Midwifery 101: what is a midwife, and why choose one?

Jessica Day, CNM is a certified nurse midwife and she has been practicing since 2012. She practices at Inova Obstetrics and Gynecology – Annandale and Inova Midwives – Willow Oaks. 

Whether you’re planning to grow your family or are already pregnant, choosing a provider to care for you before, during and after delivery is a big decision. While OB-GYNs are wonderful choices, midwives can be a great option as well.

Because many people aren’t as familiar with midwives, we sat down with certified nurse midwife Jessica Day, CNM, to learn about what midwives do and how they can benefit women throughout pregnancy and beyond.

Let’s start with some definitions. What does a midwife do, and what sort of credentials does a midwife have?

In our practice, all our midwives are certified nurse midwives (CNMs). A CNM is an advanced practice provider who has completed nursing school, earned a registered nurse credential and gone through extensive additional training focused on women’s health at the graduate level, earning a master’s degree or doctorate from a nurse midwifery program. After training, providers must be certified by the American Midwifery Certification Board to be a CNM.

In sum, CNMs are women’s health experts who are equipped to care for women across the lifespan, from adolescence through menopause, with particular expertise in pregnancy, labor and delivery, and the postpartum period.

What is a common misconception people have about midwives?

People sometimes associate midwives with home births, or they think midwives are birth coaches, like doulas. While midwives certainly support their patients during the birth process, most CNMs deliver babies in hospitals. For example, at our practice, Inova Midwives at Willow Oaks, we deliver babies at Inova Women’s Hospital on the Inova Fairfax Medical Campus. Midwives don’t just care for pregnant women, however; we see women for gynecologic care as well.

How do midwives differ from OB-GYNs?

The academic training differs in that OB-GYNs are physicians, so they go to medical school and then complete residency training in obstetrics and gynecology. In contrast, CNMs go to nursing school and then complete a graduate degree in nurse midwifery. Their licenses and certifications are different. Another difference is that OB-GYNs can perform surgeries. While midwives can perform in-office procedures, they do not perform surgery.

Are there any patients who should not be cared for by a midwife?

Midwifery care is appropriate for generally healthy women who have low-risk pregnancies or gynecologic needs. Patients with high-risk pregnancies or other medical conditions that increase the risk of complications should be seen by an OB-GYN. In some cases, things change over the course of the pregnancy, moving from low risk to higher risk, and in those cases, we are able to seamlessly refer a patient to an Inova OB-GYN or maternal-fetal medicine (MFM) specialist. The same goes for complicated gynecologic cases: We can refer patients to our partners.

We have strong, collaborative relationships with the OB-GYNs and MFMs at Inova, which makes this process simple. Our practice is highly integrated with our OB-GYN and MFM partners at Inova.

What are the advantages of choosing a CNM as your main women’s health provider?

When it comes to labor and birth, because midwives are trained as nurses, we approach care from a nursing perspective. So, we apply a nursing model to principles of bedside care, holistic care and family-centered care. We genuinely know our patients and their families, and we hope to build these relationships throughout a woman’s lifetime.

Another thing to note is that our care isn’t just during pregnancy and labor. It starts at adolescence and extends through menopause. So, a young woman can come to us to talk through birth control options, have her well woman exam with us, and get counseling on sexually transmitted infections (STI) and other risks. If and when that woman becomes pregnant, we focus on giving her high-quality, holistic prenatal care all the way through the labor and through the postpartum period. We can continue her care well after childbearing years with annual well woman exams, Pap smears, and perimenopause and menopause care. Really, we can serve as women’s health specialists for most of their needs.

Do midwives focus more on natural birth, or can you still get an epidural if you want one?

My philosophy as a midwife is this: I can’t always guarantee you the birth that you want, but I can guarantee that I’ll listen to your birth preferences and try to help you get there. We’re committed to helping patients learn about pregnancy and birth, so they can make informed decisions. We want to give patients enough time to make decisions without feeling pressured, and we’re very respectful of cultural beliefs and preferences.

Of course, we can order an epidural if you want one. And if your choice is to try to go unmedicated, we’re there to support you. We generally view birth as a natural process rather than a medical condition but can recognize when complications occur.

Are midwives associated with positive patient outcomes?

Yes, according to national data, midwifery care is associated with reduced c-section rates, lower preterm labor rates, less chance of a labor induction, higher breastfeeding rates, less chance of a third- or fourth-degree tear, reduced postpartum depression rates, decreased maternal mortality, and increased patient satisfaction. There are a lot of benefits.

If you had to sum it up in a few sentences, why choose a midwife?

• We’re highly educated
• We practice evidence-based medicine
• We also understand that birth is a choice and a natural process
• We take a holistic perspective, integrating both mind and body as central to our care
• We have a great working relationship with our physician partners when referral is required, as well as related specialties from behavioral health to social work to nutrition

Midwives are trained or trained holistically – we care for the patient as a whole rather than a certain part of the patient. Overall, if you’re looking for a provider who will listen to you and help you develop a personalized care plan that takes all of you into account, I think you’re looking for a midwife.

Make an appointment with Inova Midwives at Willow Oaks or find a midwife at an Inova hospital near you.