Rania Habib, MD, DDS (Host): The practice of midwifery can be traced back to 40,000 BC and is considered to be the second oldest profession in the world. When we think of midwives, our mind might turn to childbirth, but with their extensive training, they actually provide comprehensive care for women from adolescence through menopause.

Let's find out more on this episode of HealthWorks Here. Welcome to HealthWorks Here podcast brought to you by Emerson Health. I'm your host, Dr. Rania Habib. Joining me today is Kim Capello, a Certified Nurse Midwife and Nurse Practitioner with Concord OBGYN and Stephanie Sandwich, a Certified Nurse Midwife with AFA OBGYN.

They are here to delve into the world of midwives, including their training, scope of practice, and best tips for women's health. Welcome Kim and Stephanie. We are so excited to discuss your field with our listeners today.

Kim Capello, CNM, NP: Thanks so much for having us.

Stephanie Sandwich, CNM: It's great to be here.

Host: To begin, Stephanie, what exactly is a midwife? A lot of our listeners might be confused about that term.

Stephanie Sandwich, CNM: Yeah, and I think a lot of listeners might be confused because a lot of listeners probably think midwife and they think deliveries at home only, but most midwives attend deliveries in the hospital. And we take care of pregnant people and their families through prenatal care, labor, and delivery.

We also provide GYN care to anyone who is looking for it. We care for trans and non binary folks. We provide hormone replacement for people going through menopause, gender affirming care for trans and non binary people, contraception, anything that you can think of in the GYN realm.

Host: That is fantastic. I do think a lot of people automatically assume that midwives are only for home births. So thank you for clarifying that. Kim, what type of training did you complete to become a Certified Nurse Midwife?

Kim Capello, CNM, NP: My training was a little bit different only because I had my master's already as a Women's Health Nurse Practitioner. So I worked in a private practice in OBGYN setting for many, many years. And then I went on to get my certification as a midwife, although the two really do overlap quite a bit. But certified nurse midwives in Massachusetts have master's degrees, and oftentimes they'll go on to get their PhD as well.

So they're very highly trained and we have to also go through lots of continuing education in order to maintain our credentialing through the national level. And then we also have to keep up our licenses at the state level. So once we've gone through that training, there's still a lot of maintenance that has to be done.

When we do our in school, we learn everything from OB to GYN, to normal to not normal. So there's a lot of academic training, but our programs also do a lot of hands on training. Some of it's through models, but then the majority of it is we have to meet so many hours in a clinical setting, either being trained underneath another midwife or nurse practitioner or even a doctor.

Host: That's fantastic. So how many years total is the Certified Nurse Midwife Master's Program?

Kim Capello, CNM, NP: It does vary a little bit. I would say on average, I mean, Stephanie might be able to speak a little bit more to this. I think on average, it's about three years.

Stephanie Sandwich, CNM: The master's portion for me was two years, but yeah, I think it depends on the program.

Host: And then what do you have to do to maintain your certification as a Certified Nurse Midwife?

Kim Capello, CNM, NP: I touched a little bit on that. So to maintain our certification, we have to maintain our licensing through the state in which we're licensed, and that involves what's called continuing education credits. So we have to either take classes, go to conferences, we can read modules and answer questions so you're constantly reading and staying up to date on the most current information.

Host: Kim, what is the scope of practice for a midwife?

Kim Capello, CNM, NP: We do lots of things more than what people think. One, we are prescribers, so we can prescribe medications. We are often trained to do different procedures, typically in the office setting. For example, we'll put on IUDs for contraception or Nexplanon implants. We do endometrial biopsies, uterine biopsies, other types of biopsies. We can see women for problem visits. And that might include all sorts of things, gynecology related or maybe pregnancy related. We also do a lot of well care visits. We provide obstetrical care. We do deliveries of babies. And we also provide postnatal care. And we really kind of take care of everyone through the lifespan, all the way from adolescence until postmenopause.

Host: Now you have both done such a wonderful job of explaining the scope of your field and your training. So this next question is for each of you to answer, but let's begin with Stephanie. Why did you choose this career and what do you love about it?

Stephanie Sandwich, CNM: I think that anyone who's receiving obstetrical or gynecological care, it's a really intimate and sometimes vulnerable time, and I think it's so important to be a person that patients can really trust, and who will take the time to explain things to them, who will trust the patient's experience, and take that into account when making recommendations. And I just love that I get to meet so many different people from so many different walks of life, who I maybe don't have very much in common with, but we can kind of come together in this realm and I can learn so much from patients too.

