Midwifery Care
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes
  • Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling and prenatal care, continuous hands-on assistance during labor and delivery and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean-section.
Copyright © 1996-2001, Midwifery Task Force
All Rights Reserved
Midwives in Washington State
A Direct Entry Midwife is generally a midwife who attends women who chose to birth at home or in a birth center. They may learn their skills through an independent midwifery school or college, apprenticeship, self-study or a combination. A Certified Professional Midwife (CPM) has met the standards for certification set by the North American Registry of Midwives (NARM.)

Certified Nurse Midwives are educated in both nursing and midwifery. CNM's are certified by the American College of Nurse-Midwives. CNM's primarily attend birth in a hospital setting.

Washington state requires practicing midwives to be licensed. A Licensed Midwife (LM) meets stringent standards set by the state but is not necessarily certified. Medicaid and some HMO's will reimburse for home births with a Licensed Midwife.

In the rest of the US, standards and regulations on midwifery vary. Visit Citizens For Midwifery at www.cfmidwifery.org for more information on the Midwives Model of Care and the legal status of midwifery care state by state.
What is midwifery?
...An Ancient Art
Childbirth is a major life experience that is as unique as the woman giving birth. Since the beginning of time childbearing women have sought the individualized care, advice and companionship of midwives. Like their ancient predecessors, the modern midwife focuses on the fundamental belief and understanding that pregnancy and birth is a normal and natural process. Today’s midwife is an autonomous health professional who specializes in the complete and personalized healthcare of childbearing women and their newborns.
Recent Studies
 Planned Home Births in the United States are Safe, say reasearchers
Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week’s BMJ.

Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited.

In the largest study of its kind internationally to date, researchers analysed over 5000 home births involving certified professional midwives across the United States and Canada in 2000. Outcomes and medical interventions were compared with those of low risk hospital births.

Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America.

A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions,” say the authors.

“This evidence supports the American Public Health Association’s recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States.”

 Outcomes of planned home births with certified professional midwives:
  large prospective study in North America

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager

ABSTRACT
  • Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.
  • Design Prospective cohort study.
  • Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.
  • Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.
  • Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.
  • Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.
  • Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
RESULTS
  • Medical interventions Individual rates of medical intervention for home births were consistently less than half those in hospital, whether compared with a relatively low risk group (singleton, vertex, 37 weeks or more gestation) that will have a small percentage of higher risk births or the general population having hospital births (table 3). Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women.