FAQs - Frequently Asked Questions

What is the difference between a Certified Nurse Midwife, a Certified Midwife, and a Doula?

Certified Nurse Midwife – Certified Nurse Midwives (CNMs) have completed advanced education in both fields of nursing and midwifery. They have been certified by the American Midwifery Certification Board. The vast majority (about 96% according to the American College of Nurse Midwives) of births done by CNMs are done in hospitals. In addition to prenatal care and care during and after labor and birth, CNMs provide gynecological care, family planning, perimenopausal and postmenopausal care as well as some aspects of primary care and disease prevention.

Certified Midwife – A Certified Midwife has also completed a midwifery education program and has been certified by the American Midwifery Certification Board, however has not completed a nursing program. A Certified Midwife can provide prenatal care and care during labor and birth as well as gynecological care throughout the lifespan.

Doula – A doula and a midwife frequently work together. Doulas provide labor support during labor and childbirth and assistance in breathing, relaxation and coping techniques during labor. Some doulas also offer support after the birth and during the newborn period. Doulas do not perform medical assessments of labor, mother, or baby.

Does having a Certified Nurse Midwife mean that I cannot have an epidural or pain medicine in labor?

No. Clients of Certified Nurse Midwives use a variety of pain relief techniques and options, including ambulation, aromatherapy, breathing techniques, warm water immersion for labor and/or birth, intravenous pain medication, and epidurals. Each woman, together with her midwife, should make a personal decision on her method (s) of pain relief based on her desires and events of labor.

What should I expect when I first get to the hospital in labor? What will they do to me?

When you arrive at the Birthing Center and the decision is made to admit you, there are several things the nurses need to do to get you fully checked in. Depending on the intensity of your labor when you come in, some of these things can be hurried or postponed until you are more comfortable. It is common to have the electronic fetal monitor applied after you arrive. This is a recommendation of the American College of Obstetricians and Gynecologists and is considered the standard of care. Ideally, it can be used intermittently to check on the status of your baby once we feel certain that your baby is tolerating labor well. Continuous fetal monitoring can be considered restrictive because it may limit your movement. Another part of the admission process may be drawing blood and starting an IV. In most cases this is done fairly routinely, but it is not necessarily required and can be avoided or delayed with permission of your midwife. The exception to this is when you are known to be GBS positive and IV antibiotics are required. In this case they are started soon after admission and given every few hours throughout the course of your labor. Between doses, you may have the IV "capped off" to make moving around easier. To complete your chart, the nurses must ask you many questions related to your medical and childbirth history.

My friends tell me I should deliver at a hospital with a NICU—what should I tell them about UH St. John Medical Center?

The majority of pregnancies are relatively low risk and most babies are born near term which means that the Newborn Intensive Care Unit is rarely needed. In addition, many risk factors for delivery are known ahead of time and the potential need for NICU can be predicted. We are very fortunate in the Greater Cleveland area to have such superior care for mothers and babies and we have great access to intensive care for newborns. The fact is most babies do NOT need intensive care and at UH St. John Medical Center we have pediatricians in house 24 hours a day who have lots of experience with newborns and will attend births whenever we need them to. On very rare occasions, newborns will unexpectedly need the intensive care unit and can be swiftly transferred to Rainbow Babies and Children's Hospital or Fairview Hospital who both have excellent NICU care.

What is the quality of nurse midwifery care?

Nurse-midwifery practice is legal in all 50 states. A majority of states mandate private insurance reimbursement for nurse-midwifery services and Medicaid reimbursement is mandatory in all states. CNMs must complete a certificate or master’s degree program and pass a national board exam as well as continually update their current knowledge to be able to practice.  CNMs work primarily in an office/clinic environment. Most CNM attended births occur in hospitals but CNMs can also attend births in birth centers and at home. The average nurse-midwife attends 10 births a month. Nurse-midwives have prescription writing authority in Ohio. Nurse midwives have a very low episiotomy rate, cesarean section rate, and an epidural rate.  Nurse midwives have a high percentage of success with women desiring Vaginal Birth After Cesarean Section (VBAC).   Midwives have a low infant mortality rate compared to the National average.  Each year, nurse-midwives assist in more than 248,000 births in the United States and these numbers continue to rise -- a testament to the high degree of consumer satisfaction with this birthing choice. Visit the American college of Nurse Midwives for more information.

What is a Certified Nurse Midwife?

A Certified Nurse Midwife (CNM) is a licensed healthcare professional whose education spans the disciplines of nursing and midwifery. Nurse-midwives have a graduate degree and are certified by the American College of Nurse-Midwives. Certified Nurse Midwives are considered a specialized nurse practitioner focused on the care of women throughout pregnancy, birth, as well as gynecological exams and family planning.

What healthcare services do Certified Nurse Midwives provide?

Certified Nurse Midwives provide pregnancy care including preconception planning, prenatal care, labor and birth care, and postpartum care. But you don’t have to pregnant or even planning a pregnancy to benefit from midwifery care.  Nurse-midwives also provide GYN care like annual exams, family planning, and treatment of routine GYN problems from adolescence through menopause.

Will my health insurance cover nurse midwifery care?

CNMs are reimbursed by many private insurers, HMOs, Medicare, Medicaid in the state of Ohio.  

What a CNM can do for you?

