March 7, 2017

Why Choose a Midwife?

Prenatal Yoga – A Natural Path toward Working with a Midwife,

by Risa Klein, CNM, M.S.

Making a decision as to whom will take care of you and your gestating baby is a monumental decision. To make the best-informed decision, you need to understand some differences between the midwifery model of care, the medical model, and have a good understanding of your own health history. If you reflect on your unique life story, mindset and circumstances that have influenced you to choose yoga as a pathway to pregnancy wellness, the decision will become clearer as to who is a more likely match to guide you during the course of your pregnancy and help you deliver your baby.

Here is some information to help you decide which provider is best suited to your medical situation and philosophical viewpoint. Midwives work with healthy women. They do not take care of women who have high risk medical conditions such as Diabetes, Heart or Liver Disease, or some auto immune disorders. Rather, obstetricians do because they are trained surgeons who studied and learned about disease states – experts in their specialty field when a woman or fetus encounters a high risk medical problem and needs procedures requiring initiation and adjustments of medications, surgical procedures for such problems, including C-sections. Midwives do not perform cesarean sections, although some midwives are certified to first assist at c sections. While obstetricians are trained in medicine, disease, and abnormality – midwives are trained to recognize variations in normal pregnancies and screen their clients carefully to uncover potential health challenges that may prevent them from working together. When medically indicated, they refer their clients to the appropriate physician specializing in either obstetrics, perinatology (maternal fetal medicine), or genetic counseling. Midwives consult, collaborate and co-manage with these practitioners and co-manage with obstetricians when caring for those women who desire a VBAC (vaginal birth after cesarean section,) or twin pregnancy.

Midwives are independent health care providers with expertise in pregnancy, childbirth, the postpartum period, care of the newborn, common primary care issues, family planning, and annual gynecologic well woman care. Midwives graduate from accredited midwifery schools and receive their master’s degree, while some go on for their PhDs. A certified nurse-midwife is educated in two disciplines of nursing and midwifery. Midwives practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives. They are licensed by their individual states, and have prescription privileges. You can give birth with a midwife either at home, in a birthing center, or on labor and delivery floor hospital setting. Midwifery care is reimbursed by most health insurance companies.  Weather you work with a midwife in a solo practice such as mine, or a group practice, midwives have a holistic view of the process and do not see birth as an illness. The midwifery model of care is a more holistic approach to pregnancy labor and birth, than the traditional obstetrical medical model of care. If your medical situation, or your baby’s situation in utero requires obstetrical care, then you will be in the right hands and can still apply what you feel philosophically in making your choice for the right doctor. There are many excellent obstetricians who are compassionate and good listeners.

Benefits of Working with a Midwife: If you are not a high-risk patient, you can work with either a Certified Nurse Midwife (CNM) or Certified Midwife (CM) and reap many benefits:

1. Nutrition and Education. You will become educated in how to stay healthy and low risk during the course of your pregnancy. Midwives take a significant amount of time throughout your pregnancy to address how optimal and balanced healthy nutrition serves as the foundation for achieving better outcomes. You will learn about and be validated for the naturally occurring changes that are happening in your body as your baby gestates in inside you. This orientation continues during labor and birth, with a mindful understanding of your body’s innate potential. Midwives teach clients to become mindful of their body, breathing, postures, balance, timing, and rhythm as important assets.

2. Emotional support. Prenatal visits are the time when your midwife will take the time to get to know you, facets of your life, health, job, family history, and how ascertain they all may impact your pregnancy and birth outcome. From the first day you meet your midwife, she or he will impart confidence in your natural abilities to give birth by virtue of your own innate capacities, rather than looking outside of yourself. Fears, concerns, and feelings are explored and women are encouraged to share them as your body changes and your baby grows.

3. Patience. “I didn’t feel rushed,” is what my clients often share after their labor and birth experience. (I do not wear a watch during labor so women do not feel rushed).

Midwives honor birth as a process and give time for labor to unfold, guiding their clients patiently with specific postures and positions to promote optimal movement for baby. If you are in a small practice, midwives are apt to devote and maintain continuity of care before, during and after your birth.

4. Epidural. Yes, you can have one unless you deliver at home.

5. C section. If medially needed your midwife is with you during the procedure. The attending physician or consulting obstetrician will perform the procedure. If you need to work with an obstetrician for medical reasons, and have a planned c section, you can still apply your yoga awareness to help you during your delivery. Your midwife will support you on breastfeeding and teach you a proper latch on right from birth.

6. Parallels between Yoga and Midwifery.

“Feel your shoulders release. Gently open your hips. Take a breath. Let your jaw soften. Feel your baby as your center.” Sound familiar? While you have heard this kind of instruction in your prenatal yoga classes, it is also the language of midwifery. As a midwife, I am always excited to meet clients who practice prenatal yoga, as they understand how to cultivate awareness to move their bodies and breath. In my years of midwifery practice I believe students of yoga often have an easier time while in labor – better able to hear and implement changes suggested. Women are flexible, open-minded, and calm when they have awareness of their how to let go. It comes more naturally to attempt a recommended posture or position. Working with a midwife will feel natural and familiar to you because there is a similar mindset in midwifery as yoga practice. Just as yoga gives you opportunity to connect with and align with your body, midwives are inclined to take this concept to another profound mindset and help you focus inward and align yourself with your baby. When I was five months pregnant I took my first prenatal yoga class, and had never felt closer or more in touch with my growing baby. Doing seamless, flowing, beautiful, and challenging yoga asana is something I never anticipated doing in my lifetime, never mind during pregnancy – and yet my instructor Laurie Kiviat patiently guided me through what I called my pregnancy yoga orientation. I was grateful to her for preparing and aligning me for my birth. Looking back, it was as if she was midwifing me, however I didn’t realize it at the time. If only my own back up obstetrician applied such awareness and warmth during my delivery, perhaps I would have felt more taken care of. As a student of yoga, you know the benefits you feel over time as you become more in tune with your body. Same level of progression occurs while under a midwife’s care getting in tune with your body. During your prenatal visits, you will become more comfortable, and integrate pearls of yoga wisdom, your understanding of movement, rhythm, and breathing into your vision of birth. Regardless of who you decide will be the best healthcare provider to attend you during your pregnancy and birth, an OB/GYN or midwife, you are working with them for the benefit and health of your baby.

To find a midwife and learn more, check out The American College of Midwives website,, and the New York City Midwives website,

Risa Klein, graduate of the Columbia University School of Nursing Midwifery Program, is a highly experienced private practice CNM. Her office is on the upper east side of Manhattan. She brings her home birth approach to her midwifery practice with privileges at Mt. Sinai West’s birthing center and L&D floor. She promotes peaceful pregnancy, empowered birth, and individualized care.




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