by whether they take place before, during, or after childbirth:
Before labor (prenatal)
Conduct a variety of health assessments on the mother and baby.
Monitor maternal and fetal health during pregnancy, provide care as needed.
Provide prenatal education, counseling, and help create a birth plan.
Prepare the mother for what to expect during childbirth.
During childbirth
Monitor maternal and fetal health during labor
Assist during labor and delivery
Assist with pain management
Manage labor complications or get extra medical help if needed
Provide physical and emotional support to the mother
After labor (postnatal)
Provide routine and emergency medical care for infants at birth
Educate new mothers about breastfeeding
Support mothers with postpartum depression
Educate new parents about how to care for their new baby
What is a midwife’s role?
The ACNM reports that although midwives are well-known for attending births, and it is perhaps their best-known responsibility, most Certified Nurse-Midwifes (CNMs) and Certified Midwifes (CMs) identify either reproductive or primary care as main responsibilities in their positions. [2]
Thrower acknowledged that many people are drawn to the field because they want to be a part of the birthing process, but it’s important for aspiring midwives to understand that it’s only a piece of the picture. A midwife’s education is still a nursing education, which involves learning about many aspects of the human body.
“Students come in and that’s their main focus: ‘Oh, I get to learn to deliver babies!’ And though that’s an important part, in the end it’s kind of a small part because delivering a baby is a very brief moment in time,” Thrower said.
The extent of a midwife’s responsibility vary by location as some states require that midwives work under a supervising physician, while others allow certified nurse-midwives to practice autonomously. This is called “full practice authority”. Currently, 27 states and the District of Columbia allow certified nurse-midwives to practice independently.
Where do they work?
Midwives work in a variety of settings, including:
Hospitals
Birthing centers
Public health clinics
Military bases
Homes
Although people often strongly associate a day in the life of a nurse midwife with home births, nearly 95% of CNM/CM-attended births occurred in hospitals in 2017.
“The most common practice model for nurse-midwives in this country is that they are hospital-based,” Thrower said. “Now there are a lot of different ways that it can look, because there are other midwives working in birth centers or even home birth practices, but [most] of them are actually in a hospital midwife role.”
It’s common, according to Thrower, for many midwives based in hospitals to work in an office doing outpatient care for a few days per week. These midwives are then generally on call one or two days per week for the hospital or birth setting.
“Most of the time is spent in an office space setting where you’re providing not only prenatal care but also gynecological care for women across the lifespan,” she said.
Even your experience in hospitals can vary greatly depending on the type of hospital and size. “Every place I’ve worked at has its pros and cons,” Thrower said.
Working in a larger practice means there are more providers, so it can make your schedule more manageable, but having more providers could mean that you don’t have the opportunity to get to know your patients quite as well. In smaller practices you get to know your patients better, but if there are fewer people doing the job, your schedule can be more demanding. This may also affect your salary as a midwife.
“Different practice settings really suit different people,” she said.
What qualities should a midwife have?
Midwives care for women at nearly every stage of life and accompany them on one of the biggest choices they can make: having a child.
Aspiring midwives should, therefore, be willing to cultivate a compassionate partnership with their patients, advocate for their patients’ rights and promote patient-centered care. To that end, midwives should have:
Strong communication skills
Empathy
Patience
Passion
Flexibility
Thrower said that many midwives say they had a ‘calling’ to the profession which stems from a deep passion for the work.
Being a midwife: perks and challenges
“I think that one of the biggest characteristics [in midwives] is just that passion for women’s health care and that passion for being with people as they’re going through a pregnancy or birth, for reproductive care and reproductive justice,” Thrower said. “One of my real passions as a midwife is gynecological care. I love the care of women across the lifespan.”
While delivering babies is an amazing part of the midwife job, Thrower said there is profound joy and meaning in the everyday – for example, treating someone who is coming in for their very first Pap test.
“To be able to treat those people with dignity and respect creates a trusting relationship, and to have them leave with an experience that was not traumatic but was in fact empowering. For me that was a really precious gift that I found to be really valuable.”
Flexibility is also key to anyone considering a career in midwifery. Like many other health-care professionals, most midwives do not have a typical schedule. Since health complications and childbirth can happen at all hours of the day, prospective midwives must be prepared to be called in to work at any time depending on the needs of their patients.
FAQ: What midwives can and cannot do
Do midwives perform ultrasounds?
Yes, midwives perform many types of health assessments on a pregnant mother and baby, including ultrasounds to monitor fetal health before and during labor.
Can midwives give epidurals?
Midwives cannot administer epidurals because they are not medical doctors. Epidurals are usually given by an anesthesiologist or another specialist. Midwives may be able to prescribe an epidural if they have prescriptive authority, but they do not administer it.
Can you have a midwife and an OB-GYN?
Yes, midwives and OB-GYNs can work alongside each other depending on the type of practice. If you are expecting a child, you may be able to have both an OB-GYN and a midwife on your case.
Can midwifes do caesarean sections?
Midwives cannot perform surgeries, and therefore cannot perform C-sections which are a surgical procedure. They may assist the doctor performing the procedure, however.
