How is a midwife different from a doctor?
If you are pregnant and in good health without a medical condition, such as high blood pressure, diabetes, or a heart problem, you can choose a midwife to care for you during your pregnancy. Midwives are an appealing option for women and their partners who want a more individual, less routine approach for the birth of their child rather than a more traditional obstetrician.

This isn't to say midwives are better or more qualified than doctors. They aren't. But they are different professionals with different philosophies. For many expectant parents, midwives offer the best of both worlds: solid, certified education in labor and birth combined with personable, continuous care and a
view that birth is an individual experience for every woman. Such personalized care does not come at the expense of any medical care that might be needed, however. Rather, it's a question of approach. For midwives, medical intervention is never routine and is used only when necessary or when desired by the mother, such as an epidural. That a woman has choices within the limits of safety throughout her birth is one of the cornerstones of midwifery's philosophy.

Midwives - the word derives from Old English and means "with woman" - provide a woman's care
throughout pregnancy, labor, birth, and postpartum. They have obstetricians available for consultation and
backup as needed. Midwives believe that women should be partners in caring for themselves during
pregnancy and childbirth. They encourage women to learn about the physical and emotional changes
they're experiencing, they encourage women to create their own birth plans, and they believe a birth will go well, rather then expect complications.

How popular are midwives?
Midwifery has struck a nerve with women in the United States; the number of women consulting
nurse-midwives increased tenfold between 1975 and 1995. Midwives practice in all 50 states, as well as the rest of the world. In fact, in many European countries, obstetricians provide primary care only for
complicated pregnancies.

Recent studies in the United States have shown that healthy women with normal pregnancies who chose
certified nurse-midwives had excellent outcomes with fewer medical interventions: They relied far less on
electronic fetal monitoring, epidurals, or episiotomies). They also had a lower rate of cesarean sections.

None of this surprises Beth, mother of a three-year-old boy and a three-week-old girl, in Shutesbury,
Massachusetts. She and her husband, Dan, used a certified nurse-midwife in a hospital for both of their
children's births. "I found the midwives I used were wonderful - centered, calm, right with me all the way," she says. For her first baby, Beth endured a 30-hour labor and says her midwife, Pam, was by her side the entire time. "Doctors tend to go in and out - only a midwife would have stayed with me for so long."

For her second birth, Beth says she didn't see a doctor at any time during labor. "And that was fine," she
says. "I felt I was in the hands of very competent people who happened to be midwives.

"Generally, I wanted a woman-centered approach that saw birth as a natural process and that assumed everything would go fine, as opposed to a medical procedure that anticipates problems. For me, a midwife gave me the perspective I wanted," she says.

How do they handle complications?
Certified midwives are educated not only to be experts in normal birth, but to recognize the signs and symptoms of deviations from the norm and how to manage emergencies. All certified midwives work with obstetricians. If a complication develops during pregnancy or labor, the midwife consults with the physician, who may step in to help if needed. Feel free to ask your midwife about her consulting physician; you may even want to meet him at some point before your due date.

Although Beth wanted to have a home birth for each baby, she delivered in a hospital because she ended up requiring some medical care. "Still, my midwife was more involved than anyone else," she says. "I was comfortable knowing the doctors were there as a backup, and as it turned out I needed them. But for the rest of my labor, my midwife took time with me, explained what was happening, and provided the emotional and spiritual support I wanted."

How is she trained and certified?
Most midwives in the United States who are formally educated in the profession are certified by a national
organization called the American College of Nurse-Midwives (ACNM). ACNM-accredited midwives are recognized by the letters CNM (Certified Nurse-Midwife) or CM (Certified Midwife). A midwife using the title CNM or CM has completed an educational program accredited by the ACNM, demonstrated clinical competence, and passed a rigorous national certification exam.

CNMs and CMs provide a full range of comprehensive women's healthcare services, including well-women gynecology checkups, family planning services, pre-conception care, prenatal/postpartum care, and, of course, care during labor and birth. Most attend births in hospitals, but they can also deliver babies in birth centers and attend home births. Many insurance plans cover CNM services, and CNMs can be found on HMO panels. In more than half the states, insurance plans and HMOs are required by law to give women the option of choosing midwifery care.

What is a direct-entry midwife?
Direct-entry midwives (sometimes called lay midwives) learn their skills through apprenticeships or other midwifery training programs. They generally deliver babies at home, and their practices, standards, licenses, and legal standing vary from state to state. If you're considering a direct-entry midwife, be sure to ask about her experience and training and what kinds of physician back-up arrangements she has.

How do I find a midwife?
Choose a midwife as carefully as you'd choose a physician. Ask her about certification, where she practices, how many providers are in her group, who her collaborating physicians are, and which insurance policies reimburse for her services. If she practices in a hospital, ask about "rooming-in" with your baby, sibling visitation, and other hospital policies.

Beth, who used two midwives, advises extensive interviewing. "Talk to as many midwife candidates as you
can," she says, "and be sure to meet the doctors they partner with so you're comfortable with both. Find a
personality that matches your own. Also, if you're interviewing midwives in a practice, think about choosing a small group - that way, fewer people are rotating on-call duties, and you have a better chance of developing a relationship."

You can get the names of CNMs or CMs in your area by calling the American College of Nurse-Midwives at 202/728-9860 or by using their toll-free practice locator at 888/MIDWIFE. You can also visit the ACNM web page at http://www.midwife.org. If you want to deliver at a specific hospital, ask for the names of midwives who practice there. If you're interested in delivering at a birth center, call the National Association of Childbearing Centers at 215/234-8068.

If you want a home birth, check with ACNM or the Association for Childbirth at Home International at 213/663-4996. For a direct-entry midwife in your area, call the Midwives' Alliance of North America at 615/964-2394.

At your first visit to a midwife, she'll take a comprehensive medical history, perform a physical exam, and have laboratory screenings done. If you have certain medical or obstetrical problems - such as high blood pressure or triplets - you may be referred to an obstetrician or a perinatalogist (a high-risk specialist).