Would You Hire a Menopause Midwife?

In my 30s, I used a midwife for each of my children’s births. I’d initially joined a traditional obstetrics practice at a cushy suburban hospital in our CT town, but after speaking with some other women who had worked with midwives throughout their pregnancies, I shifted to a practice with certified nurse midwives and obstetricians on staff who delivered babies in a hospital. The experience was phenomenal. I felt informed, supported, and well-equipped to handle whatever might emerge during pregnancy, labor, and birth. Nearly 15 years later, I’m looking for another midwifery practice. This time, to help me manage perimenopause and menopause.

Like so many women my age, I feel frustrated and unsupported by my OBGYN who, while capable, knows next to nothing about this phase of my development. This has left me grasping for podcasts, books, and doctors’ social media posts to create a patchwork of information about what to expect in midlife and beyond. While I think I’m tapping into useful information, I can’t be certain it’s accurate or appropriate, or that it’s applicable to my specific circumstances.

What I really need is a qualified practitioner who can sit with me and walk me through what’s medically appropriate and sound.

I’m not alone in this: The nonprofit and advocacy group Let’s Talk Menopause estimates that 75 million women are in perimenopause, menopause, or postmenopause in the U.S. right now, with an additional 6,000 reaching those milestones every day. (To get clear on the terminology here, the Mayo Clinic defines menopause as “the time that marks the end of your menstrual cycles. It’s diagnosed after you’ve gone 12 months without a menstrual period.”) (1)

The tricky part is that there is no one-size-fits-all diagnosis when it comes to the menopause transition. Symptoms, timing, and intensity vary by individual. Symptoms like hot flashes can last years, and there aren’t many hard-and-fast rules on how to manage them. For most women, talking to a provider who isn’t well-versed in menopause about what’s happening in their bodies during this time can result in more questions than answers.

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At the same time, just 30 percent of medical residency programs offer formal training on menopause. A full 80 percent of obstetricians admit to feeling unprepared about providing for patients in menopause (2). “We have more women entering menopause than any time before,” says Dr. Katharine White, an OBGYN in Mount Pleasant, SC. “We are at this point where we have lots of people that need to be educated and cared for and we have no one to care for them.”

That equation, White says, presents the perfect opportunity for midwifery care. As providers, midwives (certified nurse midwives or CNMs, and certified midwives or CMs) support women with gynecological and obstetrical health, from adolescence through adulthood.

While most people associate midwifery with childbirth, midwives can also support women through perimenopause and menopause.

“The unique thing about midwifery is that we are relationship-based,” says Karen Jefferson, a certified midwife and Director of Professional Practice and Policy at the American College of Nurse-Midwives (ACNM). “We take more time to listen. We don’t make decisions—we provide patients with evidence-based information. Our focus is on the physiological process. People talk about normal birth, normal menopause. There is no normal. We look at transitions in life as healthy normal processes and we listen to people when they tell us what’s happening. We work with them to help their bodies go through these processes.”

What’s more, midwives tend to look at the big picture—sleep, nutrition, emotional and mental health, movement, and so on—to assess and address how menopause and perimenopause are unfolding for each individual, often offering parallel therapies or nutritional guidance in addition to scripts and labs.

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The benefits of the midwifery model of care are well-suited for the lack of uniformity across women’s experiences with menopause. From hot flashes to joint pain to headaches to brain fog to metabolic shifts, menopause is not just one symptom and isn’t the same for everyone. Given the focus on active listening and patient-centered care, midwives can bridge the gaps in healthcare inequalities and improve patient outcomes for all women.

“You need to be a partner in your care and have agency in your decision-making,” says Nicole Warren, a certified nurse midwife at Johns Hopkins Midwifery in Baltimore, MD. “I’m not putting you on an assembly line and doing to you what we do to everyone.” Finding a practitioner who can offer a careful ear and an informed approach is invaluable, no matter what stage of life a woman is in.

It appears the experts on value—investors—have taken notice. One startup called Oula, which last year captured a $22 million series A round of funding, is focused on midwifery care for women. Diana and Millie are two other startups with similar stories. Backed by Serena Williams, John Legend, and other celebrities, birthFund advocates for midwifery care, too, with a special emphasis on lowering the maternal morbidity rate of Black mothers, which is three times what it is in other communities (3).

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“Midwifery is the best-kept secret in child-bearing health,” says Warren. “I think we’ll see that midwifery is the best-kept secret of menopause. What people want when they are having a baby, is the same thing they want going through the change.”

Further complicating the issue is the gap in the number of midwives available in our country versus OBGYNs, with 14,000 certified nurse midwives and 21,000 OBGYNs in the U.S. today. Still, not all midwives have expertise in menopause, and often those who do are the ones who have taken the initiative themselves to level up their skills and knowledge around perimenopause and menopause.

When Warren first started her career as a midwife, she says she knew very little about menopause.

“If I picked up a chart and the woman was over 35, I panicked,” she says. “When I shifted, I had to get comfortable. I did a lot of reading and continuing education.”

Carina Ryder is a certified nurse midwife who specializes in menopause and runs a private practice in Takoma Park, MD. She says the need for a good comprehensive holistic approach to menopausal care is more pressing than ever.

“It’s not just about doling out hormones just like obstetrics isn’t about doling out prenatal vitamins,” says Ryder. “It’s important to address the current situation in a woman’s life, while still addressing long-term goals. It’s a partnership.”