Brief Introduction to Nurse-Midwifery

What is a nurse-midwife?

• An experienced registered nurse

• Educated in an approved midwifery school

• Certified by the ACNM ( American College of Nurse-Midwives)

• Licensed by the state  

CNMs practice within a health care setting that provides for consultation, collaborative management, or referral in case their patient’s care becomes medically or obstetrically complicated.

Midwifery Care is:

• Safe and comprehensive

• Family-oriented

• Woman-centered

• Personalized

Midwifery Care focuses on:  

• Wellness and health promotion

• Consumer choice

• Informed decision-making

• The normal in woman’s health care

• For high-risk cases physician consultation is always available

Major premises of midwifery care:

• Pregnancy and Birth are normal processes.

• Labor support is essential for a positive birth experience.

• Women are increasingly confident that they can give birth without unnecessary medical intervention.

• To optimize care women have a responsibility to educate themselves, asl questions and participate in their care. Decisions regarding care are made jointly.

• Technology should only be used when indicated.

• Many women today want to learn as much as they can about their bodies and the work of childbirth that lies ahead.

• There are several distinct differences between midwifery and medical obstetric practice, however, both occupy common ground and knowledge and are inherently complementary.

• The best model of maternity and women’s health care is an interdisciplinary approach, combining the unique contributions of medical obstetric and midwifery practice. Nations with this model of care demonstrate exceptional maternal and infant outcomes (Rooks 1997: Midwifery and Childbirth in America; Pew Health Professions Commission and University of California, SF 1999: The Future of Midwifery).

• Research shows that satisfaction with birth depends on feeling a sense of mastery over events.

The Midwifery Model for Pregnancy and Maternity Care

 “Whereas medicine focuses on the pathological potential of pregnancy and birth, midwifery focuses on its normalcy and potential for health. Pregnancy, childbirth and breast feeding are normal bodily and family functions. That they are susceptible to pathology does not negate their essential normalcy and the importance of the non-medical aspects of these critical processes and events in people’s lives. Midwives know about the medical risks, identify complications early, and collaborate with physicians to assure medical care for serious problems. But attention to the medical aspects of these complex processes, while essential, is not sufficient. Midwives focus on each woman as a unique person, in the context of her family and her life. The midwife strives to support the women in ways that empower her to achieve her own goals and hopes for her pregnancy, birth and baby, and for her role as mother. Midwives believe that women’s bodies are well designed for birth and try to protect, support, and avoid interfering with the normal processes of labor, delivery, and the re-uniting of the mother and newborn after their separation at birth.”

(Rooks,1997 p. 2. Midwifery and Childbirth in America. Temple University Press.)

Midwifery Care is supported and validated by research.

The Cochrane Database, a systematic review of the research evidence about the effects of care given to women during pregnancy and childbirth, classifies midwifery care as a form of care likely to be beneficial for women with no risk factors (see link below). There are 6 classifications ranging from beneficial, likely to be beneficial, promising, not proven either way, or not worth using.

There are many reports crediting CNMs with improving Maternal Child Health:

1)      CNMs provide personal care ( United States Congress, Office of Technology Assessment 1986)

2)      CNMs are competent Health Care Providers (Department of Health and Human Services, Office of Inspector General 1992)

3)      CNMs have proven outstanding birth outcomes ( Declercq. American Journal of Public Health: The Transformation of American Midwifery: 1975-1988, May 1992) 

4)      CNMs recommended as improvement to Healthcare System (Institute of Medicine. Prenatal Care: Reaching Mothers, Reaching Infants. 1988) 

5)      CNMs important Healthcare Providers to US Health Care System ( Susan Chollard, A Personal Touch, The New Physician, 1992) 

6)      CNMs lower C-Section Rates ( Nurse- Midwifery: “Gentling the Art of Obstetrics”, Kaiser Permanente Press Release 1992)

7)      Nurse-Midwifery---- The Beneficial Alternative ( a researched argument for reinstating midwifery as the standard of care for normal pregnancies) 

Midwifery -----The Beneficial Alternative

 “Obstetrical Care in the United States is burdened by soaring costs and a paradoxical inability to bring rates of infant mortality in line with those of other developed countries. A look at the costs and outcomes of obstetrical care demonstrates that a greater reliance on the use of certified nurse-midwives could help solve these problems. Midwifery care has a good track record with regard to quality of care; it presents a good value for health care dollars, and it rates high in patient satisfaction. “

Gabay M, Wolfe SM. (1997). Nurse –Midwifery: The beneficial alternative. Public Health Reports. 112: 386-394

  “ In any society, the way a woman gives birth and the kind of care given to her and the baby points as sharply as an arrowhead to the key values of the culture.”

Sheila Kitzinger, Women as Mothers

Delaware Valley Ob/Gyn and Infertility Group

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