Working as a midwife in or out of the hospital

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Pre-midwifery students holding newborns in Chiang Mai! A midwife cares for the health and wellbeing of women throughout their pregnancies and during labor. Midwives work in birthing centers, hospitals and also in their patients’ homes. You may wonder: are there differences in the responsibilities and practices of midwives depending on where they work? The answer is both yes and no, which may seem a little confusing.

Similarities

Whether a pregnant woman intends to have a home birth or a hospital birth, her prenatal care by a midwife will be the same. The woman and baby will be monitored to make sure the pregnancy is progressing appropriately. Midwives also recognize signs of pregnancy complications, such as high blood pressure, which may require treatment.

During the birth, a midwife will deliver the baby and care for a woman and baby immediately after birth. Midwives assess the health and wellbeing of mom and baby. If emergency interventions are needed, such as assisting with breathing, a midwife is there to provide care.

The credentials needed to attend a birth in a hospital or in a patient’s home are the same. Although there are a few different paths to becoming a midwife, midwives need to be licensed or certified in all states. 

Differences

There are many similarities between midwives working in hospitals, freestanding birthing clinics and private homes; however, there may also be some differences in the approaches used by midwives during home births.

Women who choose to give birth in their homes as opposed to hospitals usually want minimal interventions during labor and the birthing process. Midwives who work in a home setting should be comfortable providing a lot of emotional support to expectant mothers.

In addition, women who give birth in hospitals have the option of changing their minds and receiving pain medication, such as an epidural, during birth. Women who give birth at home do not have this option. Midwives who attend home births should be excellent at helping patients manage pain with natural techniques, such as breathing exercises and visualization.

One of the biggest differences between working as a midwife in a hospital setting and at a home birth is you will not have the support of other staff and the emergency equipment you have in the hospital.

Midwives who work with women in their homes should be especially conscientious about selecting women with low-risk pregnancies. A low- risk pregnancy is considered one where complications during pregnancy and delivery are unlikely. Even though complications may be unlikely, they can still occur without warning. Midwives who care for women during home births need to be confident in their ability to handle emergencies on their own. 

It is also important to understand that you do not have to select just one setting in which to practice. Many midwives work in different settings depending on their patients’ individual preferences. It can be a nice change of pace to move from one type of setting to another.  

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