Go Ask Mom

Go Ask Mom

Most midwife-attended births happen in hospitals, birth centers

Posted October 3, 2016

Midwives have been around for centuries and, though their role in women's health has changed in many ways, the image that their work conjures up for many still happens at random home births.

In reality, certified nurse-midwives are at work at medical centers and clinics across the country, working side-by-side with doctors throughout pregnancy, labor and delivery.

According to the most recent numbers from the American College of Nurse-Midwives, certified nurse midwives and certified midwives, who go through extensive training, attended 91 percent of all midwife-attended births and more than 8 percent of the total births in the United States in 2014. And most of those births - more than 97 percent - happened in hospitals or birth centers. The remaining 3 percent occurred in homes, according ot the group.

Why do women seek out midwives to help them welcome their babies into the world? Studies show that midwifery care often leads to less invasive and less expensive interventions when a women is delivering a baby. That includes lower rates of C-sections and labor induction and augmentation; less use of regional anesthesia; and higher rates of breastfeeding.

In the Triangle, pregnant women have lots of opportunities to work with certified nurse-midwives during their pregnancy. They include:

I featured a local mom this week, who delivered at UNC's N.C. Women's Hospital earlier this year with help from certified nurse-midwives. This week, which is National Midwifery Week, I checked in with one of them - Jenny Cox - to get some answers to some frequent questions about certified nurse-midwives. Here's a Q&A.

Go Ask Mom: Some people might think you only use midwives if you're having a home birth, but that's not the case. At UNC, you can work with both midwives and doctors to ensure that the delivery is safe - but also comfortable. How does it work?

Jenny Cox: There are many misperceptions the public has about midwives and the kind of care and the place that care is provided are at the top of the list.

Certified Nurse-Midwives (CNM) provide well-woman gynecologic, prenatal, labor, postpartum, and in some cases, newborn care. CNMs provide labor care in all settings, including hospitals, birth centers and homes. However, the majority of CNM-attended births occur in the hospital setting.

Each of these settings can be both safe and comfortable depending on an individual mother’s medical history and pregnancy course. Women receiving care at UNC can choose a midwife or physician for their pregnancy care depending on these same factors.

For those who elect midwifery care, a careful risk assessment is done at the first prenatal visit and this process is on-going as the pregnancy progresses. If complications arise during pregnancy or birth, we consult our physician colleagues. If the management of any complication is outside of our scope of practice, we refer the case to physician-managed care.

GAM: A lot of women who delivered their first child with a C-section want to deliver vaginally when they become pregnant with their second. What's the success rate of VBACs (vaginal births after a C-section)? Why is it best for baby to be born vaginally if possible?

JC: All mothers want a healthy baby and most desire a vaginal delivery if at all possible. When a Cesarean delivery occurs with a women’s first birth, VBAC is a safe option for many women. When safe for both mother and baby, women desire VBAC for a variety of reasons, including more immediate bonding with and breastfeeding of the baby, as well as shorter recovery times.

Midwives have a strong commitment to recognizing pregnancy and childbirth as physiologic processes rather than pathologic ones. At UNC, our prudent use of intervention and evidence-based clinical practice produce a low primary cesarean rate and a high VBAC success rate (10 percent and 81 percent, respectively). has more information on the benefits of normal, healthy childbirth for women and babies.

GAM: Of course, not all pregnancies go as planned. Are there times when midwives work with moms where it turns out a C-section really is indicated for mom and baby's health? If so, what is the midwives role?

JC: Cesarean delivery can be indicated for a number of reasons. Sometimes this need can be predicted and other times not. The media have given a lot of attention to the “Cesarean epidemic.” While the overall Cesarean rate is certainly higher than it should be, the decision for a cesarean delivery should be made based on an individual woman’s clinical scenario, which of course includes the baby’s health as well.

The midwife’s role at the time of a cesarean delivery differs depending on each institution. Although the woman is under the physician’s care for a Cesarean delivery, at UNC, the midwife accompanies the woman to the operating room and remains with her for social support.

Our role is also to help facilitate bonding and early initiation of breastfeeding. Cesarean delivery is most often not the anticipated mode of delivery, and simultaneously giving birth and having abdominal surgery is overwhelming for most women and their partners.

It is our goal to do anything we can to help make the process less clinical and as family-centered as possible. Typically the midwife resumes care of the patient post-operatively unless further complications arise that necessitate continued physician care.


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