Transcription:
Midwifery 101

Evo Terra (Host):  Certified nurse midwives are best known for supporting women who choose to have a more natural labor and delivery experience, but did you know that they provide comprehensive primary care for women from their teenage years through adulthood and beyond? You’ll learn more about through my conversation with Allison Harr, a midwife with Aspirus Ironwood Hospital and Clinics. This is Aspirus Health talk. I'm Evo Terra. Allison, I know that midwives have been associated with pregnancy and delivery since the beginning of history, obviously, but you're a certified nurse midwife if I have that right. I’d like to know how is that different than what we might think of as a traditional midwife?

Allison Harr, DNP, CNM (Guest):  Sure. Thanks for the question. In the United States, the difference between a certified nurse midwife, a traditional lay midwife, and what we’re calling now certified practical midwives or certified midwives is about licensure. So I think traditionally people are thinking about lay midwives as women who have traditionally been trained more as an apprentice situation and have no formal licensure or no formal education. Now in the United States, certified practical midwives or certified midwives do have what’s called a direct entry education where they go into a formal school for midwifery and do a four year training and then a preceptorship with a trained and licensed midwife. Certified nurse midwives are more closely akin to advanced practice registered nurses. So all certified nurse midwives have to have a registered nurse degree. So typically they need a bachelor’s degree and then go on for advanced training. Now for advance practice, registered nurses, and certified nurse midwives there are two different schoolings that they can go through. They can do a master’s degree or doctor in nurse practice or PhD. PhD is more closely related to research while the DNP is a doctorate in practice.

Host:  That’s a lot. There’s so much to this than just what we think of when thinking about traditional midwifery. Thank you for that breakdown of how your profession has evolved and changed over time. I wonder if it would be helpful to the audience for those who may not be familiar with the idea of midwifery—which I love that term by the way. Maybe you can just start by forgetting the individual type of midwife one might be. What is it that a midwife does to support a mother to be during her pregnancy?

Allison:  So midwives take care of women through their lifespan with all sorts of healthcare problems. That’s more specifically to certified nurse midwife. Midwives as a whole take care of women through their pregnancy. They traditionally have been the practitioners of doing the art of doing nothing well which means watchful waiting, allowing pregnancy to be a physiologic process meaning that pregnancy is a normal part of a woman’s lifespan. Then trying to watch the pregnancy correct and being the supporters of healthy normal pregnancy. That includes good nutrition, good hygiene, making sure that emotional wellbeing is well supported during the pregnancy, and making sure that all the things that we know make a healthy person are happening and ways to help or troubleshoot any complications that can come up. We know what a normal pregnancy should look like. So we also watch out for all those things that the signs and symptoms of something progressing into something more abnormal. Then knowing to transfer then to either an OB-GYN or physician in order to make sure that the woman and the baby are healthy.

Host:  Going back to what you just said a moment ago at the end of that. I'm curious about the difference between the more natural labor and delivery process offered by midwives over what a woman might experience just going through a traditional OB-GYN. I know sometimes OB-GYNs need to get involved, but assuming that’s not the case how do you feel the process is different?

Allison:  Oftentimes the process—In a good system, the process is not going to be that much different between an OB-GYN and a midwife depending on where your setting it. I think there’s a presumption that midwives don’t prescribe medications, especially certified nurse midwives. And that we’re all against epidurals and we’re all against other pain medication during labor. That is not true. I think midwives are always hoping for the best laid plans and best delivery and the best experience for the family based on their desires and trying to make that happen for our patients. Specifically midwives do typically have training for comfort measures during labor. Oftentimes midwives are going to what we called labor sit. So be more involved during the labor process. Checking in on you a little bit more frequently and also pushing with you for a little bit longer. Does that mean that an OB-GYN—or an obstetrician gynecologist—won’t practice the same way? Not necessarily, but you're going to experience that more oftentimes with a midwife in a full scope midwifery practice.

Host:  Sure. Moving past bulk, which is obviously the bulk of what it is and we’re here to talk about. I am curious. What sorts of primary care do certified nurse midwives provide?

Allison:  Sure. So I kind of spoke about this earlier. Certified nurse midwives can within their scope in the United States do take care of women and act a lot like an OB-GYN in the essence that for very normal healthy women we can prescribe birth control, talk about family planning, do preconception counselling which talks about how best to prepare before having a baby or before becoming pregnant. We also do routine screening like pap smears for cervical cancer, breast exams for breast cancer. Then also some midwives will also work with older women after menopause and work with hormone replacement therapy options for women having or experiencing complications after menopause.

Host:  Sounds rather comprehensive. Again, that was Allison Harr, a midwife with Aspirus Ironwood Hospital and Clinics. For more information about midwifery care or to schedule an appointment with a provider at an Aspirus location near you, go to aspirus.org. Thank you for listening to this episode of Aspirus Health talk. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes which you can find at aspirus.org.