Midwifery is a traditional and invaluable profession for the health of women and infants. In this post, you’ll learn what is the midwifery model of care, why midwives are important, what is a midwife, and the undeniable benefits midwives provide for women and why we need more.
“If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving childbirth back to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.”
Michael Odent – Obstetrician and childbirth specialist.
What is a Midwife?
“A midwife is a person who has successfully completed a midwifery education program that is based on the ICM (International Confederation for Midwives) Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education and is recognized in the country where it is located; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.
This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practice in any setting including the home, community, hospitals, clinics or health units.” [1]
How Are Midwives Trained?
In the U.S., we have a history of attempting to erase midwifery entirely. Certified Nurse Midwives (CNMs) are not required to get in home or community experience and training to become licensed. Conversely, Certified Professional Midwives are unable to get hospital experience and training in most cases.
In the U.S., we have an emerging third type of midwife known as a ‘Certified Midwife.’ This midwife is regulated by the same board as CNMs and can practice in the hospital or at home, but is also not required to get in home or community experience and training for licensure.
Learn even more about the different types of midwives in: OB vs. Midwife: The Difference You Need to Know
Are Midwives Nurses?
A midwife does not need to also be a nurse. However, some midwives are also nurses.
In general, nurses are experts in pharmaceuticals and administering pharmaceuticals. Midwives also do this, in addition, they are:
- Are primary care providers who specialize in normal birth
- Provide holistic care and work with women to prevent complications with nutrition and lifestyle
- Are trained emergency responders
- Have full practice authority without physician supervision (depending on the type of midwife and location)
Nursing should not be seen as a pre-requisite to learning medications and administering them. Keep in mind physician assistants who do this without a background in nursing.
This idea is one hurdle that the newer licensure of Certified Midwives are facing and it frankly doesn’t make sense. Especially when it’s been proven time and time again why midwifery care is so important.
Can Midwives Practice Independently?
Certified Professional Midwives (CPMs), aka, the ones who are only trained and allowed to practice in home and community settings, are independent health practitioners across the board.
However, independent does not mean the midwife should always do everything alone. There are clinical situations when any practitioner should seek the assistance or expertise of another qualified practitioner.
These practitioners can include, another midwife, an obstetrician, chiropractor, dietician, herbalist, pharmacist, etc.
Can Nurse-Midwives Practice Independently?
In about half of the states in the U.S., nurse-midwives can practice independently. In the other half, nurse-midwives need a collaboration agreement.
“Collaboration is the process whereby health care professionals jointly manage care. The goal of collaboration is to share authority while providing quality care within each individual’s professional scope of practice. Successful collaboration is a way of thinking and relating that requires knowledge, open communication, mutual respect, a commitment to providing quality care, trust, and the ability to share responsibility.” [2]
What is the Midwifery Model of Care?
Midwifery care is health care for essential sexual, reproductive, maternal, newborn, and adolescent health, provided by trained and certified midwives.
Why is Midwifery Care Important?
According to the World Health Organization’s Report on World Midwifery in 2021, they state that “Midwives can meet about 90 per cent of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions.” [3]
“Midwives do not just attend births. They also provide antenatal and postnatal care and a range of sexual and reproductive health services, including family planning, detecting and treating sexually transmitted infections, and sexual and reproductive health services for adolescents, all while ensuring respectful care and upholding women’s rights. As numbers of midwives increase, and they are able to provide care in an enabling environment, women’s and newborns’ health improves as a whole, benefitting all of society.” [4]
Again, this is not just birth. Throughout history, midwives were the original family care practitioners, caring for people in their homes for many years. This is where the term “medicine women” comes from.
The World Health Organization recognizes that this is something midwives have done from the beginning of human communities and how much midwives actively help in these regards.
How the Medical Model of Care Impacts Women and Infants
In 1996, the World Health Organization called for the elimination of unnecessary intervention in childbirth [6].
“This statement is placed in the context of the current, widespread application of technological interventions that lack scientific evidence to a primarily healthy birthing population [6].
The use of obstetric interventions in labor and birth has become the norm in the United States. More than half of all pregnant women receive synthetic oxytocin to induce or augment labor, [7] which demands additional interventions to monitor, prevent, or treat side effects.
