Melanie Cole, MS (Host): Congratulations! You're having a baby. And one of the most important next steps is deciding who will care for you throughout your pregnancy and during labor and delivery, whether you go with an OB-GYN, a doula or a midwife, you should be comfortable with who you choose for your care.

Melanie Cole, MS: Welcome to Check-Up Chat with EvergreenHealth. I'm Melanie Cole. And joining us here today is Suzanna Avery. She's a certified nurse midwife at EvergreenHealth Midwifery Care to clarify for us the difference between prenatal care providers, OB-GYN versus a midwife. Suzanna, thank you so much for joining us today. And before we dive into it, I'd like you to give us a little background on what a midwife actually is and how it differs from a doula or an OB-GYN.

Suzanna Avery: Oh, it's great to be here with you, and that's a fantastic place to start. So, a doula is a wonderful member of your team, but they're a non-medical provider. It's someone that you pay to be there for your emotional and physical support, but they're always in conjunction with a midwife or an OB. So, it's a wonderful person to include in your care team, but they're separate from a medical care provider.

And as far as an OB-GYN, that is a trained surgeon, it's someone who goes through four years of medical school, at least four years of residency and graduates with a lot of experience and really skilled surgeons. And then, a midwife is someone in EvergreenHealth system, somebody that has gone to nursing school and gotten a bachelor's in Nursing and then gotten an advanced degree, either a master's or a doctorate in Nurse Midwifery, and we are experts at normal. And so, those are basics of those three different roles.

Melanie Cole, MS: That was an excellent description. Really. I've never heard it laid out quite that way. That was just excellent. So, a family decides to partner with a midwife instead of an OB-GYN for their birth, and let's get into what questions. It's really important to ask your midwife. What's the first thing an expecting family should begin looking at when they're researching who they want to be involved in labor and delivery? And I should add that midwives are involved and beyond, right? They carry women their life course, but we'll get into that in a little while.

Suzanna Avery: Yeah. I feel like the most important thing when you're deciding who should be your care provider is that you should feel safe and heard. And that could be an OB-GYN and that could be a certified nurse midwife. But there are a lot of things that are the same in the EvergreenHealth system. So, we all follow the same ACOG guidelines, we want to follow the most up-to-date evidence-based practice. We gather the same routine lab work and ultrasounds. We want to make really sure that you and your baby are safe during your pregnancy. The really big difference is that piece that I talked about earlier, which is that OB-GYNs are surgeons. They are experts at high risk. They are wonderful at managing complex situations. And midwives are experts at normal. We really see birth, pregnancy as completely normal events most of the time. We're trained to watch for the signs when things are starting to deviate from normal. But in general, midwives are there to support labor and birth, which is a really normal and natural thing.

So, one of the things I'm the most proud of, and I think something that's pretty different between OB-GYNs and midwives is that our C-section rate hovers around where the World Health Organization says it should. So, it's always around or below 10%. We really look for normal. But when something is deviating from normal, we call in our wonderful physician colleagues and we make a plan to care for the patient and the baby they need to. C-sections are necessary, but we know in the United States they're done more often than what we see as the most healthy. And so, if something like that is a priority for you, like you're really hoping to have a normal, healthy pregnancy and you would like to be supported on that journey, a midwife, a certified nurse midwife might be a really good fit for you.

Melanie Cole, MS: So, I'd like you to speak then about who's on the care team. How do nurse midwives collaborate with OB-GYNs or other prenatal providers?

Suzanna Avery: Yeah, that's a really great question. We work completely as a team. We are all on the same team, which is to really support you, support your family, support your baby. And we work really closely with OB-GYNs. When we start care with you, we will refer you to maternal-fetal medicine for ultrasounds, genetic screening, and we work really well with them. And then, we also have doctors that we refer to if anything comes up that's a little bit more complicated. And then when you're with us and having your baby, we have a doctor 24/7 that's always there that we call on. So, sometimes in a shift, I will deliver four babies and I will never talk to my backup doctor. I'll check in with them and I'll say, "Hey, hey, it's great to see you." And then, I'll have four completely normal labors and deliveries. And sometimes I need them there. And it's really wonderful to have them there.

And in addition to those folks, we also have a really wonderful nursing staff. I think that's part of what makes EvergreenHealth a really wonderful place to have a baby. We have amazing lactation consultants that are there almost all the hours of the day to support you in a breastfeeding journey. We have really wonderful perinatal mood support, and we refer to those folks a lot. And so, we have a sweet little clinic out in Monroe, so we love those folks and we love growing that practice. And so, we're seeing more and more patients out there.

Melanie Cole, MS: Suzanna, tell us what the birth experience is like with a midwife in a hospital setting. How does it differ from an at-home birth or a birthing center? Can you have people with you? And in light of COVID, you know, that's changed a little bit. But I mean, I'm going to be honest with you, I had 12 people in the room with me.

so it was a right party with my

kids. But tell me what it's like, tell listeners what it's like when they have a midwife delivering their baby.

Suzanna Avery: Okay. I love a birth party, first of all. I love that for you. So really, the big reason folks come to us and they want a certified nurse midwife in a hospital at their birth is you get the best of both worlds.

 But with the midwife, we really look at ourselves as low tech, high touch. So, we try to really just be a lot more present and supportive. We're almost always there the entire time you're pushing your baby out, rooting for you and guiding you. And we check in a lot in labor to provide support, emotional support, physical support, guidance. We really do follow evidence-based practice, but we also really center you in the middle of that. So, we really want to make sure that what's happening in your birth, in your pregnancy is something that you're comfortable with, that works for you and your family. And so, that's sort of the core of our midwifery practice, is that really, you are an essential part of your team.

