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Delivery Decisions

If you're considering having a midwife deliver your baby, you're not alone. Although only about 8 percent of the four million U.S. births in 2000 were attended by certified nurse-midwives, that's double the number in 1989 -- an increase likely due to a wider acceptance of midwives by hospitals and obstetric practices, according to experts.

A certified nurse-midwife (CNM) is a nurse who has additional training in prenatal care, labor, and delivery, as well as postpartum maternal health, infant care, and lactation consulting. She must be certified by the American College of Nurse-Midwives (ACNM) to deliver babies. The number and length of prenatal visits you'll have with a CNM are about the same as what you'd get with an obstetrician, but some women report that they get more one-on-one time with a midwife, since many obstetricians have their nurses do tasks such as taking a patient's blood pressure.

Because CNMs advocate birthing with as little medical intervention as possible, the big difference comes in the delivery room. Though the birth may occur in a hospital, CNMs believe in allowing labor to progress as naturally as possible. Alternative techniques, such as varied delivery positions (including standing up or squatting) and massage (rather than epidurals or narcotics) for pain relief, are standard protocol. This philosophy could help explain why CNMs have lower rates of episiotomies and cesarean sections, though the fact that CNMs handle largely low-risk pregnancies likely contributes to these rates as well. If medical intervention is needed, CNMs can induce labor, perform an episiotomy, and prescribe pain relief, so long as their state and the hospital they're delivering in allows those privileges, says Elizabeth Stein, CNM, of Manhattan OB-GYN, in New York City. If complications during delivery require more invasive procedures (such as a cesarean section), a midwife will call in a backup obstetrician.

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