Nationally, one third of women deliver their babies via cesarean, [8] a major abdominal surgery with potential for serious short- and long-term health consequences. For the mothers these consequences include, but are not limited to, postoperative infections, chronic pain, future cesarean births, and placental complications that can lead to hemorrhage, hysterectomy, and rarely, death [9, 10].
Infant risks include respiratory distress, [11] and in subsequent pregnancies maternal risks include increased likelihood of preterm birth and associated morbidity and mortality [12-16].
Regardless of intervention or outcome, childbearing care perceived by the woman as disrespectful or traumatic is more likely to be associated with maternal psychological morbidity and potential for disrupted mother-infant attachment [17-20].” [22]
In fact, up to 45% of new mothers have reported experiencing birth trauma [22].
“Midwives Save Lives”
Midwives provide essential information, support, and care for new moms.
They are associated with higher rates of positive childbirth experiences, and most importantly, if the need for midwives across the world was met, the rate of maternal death, stillbirths, and newborns deaths would decrease by 83%. Saving 4.3 million lives per year [24].
In a world where 830 women die every day from pregnancy and childbirth complications, midwives save lives.
What Are the Benefits of the Midwifery Model of Care?
With midwifery care, babies: [25]
- Have significantly lower rates of preterm birth and low-birthweight infants
- Less likely to suffer from fetal distress (abnormal fetal heart tones) and birth trauma during labor and birth
- Less likely to require newborn resuscitation or special care in the neonatal intensive care unit (NICU)
- More likely to remain with their mothers and be exclusively breastfed
Women who choose midwifery care have: [25-27]
- Longer prenatal appointment times (mostly, if you’re outside of the hospital system)
- Lower costs for both clients and insurers
- Higher rates of vaginal delivery
- Lower rates of cesareans
- Reduced rates of labor induction & augmentation
- Better maternal and infant health
- Lower maternal and fetal mortality. This study found that the states in the U.S. with the most midwives across birth settings (hospitals, birth centers, and home births) were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death.
- Increased satisfaction with care and experience
- Improved psycho-social outcomes
- Lower rates of miscarriage
- Fewer hospital admissions during the antepartum period (pregnancy)
- A lower incidence of hypertension during pregnancy and labor
- Less need for pain medication in labor, including epidural analgesia
- A lower incidence of shoulder dystocia, in comparison to similar women cared for by physicians.
- Lower rate of instrumental deliveries (use of forceps or vacuum extractors)
- Lower incidence of retained placenta and fewer or equivalent postpartum hemorrhages.
- Fewer perineal injuries and fewer 3rd and 4th degree lacerations.
Conclusion on the Midwifery Model of Care
In a country with increasing “maternity care deserts,” meaning areas that have no obstetric hospitals or birth centers and no obstetricians or midwives, the highest maternal mortality of all high-income countries (and still rising), and an overmedicalization of pregnancy and childbirth crisis, we need more midwives and midwives practicing to their fullest capacity.
The World Health Organization and research studies have been calling to give women more time in labor to decrease cesarean rates and to stop using unnecessary interventions because they increase adverse outcomes when used unnecessarily [28].
Yet, our induction and cesarean rates are still on the rise. Along with birth trauma, morbidity, and mortality.
The most normal and healthy laboring women will go into the hospital and still receive CEFM (continuous electronic fetal monitoring), which over 5 decades of use, has increased unplanned cesareans under the belief they were necessary, but there hasn’t been a decrease neonatal mortality and morbidity [29].
Further, these women will still receive something just to make their birth go faster in the hospital. This is so unfair to make all of these women believe they need these things when they are doing great.
In these cases, obstetricians, midwives, and nurses in the hospital are taking away from women’s bodies doing the work and introducing potential complications for no reason.
Questions or Comments on “What is the Midwifery Model of Care?”
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Talk soon, mama!
– Katelyn Lauren
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References:
[1] The International Confederation for Midwives: What is a Midwife?
[2] ACNM Position Statement Independent Midwifery Practice
[3] UNFPA: The State of the World’s Midwifery 2021
[4] WHO: New report sounds the alarm on global shortage of 900,000 midwives
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