Sep 23, 2020 • 3 min read

What Does a Midwife Do and Do I Need One?

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An Interview with a Certified Nurse Midwife

Tell us about yourself – what made you decide to work in women’s health and what does a typical workday look like for you?

When I was 15 I met a nurse-midwife and was mesmerized by the stories she recounted about the profession. The passion grew with me for over 12 years when I finally became a nurse-midwife myself. One aspect that really drew me to the profession is the way it relies on evidence-based knowledge when available, but in the absence of scientific data assumes the body is wise and usually knows best. In relation to labor and birth, midwives often view themselves as the “protectors of the normal” — there to intervene when needed but otherwise there to support the safe passage of mom and baby. I am a labor and delivery midwife at a busy urban hospital. My day starts with receiving a report from the off-going team, during which I hear all about the patients on the floor, their labor progress, and their medical background. I then meet every patient and their families. The rest of my day is usually quite busy — it can be a lot to juggle multiple labors at different stages! The day always ends with a report to the oncoming team, just like the one I began the day with.

Where do you see the biggest need for change in today’s women’s healthcare?

There are plenty of challenges in women’s health care, but with regard to perinatal care, I think one of the biggest needs is for more comprehensive postpartum care. Currently, most people are discharged from the hospital within 24-48 hours from delivery and will generally not be seen for 4-6 weeks at which point they are offered a 15-minute postpartum check-up. Really during these first 4-6 weeks, the recovering mother should be receiving home-follow up and continued lactation support. While the rare and most serious medical issues do tend to present within 24-48 hours of birth, the most common issues tend to present within those first few weeks. Postpartum care needs to account for those issues, but it doesn’t. At the moment the burden of finding help falls on the new mother who already has her hands very full.  

In many European countries, maternal care is led by midwives and involves several home-visits for the postpartum period. Can you imagine such a system for the US and why?

I think that would be fabulous. Some hospitals are beginning to launch prenatal vans that will go directly to people’s neighborhoods. This service was born out of necessity during the pandemic, as so many people are avoiding coming to medical centers. Hopefully, this is something that can last and eventually translate into postpartum care. But unfortunately, I doubt it. Medical centers are usually reimbursed a fixed amount per visit type by insurance companies, regardless of the time spent on that visit. Because of this system, medical offices try to see as many patients as possible in a day. Unfortunately, home visits take time and therefore would likely not make sense financially. So while I don’t think home-visits will become the standard here in the U.S. anytime soon, I do think this is something that concierge practices might start exploring more. And of course, this is something that homebirth midwives have always been doing. The problem with this is that it makes this type of at-home service less accessible to those who don’t have the resources to pay out of pocket. 

The current Corona crisis boosted the popularity of nurse-midwives as maternal care providers. How would you describe the value a CNM provides to a woman’s reproductive healthcare?

In addition to providing safe care, with outcomes often better than those of physicians (with regards to cesarean section rate, episiotomy rates, etc…) most midwives strive to provide emotionally holistic care. We are often described as “low tech, high touch” providers. Midwives really care for the whole person. We don’t just want mom and baby to be safe, we want mom and baby to feel safe, and feel like they have a voice and say over what is happening to their bodies and their babies, and we ideally want the transition to motherhood to be a positive one, one that makes the person feel strong, empowered, and in awe of herself. It really is a tremendous feat to create and birth new life and the process and the person deserve our utmost respect! 

We have many expecting and new mothers reading this interview – is there anything else you’d like to share with them?

It can sometimes be hard to know whether to choose a midwife or a doctor for our care and we can spend a lot of energy trying to find the perfect provider. The most important factor in choosing a care provider, more than title and background, is that you feel comfortable asking them anything and that you feel supported by them.  

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