A midwife is a specialized health care provider trained to give holistic support based on informed consent. They lean in on developing a trusting relationship, resulting in confidence and empowerment for families. Midwives tend to be more supportive of natural approaches to pregnancy and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. Midwives are experts in uncomplicated low risk care. Some midwives also provide preconception and routine well-body reproductive care throughout the life cycle.

People often choose a midwife when they know they want a non medicated birth or want to give birth at home or in a birth center. Pregnancy and labor are very personal experiences. You have a choice about the kind of care you’d prefer. Use our Midwife Directory to find a midwife near you.

The word doula means “female helper” in Greek. A doula is a person who has training in the support of labor and birth. They can help you manage labor discomforts, get you ice water to sip on, suggest new labor positions, and act as your cheerleader. They provide a vital service to birthers who want an advocate and personal care in labor. They may have some medical training, but are not at your side for medical care. The care they provide is emotional and informational. Many doulas also provide education in pregnancy. Midwives and doulas make great teams! Add a doula to your birth team by using our Doula Directory.

In the state of Texas, there are only two types of midwives that can legally practice: Licensed Midwives (LMs), who are supervised by the Texas Department of Licensing and Regulation and often nationally certified as Certified Professional Midwives (CPMs) by the North American Registry of Midwives; and Certified Nurse Midwives (CNMs), who are supervised by the Texas Board of Nursing and have been certified by the American Midwifery Certification Board.

Ultimately, while there are differences in training and scope of practice, all midwives serve as primary care providers to low-risk clients through pregnancy, labor, delivery, and postpartum, as well as to their low risk newborns during the first few weeks following birth. 

In this capacity, a midwife: 

• follows routine laboratory and ultrasound protocols

• performs regular prenatal and postpartum exams

• educates clients on health and wellness

• collaborates with other medical professionals if complications arise

• maintains certifications in CPR and Neonatal Resuscitation

• uses Texas Electronic Vital Events Register (TxEVER) to file birth certificates & apply for social security cards

• typically has access to medications and is trained on how to use these medications 

Licensed Midwives practice in community settings, such as birth centers and home birth. Certified Nurse Midwives can practice in hospital and community birth settings, and also provide general reproductive care outside of pregnancy, prescribe additional medications, and diagnose conditions. Houston midwives support each pathway, and all midwives in GHMA actively share knowledge, trainings, and experiences together within the community.

Homebirth and Birth Center birth are safe options for pregnant people whose pregnancies are without complications and are full-term at the start of labor when monitored and attended by professional midwives. For some babies and parents who are at higher risk for complications, a hospital birth is a safer option. To learn more about safety, check out these studies:

Outcomes of planned homebirth with CPMs in North America

Outcomes of planned homebirth after regulation in British Columbia

It is a more fundamentally naturally minded approach to pregnancy and childbirth than contemporary obstetrical care. Our model of care includes:

• Monitoring the physical, psychological and social well-being of the birther throughout the childbearing cycle

• Providing the birther and family with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

• Minimizing technological interventions and

• Identifying and referring individuals who require obstetrical attention.

• Health is based on a partnership in care, where the client has autonomy after informed consent. 

• Pregnancy is a normal part of life, not a health problem.

Obstetricians/Gynecologists (OB/GYNs) and midwives differ in their schooling and philosophy of care.

Midwives are highly supportive and take a more natural approach to pregnancy and childbirth. They view pregnancy and birth as a natural process instead of a condition that needs managing. Midwives tend to be more open to nontraditional approaches to labor and delivery. People may want a midwife for a more relaxed birthing experience. Additionally, support is viewed as a partnership in care, where informed consent and accountability in health are cornerstones. 

Midwives are not required to attend medical school and can’t provide all of the same services as an OB/GYN. They typically can’t treat high-risk pregnancies or continue care with unresolved labor or birth complications. Although midwives can manage issues at home like bleeding and suturing, obstetricians can manage higher risk complications using medical or surgical interventions that aren’t available to midwives (cesarean sections, forceps, etc.).

