A midwife is a primary care medical professional who is committed to caring for pregnant, laboring, and postpartum women using research, evidence-based guidelines, clinical experience and the unique values and needs of those in their care.
They can deliver babies at home, in the hospital, and in birth centers where available.
Midwives are fully capable and responsible for helping you understand what is happening in your pregnancy or birth and often provide a more comprehensive, and emotionally supportive resource through your journey to motherhood.
They are fully trained and licensed medical individuals capable of managing your care throughout a low-risk pregnancy, labor, birth, and the first 6 weeks postpartum.
Can I have a Doctor and a Midwife?
Short answer NO, a woman can only have ONE primary care provider during pregnancy and childbirth, so you have to pick one or the other.
Also in some areas of Canada, a Nurse Practitioner can be a primary care provider for pregnancy but not the birth.
Midwives are experts at low-risk, natural pregnancy, and birth. If needed they can and do consult with specialists and other health care providers.
After the 6 weeks, postpartum care has been completed a Midwife will transfer you back to your family doctor for any further health care needs.
It’s also important to note that depending on where you are, you may need to see your family doctor for some things like prescriptions if you get sick as not all Midwives have the option of licensing to write prescriptions.
Is a Midwife the same as a Doula?
Nope. Doula also provides support throughout pregnancy, birth, and postpartum. However, a Doula is NOT medically trained. Doulas will focus more on things like providing emotional support, and alternative pain management options. They do not provide medical care.
And while some Midwives may train as doulas most of the time they do so before training as a Midwife.
What does it cost to work with a Midwife?
Midwifery costs will vary from location to location, if you are in Canada chances are it will be covered by your provincial health care. In the US you’ll need to ask for this information from your local Midwife team.
What to expect during Midwife Prenatal Care
Are the Prenatal Appointments the same as a Doctor?
Yes and NO.
Frequency of Appointments
Both Midwives and Doctors see their clients with the same frequency, usually
Once a month until 28 weeks
Bi-weekly until 36 weeks
Weekly until birth
Discussion Points during Appointments
The same topics of discussion that the Doctors bring up Midwives will discuss as well.
Things like birth location options, pain management options, available tests during pregnancy and postpartum among a host of other regularly discussed information will still be brought to your attention.
Though I will say I’ve never head a Doctor say “hey, I’m supposed to discuss this with you because it’s recommended, but …” and then proceed to talk me OUT of whatever test is recommended at that stage. But I’ve had my Midwives do so.
Exams and Tests?
Your midwife can order the same tests like routine blood work as a Doctor can. Midwives can also perform the same exams and assessments including things like cervical swabs.
Also if you are closer to birth and looking at getting a membrane sweep done, a Midwife is perfectly capable of doing things like that too.
You’ll meet the team
Midwives work in teams, so throughout your pregnancy, they will try to make sure you meet everyone on the team. Teams are usually at least two midwives but usually three or four. This means they can be on-call 24 hours a day, 7 days a week since they rotate through.
The big difference I noticed when I switched from a Doctor to a Midwife was that the appointment length was longer… where my Doctor might see me for 15 minutes (including the time the intern was talking to me), my Midwife would sit with me for at least 45 minutes often longer if I had a lot of questions.
Midwifery Labor and Delivery Care
Where can Midwives deliver Babies?
Midwives are licensed to deliver babies at home, in birth centers and/or in hospitals. Depending on where you are and which facilities are available will determine your options.
Just like with a Doctor always ask your Midwife if they are licensed to deliver at the location you prefer just to confirm that it will work with them.
Under a Midwife’s care usually means there are pre-set criteria that you would need to meet in order to be induced. Often it includes things like going overdue by a set amount of time, or baby being in distress before a Midwife will recommend using chemical inducers like Pitocin.
However, they are fully capable of doing membrane sweeps or recommending a smoothie that might naturally kick start your labor.
When we start labor there is usually a period called “primordial labor” this is the part where you are encouraged to stay home because the dilation is just starting, or the contractions are not consistent or close enough together.
Often even experienced mothers will call their birthing team at this point or head to the hospital only to be turned around and sent home.
A hospital will want to see you when you get to Active Labor, and not before. However, Midwives who are delivering at your home or in a birth center (and sometimes in the hospital), will have a bit more flexibility around this.
For example, I wasn’t even 3 cm dilated with my second son and our Midwife admitted us to the local birth center on a judgment call. And it was good that she did because I did not want to be home for that portion of the labor.
Pain Management Options
When working with a Midwife your pain management options are only restricted by your location of delivery.
For instance, a home birth would not have access to the facilities to administer an epidural, however, since Midwives can and do deliver in hospitals if you are interested in an epidural it is an option open to you.
If you are birthing at home it is common to use water, massage and other alternative methods to pain management.
If you seek a birth center delivery that also opens up the option of Nitrous Gas or similar pain management options.
And of course, delivering in a hospital means any options a hospital has available are things you could utilize as well.
Not every medical professional is comfortable re-positioning baby if kiddo isn’t progressing. Midwives, however, are usually more comfortable with and open to trying repositioning options.
With my second son, he was essentially trying to come out through my pelvic bone. As soon as my Midwife figured that out she started getting me into some of the Spinning Babies techniques to get kiddo repositioned.
To be clear, your midwife will NOT risk your baby’s safety or yours (even if you insist on it). So long as everyone is safe they generally are more open to repositioning options though.
Midwives are versed in a variety of delivery positions, they may even recommend something you hadn’t thought of based on how they see your labor progressing.
Many of them are also comfortable with you delivering in a tub of water, on the toilet, or in the shower… locations many doctors may not be ready or willing to handle.
