Call the midwife: Learn more about why you should consider midwifery care

November 13, 2018
  • Midwives provide prenatal care, care for birth, and postpartum care, as well as care for women throughout their lifespan.
  • Midwives excel at listening to patients and partnering with families.
  • There are different types of midwives. The Swedish midwives are Certified Nurse Midwives.

For many people, the role of a midwife might seem hazy. Midwives can be present at a birth, but what exactly do they do? Midwifery is actually a highly specialized field, and its practitioners have a specific skill set to offer women — and it’s not limited to labor and delivery.

“Philosophically, the midwifery approach to pregnancy and childbirth is that it’s a normal part of the woman’s life cycle,” says Megan Dunn, a certified nurse midwife at Swedish Ballard Birth Center. “There’s a real emphasis on partnering with women and families. We don’t consider ourselves the only experts in the room. We want to make sure we hear their voices and understand what their concerns are as the pregnancy goes forward. We don’t take a one-size-fits-all approach. As midwives, we’re interested not only in having a safe and health pregnancy but also having it be an empowering experience that sets people up for a good start at parenting. We are here to listen to and honor what people are hoping for to the best of our abilities.”

Dunn shares some more things you should know about midwives and why using one may be right for you.

Most healthy pregnant women are good candidates for midwifery care.

Nurse midwives are trained as nurses first, with a master’s degree in nursing and certification in midwifery. While midwives may assist their OBGYN colleagues on surgeries such as cesarean sections, they are not surgeons as OBGYNs are. Midwives are well-suited at helping women with low-risk pregnancies.

“At many health systems in the United States and worldwide, you would automatically see a midwife unless your pregnancy became high-risk and necessitated obstetric care,” Dunn says, adding that at Swedish, patients have the option of choosing a midwife or an obstetrician.

Midwives work with patients throughout their pregnancies, not just during labor.

Midwives provide prenatal care. Prenatal office visits with Swedish midwives are typically 20 minutes or more so that they have time to answer questions and develop a relationship with patients. When midwives are on call for labor and delivery, “We spend much more time with people in labor than just coming in and ‘catching’ the baby at the end,” Dunn says. “We are typically there during all the pushing, as well as offering support and comfort measures throughout labor.”

Midwives at Swedish also offer the CenteringPregnancy program, a group prenatal care model with a focus on facilitated discussions that can cover all aspects of pregnancy and labor.

If a patient does end up needing a higher level of care during her pregnancy, Swedish has an integrated medical team so consultations can be scheduled with an OBGYN or perinatologist, and a patient’s case can be transferred to their care if necessary . “Some of the things that are outside of our practice include pregnancies with multiples (twins, triplets, etc.), patients who develop gestational diabetes that cannot be controlled with diet and exercise and require medication, and patients who develop severe preeclampsia and need medication during labor,” Dunn says. “If a patient needs a C-section, the midwife is the first assistant on the surgery and the OBGYN performs the surgery.”

She adds that there are other cases that may be considered outside the “normal” range of care that are still appropriate for midwifery care. That includes patients who are of advanced maternal age, or patients who had a previous C-section and want to try for a vaginal delivery.

You can get an epidural with a midwife.

Dunn says there can be a misconception that working with a midwife automatically means having an unmedicated birth and an epidural can’t be used during labor. “That is definitely not true,” she says. “We counsel all our patients about all their options for pain relief in labor, and we support whatever decision is right for them.”

Midwives can practice the whole spectrum of gynecological care.

Women can see a midwife even when they aren’t pregnant. “You can come to a midwife for your annual exam, birth control, IUD insertion, or any gynecological or breast complaints,” Dunn says. “Midwives can also have special certifications in lactation consulting or postpartum mood disorders, and we are trained to see newborns up to six weeks old. We are essentially women’s health nurse practitioners with a specialty in pregnancy and childbirth.”

There are different types of midwives.

Midwives who work in patients’ homes or community-based birth centers can be certified nurse midwives or licensed midwives. “Licensed midwives may be trained as naturopathic doctors, which is a different training path from nurse midwifery,” Dunn says. “Especially in Washington, licensed midwives are well-trained and regulated to provide care in community-based settings. We have relationships with many licensed midwives in the community if they do need to transfer patient care to a hospital setting.”

A midwife can be the only care provider a patient sees.

Dunn says, “Most of our patients see us exclusively for their pregnancy, birth, and postpartum care. Whatever role they may imagine a doctor would play, we are in that role. We also do enjoy providing labor support to women and their partners,” she says. “It’s wonderful to be in a system with seamless access to our backup physicians if we need their expertise.”

Midwives are also experts in “soft skills.”

There are many things patients gain by using a midwife, and that includes skills that may not come immediately to mind. “We listen to women and partner with families; we spend a lot of time explaining things and answering questions,” Dunn says. “There is a lot of data and research to support that those soft skills matter when it comes to a normal life event such as pregnancy and birth. It’s important to have a provider who listens to you and that is part of our training and the tradition we come from.”

Patience is a virtue for midwives.

Dunn says the midwives have influenced the culture at the Ballard birth center. “If appropriate, it’s common to monitor the baby’s heartrate by intermittent auscultation — listening to the baby periodically throughout the labor — rather than continuous fetal monitoring. We are really quick to use the hydrotherapy tub for pain relief. And we also partner with our nursing colleagues to manage labors and be really present. If you like some of the aspects of what can happen at a home birth or birth center but like the safeguards of a hospital, then Swedish Ballard in particular would be a good match. We offer all the safeguards you want and at the same time offer that high-touch, time-intensive midwifery approach.”

The Swedish midwifery group practices at the Midwifery and Women’s Health clinics at Swedish Ballard Birth Center, Swedish First Hill, and Swedish Issaquah (this is correct), and patients can be expected to see several of the midwives during pregnancy.

To get more information about group orientations for the midwifery practice, contact the centers. To learn more about CenteringPregnancy, click here. And to get provider-approved answers to common pregnancy and parenting questions, download the Circle by Swedish app.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.