I'm writing up this post hoping to hop on the Medical Monday train for July! I've been meaning to write it for a while but I've been so busy trying to finish up school and I've been using my time off to sleep. Brief intro: I am a student nurse-midwife and my husband is a fourth year medical student (I can say that now! Holy cow!). We are busy, tired people and that's pretty much the gist of our life. Okay, that may be slightly dramatic but that's how it feels right now as we are in full-blown study mode - I'm taking my comprehensive exam (must pass to graduate!) and he is taking Step 2....on the same day....in three weeks!
As previously stated, I'm currently rounding the home stretch of my master's degree in nursing and I'm going to school to be a certified nurse midwife. For some reason midwife is a funny word to the average non-medical guy or gal (and don't get them started on midwifery...seriously, people giggle when I say midwifery!). For some reason it conjures up all kinds of images, most quite far from what modern midwifery is and what midwives have to offer women and their families. I'd like to take this opportunity to briefly educate my colleagues in the medical world and the consumers of reproductive health care (hey ladddiesssss!) about midwifery (hee hee) and why I want to be your midwife!
 |
| By the way....male midwives do exist (I've met some great ones!) - and they're still called midwives. |
What is a midwife? Why do you need one? The term midwife means 'with woman' and midwifery is the oldest profession of all time! Women have been having babies...well...forever, and have been supporting one another through it for just as long. And although much of the public sector is uneducated about who we are and what we do, modern midwifery has so much to offer women, families, and the American health care system!
I am going to school to be a certified nurse midwife (CNM) [note: there is another kind of midwife - the certified professional midwife (CPM) - who trains through a combination of structured coursework and traditional apprenticeship model with an experienced CPM. CPMs usually practice in the home birth or birth center setting. We are lucky to have some truly fabulous CPMs in our community. You can learn more about them here!]. CNMs fall into the category of APRNs (advanced practice RNs) which also includes nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists. It means we are RNs with graduate degrees (either master's or doctorate level) preparing us for practice as independent health care providers. What that looks like varies by state, but in general we see patients, manage their care independently, and have prescriptive privileges. APRNs either collaborate with physician colleagues to co-manage patients that fall outside of their scope of practice or can refer their patients to the appropriate physician as needed. And while much of the country now knows a lot about the nurse practitioner and what he/she does, midwifery still lags behind.
Now I'd like to debunk some midwifery myths, to give you a better idea of what it's like to have a midwife as your care provider!
If by some miracle you're still with me, thanks! Thanks for taking a moment to learn a little more about midwives and what we do. I didn't even begin to get into how midwives are cost-saving for a nation way in over its head on health care spending. I didn't get into how our current system of maternity care is not providing the best outcomes for moms and babies that it could be, and how midwives can and will be an integral part of positive change. I also didn't mention that I believe midwifery is a calling and that my love of caring for women and families is deep in my bones (and I'm not the only midwife who feels this way). These are all discussions for another day. :)
Additional midwifery resources:
I am going to school to be a certified nurse midwife (CNM) [note: there is another kind of midwife - the certified professional midwife (CPM) - who trains through a combination of structured coursework and traditional apprenticeship model with an experienced CPM. CPMs usually practice in the home birth or birth center setting. We are lucky to have some truly fabulous CPMs in our community. You can learn more about them here!]. CNMs fall into the category of APRNs (advanced practice RNs) which also includes nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists. It means we are RNs with graduate degrees (either master's or doctorate level) preparing us for practice as independent health care providers. What that looks like varies by state, but in general we see patients, manage their care independently, and have prescriptive privileges. APRNs either collaborate with physician colleagues to co-manage patients that fall outside of their scope of practice or can refer their patients to the appropriate physician as needed. And while much of the country now knows a lot about the nurse practitioner and what he/she does, midwifery still lags behind.
 |
| Me watching while my professor teaches a classmate how to place an IUPC (intrauterine pressure catheter) on Noel, the pregnant simulation mannequin that will actually mechanically give birth to her simulation baby. Poor Noel, she gave birth at least twenty times that day! |
Myth: If I want a midwife to attend my birth, I have to give birth at home or in a birth center.
