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When to Consider a Midwife or Doula

Know the facts and consider your options before the big day.


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One of the first priorities of mommyhood is figuring out who’s going to help bring your little one into the world. You’ve probably heard a lot about midwives and doulas, but may not understand what they actually do. Whether it’s your first child or third, here’s what you should know when it comes to keeping you and baby healthy and safe.

What do midwives do?

Sure, they can help you give birth, but that’s not their only role. “Midwives serve your needs with a focus on maternity and reproductive care,” says Lisa Kane Low, PhD, certified nurse-midwife (CNM) and president of the American College of Nurse- Midwives. “But we also provide primary care for your entire life. We have a holistic perspective and focus on wellness, encouraging healthy behaviors and meeting each person’s health priorities.”

What kind of training do midwives receive?

The majority of midwives in the US are certified nurse-midwives (CNMs) and certified midwives (CMs). CNMs are licensed in every state. CMs are licensed in five states, including New Jersey. The difference? CNMs are registered nurses who’ve graduated from an accredited nurse-midwifery education program and passed a national exam. CMs have earned graduate degrees, completed an accredited midwifery program and passed a national exam. Both groups must get recertified every five years and complete continuing education.

What’s the benefit of having a CNM or CM as my primary care provider during pregnancy?

For starters, studies have shown that women cared for by nurse-midwives compared to women of the same risk status cared for by physicians had lower rates of cesarean birth, labor induction and interventions such as episiotomies. “It’s a partnership between us and the woman. It’s patient-centered care,” says Linda Sloan Locke, CNM/MPH, president of the NJ affiliate American College of Nurse-Midwives. “We’re experts in normal birth with low to moderate risk women during pregnancy, and we have a great respect for women’s ability to give birth and use interventions only when needed.”

Will I see my doctor, too?

Not necessarily; many healthy women only see their midwives during pregnancy. For high-risk pregnancies, such as if you’re having twins or have other underlying health issues, your midwife would work as part of a team in collaboration with your doctor, says Low. For example, if you develop conditions such as gestational diabetes, your physician would manage that condition, while your midwife may still be present at the birth.

Can I still give birth in a hospital?

Yes. In fact, more than 90 percent of CNM- and CM-attended births occur in a hospital, says Locke. But isn’t having a midwife sort of “old school?” Yes...and no. While midwives have been practicing in this country since the 1920s, the number of CNMs and CMs grows each year. About 8 percent of births are now attended by midwives.

Where do I find a midwife?

Check out the Find a Midwife tool by the American College of Nurse-Midwives (ourmomentoftruth.com or its NJ affiliate newjerseymidwife.org), talk to your insurance company and local healthcare system and, of course, ask your friends.

What’s a doula?

A doula helps families understand what’s happening during pregnancy by providing emotional and social support. Some women choose a doula as an additional source of pregnancy and postpartum care. “A doula doesn’t provide medical or clinical care,” says Melissa Harley, certified doula and doula trainer with Doulas of North America (DONA) International. “Our focus is to answer your questions, offer emotional and physical comfort and gather information so you can have a positive birth experience. We work together to collaborate, not compete, with the medical professionals present so [the] woman is supported from all angles.”

While there are no current regulations about who can call themself a doula, many doulas choose to become certified through DONA International, which has a code of ethics and requires classes, ongoing training and client and professional medical references. Insurance typically doesn’t cover doulas, but you may be able to use funds from a health savings account (check with your specific plan). Go to dona.org to find a doula, then interview several to find a good fit for your family, suggests Harley.

Arricca Elin SanSone is a New York-based health and lifestyle writer.

 

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