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Acquire a Permit for lay midwives, who have no formal training, to CNMs, who are educated, tested and accredited. “When you say ‘midwife’ to a physician, their hair can sometimes stand on end, because there have been many times when they’ve had to accept a transfer from a home birth that was not managed safely,” Northern says. “That’s where a lot of the medical community’s cold shoulder toward midwifery comes from.”
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s the American public — and perhaps just as importantly, hospitals 5.0 h and health care providers — becomes more aware of those distinctions and the benefits of a midwife-led pregnancy, Northern and Britain are watching the profile of their profession rise, both regionally and nationally. “A greater percentage of women are seeking out nurse-midwifery care as a means to having a more positive birth experience,” says Northern. “Generally speaking, nurse-midwives have one foot in the essence and art of midwifery, and we have the other foot in the world of science, medicine and technology. It’s really the best of both worlds.” n
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“I think women choose certified nursemidwives because they’re hoping to avoid what they might perceive as unnecessary testing or unnecessary medical intervention during their pregnancy or during their birth. I allow the visits to be patient-guided. I don’t walk in with a specific agenda other than the basics of safe care,” she says. There’s also the sense of kinship that can get lost in the hierarchical patient-physician relationship, says Northern. “When a 25-year-old woman comes for a prenatal visit and she’s being cared for by another female who’s maybe 10 or 15 years older, it’s more comfortable to talk about pregnancy and concerns surrounding pregnancy. It feels like you’re meeting with your older sister — only your sister happens to be an expert in pregnancy and birth.” Liz Britain, Northern’s partner at Northwest OB-GYN and a 26-year veteran of the field, says that CNMs offer two distinct advantages over obstetricians. As trained nurses, they adopt a more “holistic” mindset, which includes advice on nutrition, exercise, stress management and childbirth preparation. They also have a smaller “scope of practice.” Unlike physicians, they don’t have to accommodate busy surgery schedules, leaving them more time to converse with patients. Despite their more limited range of services, midwives have often found themselves at odds with obstetricians — an antagonism that can be traced back to the 18th century, when their roles in birth were reversed. Britain and Northern say that antagonism naturally arises where their areas of responsibility overlap, but each profession has unique — and necessary — strengths. “Our training is based on normal, healthy women,” says Britain, who estimates that more than 80 percent of all pregnancies are straightforward enough to fall under that kind of care. “You don’t really need a trained surgeon to deliver a baby, but you certainly need them available 100 percent of the time. You need the expertise of a physician if things go wrong.” “The relationship between a nurse-midwife and her physician is critical,” Northern adds. “Having a clinical practice that has both nurse-midwives and obstetricians is a really nice balance.” Any professional friction might also stem from the historical misconception that midwives are untrained. Northern and Britain, both of whom are certified nurses with a decade of higher education under their belts, note that there are roughly three tiers of midwife training. These range from
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