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Column: The midwife’s role in the world of women’s health care

  • The Seattle Times illustration -- Michelle Kumata

Published: 4/24/2021 10:20:06 PM
Modified: 4/24/2021 10:20:03 PM

The World Health Organization named 2020 the year of the nurse and midwife. In 2020, COVID-19 stressed the health care system in ways that are difficult to put into words. Yet nurses and midwives continued to work and care for those in their communities. It is for this continued dedication that the year of the nurse and midwife has been extended by the WHO into 2021.

Throughout the pandemic, midwives have continued to serve clients and help families welcome new life and hope for the future, because even in the middle of a global pandemic two things are always true: There is always hope, and babies will be born.

Midwives form strong connections with the communities they serve, but there is often confusion about what a midwife is, what exactly the midwife does in the world of women’s health care, and what a midwife can bring to you and your family.

Midwives work from the principles called the “hallmarks of midwifery.” These principles are the core of what it is to be a midwife. They range from acknowledging menarche (the occurrence of a first menstrual period in adolescence), pregnancy, birth, postpartum and menopause as normal physiologic processes. Midwives empower their clients as partners in their care while providing evidence-based, personalized health care.

There are several paths to midwifery in New Hampshire and Vermont. Midwives can be either a certified professional midwife, who specializes in healthy, full-term, uncomplicated out-of-hospital birth (at home or a free-standing birth center), or a certified nurse-midwife, who is trained in the hospital setting but can practice in both hospital and out-of-hospital care. Either type of midwife is professionally trained, required to pass a national certification board and is licensed under the Board of Midwifery or the Board of Nursing in every state practiced in. Together, both types of midwives create a beautiful blend of traditional practices and modern medicine.

In most countries around the world, women are cared for primarily by their community midwife. According to the March of Dimes, most other high-resource countries besides the United States have a significantly higher proportion of births attended by midwives (50%-75%). In the United States, fewer than 9% of women seek the services of a midwife for their uncomplicated, healthy, full-term birth care. Multiple studies have concluded that pregnant women who are low- to moderate-risk and receive midwifery care are significantly more likely to report positive satisfaction with their care, lower interventions and are more likely to have a vaginal birth. First pregnancies are less likely to result in a cesarean section birth, therefore improving birth outcomes and increasing safety for subsequent births.

According to the Centers for Disease Control and Prevention, the United States has a cesarean rate of 31.7%. This is significant because the WHO recommends the ideal rate for cesarean sections to be between 10%-15% for the best outcomes. Cesarean sections can be life-saving for both the mom and newborn, but above the recommended percentage there is no evidence that maternal and newborn mortality rates improve.

The midwifery model of care aids in improving birth outcomes, such as lowering the cesarean rate, because it is client-centered. Since this model is based on the idea that pregnancy and birth are normal life events, the focus shifts to individualized education and prenatal care, while providing hands-on support through labor, birth and postpartum.

There is saying that every woman deserves a midwife, but some women need an obstetrician, which sums up the midwifery model of care perfectly. Most birthing people just need support, education and a safeguard through the transition to motherhood. Midwives focus on low-risk pregnancies, allowing obstetricians to focus on high-risk maternity care, which has the potential to decrease the current obstetrical provider shortage and utilize our resources in the most economical way without sacrificing high-quality care. Midwives are here to support you and your family’s needs, and it is our privilege to care for you.

Katie Bramhall, of Barre, Vt., is a certified professional midwife and Jessica Newcity, of Wentworth, N.H., is a certified nurse-midwife. Both are with Gentle Landing Birth Center of Hanover.




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