Pam Pray, a certified nurse midwife at Lawrence Memorial Hospital, says that midwifery is an extension of the hospital, but that a physician and a midwife will differ on their approach to birth. “We view women as healthy until proven otherwise,” Pray said.

Cathy Gordon of Shawnee, far right, gives her daughter-in-law, Emma Gordon, a look at her unborn baby via a sonogram as Emma’s husband, Matt Gordon, and their daughter, Hadley Gordon, gleefully look on at New Birth Company, Johnson County’s only midwife-led birth center.

When a woman is having a baby, planning begins long before the baby is due. She has to decide whether she wants pain medication when she has the baby and whether she wants to take classes to prepare for childbirth, and she has to make a birthing plan that she thinks is plausible to follow.

For many women, part of the planning process includes deciding whether to use a physician or a midwife. In Lawrence, women have the option to use certified nurse midwives or lay midwives, and to have an at-home birth or hospital birth.

A recent national study by the American Association of Birth Centers shows that women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean births than women who give birth at hospitals.

The study was based on more than 15,500 women at low risk of delivery complications who received care at 79 U.S. midwife-led birth centers from 2007 through 2010. It found that fewer than 6 percent of those women required cesarean births while nearly 24 percent of similarly low-risk women cared for in hospital settings required cesarean sections.

What’s the difference?

The technical difference between physicians, certified nurse midwives and midwives is education. A physician has a complete M.D. degree. A certified nurse midwife has R.N. degree as well as some other specialty training in gynecology or birth. A lay midwife’s training is all hands-on; she has likely learned from another midwife, and although she might have experience in delivering babies, she likely hasn’t had formal training.

Pam Pray, a certified nurse midwife at Lawrence Memorial Hospital, said that aside from education, physicians and midwives differ because of their philosophy and approach to birth.

“We view women as healthy until proven otherwise,” Pray said.

Most women who choose to have a midwife don’t want as much medical intervention. The woman may not want a home birth but she also don’t want all the monitoring necessary when seeing a physician. A midwife may require her patients to follow specific tests, but it isn’t extensive and the patient isn’t required to have ultrasounds or extra monitoring unless it is requested.

Emily Hester, founder of Peaceful Path Midwifery and a certified nurse midwife who specializes in home births, said a birth with a midwife is different than with a physician because it’s a bit more personal.

“We end up going into a lot of other issues than just the physical,” Hester said. “It’s the emotional, spiritual, everything going on in the family.”

Hospital or home birth?

A misconception about midwifery is that it isn’t as safe as a regular birth, but with a certified nurse midwife, a patient has a medical expert helping with the birth, which makes home births a safe option.

“What I try to do is bridge the gap between completely natural with no intervention and all-the-way hospital,” Hester said.

Hester said that she does her best to follow her patients’ birthing plans and wishes, but requests from patients to forgo certain tests or monitoring may not be fulfilled.

“I will require certain things and I’m very clear about that in the beginning,” Hester said.

For those who are wary of having a child away from a hospital but still want a more natural experience, Pray said choosing a midwife is something a mom-to-be should consider.

“Here in Lawrence you can have that experience you want but it can be in a safe way,” Pray said. “(Midwifery) is just an extension of services at LMH and allowing women to have options.”

Although some women may prefer a more natural method of birth and want to use a midwife, it is meant for low-risk patients, and Pray and Hester said it isn’t something a person who is at high risk for a birth complication should consider.

“It’s a very individual decision because it’s truly not the right choice for everyone,” Hester said.