What is a midwife?
Midwives in California are health care providers who care for pregnant people and newborns during pregnancy, labor, birth, and the postpartum period (including as the primary birth attendant).
Approximately 50,000 births per year in California are attended by midwives.
Midwives also provide care to patients beyond “catching babies.” This care includes preventive measures – such as pap smears and routine pregnancy testing – and the detection of any abnormal conditions in the mother and newborn. Midwives offer referrals or consultation with physicians and other healthcare providers when indicated by the patient’s condition. They are skilled at providing emergency care during labor and birth until the situation has resolved or additional assistance is obtained.
Midwives can prescribe and administer medications, suture lacerations that occur during birth, detect abnormal conditions, and manage many complications independently. Nurse-Midwives in California can provide routine gynecological care, including abortion care in the first trimester.
MACa member Kimberly Durdin, LM of Kindred Space LA
MACa memberBeloved Birth Collective in Alameda County Health Systems
Midwifery is a health care discipline that is distinct from medicine, nursing, and doula care. Midwives are trained to provide sexual and reproductive health care, pregnancy care, and newborn care according to the midwifery philosophy and model of care. Learn more about the philosophy and model of care here.
In the panels below, we compare routine care in the community-based setting (meaning care given in the home or a freestanding birth center) to the dominant model of care given in the typical clinic setting, where the hospital is the intended site for birth. We use community-based midwifery as the comparison because that is where the midwife-led care model is most strongly practiced.
Furthermore, there are two midwifery credential types in California – Licensed Midwives and Nurse-Midwives. Both types of midwives are trained in midwifery and philosophy of care. You will find midwives in California attending births and caring for patients in the home, in freestanding birth centers, clinics, and in hospitals. However, midwives who practice in the hospital setting are more likely to be in physician-led practices within the dominant model of care. In these settings, thanks to their training in the “whole-person” model of care and midwifery philosophy, care by these midwives also results in improved outcomes for low-risk, essentially healthy people. Nonetheless, the improvement may not be as robust as the community-based model described below. (Want the data? See resources on “Why Midwife-Led Care”)
What makes midwifery care so special?
The Midwifery Model of Care
Prenatal Care
Community Midwifery Model
4 to 10 hours of face-to-face time with the provider
Typical Visit Schedule:
8-10 visits
Typically 30 min - 60 min with the pregnant person
Between visits:
Availability of midwife via phone, text, or email
Integration of childbirth education, doula services, and breastfeeding education
Referral as needed for additional support
Dominant (Medical) Model of Care
50 min to 2.5 hours of face-to-face time with the provider
Typical Visit Schedule:
8-10 visits
Typically 15 min, with 6-10min of actual face-to-face time with the pregnant person.
Between visits:
In some practices, there is the availability of after-hours support from other team members
Urgent Care/ER for after-hours care
Referral as needed for additional support
Labor & Delivery
Community Midwifery Model
Labor & Delivery planned for home or birth center
Continuity of Care:
Midwife is known to the birthing person before labor begins
There is continuous labor support by the midwife from the start of active labor through the first hours after birth
A doula is often also present for continuous labor support
High quality safe care:
Ability to identify and treat many obstetric emergency on site.
Identification of indications for transfer of care.
The majority of transfers are for pain management or stalled labor not for emergencies.
Team for delivery and postpartum:
Minimum two trained health care providers at delivery
Doula support is routine
Pain Management:
Tools include: continuous support, massage, water therapy, nitrous oxide
Doula support is routine
Dominant (Medical) Model
Labor & Delivery occurs in the hospital
Team for Delivery:
L&D nurse (RN) is often new to the patient
The provider (MD or CNM) may be new to the patient during labor
Providers may not be in the hospital until birth is imminent (MD or CNM)
Providers are routinely not in the room until birth is imminent
Providers typically leave within 15-30 min after delivery
Multiple healthcare providers are routinely present at delivery, many are typically new to the patient at the time of delivery (Routinely: 2-4 RNs, 1 MD or CNM)
Ability to identify and treat obstetric emergency on site:
Ability to care for higher risk pregnancies
Access to emergency medications and on-site team to manage care for preeclampsia, hypertension, diabetes, inductions, etc.
Hospitals vary with their ability to identify & treat obstetrical emergencies (an anesthesia provider and physician trained in surgery may be on-call from home or present in the hospital during labor)
Pain Management:
Tools include: fentanyl, epidural and spinal anesthesia. More rarely may include: Nitrous, and water immersion.
Doula support if the pregnant person has personally arranged for a doula
Immediate Postpartum
(First 24 Hours)
Community Midwifery Model
Pregnant person is routinely home in their own space at 4-6 hours postpartum (if birth occurs in a freestanding birth center)
Active support for rest and recuperation of the birthing person and support for breastfeeding
Newborn Care:
Newborn exam
Breastfeeding support
Newborn medications (Vitamin K, Hepatitis B vaccination, Erythromycin ointment)
Dominant (Medical) Model
Birthing person and newborn typically hospitalized for 24-48hrs after birth
Screenings and check-ins with the birthing person are prioritized over rest and recuperation.
Check-ins are typically performed on the schedule of the staff person or provider (can be disruptive to rest and recuperation of the birthing person)
Newborn Care:
Newborn Exam
Breastfeeding support
Newborn medications (Vitamin K, Hepatitis B vaccination, Erythromycin ointment)
Postpartum Care
(First 6 Weeks)
Community Midwifery Model
2 to 4 hours of face-to-face time with the provider. Every visit includes care for the postpartum parent and the newborn (dyad care).
Typical Visit Schedule:
3-4 visits within the first 6 weeks
30 min - 1 hour long visits
Dyad care every visit includes:
Maternal health assessments at each visit: vitals, mental health screening, breastfeeding support, preconception counseling, and birth control.
Infant health assessment: vitals, weight gain, screenings, breastfeeding support
Whole Family Care:
special attention at every visit Ito education and support for multiple family and social needs that may impact the health of the birthing person or newborn
Dominant (Medical) Model
24 to 48 minutes of face-to-face time with a provider. Visits for the newborn and the postpartum parent are separate.
Typical Visit Schedule for birthing person:
1 visit at 3-6 weeks for assessment of the birthing person.
Scheduled for 15 min, with 6-10min of actual face-to-face time with the pregnant person.
Maternal health assessments: vitals, mental health screening, social support assessement, breastfeeding support, preconception counseling, and birth control.
Typical Visit Schedule for the Newborn
Typically 2-3 separate visits for the newborn
Individual visits are scheduled for 15 min, with 6-10min of actual face-to-face time
Infant health assessment: vitals, weight gain, screenings, breastfeeding support