Choices: Giving birth with a midwife or an OBGYN?

Most people consider giving birth with an OBGYN to be the "safe" choice, but having your baby with a midwife has gone from a crunchy alternative decision to relatively mainstream now. This cultural shift has come from women wanting more control over their births and becoming more educated about their choices. While midwives are becoming a more popular birth choice among a growing number of women, there are still many misconceptions and fear about giving births with midwives. In this post, we give the basic facts about midwives and information about how to find a midwife in New York City.

Ricki Lake has also been an outspoken proponent of midwives in her informative documentary, The Business of Being Born, which takes a closer look at how the medical industry has shaped the way women give birth. This film is a must-see for anyone considering having a baby (even if you are not considering using a midwife) as it will help you make informed decisions and give you insight into how choosing your practitioner can affect the outcome and experience of your birth.

What is a Midwife?
Midwives are trained practitioners who do a whole range of well woman care, including attending labor and deliveries. There are two recognized types of midwives in the United States: Direct Entry Midwives (DEM) and Certified Nurse-Midwives (CNM). There are some significant differences between the two types of midwives, so read on.

Direct Entry Midwifes
It's a little hard to get a handle on DEMs, because it's a new field, without standards of education. Even more confusing, some DEMs get certified and become Certified Midwifes (CM) which is a good education but not the same as a Certified Nurse Midwife (CNM). An interesting aspect of DEMs is that they enter the field through apprenticeships and community-based programs or allied fields, and often offer sliding scales. Not all states cover DEMs but some insurance does cover them. DEM's are mostly used for home births. If you are considering using a CM or a DEM they should answer all your questions about their training, experience and explain how they are the same or different than their colleagues.

Certified Nurse Midwife
Comparably, it is easy to understand the training of a Certified Nurse Midwife (CNM) because it is standardized. A CNM has graduated from an accredited nursing program and also undertaken graduate studies in a midwifery program. CNMs must pass a national exam (their "boards," if you will) and are licensed and registered by a State Board of Midwifery. CNMs do almost everything a OBGYN does such as write prescriptions, labor and delivery and give gynecological exams etc. so you can go to a CNM even if you are not pregnant. In terms of labor and delivery, midwives differ from obstetricians in that they do not do surgery. So if you've working with a midwife and you need a cesarean section, a doctor will take over your care during the labor to perform the operation.

Nevertheless, midwives tend to stick around (continuous support is one of the things that distinguishes a midwife from other practitioners) so expect her to see you through to the end. You should also know that midfives do not manage high risk problems and will refer you to a doctor if complications arise during the pregnancy.

CNMs work in a variety of settings, such as private practice, a physician's practice, hospitals, clinics, birth centers, and health departments. Some may attend home births. All states mandate Medicaid reimbursement and most require private insurance reimbursement for nurse-midwifery services. By law midwives must have a written practice agreement with a collaborating physician.

Some of the reasons to choose to give birth with a midwife are because they have excellent medical training in child birth procedures, focus on empowering the woman in her birth and promote birth as a normal process. Studies show that outcomes are the same as physician-attended births in terms of health of the baby and the mother.

What's the difference between a midwife and an OBGYN? While no generalization fits all, obstetricians and midwives tend to have different philosophical views on birth, which can have an impact on your care. OBGYNs tend to treat pregnancy as a medical condition and birth as a procedure. They will focus largely on preventing and dealing with unlikely, but potentially life threatening problems. Midwives tend to treat pregnancy and birth as a special, but normal, life event and focus on making birth a positive experience for the mother.

Do I have to have natural childbirth if I use a midwife? No. Your midwife is trained to and should support the birth experience you want to have. If you are planning on having pain relief you can discuss this with your midwife from the start and plan a hospital birth with pain relief.

Can I give birth in a hospital with a midwife? Yes, but you must use a midwife that has hospital privileges. Start by looking at the listings below for a midwifery practice that is affiliated with a birthing center or hospital and ask them what their procedures are. 

What happens if something goes wrong? All midwife practices are supposed to have OBGYNs that they work with who can be available in the event they are needed during a birth. Unfortunately, some midwives don't. When interviewing midwives make sure to ask them about their medical support and relationships with area hospitals. If you are giving birth in a stand alone birthing center or at home you will want a midwife who will be able to stay with you and who has a doctor on call in the event that you have to go to the hospital.

Will my insurance cover my birth with a midwife? Most insurance policies cover birth with midwives and many midwifery practices take various insurance policies, just like your doctor.

Finding a Midwife in New York City
Below we've listed the larger midwifery practices we know about in the tri state area but your family physician or OB/GYN can refer you to a midwife as well. In addition, the Assocaition of Certifed Nurse Midwives has a 24-hour toll-free number that provides the names of ACNM certified midwives, sorted by zip code: 1.888.MIDWIFE (1 888 643 9433).or look online at www.midwife.org/find.cfm.

NYC Area Midwives and Midwifery Practices
Some midwives generally do home births others generally assist births in a birthing center or hospital.

Birthing Center Midwives