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Pros and Cons of Hiring a Midwife (You’re Gonna Want a Midwife)

Looking for a complete list of the pros and cons of hiring a midwife? Look no further. After reading this blog post, you’ll know exactly what you’re getting if you choose a midwife so you can make that choice with confidence.

midwife using a stethoscope

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Like most things in life, hiring a midwife has both pros and cons. While I think the benefits of hiring a midwife far outweigh the potential drawbacks, I want to give you all the information so you can decide for yourself.

Different Types of Midwives

Before we dive in, it’s important that you know one thing: there are different types of midwives

To summarize, certified nurse-midwives (CNMs) usually work alongside OBGYNs in clinics and attend births in hospitals.

Certified professional midwives (CPMs) generally work in birth centers or in homes.

As I talk about the pros and cons of choosing a midwife, it will be obvious that some of the benefits and some of the downsides only apply to CPMs who work outside of the hospital. At the same time, many of the great things about midwives apply to both CNMs who work in typical medical settings and CPMs who don’t.

With that out of the way, we’re ready to dive in.

Pros of Hiring a Midwife

Let’s start with the positives, the pros of hiring a midwife, then we’ll get to the cons.

More Personalized Care

One of the biggest benefits of choosing a midwife (and one that leads to many of the others) is that midwives provide more personalized care. This is particularly true of midwives who work in private practices or birth centers or work independently.

(Midwives who work alongside OBGYNs usually practice like OBGYNs do.)

In part, midwives are able to provide better care because they have more time. At a typical clinic, OBGYNs and CNMs will see roughly 30 patients per day. That means appointments have to be short.

Out-of-hospital midwives see far fewer patients a day—usually less than 10. Because they have the freedom to take more time, appointments can stretch longer than an hour. And that provides ample time for building a relationship of trust and getting to know one another.

It also means there’s more time for education.

More Education

Midwives will usually provide much more education to their clients than OBGYNs. They have more time, which is a big factor. But they also tend to have different education. Yes, doctors know how to do surgery, but they usually aren’t trained in preventative measures.

For example, most medical schools don’t even teach a single course dedicated to nutrition.

Doctors, unfortunately, are not experts in how to stay healthy and prevent disease. They are experts in how to treat disease and resolve complications after they arise. 

For that reason, a midwife is the better option if you’re looking for advice on how to maintain optimal health during pregnancy, not just survive.

Holistic Care

Along those same lines, midwifery is, by nature, more holistic. In other words, midwives approach your care with the understanding that everything is connected—your physical health generally, your pregnancy, your mental health, etc.

For example, midwives encourage women to exercise specific muscles during pregnancy to prepare for labor. Exercises like deep squats and butterflies both strengthen and stretch the muscles that need to be toned for your body to labor effectively.

Midwives also tend to use herbs and other natural remedies rather than turning to medicine or intervention.

Some midwives (and some childbirth methods) encourage women to acknowledge and address their fears about birth. Emotions can affect our bodies in direct ways so it makes sense that midwives would make emotional health a priority during prenatal care.

Nutrition is also a HUGE part of midwives’ focus because proper nutrition can help you and your baby avoid complications, including preeclampsia and premature birth.

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Alternate Birth Locations

One big reason women choose midwives over OBGYNs is because that means they have more options for where to give birth. With an OBGYN (or an in-hospital CNM) you only have one choice for birth location: the hospital.

But with other midwives, you can choose to give birth in a birth center or at home, both of which have benefits of their own.

Hands-Off Labor Care

I heard midwifery described once as being hands-on prenatally so it can be hands-off during labor and birth. That is such a good description of the priorities of midwifery. Midwives will be “hands-on” during pregnancy, meaning they’ll get involved in how you care for yourself.

If your midwife is like mine, she’ll be persistent in asking how much protein you’re eating and how consistent you are with your labor prep exercises.

In addition to involvement in your life, a good midwife will literally take a hands-on approach to monitoring your baby’s growth and development. Many midwives will do only one ultrasound, if any.

Instead of relying on ultrasounds, midwives will use dopplers or a stethoscope to check your baby’s heartbeat. And to check your baby’s growth and position, they’ll actually touch your belly, using their well-trained hands to feel for your baby’s head and bum.

This kind of high-touch care before labor begins means midwives can stand back and let you do your thing on the day of birth. 

They won’t worry about constant monitoring or having you hooked up to an IV because they know all the things you’ve been doing to stay healthy and get you and your baby ready for a safe birth.