That’s not to say OB/GYNs won’t offer supportive and personalized care or be open to alternative approaches to your care. It’s a personal preference. Some people prefer midwives, and others prefer OB/GYNs. There are many wonderful OB/GYNs in the greater Houston area that collaborate with midwives regularly and even welcome clients that need to be transferred from midwifery care. 

If you are unsure, you should meet with both providers to see who fits your personality and your desires for pregnancy and delivery. Finding the just-right team is the key to a holistically healthy pregnancy, birth and postpartum period. 

Some of the health services a midwife may provide include*:

• Prenatal appointments and routine pregnancy care.

• Ultrasounds and prenatal blood work.

• Attending to birth and newborn care.

• Postpartum Care.

• Education on nutrition, lactation, fertility and other aspects of reproductive health.

• Birth control and family planning.

• Pap tests and breast exams.

• Screenings for sexually transmitted infections and other vaginal infections and diseases.

However, midwives can’t give epidurals. They consult with an anesthesiologist or a certified registered nurse anesthetist (CRNA). Anesthesia providers are available in hospital settings only. Midwives do not perform Cesarean sections, but some can assist in them. If you require a C-section, a collaborating physician will be called on to assume care.

*these may vary depending on the midwife's credentials, certifications, and setting they practice in.

A midwife might be for you if you have a low-risk, routine pregnancy and if you desire a more personalized relationship with your provider. If you have a health condition that could complicate your pregnancy or delivery, close collaboration between your midwife and an obstetrician is ideal. Some of these conditions include, but are not limited to:

• Uncontrolled High Blood Pressure

• Uncontrolled or Insulin-dependent Diabetes

• Previous high-risk pregnancies

Midwives consult with OB/GYNs, maternal-fetal medicine specialists (MFMs), and other healthcare providers to mitigate risk in your care when needed. 

If you decide to use a midwife, we recommend finding one who’s licensed and certified to practice in Texas. You can look up midwives by name to check that status:

Licensed Midwife Search (LM, CPM) - https://vo.licensing.tdlr.texas.gov/datamart/login.do 

Certified Nurse-Midwife (CNM) - https://txbn.boardsofnursing.org/licenselookup

A lot of people interview potential midwives to make sure they feel comfortable with them prior to beginning services. Some questions you should consider before choosing a midwife are:

• Where will I birth my baby?

• What kind of training do you have?

• How long have you been a midwife?

• How many births have you attended?

• What are your philosophies or values when it comes to pregnancy and birth?

• What kind of tests or screenings do you perform during pregnancy?

• Does insurance cover any of the cost?

• Do you work with any local OB/GYNs?

• Who comes with you to a birth?

• What do prenatal visits look like?

• What would a transfer look like?

• What are your basic statistics? (transfer, VBAC success, c-section, 1st time mom rates, etc.)

• Higher rates of spontaneous vaginal birth

• Better chance of birthing with an intact perineum

• Decrease in episiotomies

• Lower rates of 3rd & 4th degree perineal lacerations

• Lower pain rating from birthers

• Decrease in postpartum blood loss and higher hemoglobin rates after birth

• Safe for moms and babies

The short answer is yes. With training and experience, many midwives are comfortable with supporting you in your decision. Most midwives follow a community standard of care, and all of these scenarios fall within that standard. You can find a list of midwives here who offer VBAC, twin, and breech birth options. Be mindful that there are always outliers that may not be low risk within these categories. 

This is complicated. 

Coverage depends on the setting you choose to birth and the practice. Most midwives in Texas are not in network with insurance companies. Midwives keep costs down by not employing teams to handle claims and offer that discount to the community.  Hospital midwives and some birth centers do accept insurance and/or Medicaid. Needs like ultrasounds and labs can also be applied to insurance.  If you have insurance and want to utilize those benefits for your care, we encourage you to call the 1-800 number on the back of your card to ask about out of network benefits. 

