Midwives are health professionals who are best known for providing critical support and care for many expectant mothers, but their role is often little-known or understood. Patients may wonder if you can have a midwife and an OB/GYN, how their roles differs from a doula, and how to locate a reputable midwife.

In this Q&A, Rochelle Lipshutz, CNM, Clinical Director of Midwifery at The Mount Sinai Hospital, explains how midwives support patients before, during, and after childbirth and discusses how midwives work with consulting physicians at Mount Sinai to offer integrated care.

What is a midwife?

Midwives are licensed independent health care providers, meaning they provide care without the supervision of a physician. Certified nurse midwives are trained in both nursing and midwifery while certified midwives have graduated with a master’s-level degree in midwifery but do not have nursing training.

They offer a full range of reproductive and primary health care services for patients from adolescence through menopause. These services include independent provision of primary care, gynecological care, and family planning services; preconception, pregnancy, and postpartum care; and care of healthy, full-term infant for the first 28 days of life.

Do midwives only provide services for child birthing?

Midwives are best known for attending childbirth. But that is not all they do. About 76 percent of midwives provide reproductive care and about 46 percent offer primary care. Reproductive care can include annual gynecological exams, Pap smears, and prescriptions including contraceptive methods, patient education, and reproductive health visits.

Midwives also treat the partners of patients in cases of sexually transmitted infections. They can also diagnose and offer initial and ongoing comprehensive care for many common health care problems as well as admit, manage, and discharge patients from hospitals. When appropriate, midwives prescribe use of medical devices, such as breast pumps. Midwives also promote health education, disease prevention, and personal wellness programs to patients and their families. They work in a variety of settings, including ambulatory care centers, hospitals, community and public health care arenas, and homes and birth centers.

What benefits do midwives offer?

Midwives are experts in ‘normal.’ For the most part, they respect and enjoy observing the natural birth process. Midwives encourage women to use their inner strength to cooperate with this process. If a woman in labor requests pain relief, midwives support her decision-making skills. In fact, the relationship between the midwife and patient focuses on shared decision making. If medical intervention is necessary, midwives will discuss the risks, benefits, and any alternatives. Together, midwives and patients reach a decision that will guide the care in a safe and comfortable manner. And, if necessary, the midwife will work closely with doctors and nurses to ensure safety throughout the birthing experience.

How do doctors and midwives work together?

Midwives participate in hospital births as well as home births and those at birth centers. In general, the midwife will focus on basic care, however, if complications develop, the midwife will work with the physician to ensure a comfortable, rewarding, and safe experience.

How do I find a midwife?

Midwifery services are available at The Mount Sinai Hospital and Mount Sinai West. Additionally, the Mount Sinai Health System partners with several well-established local midwifery groups including Central Park Midwifery, Community Midwifery Care, and Nettle Wellness.

You can also check with the American College of Nurse-Midwives to find a local midwife. This national organization lists midwifery practices and private groups in most communities. Many patients go by word of mouth. In addition, many websites that focus on local reproductive care provide information about midwives.

Most people know menstruation is normal vaginal bleeding that is part of the monthly cycle which prepares the body for a possible pregnancy. But you may have some questions about the regular—or irregular—ebb and flow of your cycle.

Tamara N. Kolev, MD, Assistant Professor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, explains how mundane activities can affect your cycle and why one or two irregular periods is nothing to worry about.

Is it normal to have irregular periods? When should I worry about them?

Your menstrual cycle tells us about your overall health and hormone balance. Most people find that the time from the first day of one period to the first day of the next is about the same every month. This time span, called a cycle, can be anywhere from 22 to 35 days. Women on birth control tend to have periods that are shorter, lighter, or—depending on the birth control—disappear altogether.

If you have an irregular period once or twice, that’s probably fine. But, if you notice that you’re continually having irregular periods, it’s better to get evaluated to diagnose the underlying reason and get your body back in balance.

Why am I bleeding in between periods?

There are several reasons why some women have minor bleeding (spotting) between periods. It could be as simple as too much stress, too little sleep or certain medications.    The cause could also be a physical condition, such as fibroids, cervical or uterine polyps, or a chromosomal abnormality, all of which are generally non-cancerous (benign).If you’re at all concerned, you should check in with your primary care doctor or gynecologist.

If I exercise regularly, will my period be lighter–or will I even skip a period?

Exercise can help regulate your periods. When you exercise, your body releases hormones such as endorphins and serotonin, which can also help with menstrual pain, cramps, and mood disturbance. But if you exercise too much—especially if you also don’t eat enough—you may skip a period because your body needs a certain amount of body fat to produce estrogen and maintain the hormonal balance required to have normal periods.

What about diet and weight gain, will either—or both—affect my period?

Gaining or losing a few pounds shouldn’t affect your menstrual cycle. But if your weight changes dramatically, especially if it happens quickly, it can affect your periods. Along the same lines, if you’re not getting enough calories and nutrients to maintain a healthy hormonal balance and produce enough estrogen, your periods may become irregular or may skip a month altogether.

In terms of your daily eating habits, there is growing evidence that what you eat can affect premenstrual syndrome symptoms, such as mood swings, bloating, and fatigue. It can help to eat foods that are rich in omega-3 fatty acids, vitamin D, and calcium or take vitamin D or calcium supplements. Doctors also recommend reducing your intake of fat, salt, and caffeine. Additionally, not having enough iron in your system can make your periods shorter and less regular.  And if you have heavy bleeding when you menstruate, that may lower your iron level.

Alcohol use and smoking can also affect your period. While a glass or two of wine shouldn’t cause fluctuations, heavy drinking can disrupt your hormones and lead to late or irregular periods. Heavy smoking can shorten your menstrual cycle and make periods heavier and more painful.

How will stress and lack of sleep affect my period?

When your body is under stress, it can go into fight-or-flight mode, which may signal the body to overproduce certain stress hormones. This could change your overall hormonal balance. Lack of sleep, in particular, affects both stress hormones and melatonin levels. Melatonin is a hormone that helps to regulate the start of your period and the length of your cycle.   For this reason, changes in melatonin levels can affect your cycle. You may find your periods delayed, or they might skip a month altogether.

When should I see a doctor?

Typically, if you often have bleeding between periods or especially heavy bleeding, you should get it checked out. For premenopausal women, if you don’t have a regular cycle, or if you miss your periods regularly or for several months, you should be evaluated, even if you think the reason is excessive diet or exercise or not getting enough sleep. In general, if you’re at all concerned, make an appointment with your gynecologist for a check-up.

Can I get pregnant during my period?

If it’s truly your period, then no, you cannot get pregnant while menstruating. However, if you’ve been having irregular bleeding between periods, you may be unsure if the bleeding is a real period or if you are bleeding during ovulation. If you are bleeding while ovulating, then you could get pregnant.

Will my period change as I get older?

Yes. After menarche (onset of menses) your period may be irregular and unpredictable. But as you get older, certainly by your 20s, it should become more regular. As you get older, and you approach menopause, your periods will likely start to spread apart and become lighter and less regular. If, instead, they get heavier or more frequent, then it’s important to have that evaluated.