Part of the delivery process is that someone will need to “catch baby” when they come out. In a vaginal delivery under the care of the Midwife, the Midwife is fully capable of doing this.
However, you may also end up catching baby yourself. In situations like a water birth, the Midwife can gently nudge baby in the direction needed for you to be the first person to touch/handle baby.
I will say, that I have caught my own baby twice now it is an amazing moment. I also recommend having your partner up by your head at this point to watch baby float effortlessly and calmly up to you. It’s one of my husband’s most treasured memories and I’m so glad he got to see it.
Postpartum Care from a Midwife
The first couple of weeks of postpartum appointments will be in your own home. YEAH for the comfort of NOT having to go anywhere when you are exhausted as all heck!
After that, you’ll be invited to attend the appointments at the Midwives office or local birth center.
Where I am there are about 6 postpartum appointments.
Midwives also remain on-call 24 hours a day for any concerns you may have about yourself or baby during these 6 weeks of recovery.
Well Baby Checks
The regulated checks vary from location to location so ask what is normal in your area.
However standard well-baby checks will include things like weight, length and even head circumference measurements.
Our Midwives also checked for jaundice, how baby was latching (we chose to breastfeed) and will ask about baby’s diaper output and what their poop (if they have any) looks like.
If this is your first baby, please be aware that the first few poops are something called Meconium, its a black almost tar-like substance that sticks to EVERYTHING! Regular baby wipes don’t tend to get it off baby’s bum easily so you’ll want some gentle washcloths available to help with that.
But meconium doesn’t last long, soon you’ll be in runny poops that are greeny/brown (depending on what baby is fed) which are much easier to clean off.
Well Mamma Checks
In the early weeks, your Midwife will likely feel your lower abdomen to see how your uterus is doing (aka fundal massage). It’s important that it returns to its regular size postpartum for the healing process so they like to check.
You will also be asked about how your postpartum bleeding (called Lochia) is doing. They will want to know things like flow volume, color, and if it has a funky smell or not.
But the care isn’t just for your physical self, Midwives are also looking to see how you are handling the emotional side of becoming a Mother (or becoming a Mother again). Every birth is so different and the change in family dynamics can affect your postpartum recovery.
A Midwife is aware of all the things that can influence you mentally and emotionally and will likely ask questions to get you talking about all the things you are experiencing now.
If a Midwife suspects something like Postpartum Depression or Postpartum Anxiety or other concerns they will, of course, refer you to the resources they have available for help.
They can also give you the heads up on what to expect when it comes to things like baby blues, and common things they’ve noticed in other newly made Mamma’s.
One of the best parts of this that I found to be really helpful with my second was that they would discuss the birth with me. Giving birth can be something we need process and having a medical professional there to ask questions is a great resource, especially if they were at the birth. It has factored into my ability to heal the emotional strain of that particular delivery and can also aid in writing your birth story.
If you choose to breastfeed a Midwife will often (though not always) provide advice on what they have seen work for other mothers. While Midwives are typically not trained to be Licensed Lactation consultants they see a lot of clients and are fairly knowledgeable about the current recommendations.
I’m sure they would also make recommendations on formula feeding for support too, I just haven’t gone this route personally so I’m not 100% certain. I do know though that when I’ve worked with a Midwife I’ve never been made to feel like I made the wrong choices even when the Midwife didn’t agree with me.
What happens after 6 weeks?
A midwife will transfer your file back to your family doctor after the 6-week postpartum check-ups are complete. If there is any additional care they recommend it will be discussed with you in your final appointment and added to the file for your family doctor to follow up on.
What will a Midwife do if I have complications?
Midwives will consult with any other care provider as needed, and they will also transfer your care if a situation arises that requires it (like a c-section).
In Canada, each province has it’s own very clear guidelines on when a Midwife needs to consult or transfer care to a physician. In many transfer cases, Midwives will continue to provide supportive care and resume primary care when possible later on.
But there are some situations (like Diastasis Recti Muscle Separation) where a Doctor may not be the care provider your Midwife will consult with.
In my experience, a Midwife will readily work with other care providers like Pelvic Floor Physiotherapists, Chiropractors, Massage Therapist and other related providers for a more Whole Woman approach.
For instance, it was my Midwife who thought I may have a Diastasis Recti Muscle Separation and recommended I talk to my Pelvic Floor Physiotherapist who came up with a plan of treatment the Midwife signed off on.
I’ve also had my Midwife recommend that I get regular massages, and other services I wouldn’t have thought of trying both while pregnant and postpartum to assist me in my own best health.
Midwives believe in Informed Choice
In my experience Midwives believe that every person has the right to be the primary decision-maker about their own care. They have been encouraging and focused on my full participation in planning and executing my and my baby’s care.
They allow enough time for meaningful discussion during appointments and for all questions to be answered.
Midwives often see themselves as a partner in the process of pregnancy, childbirth and the postpartum recovery period. Working with not just the pregnant woman, but her family to provide support in a non-authoritarian way respecting your needs and experiences.
How do I find a Midwife?
Depending on where you are will depend on the best way to find a Midwife. Often a google search of “Midwife” with your province/state and city/town will turn up something. However, here are the links I’ve located so far. If you know of any other sites please let me know and I will add them to the list.
Is a Midwife Right for You?
There are a lot of reasons why women enjoy working with midwives, but that doesn’t mean a midwife is right for everyone. If you are a low-risk, healthy woman, with a low-risk healthy pregnancy a Midwife could be the right fit for you. Especially if you are looking to try for an all-natural labor and delivery.
I’ve worked with a doctor for the first part of our first son’s pregnancy and switched to a midwife in month 7, for our second son we went with the midwife the first time around and I have had two amazing experiences. So I’m a little pro midwife, myself. 😉