Midwives are trained to analyze risk status, handle certain complications, and to know when a transport to the hospital may be necessary. They will refer people to OB/GYNs if the pregnancy or birthing experience becomes complicated or high-risk.  These ongoing risk assessments create a clear plan for both the midwife and client so surprises are limited and decisions are informed.

One of the most common complications midwives handle in the community setting is excessive bleeding from the uterus immediately after the baby is born, and they carry the same medications used in hospitals to stop the bleeding. The second most common complication in a community birth is a baby who needs some help to take his or her first breaths. Every midwife at your birth should be certified in neonatal resuscitation. Again, in this scenario, midwives follow the same standards as the hospital. 

Often, the most common reason for transporting a pregnant person to the hospital happens during a very long labor where the birther nears exhaustion. In this case, the hospital can provide an epidural and Pitocin®, which can be useful tools to support sleep and enable a safe delivery. 

Emergencies, although rare, are why using a trained midwife is important if you desire an attended birth. Ask them if they have these trainings and supplies. Midwives believe all people have a right to choose how to birth and where to birth, but only after they have the information to make a good choice for them.

Unassisted birth (or free birth) describes birth with no supervision by a licensed care provider. This choice may be for religious reasons, philosophical reasons, prior experiences with medical care or childbirth, or a desire to avoid over-medicalized management of their birth. No matter the reason, GHMA believes it is an individual’s right to choose the birth location and attendants, but it is also the responsibility of the pregnant individual to be fully informed about their decision. Midwives with GHMA will not attend unassisted births and cannot file a birth certificate for families that choose this birth route. 

It is important to note that the studies supporting the safety of out of hospital birth have one important criterion in place: that they are attended by a trained care provider. We urge pregnant families to carefully consider how a difficult situation, such as a severe postpartum hemorrhage or a newborn needing resuscitation, would be handled. There are many great midwives in the Greater Houston area that can work with you to provide a safe, low intervention birth experience that fits your needs. 

Please note: Birth Keepers that provide midwifery services and are not licensed midwives or certified nurse midwives are considered by the state of Texas to be practicing midwifery without a license. GHMA does not support this illegal practice and encourages all families to thoroughly interview their care providers.

Check to see if your provider is eligible to practice in the state of Texas!

Licensed Midwife Search (LM, CPM) - https://vo.licensing.tdlr.texas.gov/datamart/login.do 

Certified Nurse-Midwife (CNM) - https://txbn.boardsofnursing.org/licenselookup

Midwives in Texas are legally licensed to carry equipment and medications to safely manage normal deliveries depending on their licensure, midwives should bring the same equipment to home births that birth centers have. Much of the hospital equipment and life saving medications are also brought by your midwife. Some of the equipment midwives bring includes:

• Monitoring equipment for you and your baby, including a doppler, blood pressure cuff and stethoscope, thermometer, pulse oximeter, and infant stethoscope.

• Supplies for the newborn exam and any newborn procedures that you choose, including a scale, measuring tape, CCHD, glucometer, erythromycin ointment, and vitamin K.

• Antihemorrhagic drugs to stop excessive postpartum bleeding.

• Resuscitation equipment for baby and birther: a bag and mask resuscitator and oxygen.

• IV setups and antibiotics.

• Suturing equipment to do repairs if any tearing occurred, and lidocaine to numb for suturing.

• Homeopathies, essential oils, and herbal tinctures.

• Some midwives do have medication for therapeutic rest and nitrous oxide. 

If having a home birth, this is a common concern. Midwives aim to leave your home as clean as it was when we arrived! The only way you should know you had a baby, is that a baby is in your arms. 

Yes!

That’s the answer. It is your pregnancy and your birth. Midwives follow the evidence, so we will always recommend what the evidence shows while providing informed consent.  Quick list of what that means:

• Can I have a waterbirth - YES!

• Can I eat and drink in labor - YES!

• Can we do delayed cord clamping - YES!

• Can I labor and birth in a position I choose - YES!

YES - YES - YES!