Right After Birth

That same principle applies to how midwives (outside of the hospital) approach the moments right after your baby is born.

Rather than rushing to get your baby bathed and measured and giving him or her shots and ointments, they’ll let you bring your baby up to your chest and leave you alone.

To learn more about what happens right after birth and the choices you have, check out What Happens To Baby After Birth?.

Better Birth Outcomes

Even research has shown that midwives are doing something right. Multiple studies (like this one and this one) have shown that midwives consistently achieve better birth outcomes than OBGYNs. 

Having a midwife as your primary care provider during pregnancy and birth means you have…

  • Less chance of needing a c-section (i.e. higher chance of vaginal birth)
  • Lower risk of severe perineal tearing
  • Less likelihood of postpartum hemorrhaging
  • Less chance of assisted delivery (forceps or suction device)
  • Higher chance of feeling satisfied with your birth experience 
  • Lower risk of preterm birth
  • Less likelihood of meconium aspiration
  • Lower chance of baby needing resuscitation
  • Lower risk of death (for you and baby)

You’ll also be far less likely to experience the many interventions that often come with birth (continuous fetal monitoring, having an IV, induction, etc.). And you probably won’t be given medications like Pitocin, opioids, or an epidural. 

To learn why you might want to avoid interventions and medication, check out these blog posts:

>> The Cascade of Interventions [Explained]
>> Medications During Labor: Is It Worth the Risk?

No Timetables

As a related side note, midwives are also less likely to have a timetable they want to keep to. Whether because of a broken system, misaligned financial incentives, or personal motivation, OBGYNs often want labor to proceed according to a specific—and tight—schedule. 

But timing a woman in labor only makes her more stressed and will usually have the opposite of the desired effect—slowing down labor and making things more complicated.

More Success Breastfeeding

While you might not be thinking about breastfeeding when choosing a care provider, maybe you should be! Breastfeeding is a beautiful thing and is the best way to provide your baby with the nutrition he or she needs. But it can also be hard.

Women who are beginning to breastfeed need education, support, and encouragement. And midwives can provide all three.

Studies have shown that women cared for by midwives have better rates of both initiating breastfeeding and of continuing to breastfeed after the first few weeks. 

This might be because women feel safe with midwives. It might be because midwives usually see their clients more frequently in those first few weeks postpartum. And it’s also certainly connected to how birth goes—if labor and birth are traumatic, it’s going to be harder to manage things postpartum.

RELATED >> Breastfeeding vs. Formula: 25 Benefits of Breastfeeding.
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Less $$$

Generally, giving birth with a midwife outside of the hospital is going to be cheaper than giving birth in the hospital. 

If you choose the OBGYN/hospital route, you’ll likely pay between $6,000 and $10,000 (depending on extra lab costs, ultrasounds, or hospital costs like epidurals and c-sections). 

If you have good insurance or you’ve already met your deductible for the year (and depending on where you live) you may pay less than that.

Midwives, on average, charge between $2,000 and $9,000 in the US. That’s a big range, obviously. Fortunately, most women will pay somewhere between $3,000 and $7,000 to hire a midwife. And if you give birth at home, you won’t have any costs associated with the place of birth.

(Birth centers can cost anywhere from $2,000–7,000 but your midwife fee is often included in that.)

Clarity About Cost

With midwives, it’s also much easier to know exactly how much things will cost from the start.

Hospitals are incredibly vague about how much they charge and for what. If you get any number at all, you’ll probably just get an estimate based on other women who had the same insurance provider as you.

Midwives, on the other hand, can tell you exactly what they charge, and for what, at your first appointment. If you plan ahead for the supplies and other items you’ll want for the birth, you can know exactly how much you’ll be paying before labor begins.

READ MORE >> How Much Do Midwives Cost?
READ MORE >> How Much Does a Home Birth Cost?

Cons of Hiring a Midwife

Now that you know the pros of a choosing a midwife, let’s round out the picture by digging into some of the cons, reasons you may choose not to hire a midwife.

Not Accepted In the Hospital

In my mind, one of the biggest cons of choosing a midwife is what happens in the case of a hospital transfer. Obviously this only applies to midwives functioning outside of clinics and hospitals. 

While it is rare that a planned home birth will end up in the hospital, it does happen. And when it happens, there is little to no continuity of care.

What that means is that, in America, (out-of-hospital) midwives and OBGYNs don’t usually work together. It’s a flaw in our system, really. If a midwife chooses to practice outside of the hospital, she is usually looked down upon by doctors.

