Working With a Midwife During Your Surrogacy Journey

Today is International Day of the Midwife, and the evidence is in: investing in midwives saves lives, improves health, and strengthens health systems.

At Family Source, we believe that all women should be allowed to have full control over their birthing experiences, and that includes our surrogates. While some agencies require their surrogates to give birth in a hospital, we happily accept candidates who would like to birth in their own home or a birthing center with the assistance of a trained and experienced midwife.

Modern birth outside of a hospital can be a safe choice if the carrier is considered low risk, has excellent support, and has prepared herself thoroughly with childbirth education classes. Data shows that investment in midwives is a cost-effective approach to improving health outcomes for mothers and babies and reducing maternal and neonatal mortality and stillbirth. Midwife-led models of care result in excellent maternal and neonatal outcomes and quality care.

Midwives provide care for women, children, and adolescents outside of health facilities and near where they live, which is particularly important now amid the pandemic since this can prevent medical services from being overrun.

What is a midwife, and what kind of training do they have?

A midwife is a woman who cares for a healthy mother through their pregnancy and birth and postpartum period. There are different kinds of midwives, depending on the state in which you live. Each has a different level of training, but all provide care for women through pregnancy and birthing.

The most common types of midwives today are:

• Certified Nurse-Midwife (CNM)
• Certified Midwife (CM)
• Certified Professional Midwife (CPM)
• Direct-Entry Midwife

A Certified Nurse-Midwife (CNM) is a nurse who has completed graduate school. They are certified by the American Midwifery Certification Board and are licensed to practice in all 50 states. They are recognized federally as primary care providers and can prescribe medications.

A Certified Midwife (CM) is not a nurse, but has completed graduate school in midwifery. They are certified by the American Midwifery Certification Board, but not all states recognize their license. CMs can only prescribe medication in New York and Rhode Island.

A Certified Professional Midwife (CPM) is certified by the North American Registry of Midwives. They are required to work with a qualified midwife and finish an evaluation process or graduate from a midwifery program before taking a final exam for certification. Each state has different requirements for CPM. CPMs generally attend out-of-hospital births and work out of their home or a birth center practice.

A Direct-Entry Midwife (DEM) has no formal certification. They attend births at home or in birthing centers. There are no national certifications for DEM and not all states have qualifications to become a DEM.

How are they different than an OB/GYN?

Both providers are trained and experienced with labor and delivery. The most significant difference is that OBs serve both low- and high-risk women during pregnancy, while Midwives serve low-risk women only.

Evidence shows Midwives use fewer interventions and tend to take a holistic approach to maternity care. In most home birth practices, Midwives care for a smaller number of women, offering more personalized, intimate care. On average, we spend about an hour with our clients at each prenatal visit. Our clients are given our personal cell phone numbers and are free to call and text when they have questions. This creates a trusting bond, and often a close relationship between our clients and us.

For the birth, we are with our clients from the time they begin to labor until several hours after they deliver. We are with our clients offering food, water, positional changes, and emotional support while managing their labor and ensuring mother and baby are healthy. We also care for the newborn for the baby’s first six weeks of life.

Photo Credit: Aly Renee Photography, Fort Worth, Texas

Is a midwife the same as a doula?

No, a midwife and a doula are not the same.

A doula is a birth professional who offers mental, physical, and emotional support. Think hand massages, back rubs, reminders to snack while laboring, offering positional changes, etc.

A Midwife is a medically trained professional whose primary focus is on a safe and healthy delivery. While many Midwives also offer the same emotional and physical support a doula does, their main focus at a birth is ensuring a safe delivery.

As well, a doula often only meets with her client a handful of times throughout the pregnancy to discuss the mother’s birthing desires. A Midwife sees a mother from the start of her pregnancy throughout the postpartum period.

Photo Credit: Life Diagrams Photography, Fort Worth, TX

Does FSC accept surrogates who specify that they want to work with a midwife? Does FSC work with surrogates who want to give birth at home?

Yes, FSC is proud to support women who birth with different providers and choose alternative birthing environments.

Photo Credit: Birth Unscripted Photography, Fort Worth, Texas

What are the benefits of choosing a midwife for a surrogate birth?

As both a surrogate and Midwife, the most significant benefit I see is the level of involvement the Intended Parents are able to have in a Midwife-led pregnancy and delivery. Appointments are casual and informational. With an hour scheduled, IPs are welcome to come with their surrogate and get all their questions answered. They are always treated as the Parents and decision-makers when it comes to their baby. During the birth, they are able to be hands-on, support their surrogate, be educated throughout the entire labor and delivery by the Midwives, and even “catch” their baby should they choose to! Intended parents are also offered cord-cutting and immediate skin-to-skin contact.

With out-of-hospitals births, the birthing environment is typically calm and peaceful, which is a wonderful environment for nervous and excited parents to be in. It allows them the opportunity to support and bond with their surrogate fully. The labor and postpartum period are uninterrupted, which means the baby is never taken from their parents’ loving arms. Everything can be done in the comfort and safety of their arms or on their chests.

The Midwife is also able to provide newborn care, so they do not need to seek out the care of a pediatrician while they are in the surrogate’s hometown. All testing and monitoring can be done by the Midwife.

Photo Credit: Aly Renee Photography, Fort Worth, TX

When can you NOT choose a midwife for a surrogate birth?

As a surrogate, you should have an excellent medical history and therefore be considered low-risk. So nearly any surrogate should qualify for birthing with a midwife. If you are carrying multiples, you may want to consider a midwife in the hospital or an OB; however, home birth midwives do attend some twin births as well. Additionally, if any complications arise during pregnancy, you may need to transfer from your Midwife to an OB.

Photo Credit: Birth Unscripted Photography, Fort Worth, TX