Which Birth Setting You Should Choose
If You Want A Midwife ?

Here are your birthing option if you want to have a midwife:

First is the free-standing birthing center.

Birthing center is a place where you are supported to have natural birth in home-like environment. If you decide to give birth in a birthing center, your pregnancy, labor and delivery will be assisted by midwives. Usually, you'll have a mix of nurse-midwives and direct-entry midwives in this birth setting. The main midwife (who is usually also the founder of the birthing center), however, is usually a certified nurse midwife. She practises in a birthing center under supervision of a physician.

Whenever there is an emergency need, she can arrange for hospital transfer and obtain back-up from her supporting physician.

Second is giving birth at home.

If you choose to have a homebirth, you usually will be assisted by a direct-entry midwife. Unfortunately, you cannot have a choice of having a certified nurse midwife to attend you if you choose to give birth in this birth setting. This is because a certified nurse midwife has to practice under supervision of a physician. And it's very rare that the supervising physician is willing to permit the nurse midwife to help a homebirth.

This birthing choice also has a drawback in that in the event of emergency, you have to arrange the hospital transfer yourself (with the help from your midwife of course), and has to be content with any physician on call. In contrast, if you give birth in a birthing center, then in the event of emergency, everything is arranged for you.

Third is giving birth at hospital.

You may have thought that you will have to forgo the care of a midwife if you choose to have birth at a hospital. Don't worry, because there is always a chance to have a midwifery care in this birth setting. What you should do is research carefully what is available in your area.

Although midwifery care is easily found in hospitals in European countries, in the US, most women are assisted by doctors at the hospital when it come to giving birth. Even in the US hospitals where certified nurse midwives are employed, these midwives still play a minor role in assisting birth. It's the physician who has the final say on everything, and it's the physician who 'delivers' the baby.

However, you may find an unusual arrangement of certified nurse midwives who can assist birth at a hospital, while at the same time become your primary care provider. In Houston, where I live, there is a midwifery practice set up by several certified nurse midwives who deliver babies at a particular hospital. In this arrangement, pregnant women are given prenatal care by these midwives. If the patient is proven to be high risk, she'll be transfered to their supervising obstetrician for care and birth. When the pregnant mom is ready to give birth, one of the nurse midwife in the practice assists her in the hospital. As long as the pregnancy and birth are normal, there is no physician involved.

However, this arrangement has some drawbacks in that you may not like all of the nurse midwives in that particular practice, and it's also difficult to say which one of the midwives is going to attend your birth. Of course the main midwife, who you see regularly during prenatal appointment, is the one intended to attend your labor and birth.

However, since the practice consists of several midwives, there is always possibility that you end up with a nurse midwife who you don't particularly like or familiar with. This drawback also happens if you choose to give birth with an obstetrician who is part of a practice consisting of several doctors. In addition, although the midwife will help you to have a natural birth at a hospital, the midwife is also bound by hospital's protocols. So, don't expect to have a home-like or birth-center-like environment in this birth setting, even when midwife is your primary care provider.

• What is a midwife ?
• Midwife services: how a midwife care for you during pregnancy, labor/birth and after birth
• Finding and choosing a midwife
• Midwife fee and how to pay for it
• Type of midwife, part I : certified nurse midwife
• Type of midwife, part II : direct entry midwife

• Why choose to have a natural birth ?
• Why homebirth ?
• Giving birth at hospital
• Giving birth at a birth center

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