Host: You can tell by the way you said that, that you love what you do. So I'm so excited that you're passionate about your field. Kim, same question to you.

Kim Capello, CNM, NP: What I really love about my job and it's from the gynecology perspective and also from the pregnancy perspective is just, I'm so passionate about women being involved in their care. I think we've created a culture where sometimes people feel like they have to be told what to do, and I think it's a time where women need to ask questions and be involved in their care. I love empowering women, and I love educating and teaching them about their health, and we're also live a little bit in a Western culture where pregnancy and birth has become very medicalized.

And I think the one thing with midwifery care is that we're kind of going back to the beginning and reminding people that birth is normal. Pregnancy, is normal. Yes, absolutely, there are complications that arise, but the majority of pregnancy is normal.

Host: Kim and Stephanie, could you each share an inspiring story about your work as a midwife? We'd love to hear a brief story about someone you cared for that was particularly meaningful to each of you. Kim, why don't we begin with you?

Kim Capello, CNM, NP: So I had a new patient who came to see me. She was in her late fifties and she had not been to a gynecologist in over 20 years, I think since her last child was born. And she says, I don't go to doctors, and she had a tremendous fear of exams, and we really delved into it deeper, and a lot of it was just this fear that we were going to find something bad or something wrong with her.

And so I spent a lot of time with her and talking with her and really listening to her fears and her concerns and together we're able to formulate a plan for her care and at the end of the visit she said to me, you're the first person who has ever really listened to my concerns and I feel comfortable and I feel safe and she's come to see me every year since.

Host: That's got to be such an amazing feeling to know you made such a difference in this woman who's already 50 years old and probably seen multiple practitioners before she found you.

Kim Capello, CNM, NP: Thanks, it was great. It was a great feeling.

Host: Stephanie, same question to you.

Stephanie Sandwich, CNM: I think that's what Kim was talking about. That's the thing about this profession is that you just get to make these bonds that can continue for years. I'm thinking about one person who I started seeing for GYN care when she was in her late teens and I saw her over the course of the years and she has now had two babies with us.

I've seen her through her pregnancies and it's just been like so amazing to just watch her grow as a person, get to know her over the years and now watching her as a parent to two young kids. And, just taking care of her after the pregnancies. You make these bonds with these people.

And, I think about a lot of people when I'm not at work, just wondering how they are and how they're doing. And, the bonds we make are so special.

Host: That's amazing. You're really building this lifelong relationship with these patients when you're seeing them from the teenage years all the way through menopause. So it really is an amazing field. Ladies, you are so knowledgeable about women's health. So let's move on to this fun section where we're going to call it your best tips, rapid fire question. So what we want is for each of you to give us your favorite tips about these particular topics. So Stephanie, we'll start with you and then we'll follow with Kim for each of these questions. What is your best tip for women trying to become pregnant?

Stephanie Sandwich, CNM: I would say that there's a wide range of normal. There are lots of ways families are made and if you have any concerns or questions, come see a midwife.

Host: And what about you, Kim?

Kim Capello, CNM, NP: I think there's so much pressure in terms of women feeling like, Oh, I'm going to get pregnant right away. It's going to happen right away. And if it doesn't happen right away, there's a lot of stress that becomes involved in it. And I would say just have fun with trying to get pregnant, you know, you don't necessarily have to track everything or write everything down.

And again, I think, if months are going by and if it things seem abnormal in any way, like Stephanie said, come find a midwife and we will help you.

Host: All right. Best tip for women in labor.

Stephanie Sandwich, CNM: What I would say is, do an assessment of who you are, what your values are, get a sense of what you might think it will be like to be in labor, but be open to the fact that things can really change in the moment and pick a team that you trust to see you through any of those changes.

Host: Love it. What about you, Kim?

Kim Capello, CNM, NP: I think it's great to go into labor having a birth plan. Okay, and having an idea of what you would like your story to be, but also having a little bit of a flexible mindset. Because what Stephanie said, sometimes things don't go according to plan. As much as we try, birth is one of those things that is very much or can be very much out of our control.

Host: Thank you for that. I think you're right. I've had so many friends go into labor with a very specific birth plan and they were very upset when they had to change that plan. So I think it's a great reminder to just be open minded. Best tip to manage menstrual symptoms.

