Parenthood is full of decisions. One of the first is: “Who will care for me during pregnancy and birth?” One of your options is a midwife or team of midwives – but what is a midwife, and what sets midwives apart from other care providers?

What is a midwife, and could they be a better choice for your pregnancy care?

What is a midwife, exactly?

Midwives are experts in normal pregnancy and birth. They see childbearing as a healthy and precious process and important work. One of the things that makes the title of midwife special is the literal meaning of the word midwife: “with woman”. Midwives take a woman-centred approach, prioritising the relationship between the woman and her midwife.

Some midwives are nurses before undertaking further training and study to become midwives. Other midwives are not nurses and have completed a direct entry midwifery degree. A midwife’s role is as a skilled healthcare professional and to provide nurturing care as they work in partnership with you. Midwives encourage women to make informed decisions for themselves and their babies and that supporting a woman empowers them both as a woman and a mother.

Beyond this, though, empowering a woman to make informed decisions and choices during pregnancy, labour and birth also goes a long way to reducing any sense of fear, regret or powerlessness they might otherwise experience during and after the birth of their baby.

Within some hospitals, a caseload midwife or small team of midwives offer care to women, meaning that you will see the same midwife or midwives at each appointment. However, in other hospitals, a woman may encounter many different midwives during pregnancy and birth.

What is a private midwife?

Rather than working for a hospital, private midwives run their own private practice in the community. In Australia, private midwives must have worked three years full-time following graduation and have postgraduate qualifications in prescribing medications and ordering diagnostic tests. A private midwife can support your birth either in a hospital or at home.

What is “continuity of care”?

Private and caseload midwives offer care to women from early pregnancy, through labour and birth, and up to the first six weeks after their baby arrives (postnatal care). This is what is meant by “continuity of care”. Rather than being cared for by a hospital midwife you haven’t met, your care is provided by someone you have come to know and trust. Private midwives will generally work closely within a small group of private midwives, who provide support and backup care if this is required.

A major advantage of the care of a midwife with whom you have developed a relationship is the confidence and sense of safety this provides during birth. This benefit was captured in a recent research study, and is made clear by the following statement from one of the study participants: “I was not afraid of my labour because my midwife was beside me. And I knew that I could trust her since she was with me throughout my pregnancy.”

What is a midwife, and could they be a better choice for your pregnancy care?

Midwives as a one-stop-shop

Midwives are often referred to as a one-stop shop for maternity care. They can help you and your baby stays healthy during pregnancy by providing all your pregnancy and postnatal care appointments. They can also book any tests or scans you choose to have.

During labour, midwives have skills in natural methods of managing pain and ensuring the environment in which you birth supports calm and a sense of safety. If you choose, midwives can also provide or arrange medical pain relief, ensuring you know the risks and benefits.

After birth, midwives also guide you through caring for a new human being – from breastfeeding to nappy changes and settling.

What about higher-risk pregnancies?

Some women have higher risks or complications needing the care of an obstetrician or other specialist. Depending on where the work, some midwives can continue to care for you if you have a high-risk pregnancy in collaboration with an obstetrician and medical team.

If a woman has to transfer care to an obstetrician, she will be cared for during labour by midwives, with your obstetrician present only for the birth. This may well mean that you meet your midwives for the first time during your labour. This is true in both public and private hospitals.

Having a better birth and healthier baby with continuity of midwifery care

If you choose midwife-led continuity of care, whether, with a private midwife or another model, you and your baby gain several advantages. For example, a review of 15 randomised controlled trials involving more than 17,000 mothers found significant benefits. The women who were cared for by models who supported the continuity of care had fewer:

  • instrumental births
  • episiotomies (surgical cuts in the perineum)
  • preterm births
  • pregnancy or baby losses

Researchers found no adverse outcomes associated with continuity of midwifery care.

What is a midwife, and could they be a better choice for your pregnancy care?

How the relationship with your care provider leads to a better birth

Of course, the benefits of continuity of midwifery care go beyond physical health. When women receive continuous care from a known midwife, they tend to have a more positive birth experience. One of the reasons is that seeing the same midwife from pregnancy to the newborn period makes for a less hierarchical relationship.

In a more traditional “doctor-patient” relationship, the doctor is often seen as “in charge”. A woman and her midwife develop a partnership – the woman by the midwife’s knowledge and experience and the midwife by the woman’s needs and desires for her pregnancy, labour and birth.

As one mother in a recent Swedish study describes it: “She [the midwife] was like a family member. She was there, holding our baby, and there was immense happiness in the room.”

What is a midwife, and could they be a better choice for your pregnancy care?Another benefit of continuity of care, especially with a private midwife, is that the regular appointments provide more time to get to know you.

As a result, your midwife can provide more personalised care. “They would just listen to me with full attention,” explains a Japanese mother. “They were not doing that because it was their job, I could feel that it was from their heart. I was treated as an individual person, not just a woman giving birth.”

Many women feel apprehensive as birth gets closer. They might not know what to expect. Or they might have had an unpleasant experience in the past. Opting for your trusted midwife can make difficulties and uncertainties much more manageable. “I dared to trust myself because she [the midwife] trusted me,” shares another research participant. “She made me feel calm, and I dared to trust myself and my body.”

Women increasingly recognise that birth is much more than a physical event. It’s one of the most significant psychological and emotional experiences in life. It isn’t just a matter of “as long as the baby is healthy.” Birth can change a woman’s life, for better or worse. Therefore, a woman’s health and well-being during and after birth matters too. Rather than going with a “default” care option, it is vital to consider the available healthcare options carefully and make a decision that ensures you receive the care you can trust.

Reference List

PBB aims to keep you informed with the latest research-based information. Check out our reference list used in the creation of this article.

Published 14th July 2022

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