History and physical examination including Pap smears, breast and pelvic examination, breast self-exam education; referral for mammography and laboratory studies; and general wellness counseling. Contraceptive counseling including prescription for oral contraceptive pills, IUDs, diaphragms, subdermal implants, intravaginal  rings and injectables. A visit with a CNM for family planning will include discussion of health benefits, risks, and management of all birth control options and assistance in deciding what is best for you. Screening and treatment of vaginal infection, urinary tract infections, sexually transmitted diseases, menstrual irregularities, and pelvic pain.  Pre-conception and maternity care including advice on how to achieve optimal health before and during pregnancy, how to minimize risks and screen for potential problems.  Medication recommendations including prescription vitamins, birth control pills, antibiotics and other medication and health care products. CNMs can prescribe medications in Ohio and all other states. Perimenopausal and postmenopausal consultation including annual examinations with complete health history, assessment and physical examination and counseling on symptoms that may also develop during this transition time. Medication and alternatives for a healthy life transition can be discussed.

Why should I select a CNM for my healthcare?

CNMs offer safe health care services and high quality health care for women. They will take a complete family and personal medical history and give you a thorough and gentle examination. Your CNM may advise  lifestyle changes and nutritional guidelines for you to reach your optimal health. You will be encouraged to ask questions and be given plenty of time for answers. CNMs will teach you how to develop and maintain good health habits. CNMs provide a compassionate and holistic approach to women's health care.

Will a physician be available when I am in labor?  

UH Westshore Midwifery Associates work in close collaboration with eight board certified OB/GYN Physicians in both the office and hospital settings. At UH St. John Medical Center obstetricians are in-house 24 hours a day and can consult with the nurse-midwives regarding any complex issues as well as respond to emergencies. Most midwife patients have had uncomplicated pregnancies, and have uncomplicated deliveries attended only by their midwife and nurses-- but help is right there when needed. The best outcomes for mothers and babies, and the highest quality care is achieved when Certified Nurse-Midwives, physicians and nurses work together as a team in a collaborative care model.

What is the midwifery philosophy at UH Westshore Midwifery Associates?  

As nurse midwives we believe that childbearing is a profound experience, which carries significant meaning to the woman, her family and the community. Birth is a normal physiological process. Midwives are the most appropriate care providers to attend low risk women during pregnancy, labor, birth and the postnatal period. Midwifery care empowers women to assume responsibility for their health and for the health of their families. Midwifery care takes place in partnership with women and is personalized, continuous and non-authoritarian. Midwifery care combines art and science. Midwifery care is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological and physical experiences of women and based upon the best available evidence. Midwives have confidence and trust in, and respect for women and their capabilities in childbirth. The woman is the primary decision-maker in her care and she has the right to information that enhances her decision-making abilities. As a result, our nurse midwifery care promotes, protects and supports women's reproductive rights and respects ethnic and cultural diversity. Our midwifery practice promotes and advocates for non-intervention in normal childbirth and builds women's self confidence in handling childbirth.  Our midwives use technology appropriately and effect referral in a timely manner When problems arise our midwives offer anticipatory and flexible care. Our midwives provide women with appropriate information and advice in a way that promotes participation and facilitates informed decision making. Our midwifery care maintains trust and mutual respect between the midwives and the  women we serve.

Will a midwife be with me when I am in labor?

The UH Westshore Midwifery Associates are committed to being present and actively involved with the birth of your child. One of our five midwives is available 24 hours a day, 7 days per week as we take turns being “on-call” for laboring women. We know that women seek our care because they are looking for that kind of sensitive support. When a mother is in the active phase of labor, the CNM arrives to evaluate the client's condition, help make the plan, and offer support and guidance. The midwife explains events and choices, offers suggestions and hands-on support, and monitors progress throughout the birthing process.

What if I want pain medications or an epidural for labor?

Nurse midwives are highly skilled at helping women with unmedicated, natural childbirth, but it is not a requirement with midwifery care. It's a very personal choice and we don't make it for you. In the Holistic Birth Center within UH St. John Medical Center’s birthing unit, we use supportive techniques like hydrotherapy, massage, aromatherapy, birthing balls, and IV pain medication to help women through labor.  If you desire an epidural the Birthing Center at UH St. John’s has several beautiful family oriented suites that can be utilized by you and the midwives for your birth experience. During the pregnancy, we discuss birthing options and develop an intended approach to the birth experience that best fits each family’s needs and wishes.

Can I see a nurse midwife if I have had a previous birth by c-section?

A Vaginal Birth After Cesarean Section (VBAC) depends on many factors, including the type of uterine incision that was used for your prior C-section, the reason for the c-section, the mother’s commitment to a successful VBAC, and trust in your caregiver.  Additional interventions including IV access and continuous fetal monitoring are required for VBAC.  The Westshore Midwifery Associates supports you in your decision and provides prenatal care and attends your birth if you are attempting VBAC.  Nurse midwives have a higher than average success rate with women attempting VBAC.   Your pregnancy will be monitored closely and individual determination is made regarding your best choice whether VBAC or repeat c section.  The midwives of UH Westshore Midwifery Associates educate, advise, and support patients through this process.

Holistic Waterbirth

Holistic Waterbirth

The benefits of utilizing hydrotherapy for labor and birth include a reduced perception of pain, freedom of movement, continue >

Waterbirth Facilities

Waterbirth Facilities

As a hospital-based holistic birthing center, we provide a unique environment that closes the wide gap found between continue >