For some, the word “midwife” might bring to mind a very specific image: a home birth, a low-intervention delivery or someone who supports only uncomplicated pregnancies outside of a hospital.
But midwifery care can look very different depending on a provider’s training, credentials and practice setting.
For people who are pregnant or planning to become pregnant, understanding those differences can help them make more informed decisions about the type of care that feels most appropriate for them.
Jana Sullivan, a certified nurse-midwife with the Methodist Physicians Women’s Health and Midwifery, located at Methodist Hospital, said one of the biggest misconceptions is that all midwives have the same background or provide care in the same environment.
In Texas, she said, there are different paths to becoming a midwife, and it’s important for patients to understand the differences. Some midwives train through apprenticeship programs and primarily provide care in home birth settings. Certified professional midwives complete specialized education and certification and are licensed to practice in out-of-hospital settings, such as homes and birth centers.
Certified nurse-midwives, on the other hand, are registered nurses who go on to complete graduate-level education in nurse-midwifery and obtain national board certification. They are trained to provide comprehensive care throughout pregnancy, labor, birth, the postpartum period and throughout a woman’s lifespan.
Because of their education and training, certified nurse-midwives are able to practice within hospital systems as part of a collaborative healthcare team.
At Methodist Healthcare, certified nurse-midwives work alongside OB-GYN physicians and maternal-fetal medicine specialists to provide personalized care for women with both low-risk and high-risk pregnancies. This ensures patients have access to the highest level of care if additional expertise is ever needed.
Sullivan said the goal is not to criticize one path, but to help patients understand the differences so they can make an informed decision.
“It is important to understand who you’ve entrusted your care to and what their background and education is,” Sullivan said.
What does a certified nurse-midwife do?
For patients receiving prenatal care, Sullivan said many routine visits with Methodist Healthcare midwives look similar to what they would experience with an OB-GYN.
“We are very similar to OB-GYNs in terms of the basic care we provide day to day,” Sullivan said.
Certified nurse-midwives provide prenatal care, monitor mother and baby, order testing, prepare patients for labor and delivery and provide postpartum support. They also attend vaginal deliveries.
The main clinical differences, Sullivan said, are that midwives do not perform complex gynecological surgery or cesarean-sections, though they may assist physicians during C-sections.
Where midwifery care can feel different is in the philosophy behind the care.
“Midwifery care is typically based on education and empowerment of a patient,” Sullivan said.
Rather than trying to direct patients down a certain path, Sullivan said midwives often focus on shared decision-making. That means explaining risks, outlining options and helping patients make decisions about their care based on their needs, preferences and medical situation.
She said patients have described that difference in a meaningful way.
“‘You listen to us, you inform us of the risks, recommend treatment plans and options, and you allow us to make a decision that’s based on what my needs are,’” Sullivan said, sharing feedback she has heard from patients.
A hospital-based option with support nearby
Some people are drawn to midwifery because they want a more personal experience, more involvement in their birth plan or fewer unnecessary interventions. Sullivan said those preferences can include things like delayed cord clamping, keeping the placenta or having more conversations around induction and other medical decisions.
However, choosing hospital-based midwifery does not mean avoiding medical intervention when it is needed.
“We still do medical intervention, but it’s usually when it becomes a necessity,” Sullivan said.
At Methodist Healthcare, Sullivan said midwives support patient preferences within a hospital setting.
“We still support those things -- we just do it with the support of a hospital or the ability to do emergent cases if we needed to, like C-sections. Patients deserve options, and they deserve to decide what works for them.”
When pregnancy needs change
Midwifery is often associated with low-risk pregnancy, but Sullivan said the model at Methodist Healthcare is collaborative and can also support some patients whose pregnancies become more complex.
“I think the big piece for us is that we are a midwifery-led practice,” Sullivan said. “We care for patients with normal to low-risk pregnancies, but we’re also part of a collaborative team that includes maternal-fetal medicine (MFM) specialists for patients with high-risk pregnancies.”
For Sullivan, that distinction matters because patients whose babies have a condition, or who develop a medical condition themselves, still deserve a pregnancy and birth experience that feels personal, supported and meaningful.
“They should get a pregnancy they have dreamed or hoped for,” Sullivan said. “They should be able to have the same sensation of, ‘I want this to be the best thing ever.’ They don’t want it to always feel like, ‘This is wrong, this is wrong.’”
The goal, Sullivan said, is not to minimize medical concerns. It is to help normalize the birth experience when possible while keeping hospital-based support close by.
“We want to normalize that birth experience for them, even if they’re having a high-risk baby or condition for themselves,” Sullivan said.
If a patient becomes high risk or develops a condition during pregnancy, the midwives work with OB-GYNs and maternal-fetal medicine specialists.
“If they become high risk or there’s a condition that develops, we either send them to the high-risk doctors, MFM or we collaborate with an OB-GYN.”
Depending on the patient’s needs, that might mean consulting with a physician, co-managing the pregnancy or transferring care to an OB-GYN.
“There’s always a possibility for the need of a higher level of care, and we’re happy to support patients, no matter what,” Sullivan said.
Questions to ask when considering midwifery care
For people deciding between a midwife and an OB-GYN, Sullivan recommends asking about the specific practice’s training, philosophy and approach to complications.
Questions may include:
- What is the provider’s training and credentials?
- What is the practice’s approach to care?
- What expectations or limitations exist in the hospital setting?
- Who is on call during labor and delivery?
- How does the team handle complications or higher-risk needs?
She added that people should also think about what they want from pregnancy and delivery and talk openly about those expectations early.
“Walk in with an idea of what you expect from your pregnancy, because that will help determine if we can accomplish those goals or we can’t,” Sullivan said.
At the new Methodist Physicians Women’s Health and Midwifery clinic, patients are encouraged to meet the midwives in the practice so they feel comfortable with the team.
“We want to make sure they meet all of us, so they always see a familiar face, but we encourage patients: Find the personality that best fits your needs. We want to empower and educate you. We want you to feel confident in your care. We’re there to support you.”
Care beyond delivery
Midwifery care doesn’t end after the baby is born. Sullivan said in addition to pregnancy and postpartum care, midwives also provide gynecological care, preconception care, contraceptive care and care through other stages of a woman’s life.
“We cover the spectrum of women’s lives -- even menopausal care.”
Sullivan knows birth stories stay with women for years.
“When you meet any woman, if they have a child, they can tell you everything about their birth story,” she said. “And it’s either really good or really bad.”
That is why education, expectations and support matter.
For patients who want a birth experience centered on education, options and shared decision-making, certified nurse-midwifery may be a meaningful option -- one that also provides the safety of hospital-based support close by if needed.
“I want every patient to feel informed, supported and empowered throughout their pregnancy,” Sullivan said. “Our goal is to provide personalized midwifery care in a hospital setting, combining the experience many patients are looking for with the added reassurance of having comprehensive care close by if it’s needed.”
Methodist Healthcare now offers certified nurse-midwifery services at two locations: Methodist Hospital and Methodist Hospital | Metropolitan, giving patients more options for hospital-based maternity care across San Antonio.
To learn more about OB-GYN services, certified nurse-midwifery care and women’s health services, click or tap here.