Making a Midwife Part of Your Birth Plan

If you are pregnant, choosing a person to manage your pregnancy is a big decision. Some women choose an obstetrician, while others opt for a midwife.

Midwives are specialists in low-risk pregnancies, and you don’t have to be crunchy to benefit from using one.

UNC Health certified nurse midwives Meg Berreth and Jamie Martin answer some commonly asked questions.

What do midwives do, and how are they different from obstetricians?

The word midwife means “with woman.” Midwives care for women throughout their lives, and they specialize in care during pregnancy, delivery and the postpartum period.

There are a few different types of midwives with varying credentials. Certified nurse midwives have the highest level of training, as they are registered nurses (many have worked as labor and delivery nurses) who also have master’s degrees in nurse midwifery and board certification with the American Midwifery Certification Board.

Certified nurse midwives are advanced practice providers who take a more holistic approach to birth.

“We treat birth as a normal physiologic process that women have been experiencing for thousands of years,” Martin says. “I hope to empower my patients to make their own health choices and feel like they’re an active participant in the amazing life they’re creating.”

With a midwife, prenatal checkups, labs and ultrasounds happen at the same frequency as they would with an obstetrician. However, midwives tend to spend more time assessing their patients’ overall health and well-being and educating them on what to expect during pregnancy and after birth.

During labor, midwives offer a lot of support.

“Certified nurse midwives have received extensive training on how to help a woman cope with labor using breathing, movement and positioning. If there’s more than one safe way to do something, we present those options and let you choose,” Berreth says. “We try to focus on the patients’ goals and give them the best birth experience possible within the bounds of safety, using minimal interventions unless they are needed.”

The benefits of midwifery care include lower cesarean delivery rates, fewer episiotomies, less use of forceps and vacuums, and higher satisfaction with care, Berreth says.

What if I have a complication during pregnancy?

Certified nurse midwives collaborate with physician colleagues who can step in if complications arise during the pregnancy or birth. Midwives are not surgeons, so a physician colleague would perform a C-section if one were needed.

If you have a high-risk pregnancy, don’t count yourself out from a midwifery care practice, such as the UNC Midwives. A midwife can assess your medical record to see if you would be a fit. If not, you’d be referred to a physician colleague, Berreth says.

At other practices, including the one at UNC Rex Holly Springs, patients see both midwives and physicians over the course of their pregnancies and could have either one attend the delivery.

If I use a midwife, can I still get an epidural?

Absolutely. Midwifery patients have access to the same pain relief options as OB-GYN patients, Martin says.

“Some moms come in the door wanting an epidural, and that was always their plan, and some decide they want one during labor,” Berreth says. “Our priority is a healthy baby, a healthy mom and an experience that the family feels good about. So if an epidural is part of that experience, we can consult our anesthesia colleagues just as quickly as physicians can.”

Nitrous oxide, better known as laughing gas, is also a popular pain relief option. However, if patients would rather have an unmedicated birth, a midwife works with them to maximize their coping skills.

Do midwives induce labor?

Midwives can induce labor; however, the midwives at the UNC Medical Center do not induce labor unless there is a medical reason, Berreth says.

During labor, midwives encourage patients to move around, wear their own clothing and eat if it’s appropriate.

Do I have to have a home birth if I use a midwife?

No, midwives can practice in a variety of settings. In fact, the majority of certified nurse midwives in the U.S.—about 85 percent—deliver babies in a hospital setting.

“When it comes to childbirth and obstetrics, you often can anticipate complications, but sometimes you can’t. A matter of minutes can make a big difference. We have pediatric specialists and obstetric specialists immediately available should mom or baby need them,” Berreth says.

Can I use a midwife if I had a C-section in the past?

Yes, midwives are trained in helping women have vaginal births after C-sections, known as VBACs. The midwives at the UNC Medical Center have a high success rate with VBACs, Berreth says. Midwives also help patients who plan to have a C-section, bringing more holistic care in collaboration with their physicians.

If I have a midwife, can I still use a doula?

A doula is a dedicated support person whom a family hires to be with them throughout labor and delivery. Doulas don’t provide clinical care. They play a complementary role to midwives and obstetricians because they can support the laboring mother the whole time, without the possibility of being called away to help another patient.

“Having both a midwife and a doula is ideal, especially for first-time moms. The extra support can really make a difference,” Martin says.

Some hospitals, including the North Carolina Women’s Hospital in the UNC Medical Center, offer volunteer doula programs that allow any pregnant person to request a doula for free.

Can I see a midwife for my well visits – even if I am not expecting?

Midwives are trained to offer full-scope care for women throughout their lives, including routine gynecologic care, obstetrical services and women’s preventive healthcare.

Looking for a midwife or an obstetrician? Find one near you.