Fact: In 2010, 95.7% of CNM-attended births occurred in hospitals, 2.2% occurred in freestanding birth centers, and 2% occurred in homes. More than 50% of CNMs list physician practices or hospitals/medical centers as their principal employers. You are more likely to find a CNM practicing in the hospital setting than anywhere else. If you'd like to have your baby in a hospital, a midwife would love to care for you! On the flip side, if you are a healthy, low-risk woman and have never explored the possibility of out-of-hospital birth, I encourage you to! Women who give birth in birth centers are more likely to avoid unnecessary interventions, more likely to give birth vaginally, and the outcomes for both mom and baby are as good if not better than in hospital birth! You can read more about the findings from the study I'm referencing and how to find a birth center in your area (just go check one out!) at the American Association of Birth Centers. Fun fact: there are more birth centers in the state of Texas than any other state in the country.
Myth: If I have a midwife, I have to have a "natural" birth...that's not what I want (gimme my epidural!).
Fact: Midwives believe pregnancy is a normal physiologic process. Pregnant women aren't sick! They're just pregnant! We are trained experts in NORMAL birth and are wonderful care providers for low-risk pregnant and laboring women. Midwives generally avoid unnecessary interventions in the absence of problems and can help prevent the cascade of interventions that often lead to cesarean deliveries (which come with the risks of major abdominal surgery and should be avoided when possible). However, midwives are only partners in the care of our patients. As was taught to me by a professor of mine and as I like to tell my patients: "You're driving the bus!" If your plan involves an epidural, we are happy to see that you get one and have the safe and special birth experience you were hoping for. If your plan involves an unmedicated birth, we are so happy to assist you with this as well. Our training includes non-pharmacological pain relief options and labor support, and unlike many other providers many midwives will remain present to "labor with" their patients and provide support from the time a woman becomes active to the time she gives birth.
Myth: But I'm in deep trouble if something goes wrong, right?! What if something happens with my baby?!
Fact: Midwives are just one part of the fabulous health care team that works as one to take the very best care of you and your baby. Remember when I said midwives are experts in normal labor and birth? It means we are trained to recognize deviations from normal early in the process and make the proper collaborations/referrals as needed. For example, a midwife can co-manage with a physician a patient who has perhaps had a high risk pregnancy but is expecting a normal vaginal delivery, allowing patients to get the best of both worlds! If something changes, every midwife has a supporting physician she can call for either consultation or collaboration - we love our physician partners! If you need a cesarean delivery, our physician partners will be there to perform your surgery, often with your midwife in the OR as first assist! (Many midwives have special training to assist physicians in the OR with cesareans and/or other gynecological surgeries.) Midwives are also trained in emergency procedures and are equipped to handle obstetric and postpartum emergencies if they happen (like postpartum hemorrhage and shoulder dystocia).
Myth: Wow...I really enjoyed my midwifery care for pregnancy and birth. I'm bummed I can't see her again until my next pregnancy.
Fact: Dry your tears, ladies! Midwives are trained to care for women throughout the lifespan! We preform well-woman annual exams, Pap smears, breast exams, STD testing, and can counsel you regarding birth control options...then write your prescription once you choose one! We are also there for gynecological problems and can see you if you're having issues with your periods, pelvic pain, or any other concerns about your lady parts. As always, we partner with skilled physicians to refer our patients as needed. Midwives have the wonderful opportunity to care for women throughout their lives, often forming deep, trusting relationships that promote quality care and empowerment of women to be active in their own health and wellbeing.
 |
| And we always encourage audience participation! Image from Midwives of New Jersey found here. |
Additional midwifery resources:
- The professional association for CNMs, the American College of Nurse-Midwives has many resources to look through including my favorites:
- Midwifery: Evidence Based Practice - a summary of midwifery research
- Pearls of Midwifery - a PowerPoint presentation explaining the "pearls" of midwifery care
- Documentary film The Business of Being Born - understanding the biases that all documentaries are made with, watch this film with an open mind as it examines the current system of maternity care in the U.S. and how we might do better. The film really emphasizes the difference between hospital and out-of-hospital births without really exploring the benefits of in-hospital midwifery birth, which is a great option for so many women. [Currently streaming on Netflix.]
- And for fun (and for the love of great television!): Call the Midwife - a British series about midwives in East London in the 1950s based on the memoir of midwife Jennifer Worth. The show boasts more popularity with British viewers than Downton Abbey (GASP! I know!) and captures the heart of midwifery in so many ways. [It is also currently streaming on Netflix, with more recent episodes streaming on PBS.com.]
Again, thanks for stopping by, thanks for reading, and thanks for learning more about what I do. If you have specific questions about midwifery or would like to know more, you're welcome to email me - thinkedthinker [at] gmail [dot] com.
Have a safe and happy independence day!!!!
xo,
Ash
