Scott Webb (Host): Today we're going to learn what certified nurse midwives do and how they help women and couples plan for and navigate pregnancies and look forward to the warm and fuzzy times after their child is born. And joining me for this conversation is Shannon Markle. She's a Certified Nurse Midwife with the Franciscan Physician Network.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Shannon, thanks so much for your time today. We're going to talk about nurse midwifes, midwives, maybe that's, maybe, is that the better way to put that? Midwives? Yes. And, everything in between and along the way. But as we get rolling here, why should folks, why should women, couples choose a Certified Nurse Midwife?

Shannon Markle MSN, CNM (Guest): Many women, couples, families choose to see a Certified Nurse Midwife because it's a more personalized method of care. Nurse midwives tend to spend a little bit longer with their patients, get to actually know them and their families a little bit better. We really support women making their own healthcare decisions, and we're very big on giving them education regarding the evidence and letting them choose their plan of care.

So, for instance, the traditional medical mode is kind of paternalistic in that we say to people, you're going to do this and this and this and this. Where in the nurse midwifery philosophy, we say, so the evidence tells us this and this, and the recommendations are this and this. What would you like to do?

Host: Yeah. I like that. And just before we get too far along here, when we say certified, what does that mean? If you can talk a little bit about the education, experience and certification.

Shannon: Certified Nurse Midwives are Advanced Practice Nurses, just like a Nurse Practitioner. So we have all been registered nurses in labor and delivery for a long period of time. And then we returned to graduate school for a master's degree in additional training. We prescribe medications. We were certified by a national certifying board, the American College of Nurse Midwives. We maintain licensure and accreditation. We do continuous education to make sure that our credentials are up to date and our knowledge is up to date.

Host: Nice. So let's then talk about, you know, sort of, it seems like common sense, but since I, I had both of my kids more the traditional way, if you will. What exactly does a Certified Nurse Midwife do?

Shannon: When you're talking about pregnancy care, we see women for their entire prenatal care, just like you would see a physician, and we deliver babies in the hospital. We first assist on C-sections, so we are not surgeons. That's one of the reasons that we need to have collaborating doctors available in our practice, so we can consult a doctor, meaning we're going to have a conversation about this patient and then we're going to follow the plan of care that we establish together. We can collaborate on care, meaning the doctor and Tthe midwife may go in together and discuss care or act upon that plan of care, or we can refer our patients entirely to a physician if we say they've developed a condition that is just too high risk for a midwife to care for.

Host: I see. So there's definitely some collaboration, uh, yeah. We consider that multidisciplinary or whatever the right word would be. Yeah. So that, that sounds really good. And I good to know, I'm sure for women and couples and families, that they've got a sort of a team, you know, in their corner.

Shannon: They do. They literally get the best of both worlds, when you choose a nurse midwife. You get the benefit of that warm and fuzzy caring presence and the evidence, and the empowerment, but you also have the medical expertise there when it is needed.

Host: So Shannon, we've talked about some of the benefits of choosing a Certified Nurse Midwife, but maybe you can go into a little bit more detail.

Shannon: Well, seeing a Nurse Midwife can carry quite a few benefits. Decreased risk of needing a cesarean, reduced rates of labor induction and augmentation. Reduced use of regional anesthesia like an epidural. It's not that you can't get an epidural when you see a nurse midwife. But we are very good at supporting you to avoid one if that is what you prefer. Nurse Midwives tend to have decreased infant mortality rates, decreased risk of preterm birth. We really have very good outcomes.

Host: So Shannon, tell us about the Center for Midwifery. My brain wants to say, midwifery, but I know it's midwifery. So tell us about the center.

