Midwives play a vital role in the health of pregnant women, both before, during and after the birth of their children.
According to National Academies, almost 4 million births happen in the United States every year, with 98.8% taking place in a hospital setting, and 1.2% happening out of hospital. Within this, 67% of births occur at home, 28% are in a birth center and 5% take place in other settings.
Most childbearing women in the country are healthy and can choose to give birth in whatever setting they choose. Those with medical conditions, or those who are at high risk of developing one that could affect labor, often choose to have their babies in hospital and be in the care of a specialist doctor.
As well as certified midwives (CMs), certified nurse midwives (CNMs) and certified professional midwives (CPMs), obstetricians, gynaecologists and family physicians deliver babies.
What does a midwife do?
Midwives provide care during pregnancy, childbirth and the postpartum period, and guidance and treatment for sexual, reproductive and gynaecological health. They can also be involved in family planning services, including preconception care. Midwives will also provide care for healthy newborns during the first 28 days of their lives.
Their tasks might include conducting physical examinations, prescribing medications, admitting, managing and discharging patients, ordering and interpreting tests as well as medical equipment and devices, and providing home health services. They may also be involved in promoting health and wellbeing, disease prevention and counseling. All are provided in partnership with individuals and families and can take place in a range of settings including private offices, remote care delivery offices, community and public health systems, hospitals, homes and birth centers.
Stabilizing a baby following delivery
The four different types of birth in the US are categorized as:
- Vaginal delivery.
- Assisted vaginal delivery (using vacuum or forceps).
- C-section (cesarean birth).
- VBAC (vaginal birth after cesarean).
The specific procedures will differ depending on the type of birth, and a lot of things can happen both during and immediately after a baby is born. Midwives and physicians will be used to dealing with the unknowns that come with that. But the basic steps for a straightforward delivery will include:
Cutting and clamping the umbilical cord
Cutting and clamping the umbilical cord near the navel, which ends the baby’s’ dependence on the placenta for nutrition and oxygen. Before birth, the lungs need less blood supply as they are not yet used to exchange oxygen and carbon dioxide, so when the baby begins to breathe air, the change in pressure of the lungs helps close the fetal connections and redirect the blood flow. If a baby has too much fluid in their lungs, massaging and stroking the baby’s skin can stimulate the baby to cry and help bring the fluid up, so it can be suctioned from the mouth and the nose.
Providing warmth
Providing warmth is vital. A newborn can become cold as they are wet from the amniotic fluid, so drying the baby, using heat lamps and warm blankets can prevent heat loss. Also, placing a baby skin-to-skin can help not only keep a baby warm, but it also reduces crying and improves the mother’s interaction with her child in the short and long term.
Apgar test
Health assessments begin immediately after birth. The first one is the Apgar test, which evaluates the condition of a newborn at one and then five minutes after birth. The healthcare provider will give a point value to signs such as activity and muscle tone, pulse rate, appearance, reflex irritability and respiration. A score of seven to 10 is considered normal, a lower score may mean some intervention to help the baby is required.
Physical examinations
Physical examinations are also undertaken speedily in order to assess whether the baby is healthy or not. Other procedures will then be done over the next minutes and hours, such as measurement of weight, length and head circumference, monitoring of the temperature, heart and respiratory rate, keeping the umbilical cord stump clean and dry, and giving the baby its first bath.
Treatment
If there are signs the baby is having some problems, treatment can be done in a delivery room, and the midwife and other members of the healthcare team will work together to help the baby. Those who need intensive medical care are often admitted into neonatal intensive care units, which provide advanced technology and trained staff to give the right care.
Before leaving the delivery area, the baby and mother will be given ID bracelets with matching numbers.
How to become a midwife
For anyone working within the profession, a commitment to healthcare and personal development is important, as well as getting the right qualifications and understanding changes and improvements within the sector by reading and researching via a range of resources.
Midwives need to be caring, patient and have a strong sense of empathy. Observational skills are crucial, and they have to stay calm in sometimes stressful situations, dealing with both the needs of the mother and then of her baby after it is born.
Studying for a Doctor of Nursing Practice Neonatal Nurse Practitioner Track (DNP NNP online) at the Baylor University Louise Herrington School of Nursing Online will provide practicing registered nurses (RNs) with the tools and qualifications needed for an advanced practice role leading nursing care for infants through the first years of life. It focuses on high-risk neonates and their families and delivers in-depth knowledge of theory, assessment, research, critical thinking, patient management and program planning.
The demand for nurse midwives in the US is consistently strong. According to the Bureau of Labor Statistics, the overall employment for these roles is projected to grow 40% from 2021 to 2031, which is faster than the average for all occupations, and it is expected there will be approximately 30,200 openings for nurse anaesthetists, nurse midwives and nurse practitioners each year, on average over that decade.