Maternal and infant health are key indicators of the vitality of any culture. All communities have a strong interest in protecting and serving the needs of their pregnant women and newborns. Community midwives serve critical roles by facilitating education, health care and resources for women of childbearing age. In addition to the traditional role of birth attendant, a community midwife also functions in a variety of other roles related to women's health.
Roles and Results
Community midwives perform routine women's health checkups, educate women on prenatal health and nutrition, provide birth education classes and assist women with breastfeeding and infant care. As labour and birth attendants, midwives provide coaching and comfort. Births attended by midwives result in better birth outcomes, including reduced use of pain medication, fewer episiotomies and less frequent use of forceps, according to the Cochrane Collaboration. Community midwives play critical roles in rural areas and in other circumstances under which access to hospitals and obstetricians is limited.
Types of Midwives
The practice and legal status of midwifery varies from place to place. The term "community midwife" does not have a universally understood meaning, but it most commonly refers to a midwife who practices outside a hospital setting, in homes, clinics and birth centres. Less frequently, the term "community midwife" may be used to distinguish between traditional midwives (also called "lay midwives" or "direct entry midwives") and practitioners certified by the American College of Nurse-Midwives, including a Certified Nurse-Midwife (CNM) and a Certified Midwife (CM),
Midwifery in the United States
The majority of midwife-assisted births in the U.S. are attended by CNMs and CMs, and 96 per cent of such births occur in hospitals. However, the number of women choosing midwives for out-of-hospital births appears to be increasing. For example, the California Medical Board reported a 35 per cent increase in planned home births between 2007 and 2008 (from 1,687 to 2,278).
In most parts of the world, midwife-attended births are norm. The World Health Organization (WHO) published a position paper in 1985 that set forth international standards for birth options. WHO recommended the training and promotion of community midwives and instructed that midwifery care be the standard for normal pregnancies and birth. Although utilisation of midwives varies by country, community midwives serve important functions internationally, particularly in rural areas and developing nations.
Published studies demonstrating the safety of birth with a qualified midwife have resulted in an increase in midwife-attended births in the United States. In 1990, only 3.9 per cent of births were attended by midwives. That figure more than doubled to 8 per cent by 2003. As more women demand access to midwifery care, and as public officials seek ways to lower the cost of maternity care, community midwives are likely to play even greater parts in health care, education and childbirth.
- The Cochrane Collaboration: Midwife-Led Versus Other Models of Care for Childbearing Women
- Centers for Disease Control and Prevention: New Study Shows Lower Mortality Rates for Infants Delivered by Certified Nurse Midwives
- World Health Organization, Regional Office for Europe: Joint Interregional Conference on Appropriate Technology for Birth
- California Medical Board: Revised 2008 Licensed Midwife Annual Report Summary
- Centers for Disease Control and Prevention: QuickStats: Percentage of Births Attended by Midwives--United States, 2003