Why You Should Consider Hiring a Menopause Midwife

Krystle Ilar remembers all five of her boys’ births in clear detail. Each delivery calm, peaceful, relaxing, surrounded by good energy, and a certified nursing midwife to guide her through each contraction and push.

“During labor, she was always near me, encouraging me and just speaking words of life and love over me,” Ilar told Flow Space. “She stood with me and swayed with me during contractions, she would breathe when I breathed, her body language and voice were always so gentle and reassuring and filled with love.”

In the weeks following each birth, Ilar’s midwife would come to her home, check on the baby and her. Each visit longer than the last.

“My midwife made me feel like postpartum recovery wasn’t just about the baby, but about me too,” Ilar said. “I appreciated that the most from her. I never felt judged. I always felt heard.”

Midwives are often the caregiver of choice for women who are looking for a less traditional way to give birth, most notably without medical intervention, with many women choosing a midwife because they want to give birth at a birthing center or at home.

And their demand is only increasing. 

The percentage of births in the United States attended by certified midwives or nurse-midwives has risen annually since 1989, according to the National Center for Health Statistics. 

And while midwives are often seen as only providing care for pregnant women, the true practice and mission of midwifery is rooted in the focus of helping women maintain a sense of normalcy once menstruation begins until it ends. 

Ilar, now 40, says she plans to use her midwife for exactly that, and is excited to have her midwife alongside her as she enters the next phase of her life—menopause. 

What is a midwife for menopause?

The term “midwives” is typically used as shorthand for certified nurse-midwives (CNM). They are the most common amongst the midwifery rank and are registered nurses (RN) who have graduated from an education program accredited by the Accreditation Commission for Midwifery Education. This degree can be a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) with a concentration in nurse-midwifery. 

Certified midwives (CM) hold a graduate degree in midwifery from an accredited program and are board certified by the American Midwifery Certification Board (AMCB). CMs do not have a nursing license.

There are also Certified Professional Midwives (CPM) who must pass a national certification exam that they prepare for either via apprenticeship or an accredited program. CNMs and CMs can prescribe medication while CPMs cannot.

“Midwife is a term that means “with women” and that is actually a fairly accurate description in that we partner with women throughout their lifespan to help them be healthy,” Libby Mollard, certified nurse midwife, tells Flow Space. “One thing I love about midwifery is the focus on normalcy in different phases of a woman’s life and honoring the normalcy of the menopause transition instead of seeing it as a disease state.”

Mollard explains that they can support women’s symptoms through the menopausal transition with both medical and other alternative therapies, but do so in a manner that empowers the woman to be an active partner in her care. 

“We look holistically at mind, body and spirit and how each of these are impacted, as we do not see women simply as bodies, and we can offer education and support like we do in other phases of a woman’s life,” she adds. 

This includes offering nutrition and exercise tips that may alleviate certain symptoms before offering medical intervention, and there is a heavy focus on your mental health and well-being through the menopause transition. 

Why women opt for a midwife during menopause

The midwifery model of care is philosophically different then the medical model of care. The medical model focuses more on monitoring, control and management of the body whereas midwifery focuses more on support of natural physiological function.

“I think there are numerous benefits to using a midwife for menopause,” Ilar said. “”She’s not there to judge, she listens and I feel heard, we find holistic ways to help me when things come up, and she helps me find the root of the issue instead of slapping a medical bandaid over it.”

While the more traditional route of care during menopause is to see your OB-GYN for management of symptoms, midwives are able to provide alternative treatment plans that include addressing nutrition, exercise and mental health concerns that can be exacerbating menopausal symptoms. 

“Midwives are more willing to integrate alternative and holistic therapies with traditional medical treatments which can improve the entire menopausal symptom experience,” Mollard said. 

Midwives also work under less strict scheduling confines than a medical institution has and can spend more one-on-one time with a patient—and even make house calls. Midwives are also more readily available after hours if questions or concerns arise that need to be addressed quickly. 

But some women opt to partner in care with a midwife and an OB-GYN. 

“This should be more common, as there is so much opportunity for collaboration,” Dr. Meleen Chuang, MBA, clinical associate professor at NYU Grossman School of Medicine andNYU Langone Hospital Brooklyn chief of service OB-GYN tells Flow Space. ““”Some opportunities may occur in areas such as managing hormonal treatments, addressing lifestyle changes and providing support for mood disorders.”

And some midwives may be able to prescribe hormone replacement therapy, one of the most common treatments for managing menopausal symptoms. Chuang says they often will look for alternatives before prescribing the therapy, but the benefits of having a midwife for menopause is the holistic approach that focuses on the woman as a whole, giving individual, personalized care in a supportive environment.

“Some reasons to consider a doctor instead of midwife surround the limited medical interventions the midwife can manage—but this only means there should be collaboration, not necessarily restricting to one or the other.” 

OB-GYNs may be better suited for some patients that have more complications, such as history of cancer, prior gynecological surgeries or serious health conditions that may increase risks.

“The best thing for women experiencing menopause is to have a supportive care team with good coordination of services and making sure the team addresses the needs of the patient,” Chuang added. 

What to expect during a midwife menopause visit

Your first visit with your midwife will likely take at least an hour. 

“During that initial visit, I make sure I understand their medical history, what’s going on with them, what’s already been done by other providers, anything that they’ve already tried, and how that went,” Christina Cameli, CNM and menopause practitioner, told Flow Space. 

From there, your midwife will likely help you assess what stage of menopause you are in. If you’re in perimenopause or about to enter, or on the cusp of menopause. Then you’ll discuss any symptoms you may be having, how your mental health, sleep and diet have changed, if at all. 

“And then I try to teach them about what I think is going on with their body,” Cameli said. 

This includes what exactly menopause is, what the transition does to the body, how it affects every woman differently and what it might look like for you depending on your family and medical history.

Once all your questions have been answered, your midwife will determine an appropriate follow-up time for your next appointment, which can vary from two weeks to several months if you’re not experiencing any concerning symptoms. 

Blood work or labs might need to be taken, and if a midwife can’t provide a procedure or test, she will generally provide a referral to an OB-GYN practice or hospital with which she has formed a relationship with. 

Why more midwives are focusing on menopause

While midwives are most commonly known and used for pregnancy, many are shifting their practice to strictly menopause care because of the lack of focus the hormonal transition receives in mainstream medicine and society. 

“For some reason, this part of life really fascinated me,” Cameli said. “And as a feminist, I become very fired up when I see women at the height of their game. They have so much expertise and wisdom, and are rising in positions of power and mastery in their careers or in their families, and sometimes menopause really disrupts that.”

For Mollard she says, the world markets to women who are perimenopausal or menopausal through a medical lens saying ‘this is a disease and you will suffer.’ 

“But actually menopause is a normal life transition, and women spend more years in this life transition than any other,” she explains. “It is a time where women can experience great personal growth and can use their life experiences and wisdom to lead in their careers and in their family.”

Midwives can also provide support for women once they are no longer in menopause, to help them stay healthy as they age. They also know your specific health concerns and needs and are more in tune with what your body requires, and can make recommendations for years to come. 

And the shift of focusing on menopause care from a one-size-fits-all approach to a more individualized, slower paced way of care is what draws midwives to the practice. They’ve found they can go beyond just helping women alleviate concerning medical symptoms or answer basic questions with a quick appointment, and provide deep education and an understanding about what and why these symptoms are present and ways to heal from within.

“We’re so powerful,” Cameli said. “We’re so important for social wellness and change, and it just seems like the most powerful thing I could do to support our society was to make contributions in midwifery to midlife care, just by caring for them. I wanted to get out of their way, and I can do that in this job.”