The core role of a midwife is to provide continuous, holistic care throughout pregnancy, labor, birth, and the postpartum period. This model focuses on the natural process of childbearing while recognizing the need for diagnostic tools when complications arise. While midwives rely heavily on hands-on assessment, they utilize medical imaging to ensure the safety of both the birthing person and the fetus. Midwives usually do not perform ultrasounds themselves, but they routinely order them as part of standard prenatal care.
The Midwife’s Role in Diagnostic Imaging
Midwives generally do not perform the detailed diagnostic ultrasounds used to assess fetal anatomy and development. Procedures like the dating scan or anatomy scan are typically conducted by specialized medical imaging professionals, such as sonographers or radiologists. The midwife’s role is not to operate complex imaging equipment, but to integrate the test results into the patient’s comprehensive care plan.
Ordering an ultrasound is a routine part of modern prenatal care managed by the midwife. These imaging studies are necessary for reasons including confirming the estimated due date in the first trimester and assessing fetal growth and placental location later in pregnancy. The midwife writes the referral, ensuring the patient receives the necessary imaging at an external facility.
Once the official report is provided, the midwife interprets the findings and discusses them with the patient. If an ultrasound suggests a condition like placenta previa, the midwife uses this diagnostic information to adjust the patient’s risk assessment and plan for specialized obstetric consultation. This collaborative approach allows the midwife to maintain a low-intervention philosophy while incorporating high-tech diagnostics when appropriate.
How Midwife Credentials Affect Scope of Practice
The ability of a midwife to independently order diagnostic tests, including ultrasounds, depends on their professional credential and the state or jurisdiction in which they practice. The two most common credentials in the United States are Certified Nurse-Midwife (CNM) and Certified Professional Midwife (CPM). These certifications represent distinct educational paths and scopes of practice.
A Certified Nurse-Midwife (CNM) is an Advanced Practice Registered Nurse (APRN) who has completed an accredited graduate-level program. CNMs typically practice within hospital systems or clinics and have the broadest scope of practice. This scope includes the independent authority to order, interpret diagnostic tests, and prescribe medications in most states.
In contrast, a Certified Professional Midwife (CPM) is trained specifically for out-of-hospital settings, such as homes or birth centers. Their authority to order tests is often more restricted. CPMs, and Licensed Midwives (LMs) in some regions, may be required by state law to operate under a formal collaborative agreement or physician supervision to order ultrasounds. These state-by-state variations mean ordering autonomy differs significantly between states.
Standard Midwifery Prenatal Monitoring Techniques
While midwives utilize diagnostic imaging, their prenatal care prioritizes hands-on, low-technology methods for routine monitoring. These physical assessment techniques are performed during every prenatal visit to gauge the health and progress of the pregnancy.
One primary method involves measuring the fundal height, which uses a simple tape measure to track the distance from the pubic bone to the top of the uterus. This measurement helps assess fetal growth and approximate gestational age, indicating whether an ultrasound is needed for further investigation.
Midwives also use palpation, known as Leopold’s maneuvers, to systematically feel the abdomen. This determines the baby’s position, presentation, and estimated size within the uterus. This physical examination offers direct, real-time information that guides clinical decisions about labor preparation.
Fetal heart tones are routinely monitored using a handheld Doppler device, which uses sound waves to amplify the fetal heartbeat. This intermittent auscultation confirms the fetus’s well-being without requiring the continuous monitoring of a full ultrasound machine.
Routine checks of the patient’s blood pressure and urine analysis for protein and glucose are also performed. This screens for common pregnancy complications like pre-eclampsia or gestational diabetes.