While many people associate midwifery with home births, midwives actually offer comprehensive care for women at all life stages — and they can also do so in a hospital setting. In fact, 87% of the midwife-attended births occur in a hospital setting in collaboration with nurses and physicians, according to the National Center for Health Statistics.

“Midwives are licensed healthcare professionals who can provide care to women across every stage of life, not just during pregnancy,” says Karen Bergstein, the lead midwife at NewYork-Presbyterian Allen Hospital.

Midwives can provide a range of reproductive and gynecological care, from contraceptive counseling and routine exams, to delivering babies, to prenatal and postpartum support.

Health Matters spoke to Karen to better understand the job of a midwife and their approach to women’s health.

What kinds of services can midwives provide, outside of pregnancy-related care?

Midwifery practice isn’t just limited to pregnancy. We can also provide gynecological services such as Pap smears and breast exams, test for and treat sexually transmitted infections, prescribe birth control, and help women through menopause. We can also assist during obstetric or gynecologic surgeries. In the U.S., midwives have a bachelor’s degree, either in nursing or a health-related field, and then obtain a graduate degree from an accredited midwifery program, followed by a certification exam from the American Midwifery Certification Board.

Midwives are also equipped to support women experiencing perimenopause and menopause, offering both natural approaches to care as well as pharmaceutical. If the patient is a good candidate for hormone replacement therapy, for example, we have the ability to prescribe the proper medication.

How do midwives support patients before and after they give birth?

While the midwifery team at NewYork-Presbyterian Allen Hospital works solely in the hospital setting, midwives can treat patients in hospitals, in clinics, and at patients’ homes. At the Allen Hospital, we have midwives on the labor floor nearly 24/7 working closely with doctors and nurses to treat predominantly low-risk patients.

Our care is grounded in the idea that pregnancy and birth are natural life events, rather than medical conditions; we aim to support the natural progression of labor, while closely monitoring the health of both mother and baby. We also focus on empowering our patients through education — on what labor feels like, how to cope with early labor, and how to prepare physically and emotionally for childbirth.

During prenatal visits, we typically check vital signs, monitor the baby’s heartbeat, check for any irregularities, provide guidance for diet and exercise, and discuss any concerns the expecting patient may have.

After delivery, we typically help the patient with breastfeeding and postpartum care. This includes supporting physical recovery, emotional and mental health, family planning, and basic newborn care.

How do midwives support pain management during labor and delivery?

We counsel pregnant patients on whether or not they’d like to have an epidural during pregnancy. While we specialize in natural births, the choice is entirely up to each person’s individual preference, and we are there to support them no matter which they choose.

At NewYork-Presbyterian Allen Hospital, we offer childbirth education classes, which can help address expecting patients’ fears and prepare them to go into labor confidently. For natural births, we also encourage the freedom to move around in different positions during labor. We use birth balls (or yoga balls), peanut balls, squat bars, massage, and counter pressure to promote movement and alleviate pain. We’ll even get partners involved, showing them how to help the woman move, massage their lower back, and apply counter pressure. While our wireless monitors allow patients who are having natural births to move around the room freely during childbirth, we also try to facilitate movement as much as possible for patients with epidurals. For example, we can reposition her every hour or so to mimic the type of movement she would be doing if she had full mobility.

How do midwives support patients during labor and childbirth?

During labor, we can work alongside labor room doctors and nurses to help guide the ideal positioning of the baby, monitor progress, assist with pain management, and deliver the baby.

As we spend the majority of our education studying the process of childbirth, we’re particularly helpful in guiding the baby into an ideal position for birth. Sometimes, this means rotating the baby slightly or encouraging the mother to try out a few different positions herself to help improve comfort and use gravity to promote cervical dilatation and efficient labor.

Midwives are experts in physiologic birth; our care is evidence-based and rooted in the belief that a woman’s body knows how to birth. We support the body’s natural process by trying to minimize interventions unless they’re necessary, and we use shared decision making to help our patients feel more empowered and less fearful.

What is a midwife vs. a doula?

The biggest difference between midwives and doulas is that doulas offer non-medical support throughout the pregnancy journey. While a midwife is a licensed healthcare provider, a doula is a birth coach and companion who can offer support during labor and childbirth.

Midwives and doulas complement each other very well. While the doula might be providing hands-on support to the patient, like a massage, or helping with hydration, the midwife may be handling medical responsibilities — monitoring labor, guiding the positioning, and delivering the baby.