Shannon: So the Center for Nurse Midwifery is basically a office, just like an obstetrician office, but we have four certified nurse midwives with a wealth of experience between us. And we have a collaborating doc that's in our office, Dr. Ashley Monk. And the nurse midwives that are in our group are Lori Axley, and she has, gosh, I believe, nearly 30 years of experience. And then, Heather Jackson, she's our newest one. She's got about three years of experience as a nurse midwife, but many years as a labor nurse, before that. Jessica Jenkins, she's been a nurse midwife for about eight years, and I've been one for about 10. But both Jessica and I were nurse midwives for about 15 years before we went back. So we've all been doing this a really long time.

Host: Yeah. Uh, we talked earlier about sort of what makes a Certified Nurse Midwife and obviously experience is a big part of that. And, I'm sure in developing a plan and the trust, you know, factor between, again, women, couples, families, and so on. So, when those groups of folks, so women, couples, families, whomever, walks through the door there, what can they expect in terms of their birthing plan?

Shannon: So it's going to be very similar in some ways to traditional obstetric care. You know, they're going to come in, we're going to do some physical assessments. We're going to listen to the baby. We're going measure their belly. Now, if they have their husband or children, they're actually welcome to participate in that. There's a lot more education and a lot more discussion that happens. The prenatal care, the basics of it are essentially the same because we're following the recommended guidelines. So we're going to take the blood pressure, we're going to dip the urine at the first prenatal visit, things like that. We're going to order all of the blood tests and ultrasounds.

Host: So, then let's talk about the different stages. You know, are you with, uh, women and couples and families? Are you with them throughout all the stages of pregnancy? All the way to the warm and fuzzy moments at the end? The great, successful moments at the end.

Shannon: Yeah, typically they're going to see us through the whole entire pregnancy and through the active part of labor. So, we're not usually there when a woman first shows up at the hospital thinking she might be in labor. Usually the active onset of labor has been defined to be six centimeters in modern women.

So we're usually there from about the time active labor starts all through the pushing phase until after mom and baby are stable in recovery. And then we go home and we still continue to see them for postpartum care in the hospital, and we follow up in the office with two postpartum visits.

Host: Nice. Yeah. And, having had a couple of kids of my own, the needs of mom and couples and families don't end just when the babies are born, though, that is an awesome moment, obviously for all of us, and I'm sure for you as well. What is a well women general care, what does that mean?

Shannon: Well, woman care is essentially the annual exam that a woman will typically come in and get a breast and a pelvic exam, a pap smear if she needs one. If a woman's having any issues like a yeast infection or a urinary tract infection or a sexually transmitted infection, routine screenings, these are all things that they can see us for as well. We see women from the time of their first period, way past menopause, all the way through the end of life.

Host: So as we wrap up here today, let's talk a little bit about prenatal care and it's sort of trying to help women and couples and families, you know, have those healthy deliveries, which everybody wants. What do you do to help them in those early stages or even pre-pregnancy to get pregnant?

Shannon: Well, it's a really good idea to come in and have a preconception visit when you're thinking about becoming pregnant because we can help to identify and sometimes even mitigate risk factors if we know about them ahead of time. It's a great idea to start taking a prenatal vitamin, for instance, a few months before you become pregnant.

And that's something that a lot of people don't realize. They wait until they get that positive pregnancy test and start taking that vitamin. But one of the things that you need, folic acid, is actually something that you need before you even know that you're pregnant. So that's just one example of things that you can change by paying attention and getting care sooner. We routinely identify for risk factors and we do additional screening or testing if they're needed. And we just closely follow women all throughout the pregnancy to make sure that they feel that they are able to come in and discuss their concerns with us, and we can address them as they arise.

Host: Yeah. That's great. Well, this has been really educational today. Like I said, you know, so you sort of have an idea. Okay. Certified Nurse Midwife. I had an idea of what you all do, but now I really know and it's good to know and good to know that you're with women throughout their journey of their life that may or may not include pregnancy, but if it does, how you can help them have happy, healthy babies and families and so on. So thanks so much for your time today. You stay well.

Shannon: Thank you so much.

Host: And to learn more about certified nurse midwives, go to franciscanhealth.org.

And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.