Exploring Midwifery


Almost every mother will tell you that, if she had to, she would give birth all over again to that sweet bundle of joy. But many of those mothers can also recollect a delivery that frightens even the toughest mom-to-be. If you’re pregnant, you’re no doubt wondering how to reduce the chances of a rough labor and delivery. For years, midwives have eased the emotional and physical discomforts of child-birth, helping hundreds of thousands of babies enter the world. Are the services of a midwife the right addition to your birth plan? Do you even know what the services of a midwife are? Or how to find one in our area?

What is a midwife?

The profession of nurse-midwifery is nearly a century old, but remains shrouded by mystery and myth. In contrast to the medically unsophisticated images commonly portrayed by Hollywood, modern midwives — most typically certified nurse-midwives (CNMs) — have received nursing degrees and years of additional training or graduate degrees for their profession. Although there are midwives who have not received advanced nursing degrees, the state of Maryland does not license them.

Today’s midwives work in conjunction with hospitals, birthing centers and physicians to offer women individualized health care and education, to provide information about available options and to reduce the risk of unnecessary medical intervention during childbirth.

A CNM performs physical examinations and attends labor, but he or she also provides holistic care that focuses on emotional well-being and family development. A commonly cited benefit of working with a midwife is that the relationship allows a mom-to-be to spend more time with her prenatal caregiver.

Elisabeth Lawlor of Annapolis gave birth to her two boys at Anne Arundel Medical Center (AAMC) while under the care of midwives from Bay Area Midwifery in Annapolis. “They never rushed my appointments and always took time to listen to my concerns,” says Lawlor.

What does a midwife do?

A complex combination of physiological and emotional factors are at play during pregnancy and childbirth. Midwives are trained to take both into account. During a prolonged labor, for example, midwives work to determine what if anything is physically wrong, but they also explore the possibility that an emotional block is affecting the mother’s progress.
The mind-body approach is appealing to many expectant parents. Jane Burdette of Laurel also gave birth to two children at Bay Area Midwifery Center at AAMC. The midwives, she says, made a big difference. “It’s not just a medical diagnosis for them. They take into account your whole mentality that comes with being a woman and being pregnant. It’s not just about giving birth for them.”

Melissa Youssi, CNM, is a midwife at Special Beginnings Birth & Women’s Center in Arnold. She describes the woman who comes to a midwife as someone who wants to be informed about all procedures and tests, someone who wants a personal relationship with her provider, and someone who views labor and childbirth as natural, normal processes.

Youssi believes high levels of personal involvement and accountability are the hallmarks of midwifery care. “I always tell clients that they need to make the decisions; we’re just a resource. They are the true experts on their health care,” she says.

The job of a midwife doesn’t end at the birth of a baby. Nor does it always being with pregnancy. Midwives see patients for routine gynecological care, contraceptive counseling, premenstrual syndrome treatment, breastfeeding counseling, postpartum depression counseling and perimenopausal and menopausal consultation.

What about pain management?

Pain management is a core concern during labor and delivery, regardless of which professional is attending the birth. Although there is conflicting research, many midwives believe that epidurals can contribute to a higher C-section rate. Consequently, midwives often encourage moms-to-be to consider a labor with alternative pain management techniques, including walking, position changes, massage, acupressure points and homeopathic or herbal remedies during labor.

In the end, though, Youssi reiterates that it’s the woman’s choice. The patient knows her own body’s needs better than anyone. If she chooses an epidural or other form of pain medication, her midwife will support that decision.
What if there’s a problem?

Midwives work closely with medical professionals to ensure the safest births possible. During routine pregnancies, physicians are consulted on a periodic basis.

At Special Beginnings, a consulting physician reviews cases once a month. When there are complications, the physician becomes a regular member of the patient’s health care team. When there is any question or doubt, an obstetrician or perinatalogist is always available.

Despite their reputation as “non-traditional” labor attendants, midwives know that medical intervention is sometimes necessary to protect the health of mother and child.

At Special Beginnings, 9 percent of patients who begin labor at the birthing center have C-sections; 13 percent of patients who begin labor at the hospital with one of their midwives have C-sections. The overall rate at AAMC is 37 percent. (This rate appears higher because many higher-risk patients choose to deliver at hospitals.)

“We don’t like using a recipe of interventions for every person,” Youssi says. Instead, midwifery practitioners help every mother-to-be develop a unique birth plan that meets the needs of her body and her baby. When intervention is required, midwives coordinate with obstetricians and other specialists to provide continuity of care. This individualized approach allows midwives to work with even the most complicated
of pregnancies.

Who pays for midwifery care?

Most health insurances will cover the costs associated with midwifery care when the mother chooses to deliver at a hospital. A recent trend of dwindling coverage at birthing centers, though, has local practitioners worried and perplexed. The reduced coverage will eliminate the birth center as an option for many women even though birthing center costs are reported to be, on average, half those of hospital births.

5 Myths of Midwives

1.    Insurance doesn’t pay for midwifery care.
2.    Midwives can’t be helpful if you want an epidural.
3.    Midwives can’t be helpful if you have a complicated pregnancy.
4.    Midwives are only used during pregnancy, labor and delivery.
5.    Midwives have not received college degrees and training.

Find a Midwife

American College of Nurse-Midwives
www.acnm.org/find.cfm , 240-485-1800

Bay Area Midwifery Center
www.bayareamidwifery.com , 410-573-1094

Special Beginnings Birth & Women’s Center
www.specialbeginnings.com , 410-626-8982

By Jennifer Murphy

Jennifer Murphy is a wife and mother of two. She lives in Carroll County.