And if a midwife’s client transfers to the hospital for any reason, she is usually legally unable to be that client’s primary care provider any longer. The mother is now solely in the care of the doctor, someone she’s likely never met before.

While OBGYNs and midwives will continue to see things differently, it doesn’t have to be such a negative relationship. But, alas, that’s just how it is right now.

Not Surgeons

To state the obvious, midwives are not surgeons. OBGYNs are.

In the (rare) case that a c-section is truly needed, a midwife will not be able to perform that procedure. That means that if a woman is birthing outside of a hospital, she will have to be taken to the hospital before she can get that c-section.

That said, even in emergencies, women in the hospital don’t get to the operating room right away. Sometimes there is no surgeon immediately available and sometimes it just takes a while for procedures to be followed and the surgery to actually begin. 

Plus, good midwives know what warning signs to look for and will transfer you to a hospital long before you or your baby are in immediate danger.

Unable to Provide Epidurals

Most women worry about the pain of childbirth and how they’ll cope. That’s why a lot of women opt to have an epidural. But if you choose an out-of-hospital midwife, an epidural isn’t going to be an option.

No need to worry though; midwives can help you learn lots of natural ways of coping, from relaxation techniques to using words and sounds to getting in the water.

Not for “High-Risk” Situations

While midwives are the experts on normal, healthy pregnancy and birth, occasionally a woman and her baby will experience complications or health situations that require the care of a specialized doctor. 

Though only about 10% of pregnancies will fit in this “high-risk” category, that 10% will need the care of an OBGYN rather than a midwife. 

Sometimes Unable to Carry Medications

In addition to different certifications, like I explained earlier, midwives may also be licensed or unlicensed. If a midwife chooses to remain unlicensed, she is legally barred from carrying medications such as Pitocin (for hemorrhaging) and lidocaine (for numbing).

In the cases that women need or want these medications, an unlicensed midwife won’t be the best choice.

Culturally Unaccepted

In addition to being treated poorly in hospitals, midwives (and out-of-hospital births) are not the cultural norm. If you choose to be cared for by a midwife and, especially, if you choose an out-of-hospital birth with a midwife, you will likely face some negativity from friends and family—and even strangers. 

The last thing a woman needs when preparing for birth is nay-sayers and horror stories. So if you choose a midwife, be ready to arm yourself against the negative vibes that will come your way.

Not Always Covered By Insurance

Though birth with a midwife often costs less than birth with an OBGYN, the financial downside of midwifery and out-of-hospital birth is that insurance doesn’t always cover it. In fact, insurance often won’t cover it.

When choosing a care provider, be sure to talk to your insurance company. If they say they won’t cover midwifery care or a birth in the location you’re hoping for, start saving now.

Less Available

Finally, midwives have less availability than OBGYNs. We see this in two ways.

First, you may have a hard time finding a midwife in your area. Local laws* may contribute to this, but even aside from that, you’ll likely notice more women’s clinics near you than independent midwives.

Second, because midwives put so much emphasis on personalized care (and because they don’t work in shifts like doctors), they only accept a few clients every month. 

Depending on whether you go to a birth center with multiple midwives or a single midwife, they may accept anywhere from 3-8 clients per month. Since midwives don’t typically induce women, they can’t say for sure when the babies will come, so they can’t book too many too close together.

*Note: Though I believe it wholly unconstitutional, there are some states where home birth midwives are illegal. In these states you will still be able to hire a midwife that works in a hospital (and possibly one who works in a birth center) but if you want a home birth, you have to do so outside of the law.

Conclusion: Choose a Midwife

So there you have it…the pros and cons of hiring a midwife. In providing this blog post, I hope I’ve helped you understand your choice better. I tried not to leave anything out—good or bad—because that’s the only way you can be truly informed. 

Unless you have health concerns that require close monitoring by a doctor, I recommend you hire a midwife. They are the experts in normal pregnancy and birth, and they have the time and the education to prepare you for the best birth possible. 

If you want a great birth experience, choose a midwife.

Not sure how to go about that? I’ve got you covered! You need my new ebook…

How to Find a Midwife: Choosing the Provider You’ll Hire Over and Over Again

You can get it now for just $29! Go here to learn more.

I really just want the best for you and your baby. And I truly believe that that is most likely to happen if you hire a midwife.

Until next time,

Allison

READ MORE:

The Real Pros and Cons of Home Birth

What Makes Midwives and OBGYNs So Different?

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