If you are healthy and your pregnancy is expected to be normal and healthy, a midwife may be the right care provider for you. If you are generally healthy but have a few chronic conditions that are well-controlled, a midwife may still be able to care for you independently or in collaboration with a doctor or physician. If you have a serious health condition such as heart disease or active cancer, or if you have had an organ transplant, an obstetrician may be able to manage your pregnancy more effectively.
Holistic care throughout your pregnancy, birth, and postpartum period
Women- and family-centered care (you are encouraged to take an active part in your health care decision making)
Education to help you stay healthy throughout your pregnancy
Competent and compassionate care
Care that is based on the best evidence and national guidelines
Midwives view pregnancy and birth as a normal process in the absence of complications. Research shows that midwifery care can lead to fewer interventions, fewer cesarean sections, higher breastfeeding rates, and greater patient satisfaction.
Most insurance companies and Maryland Medicaid plans will cover birth with a midwife in a hospital or out-of-hospital birth center. It is always a good idea to call your insurance company to discuss which services are covered.
Both midwives and obstetrician/gynecologists (ObGyns) are trained to manage pregnancy, labor, birth, and the care of women across their lifespan, but their skillsets differ in important ways. Midwives are experts in normal labor and birth, and try to limit the use of medical interventions in the absence of complications. They provide education and empower women to make informed choices throughout their birth experience. Midwives are also trained in non-pharmacologic pain coping techniques to help you labor naturally, and they can support your choice for pain medication or an epidural. They know how to quickly recognize complications during labor and birth, respond to emergency situations, and when it is essential to refer to a physician for a higher level of care. ObGyns are physicians trained to manage “high risk” pregnancies that require an increased level of surveillance, and they are trained surgeons able to perform planned or emergent cesarean sections. Midwifery care is safe and appropriate for most women in Maryland.
Doulas are individuals who are trained to provide uninterrupted support to a laboring woman throughout her labor and birth. They provide for the woman’s physical and emotional needs, and make an excellent addition to a woman’s labor support team. Many doulas are also trained to support and educate women through pregnancy and the postpartum period. Midwives are trained to provide the same type of support as a doula, but midwives are additionally responsible for the medical management of you and baby throughout pregnancy and birth.
Certified Nurse-Midwives (CNMs) are registered nurses with graduate education in nurse-midwifery. Accredited graduate-level nurse-midwifery education programs provide a university degree as well as hands-on clinical training with a practicing Nurse-Midwife. Nurse-Midwives are certified through a national examination from the American Midwifery Certification Board. They provide generalized women’s healthcare, including check-ups and physical exams, across the lifespan. They are also trained to provide:
pregnancy, birth, and postpartum care
well-woman gynecological care
treatment of sexually transmitted infections
CNMs are able to prescribe a full of range of medications and treatments, including pain control medications. Most midwives in Maryland are Certified-Nurse Midwives.
Certified Professional Midwives (CPMs) have passed a national examination administered by the North American Registry of Midwives. They may have trained as an apprentice with a practicing CPM or through an accredited formal education program. CPMs typically only care for women during pregnancy, birth, and the postpartum period outside of the hospital. They are not able to prescribe most medications.
You will deliver in the setting of your choice—hospital, out-of-hospital birth center, or home—depending on the midwife or midwifery group you have chosen. The midwife will also consider the environment that is safest for you and your baby, based upon your current health status. Most midwives in Maryland deliver only in the setting in which they are insured to deliver, which is typically a hospital or an out-of-hospital birth center. However, there are some Certified Nurse-Midwives in Maryland who are licensed and insured to deliver in the home setting. Certified Professional Midwives typically deliver in the home setting.
Midwives are trained to recognize and manage many complications that can arise during pregnancy. Depending on the complication and the severity of your case, a midwife can continue to manage your care, share management of your care with an ObGyn physician, or refer you to a physician for more specialized care.
Midwives are trained to manage complications during labor as well. If you are in a hospital setting, a physician can be called into the room at any time to assist with complications that require a higher level of intervention. In an out-of-hospital setting, you will be transferred to the nearest hospital in the event of a serious complication. Most complications in birth are detected early and there is time for transfer.
Absolutely. Midwives work with you to design the birth experience that is best for you. We are trained in non-pharmacological pain relief techniques, such as relaxation and hydrotherapy, but we can also facilitate epidural pain control in a hospital setting.
If it is determined that a cesarean section is best for you or your baby, either during pregnancy or labor, your care will be transferred to an ObGyn as midwives are not trained surgeons. Some midwives are able to accompany you into the operating room to provide continued support throughout your birth experience.
Yes! Midwives support women in their decision to have a vaginal birth after a cesarean section and are trained in the rare complications that could arise. As certain hospitals will not allow a woman with a prior cesarean section to attempt labor, it is important to discuss this with your midwife early in your pregnancy.