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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.

If you decide to have a midwife deliver your baby, you'll want to check her credentials. You can learn if she's certified by calling the ACNM and you can check her licensing status (in states that require licensing) by contacting your state board of nursing or board of medicine. Stein recommends that you ask about a midwife's level of experience and find out who her physician backup is. It's important to meet that doctor ahead of time and to know how long it would take for you to be transferred to the hospital if you're delivering in a birthing center. You may also want to ask if a pediatrician and anesthesiologist will be on call and how quickly they could be at the hospital. Finally, women considering this option should look into their insurance coverage: Some midwives report a lower rate of reimbursement than doctors receive, leaving you to foot the bill or battle your insurance company.

Midwife-assisted deliveries aren't for everyone. "It's a great option for someone seeking a natural delivery," says Jacques Moritz, M.D., director of gynecology and The Birthing Center at St. Luke's-Roosevelt Hospital Center, in New York City. "But you should make sure you don't have any medical risk factors, like diabetes or high blood pressure, before choosing a midwife over an obstetrician." For more information about certified nurse-midwives, call the ACNM at 202-728-9860 or visit its website, www.midwife.org.

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