Stephanie Sandwich, CNM: I honestly think that sometimes it's good to just talk about what it is that you're experiencing, whether it's with your friends or with a trusted healthcare provider, because there is a wide range of normal, but there are also some things that maybe what you're experiencing, there's something that we can really offer to help with, so yeah, I would say, especially if it's something that you feel like you're not able to manage with the tools that you have, talk to someone about it.

Host: Kim, what about you?

Kim Capello, CNM, NP: Yeah, I would absolutely echo that, Stephanie. I think communication is really key and I think we have in a little bit in this culture, it's sort of taboo to talk about it. We don't talk about menstruation. We don't talk about menstrual problems, but it is normal. It's a normal part of being a woman.

And I think finding those people that you can trust and understand, I mean, your normal might not be someone else's normal. And we're all individuals. And I think that's the key is, you want to find someone who's going to treat you as an individual, not just what the quote unquote norm is.

Host: Another taboo topic that society doesn't like speaking about is menopause. So what are your best tip to manage menopause?

Stephanie Sandwich, CNM: I feel like mine is going to be the same. I think that it's just a different stage of life, but there are a lot of tools that we have to help manage symptoms, depending on how they're impacting your life. And, you can even start with talking to your friends because I guarantee you they're having their own experiences too. And that can really give you some good perspective.

Host: What about you, Kim?

Kim Capello, CNM, NP: One person's menopausal experience is not going to be the same as your friends or your mothers. Right? And I think, some women feel like they almost have to like, suffer through it.

And, it doesn't have to be that way. I think we have lots and lots of modalities in terms of treating symptoms that are very safe and effective. So come and find a midwife. We'll help you through it. We'll talk you through it.

Stephanie Sandwich, CNM: That's a really good point, Kim about people getting the message that you kind of have to suffer through it. I think, of course there are always limits to what medicine can offer, but, I think that if you're dealing with a provider who's not at least going to try to get creative with you, maybe you should find someone else.

Host: Especially if they're not openly communicating with you. Last question for our rapid question sequence. What is the best tip that women may not know for their overall health?

Stephanie Sandwich, CNM: I'm going to just be a broken record, I think. I think just communication about what's going on for you. Finding people that you trust to talk to. That's just what's going to get you through all of the different phases and challenges of life.

Host: Same question to you, Kimberly.

Kim Capello, CNM, NP: I think that the overall is I just encourage women to, in general, just take care of your health. You only have one of these and sometimes you can't do it alone and you might need help and you need to find the right person, who's willing to like open up that toolbox and help you find those resources that can just help make you the best you, you can be.

And when you come and see one of us, we will teach you about your self care and screenings and the appropriate times to, for example, how often do you need a pap smear? When do I start mammogram screening based on my family history?

When do I do other types of screenings, and see us regularly. It's not just a one time visit. I think coming to see a midwife so that we can help you promote your own health and avoid illness is part of what we do.

Stephanie Sandwich, CNM: And I would just add to that that a lot of our GYN annual exams, we're doing the routine screenings and we're catching up, like I'm always excited to see my long term patients and we can chit chat and catch up, but it's so nice to have that rapport, speaking as a patient and a provider myself, to have that foundation that if something does come up that is really concerning to you, you have someone you know exactly who you're going to go to, you have someone who you know and who you trust.

Host: As we wrap up, what do each of you want people to know about midwives? Stephanie, let's begin with you.

Stephanie Sandwich, CNM: I want people to know that we are highly educated providers, who are really passionate about the work we do for the families we care for and people really love seeing their midwife.

Host: Kim, same question to you.

Kim Capello, CNM, NP: I echo what Stephanie says. I think that, when we started the podcast, this image of midwives being just these women that just do home birth and that's all they do. But, we are very highly trained, specialized training and just taking care of women, and we see them from adolescence all the way to post menopause.

And we are really trained in terms of patient empowerment and informed care, and we really use a team approach where it's a communication between the provider and the patient so that collectively we can come up with a plan. You know, we're never going to tell you what to do. It's always going to be a conversation.

Host: Thank you both so much for providing all of this wonderful information.

Kim Capello, CNM, NP: Thank you so much for having us.

Stephanie Sandwich, CNM: Thank you.

Host: Again, that was Kim Capello and Stephanie Sandwich, and we want to thank them both for sharing all of this wonderful knowledge about midwives. To learn more about the midwife service at Emerson Health, please visit emersonhealth.org/midwives. I'm your host, Dr. Rania Habib, wishing you well. Thanks for listening to the Emerson HealthWorks Here podcast. Subscribe to this podcast on your favorite podcast sources, including Apple Podcasts, Google Play Music, and Spotify.