And in the labor and delivery unit, we are just really present. We're around a lot. And the difference between a hospital and a home birth is really that you're in a hospital. It's not your home. It's not comfortable like your home. But there is also a doctor and lots of nurses around the corner. So, people who are feeling like, "I really want to be super safe. I want to make sure that I have every part of my care team that I would possibly need close by," then a hospital is probably the best place to have your baby.

Melanie Cole, MS: Suzanna, one of the biggest questions I've heard about midwives, and there are a lot of myths and misconceptions that you are debunking here today just beautifully, what about an epidural? What about pain management?

Because there is that myth going around. If you see a midwife, you can't have an epidural. Please clear up what the pain management situation is.

Suzanna Avery: That is the question. And when I was doing this interview, I asked all of my colleagues, "Hey, is there anything that you really feel strongly that I say to represent midwives?" And that was the biggest thing. You can absolutely have an epidural if you have a midwife. About half of our patients do. I had a beautiful birth and I loved my epidural and I loved my midwives. And I think that that's something that you should know you can have. There's lots of pain management. We get people in the tub. We'll support you if you don't want an epidural. There's pain medicine that go through your IV. There's tons of ways we can help support you. But if you want that epidural and you want a midwife, we are so happy to help you get that.

Melanie Cole, MS: Rock on. I'm so glad that you spoke about pain control, because it is a fear of some women. When thinking about midwives now, and you mentioned how you work with so many of these qualified excellent providers, under what circumstances, Suzanna, would prenatal care need to be transferred to an OB-GYN? And tell us about an instance when a family's prenatal care has been transferred to OB.

Suzanna Avery: Yeah. That kind of brings us back to the beginning and the differences. So, OB-GYNs again, experts at high risk. So if you have chronic hypertension requiring medication, if you have diabetes requiring medication, if you're pregnant with multiple babies at the same time, those are all instances where a midwife would not be your best provider. You would get your best care from a physician. And so along your pregnancy, if you develop diabetes that needs medicine or hypertension that needs medicine, that is a case where we often will find a wonderful physician colleague to step in and take over care for that pregnancy.

And then, there's the cases that happen in the hospital. So, sometimes people have completely normal healthy pregnancies. And then when they get to the hospital, they start to develop really high blood pressure or other complications arise that we need to get the physicians involved. And sometimes we're able to co-manage because we have really wonderful relationships with the doctors that back us up in the hospital. They're really great and supportive. And so often, we're able to manage those patients together and sometimes things arise. Like if your blood pressure gets very, very high, it is time for a physician to take over. So, that's kind of the big instance we see when we say, "Okay, it's time for the midwife to step back from medically managing this, and it's time for a physician to step in."

Melanie Cole, MS: This is such an informative episode. Suzanna, as we wrap up, I'd like you to really wrap up your summary with what you would like listeners to know when they're thinking about who they want to deliver their baby. It's such an exciting time. I mean, really such an exciting time. And while you're telling us, you can give us a little background on what the role of a midwife is after birth and how she can care for the woman as she goes through.

Suzanna Avery: Yeah, that's such a great question and thanks for the opportunity to do that. I think that if you want a provider who is really looking holistically at your wellbeing, how you're doing emotionally, physically, how you're partnership is going in the pregnancy, if you really want a provider that will take holistic care of you, a midwife is pretty wonderful in my experience and what I've seen and heard. I really feel proud to be a midwife and I think that we provide really wonderful care. I think I feel lucky to work in a system where I have all the backup support I need. And I think that that really is the role of a midwife, you know, both in pregnancy and labor and postpartum.

Something that's really special at the Evergreen midwife clinic is that we see people for two-week postpartum visits in addition to their six-week postpartum visits if there's any reason that they or we think they would need a little extra check-in. And so, that's mostly just an emotional check-in. We have people come in for 30 minutes and maybe we need to debrief their birth, maybe we need to talk about what happened. Maybe, you know, wow, this is really challenging with their older kiddo, and this baby is really bringing up a lot of big emotions in their family system. And maybe they just need to have a big old cry for 20 minutes, and then they feel like, "Okay, yeah. I can do this. Like, I'm all right." Maybe we need to loop them in with our wonderful perinatal mental health provider who we have in the system, which is one of the best assets we have at EvergreenHealth.

And then, something that's probably my favorite thing about being a midwife and being a midwife in a community is that I catch somebody's baby and then I put in their IUD at their eight-week postpartum visit. And then, I pull out their IUD a year and a half later, and then I see them for their first pregnancy visit with their next baby. That is the sweetest thing to watch people's families grow and be part of supporting them through that kind of however they need to be supported. It is just like the sweetness that makes this work. That's sometimes hard because a lot of babies like to be born at 2:00 AM. It's the part of this job that keeps you in love with it and doing it with a big, joyful heart. It's just so sweet to support our patients.

 And it's really lovely to be able to see families through their whole childbearing years and beyond. This practice has been around for over 10 years, so some of our midwives who have worked here for a long time are seeing people navigating menopause that have teenagers, and they have those deep relationships that you have with a provider, the nurse practitioner who's taken care of you for 15 years, you know, that's somebody that you can really trust that can help you navigate different chapters of your life. And yeah, I could talk about this all day. It's just the best. It's the best work. It's so fun.

Melanie Cole, MS: How wonderful. I can hear the passion in your voice, and I imagine that the women that you help just absolutely love you. And thank you so much for joining us, Suzanna, and telling us all about midwifery and each birth, and each family's unique, so it's important for us to know you and learn your birth experience preferences.

EvergreenHealth is here to partner with you and your family from the moment you begin considering pregnancy to the months and years after you give birth. Visit evergreenhealth.com/maternity to discover more. And that wraps up this episode of Check-Up Chat with EvergreenHealth. Thanks so much for joining us today.