What Modern Midwifery Looks Like

This traditional birthing option has evolved to meet the needs of today’s pregnant moms
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When you or someone you know is pregnant, there are multiple appointments throughout the pregnancy leading up to the big event: labor and delivery. Having support throughout that journey is pivotal to a pregnant woman’s care and experience. For some, the person providing that support is a midwife. 

“Midwives have been around as long as women have been having babies,” says Sarah Dumas, a certified nurse midwife and clinical director at the Women’s Birth & Wellness Center in Chapel Hill. The term midwife means “with woman” and, for generations, it has been used to describe the person who assists a mother giving birth. Dumas is a second-generation midwife who grew up attending births as a Red Cross volunteer in a military hospital before going to nursing school, working in an intensive care unit and, later, attending midwifery school. 

Traditionally, up until the 1900s, midwifery was passed down from one generation to another through apprenticeships. Today, it is a profession most commonly achieved after first working as a certified nurse before earning a master’s degree in a midwifery program accredited by the Accreditation Commission for Midwifery Education. This requires passing a certification examination as well.

“Nurse midwives, in training, learn well-woman care, primary care, breast health, gynecology, contraception, pregnancy, birth, postpartum and newborn care (for the first 28 days of life),” Dumas says. “It’s got a breadth to it, certainly.”


Where Nurse Midwives Practice

There are midwives who practice in every setting: hospitals, birthing centers and home births — although state regulations vary, and North Carolina laws currently do not allow home births. Midwives are required to work under the supervision of a licensed medical physician. As more women seek midwifery care, more hospitals and OB-GYN practices are including it as a part of their services. 

As the only free-standing birth center in the Triangle, the Women’s Birth & Wellness Center has been around for more than 20 years and treats mothers who travel from as far east as Wilmington, as well as from border states Virginia and South Carolina, to experience an unmedicated birth. Most patients commute 45-60 minutes for regular appointments, labor and delivery. 

The birthing center places an emphasis on education and offers optional community prenatal care. Mothers must be low-risk and are given the flexibility during labor to move freely and in whatever desired position they feel comfortable. The center also offers patients a water birth option. 

Two myths about midwifery are that it is exclusively for mothers who want to experience an unmedicated childbirth and can only be found outside of a hospital setting.

“Midwifery care is not just for people who want unmedicated births; midwifery care is for anyone wanting to have a baby,” Dumas says.

Midwifery care is becoming more common in hospitals, with some supporting a model that prioritizes making a midwife the first provider on call, with a patient’s physician available if needed. Duke Regional Hospital is currently working toward providing that model 24/7. 

Mothers can still have a home-like experience in a hospital labor room by bringing in comfort items, such as pillows or clothes, says Lisa Barkley, a certified nurse midwife with Duke Health. Some hospitals offer labor rooms that resemble bedrooms. 

Aesthetics aside, Barkley says she tries to give them the experience they are looking for because “it’s such an important time in their life.” She says she gets “all types of patients — some that want very little intervention, to women that want everything. I stay with the patient during the entire labor and delivery process. Push with her, help with pain management — that’s what you’ll find with most midwives.”

Originally a labor and delivery nurse, Barkley pursued midwifery after her own experience delivering three of her children with the support of a midwife. That same midwife later became one of her professional mentors and friends. 

“Probably the main reason I became a midwife is because of the care she gave,” Barkley says. 


Empowered Parents Have Choices

“Parents have become more empowered to speak up for what they want, compared to 20 or 10 years ago,” Barkley says. 

This means mothers and their partners are more often wanting to have input, ask questions and make decisions about the kind of labor experience they want. And because midwives place such an emphasis on support, they are able to take more time to educate and build relationships with patients. The faith and trust parents-to-be put in their midwives speaks to how special they are to their patients. That relationship goes both ways, Barkley says.

“I’m trying to put into words how much my patients mean to me; it is investing in the patients’ lives,” Barkley says. “[For] some of them, I delivered three or four of their children.” 

Barkley has seen a shift with more midwives becoming involved in legislation and helping to train and teach medical students. Nurse midwives are able to write prescriptions and do some medical procedures, but there still are limitations in terms of what nurse midwives can do and how widely accepted they are in the medical field. 

However, Dumas says some hospitals and physicians have adopted practices more common in traditional midwifery care, such as allowing various labor positions or taking a more educational approach. 

“More women are specifically asking for midwifery care, wanting to have a voice and be an active participant in their care. The midwifery model has shared decision-making at its core,” says Dumas, who feels the popularity of midwifery has increased, in part due to social media and the internet. Instead of being bound by limited exposure and understanding within one’s own town, or via family members’ experiences, information about other options is more readily available online. 

While there are always going to be some “not great midwives,” Dumas says it’s important to recognize that one type of provider isn’t necessarily better than another. In general, she says, “if you want to have a partner helping figure out how you want to be taken care of and assisted during birth, midwifery can be really excellent.”

Samantha Gratton is a freelance writer in Raleigh who enjoys traveling on a budget, rock climbing and doting on her little ones.