Ask the Midwife: Certified Nurse Midwife

Earlier this month I had the pleasure of speaking with Alexis Gee, a Certified Nurse Midwife from Michigan. She was kind enough to take time out of her busy practice to answer some commonly-asked questions regarding midwifery care. I hope that this helpful information will serve many women and families who are in the midst of deciding what type of care to use for their childbirth experience.

Meet Alexis...

My name is Alexis Gee and I am a Certified Nurse-Midwife in Midland, MI. I always knew that I wanted to work with women and was fascinated by pregnancy and childbirth. I planned to go to medical school, but fell in love with the midwifery model of care when I was completing a minor in Women's Studies at the University of Michigan. After completing my bachelor's, I went to Vanderbilt University for my nursing and midwifery education. I've been with my current practice now for almost a year. We are a private practice with 3 CNMs and two physicians and perform hospital deliveries. I love being a midwife and feel it is such a rewarding career, as well as a privilege to be a part of such a special time in women's lives.

How is midwifery care different from OBGYN care?

There are several differences, the main one being how midwives approach pregnancy, birth, and well-women care. Midwives provide women-centered care, meaning the women is educated in order to make her own choices in her healthcare. They also try to minimize any interventions that are unnecessary. They view pregnancy and birth as a normal, healthy life process rather than a disease or illness. Overall, they are more holistic and naturalistic in their philosophy of care.

Is it possible to see both a midwife and an OBGYN during pregnancy?

Yes, in some practices midwives work side by side with OBGYNs. They share call with the physicians, so depending on who is on call at the time of the delivery you could have a midwife or a physician. For prenatal visits, some practices have you see one primary provider while others have you rotate and meet all of the providers.

I have seen all different sorts of titles for midwives - what types of midwives are there? How do I determine which type is best for me?

I am a Certified Nurse-Midwife, which is the most commonly seen type of midwife. We are also registered nurses and have a masters degree in nursing. They pass a national certification exam and are licenses in the state they practice.

There are other types of midwives as well, see here for more information.

In order to determine which type of midwife is right for you, you probably first should decide what kind of setting you want for your childbirth experience. Then determine which types of midwives are available in your area.

Who is a midwife for? Who is a midwife not for?

As a general rule, women who are low-risk with normal, uncomplicated pregnancies are good candidates for midwifery care. Women with complications such as high blood pressure, gestational diabetes, thyroid problems, preeclampsia, and multiples may or may not be candidates for midwifery care depending on the practice and the experience of the midwives. It is not uncommon for these patients to be co-managed, meaning the midwife will consult with the physician regarding the plan of care for these patients.

Can I have pain medication if I have a midwife?

Yes. The most important thing is for the woman to have the kind of birth experience SHE desires. I tell my patients I will fully support them whether they want an epidural or want to go without medication. However keep in mind, depending on the practice and setting, this may limit what options are available. In addition, I tell my patients to keep an open mind, because you never know what kind of labor you will have or how long it will be.

Do most insurance providers cover midwifery care?

Yes. As midwives become more prevalent, more insurance companies are reimbursing for midwifery care. It is never a bad idea to double-check with your insurance company regarding what they will cover. Usually they will cover care from a midwife in a hospital or birth center, but will less often cover a home delivery.

Are midwives allowed in hospitals? What about birth centers and home births?

Yes, actually the majority of Certified Nurse-Midwives practice in hospitals. They also practice in birth centers and can do home births in some states.

What happens with my midwife if I need emergency care during labor?

Midwives are trained in obstetrical emergencies, including shoulder dystocia, neonatal resuscitation, and hemorrhage. They are fully capable of stabilizing the patient while the physician is called in case surgical intervention is needed.

What types of procedures are midwives unable to perform?

Midwives are not able to perform cesarean delivery. In the event that this was necessary, they would call the physician in to perform the surgery. An advantage of this is that usually the midwife is able to stay with her patient for support throughout the process. Midwives also do not do forceps-assisted deliveries. Some midwives are trained to perform vacuum-assisted delivery and circumcision. Midwives are also trained to repair vaginal lacerations, but if these are severe they may call a physician for assistance.

Is midwifery care really a safe option?

There is a wealth of evidence that midwives provide care that is safe with comparable or better outcomes than OBGYN care. Certified Nurse-Midwives are licenses in the state that they practice, have a master's degree in nursing, and pass a national certification exam and meet continuing education requirements.

If I am using a midwife, is it still necessary to have a doula?

Depending on how busy the practice is, the midwife may not have as much time as she would like to spend with one patient. It is not necessary to have a doula, but it can be very helpful for women who desire to deliver without pain medication and need one-on-one support. If the midwife has more than one patient, she will have to divide her time according to the needs and acuity of each patient. For women who do not have a family member to be their support person (or even for one who does), a doula is an excellent option.

What happens if my midwife has another birth to attend to while I am in labor?

The midwife will do her best to divide her time fairly between patients. She may need to call in another provider for assistance if two patients are going to deliver at the same time.

Is midwifery care less expensive than traditional OBGYN care?

In general, midwifery care is less expensive for many reasons. Midwives order less lab tests and ultrasounds, and overall are less likely to perform costly interventions or prescribe expensive medications. They are usually reimbursed at a lower rate than physicians because physicians have a broader and more extensive education.

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