What is a NH Certified Midwife (NHCM)?

A NHCM is a midwife who has been certified through the New Hampshire Midwifery Council. The council is made up of 6 members: an obstetrician, a pediatrician, three midwives certified in NH, and one member of the general public who has familiarity with midwifery. These members serve without compensation and are administratively attached to the Department of Health and Human Services. (For more information on the midwifery statute and the midwifery rules, see http://www.gencourt.state.nh.us/rsa/html/XXX/326-D/326-D-mrg.htm)

A NHCM offers prenatal care, attendance at childbirth, postpartum care as well as support for a woman and her family during the normal child-bearing cycle. She shares with trained midwives all over the world these basic philosophies:

Midwives recognize the right of all women to safe, satisfying health care.

Midwives believe pregnancy and childbirth are healthy, normal experiences. Childbirth can be one of the most creative, powerful processes life has to offer. The outcome of childbirth is determined primarily by the care women give themselves and the training of their birth attendants rather than by the place of birth. Midwives are skilled in the education of pregnant women regarding diet, exercise, avoidance of harmful substances, etc.

Midwives encourage family-centered childbearing.

Family members are an intrinsic part of the birth experience, not mere observers given permission to be present. Family participation and bonding are encouraged throughout the entire birth.

Midwives are committed to making possible the woman’s/couple’s desires regarding their childbirth experience.

In addition to physical care, midwives emphasize the emotional, spiritual, social and educational needs of the client. They foster the childbearing woman’s self-determination, support emotional and spiritual strength, and promote her well-being. They encourage women to participate in their own care and consider them responsible partners in the health care system.

Within the limits of safety, midwives are committed to a philosophy of non-intervention during birth.

Midwives are guardians of normal birth but are also concerned with preventing complications and handling unexpected problems. If complications require a physician, the midwife will arrange for this referral while maintaining support to the client.

What services does a NHCM provide?

  • Prenatal care
  • Out-of-Hospital delivery, either in a free-standing birth center or home birth
  • Education and counseling regarding important aspects of pregnancy, birth and infant care
  • Continuous support during labor, birth and the immediate postpartum
  • Normal newborn care (initial)
  • Postpartum care of the mother
  • Family planning education and counseling
  • Client advocacy and support in the hospital setting

What is the cost for NHCM care?

A NHCM provides quality, personalized care at lower cost than traditional maternity services.  A fee schedule is available from individual midwives.  Your insurance company may cover these services.  Medicaid coverage is also available for qualifying families.

How does a NHCM practice?

Although we share the same midwifery philosophy, we are a diverse group of women and all practice a little differently.  We are independent practitioners (not affiliated with a hospital) and routine prenatal and postnatal care may take place in the home setting or in our own offices or homes. In addition, physician consultation and evaluation is arranged on an individual basis.  Most parents and birth attendants feel more comfortable knowing that they have made arrangements in advance for emergency transfer if it becomes necessary.Midwives generally travel up to an hour from their home to attend a client.  You may wish to consult with a few midwives to find one you feel most comfortable with.

Labor and Birth

Mother and baby are carefully monitored and cared for throughout labor and birth.  NHCMs are trained to recognize complications requiring hospitalization and to manage an emergency when necessary.  Most childbirth complications with prenatally screened “low-risk” women are minor and can be handled by a practitioner experienced in normal birth at home.  Emergency equipment and specific medications are carried by NHCMs to births should the need arise.

Who may not be a candidate for midwifery care?

Pregnant women must be screened prenatally for health conditions that would present potential complications to birth.  Early in pregnancy, the NHCM will recommend that each client receive a general physical exam by a qualified health care provider to screen for health problems that may complicate the pregnancy and delivery.  She will then continue the screening process during routine prenatal care. Some potential problems include preeclampsia, kidney disease, severe anemia, heart disease, hypertension, diabetes, drug addiction, severe infection, abnormal presentations, twins, Rh sensitization, placenta previa or premature labor.  If such high-risk conditions are identified, the woman should plan for the birth to take place in a facility equipped to deal with possible complications.

What about transfers?

You can discuss possible reasons for transfer to a hospital with your midwife.  In the event of transfer, the NHCM will remain with her client to provide continuity of care, to act as an advocate and resource to the health care team, and to continue with loving support.