Midwifery is a blanket term used to describe a number of different types of non-MD medical practitioners who provide prenatal care to expecting mothers, deliver the infants and provide postnatal care to the mother and infant. Nurse-midwives also provide gynecological care to women of all ages. Practitioners of midwifery are known as midwives and are almost exclusively women. Most deal with normal births only; if something abnormal is discovered during prenatal care, the patient is sent to an OB/GYN. Other midwives will deal with abnormal births, including breech births.
There are two main divisions of modern midwifery in the United States, nurse midwives and non-nurse midwives.
Nurse Midwives Nurse midwives are RN's (Registered Nurses) with a Bachelor's Degree in Nursing who return to college for two additional years to specialize in midwifery and gynecological care of normal women. Most Nurse Midwives also have a Masters Degree in Nursing. Nurse midwives practice in hospitals and medical clinics, and may also deliver babies in birth centers and assist with home births. They are able to prescribe medications and provide care to women from puberty through menopause, not only during childbearing. Nurse-midwives work closely with an OB/GYN, who provides consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse midwife in collaboration with a physician. Currently 2% of nurse midwives are men.
Non-Nurse Midwives Midwives who are not registered nurses vary greatly in their training, certification and methods. Some are graduates of Colleges or Schools of Midwifery which offer degree and certification programs of different lengths. The American College of Nurse-Midwives (ACNM) certification council provides accreditation to non-nurse midwife programs as well as colleges which graduate nurse midwives. All midwives certified by ACNM must pass the same certifying exam. Other midwives are trained through apprenticeships; they assist a practicing midwife for a period of time to learn the trade.
Midwives deliver children in any number of settings. While the majority of nurse midwives perform deliveries in hospitals, some nurse midwives and many non-nurse midwives often perform home deliveries. In many states midwives perform deliveries at birthing centerss where a group of midwives work together. Laws regarding who can practice midwifery and in what circumstances vary from state to state, and some midwives practice outside of the law.
All midwives believe that birth is a natural process. In general, midwives perform births without painkillers, epidurals, or labor-inducing drugs. While some do use drugs in emergency situations to stop hemorrhaging, others use herbs and massage in place of all drugs. Midwives were early adopters of the water birth method and birthing chairs. In general, midwives cut down on postnatal complications by letting births proceed naturally, so jaundice commonly caused by labor-inducing drugs (needed because epidurals inhibit contractions), and requiring additional hospital stays is much less common with midwife assisted births than OB/GYN births. Postnatal infections are also much less common in mid-wife assisted home births than in hospital births. In hospital births with nurse midwives, statistics show bigger and healthier babies, less use of pain medications, less complications.
Someone needs to write about the history of midwifery, the competition between mostly rural & female midwives and mostly urban & all male early medical doctors in the 18th and 19th centurys, and modern midwifery in countries other than the US
See also: doulas