Why Choose a Midwife?

Prenatal Yoga – A Natural Path toward Working with a Midwife

by Risa Klein, CNM, M.S.

Making a decision as to who will take care of you and your gestating baby is monumental. To make the best-informed decision, you need to understand some differences between the midwifery model of care and the medical model, and you must have a good understanding of your own health history. Start by reflecting on your unique life story, mindset, and circumstances that have influenced you to choose yoga as a pathway to pregnancy wellness. This reflection will help clarify who is a more likely match to guide you during your pregnancy and help you deliver your baby.

Here is some information to help you decide which provider is best suited to your medical situation and philosophical viewpoint.

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Midwives vs. Obstetricians: What’s the difference?

Midwives provide comprehensive prenatal care including regular check-ups, fetal monitoring, and childbirth education. During labor and delivery, they offer physical and emotional support, and customize the birth and labor experience to their patient’s preferences, often providing care in home birth, birth center, and hospital settings. Midwives work with healthy, low-risk pregnant people. They do not take care of those who have high-risk medical conditions such as diabetes, liver disease, or certain autoimmune disorders. 

Rather, obstetricians care for these patients because they are trained surgeons who have studied and learned about disease states. When a pregnant person or fetus encounters a high-risk medical problem, they require an expert in the field of obstetrics to administer medications and perform surgical procedures such as cesarean sections.

Midwives do not perform cesarean sections, although some midwives are certified to assist at cesarean births. The First Assist certification qualifies Midwives to participate and provide continuity of care for patients during their cesarean. While obstetricians are trained in medicine, disease, and abnormality, midwives are trained to recognize variations in normal pregnancies and screen their clients carefully to uncover potential health challenges that may prevent them from working with a midwife. When medically necessary, they refer their clients to the appropriate physician specializing in either obstetrics, perinatology (maternal fetal medicine), or genetic counseling. Midwives consult, collaborate and co-manage with these practitioners and co-manage with obstetricians when caring for those women who desire a VBAC (vaginal birth after cesarean section,) or twin pregnancy.

The differences can be seen in the infographic below:

What kind of qualifications does a midwife receive?

Midwives are independent health care providers with expertise in pregnancy, childbirth, the postpartum period, care of the newborn, common primary care issues, family planning, and annual gynecologic care for healthy women. Midwives graduate from accredited midwifery schools and receive their master’s degree, while some go on for their PhDs. A certified nurse-midwife is educated in both the disciplines of nursing and midwifery. Midwives practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives. They are licensed by their individual states, and have prescription privileges (meaning they can prescribe medication).

What role does a midwife play during labor and delivery?

You can give birth with a midwife either at home, in a birthing center, or on a labor and delivery floor in a hospital setting. Midwifery care is reimbursed by most health insurance companies.  Whether you work with a midwife in a solo practice or a group practice, midwives have a holistic view of the process and see birth as a natural process, not a medical incident. The midwifery model of care is a dynamic approach to pregnancy labor and birth, as opposed to the traditional obstetrical medical model of care.

Midwives are independent healthcare providers with expertise in:

Benefits of Working with a Midwife

Nutrition and Education

You will become educated in how to stay healthy and low-risk during the course of your pregnancy. Midwives take a significant amount of time throughout your pregnancy to address how optimal and balanced nutrition serves as the foundation for achieving better outcomes. You will learn about and be validated for the naturally occurring changes that are happening in your body as your baby gestates inside of you. This orientation continues during labor and birth with a mindful understanding of your body’s innate potential. Midwives teach clients to become mindful of their body, breathing, postures, balance, timing, and rhythm and see all of these as important assets.

Emotional Support

Prenatal visits are the time when your midwife will take the time to get to know you by learning about facets of your life, health, job, and family history, and how they may all impact your pregnancy and birth outcome. From the first day you meet your midwife, they will impart confidence in your natural abilities to give birth by virtue of your own innate capacities, rather than looking outside of yourself. You are encouraged to explore and share your fears, concerns, and feelings as your body changes and your baby grows.

Patience

“I didn’t feel rushed,” is what many clients often share after their labor and birth experience with midwives.

Midwives honor birth as a process and give time for labor to unfold, guiding their clients patiently with specific postures and positions to promote optimal movement for the baby. If you are in a small practice, midwives are apt to devote and maintain continuity of care before, during and after your birth. This means you will see the same midwife throughout your pregnancy, labor and birth as well as postpartum. 

Epidural

Yes, you can still opt to receive an epidural (unless you choose to deliver your baby at home).

Cesareans 

If a cesarean section is needed, your midwife will accompany you while the attending physician or consulting obstetrician performs the surgery. If you need to work with an obstetrician for medical reasons, and have a pre-planned c-section, you can still apply your yoga awareness to help you during your delivery. 

Parallels Between Prenatal Yoga and Midwifery

“Feel your shoulders release. Gently open your hips. Take a breath. Let your jaw soften. Feel your baby as your center.” Sound familiar? While you have heard this kind of instruction in your prenatal yoga classes, it is also the language of midwifery. Many midwives are often excited to meet clients who practice prenatal yoga since they understand how to cultivate awareness of their bodies and their breath. In my years of midwifery practice I believe students of yoga often have an easier time while in labor – they are better able to hear and implement changes suggested. 

Pregnant folks are flexible, open-minded, and calm when they have awareness of how to let go. It comes more naturally to students of yoga to attempt a recommended posture or position during delivery. Working with a midwife will feel natural and familiar to you because there is a similar mindset in midwifery as there is in yoga practice. Just as yoga gives you the opportunity to connect with and align with your body, midwives are inclined to take this concept to another mindset and help you focus inward and align yourself with your baby.

My Experience With Prenatal Yoga

When I was five months pregnant I took my first prenatal yoga class, and I never felt closer or more in touch with my growing baby. Doing seamless, flowing, beautiful, and challenging yoga asana is something I never anticipated in my lifetime, nevermind during pregnancy – and yet my instructor Laurie Kiviat patiently guided me through what I called my “pregnancy yoga orientation”. I was grateful to her for preparing and aligning me for my birth. Looking back, it was as if she was midwifing me, however I didn’t realize it at the time.

If only my own obstetrician applied such awareness and warmth during my delivery, perhaps I would have felt more taken care of. As a student of yoga, you know the benefits you feel over time as you become more in tune with your body. The same level of progression occurs while under a midwife’s care. During your prenatal visits, you will become more comfortable integrating pearls of yoga wisdom with your understanding of movement, rhythm, and breathing while crafting the vision of your birth.

Regardless of who you decide will be the best healthcare provider to attend to you during your pregnancy and birth, a midwife or an obstetrician, you are working with them for the benefit and health of your baby. Both professionals aim to ensure the health and well-being of you and your baby.

For more information on midwives, visit the American College of Midwives and the New York City Midwives.

To see the online and in-person classes that the Prenatal Yoga Center has to offer, click the button below!

Risa Klein is a graduate of the Columbia University School of Nursing Midwifery Program and a highly experienced private practice CNM. Her office is on the Upper East Side of Manhattan, with privileges at Mt. Sinai West’s birthing center and L&D floor. She promotes peaceful pregnancy, empowered birth, and individualized care. Visit her at Manhattan Midwife.