Joey Wahler (Host): It's a relatively unique medical profession that many people are unfamiliar with. So, we're discussing midwifery, the role of being a midwife. Our guests, Kristen Frost, she's a certified nurse midwife, and Tara Fitzgerald, a certified midwife, both with Guthrie Cortland Obstetrics and Gynecology.

This is Medical Minds, conversations with Guthrie experts. Thanks for listening. I'm Joey Wahler. Kristen and Tara, hi there. Thanks for joining us.

Tara Fitzgerald: Hi. Thank you for having us.

Kristen Frost: Hi. Thanks again.

Host: Same here. Great to have you aboard. So for each of you, how did you first become interested and involved in midwifery? First, you Kristen.

Kristen Frost: So, I'm Kristen Frost. I'm originally from Auburn, New York, and I now live in Marcellus with my husband and our three daughters. I actually started in healthcare shadowing my senior year of high school as a New Vision student, and one of my most memorable experiences during that time was watching a woman give birth with a nurse midwife.

I went on to pursue a pre-med path initially. But when I had my first baby nearly 12 years ago, the care that I received from midwives helped me realize that I really wanted to be able to provide that kind of care to women and mothers someday as well. So, I went on to become an RN. And first, I worked in a neuro-intensive care unit, which really was about as far away from midwifery as I could have ended up, but it was a great way to learn about the human body in depth and critical patients are really sick, like in all systems. So, it gave me a good background.

Getting more confident in emergencies translated well to midwifery because situations can change quickly in labor. So, I then worked as an office nurse in OB-GYN working primarily with midwives and that reinforced that I still loved midwifery. So, I started attending a nurse midwifery graduate program, and I graduated in the summer of 2021. And I welcomed my youngest daughter a month later. And then, I practiced in Auburn with Tara and our colleague Jessica Allison. And together, we transitioned to Guthrie Cortland last summer.

Host: Gotcha. Sounds great. So, how about you, Tara?

Tara Fitzgerald: Hi. My name is Tara Fitzgerald. I'm originally from the Hudson Valley area, but moved out to Ithaca almost five years ago with my now husband. We're currently living in Auburn with our two dogs and cat. I've been drawn towards women's health for a long time. I was also a New Vision student in high school and got a lot of healthcare experience early on, but unfortunately never got to shadow a midwife.

And I like to think that if I had, maybe it would have made my journey into midwifery a little more straightforward. I originally started a pre-med path and completed my undergrad in education in Biology and Math. I volunteered in a few different healthcare settings and was working as a volunteer EMT back in the Hudson Valley area when one of the paramedics told me about a midwifery program that she was looking into, and I became very intrigued. I started reading more and more about midwifery and it was exactly the women's health profession that I was looking for and just fell in love. I completed my clinical experience as a student in Auburn and started working with Kristen and Jessica there in 2022. And I'm so lucky to be able to continue working with them now at Guthrie.

Host: It sounds like you both really love what you do, to say the least. Kristen, back to you, and for those unfamiliar, let's kind of back up for a moment. What exactly, in a nutshell, does a midwife do?

Kristen Frost: Midwives actually provide a wide range of care for women from puberty through menopause and beyond. The midwifery model of care is focused on providing holistic, patient-centered care. Midwives focus on supporting the normal physiologic process of pregnancy and birth. We attend births in the home, birth centers, and hospitals. And I'll let Tara finish.

Tara Fitzgerald: Yeah. Beyond pregnancy, midwives specialize in other aspects of reproductive health care, routine gynecology, family planning, primary care. This includes annual GYN visits for cervical cancer screening, breast exams. We can screen for, diagnose, and treat common problems such as STIs, vaginal infections, abnormal periods, sexual health concerns, infertility. We provide counseling on birth control and we can also prescribe contraception including placement of long-acting contraceptives like IUDs. And we can also provide care for pre and post-menopausal women as they go through that major life transition.

Host: Wow, that's a lot, huh?

Tara Fitzgerald: Yes, definitely.

Host: And so Tara, also, what would you say the main differences are between what Kristen does as a nurse midwife and what you do as a midwife?

Tara Fitzgerald: So really, the main difference between a certified nurse midwife and a certified midwife is that a CNM earns an RN license prior to starting a midwifery education program, whereas a CM is not an RN prior, but still needs to complete a bachelor level education and complete the science and health courses or training required by the midwifery education program. Both CNMs and CMs are educated in graduate level, midwifery programs, and both need to take and pass the same national certification exam in order to practice.

In New York State, CNMs and CMs have the exact same scope of practice and are often grouped under one umbrella term, which is licensed midwife or LM. So essentially, we do the exact same thing, and there are even more types of midwives out there and it's different in each state. So, I encourage people to kind of go out and learn more themselves. And you can also go to newyorkmidwives.org to learn more about midwives in New York specifically.

Host: And so, Kristen, back to you for a moment. How does the role of midwife differ from that of an obstetrician?

Kristen Frost: Obstetrician-gynecologists, or OB-GYNs, are medical doctors who specialize in women's health, pregnancy, and childbirth. So, midwives and OB-GYNs share very similar responsibilities. And here at Guthrie, we work together with our physician colleagues to provide care for our patients. We really make a great team. So, midwives are the experts in healthy pregnancies. We tend to provide the majority of prenatal care for our patients as well as managing most of the normal labors and deliveries. This allows our physician colleagues to reserve most of their time to provide more specialized care when it's needed and to perform gynecologic surgeries.

When pregnancies become higher risk, we collaborate with the OB-GYNs to provide whatever extra care and monitoring is needed. And this is really great, because even those with higher risk pregnancies can still work with midwives if they choose. We can care for these patients prenatally and will often manage their labors and deliveries at the hospital along with the support of our OB doctors. And the physicians are always available in case of any complications. So if a C section needs to be planned or has to be done emergently during labor, midwives are able to assist the OB-GYNs during the delivery.

Host: It's interesting when you mention the term high-risk pregnancy from here on in, I always when I hear that think of when my wife and I had our daughter about a year and a half ago and the doctor who delivered her said, "I consider all pregnancies to be high risk."

Kristen Frost: Yeah. And there is some truth to that. The medical model really transferred a lot of maternity care from midwives to OB-GYNs in our country for a long time, and that's really not the case in a lot of other parts of the world, and outcomes are really good there. So, I think it's great that with our country kind of struggling with maternal health outcomes in a lot of ways that we're seeing a resurgence in midwifery care, because midwives have a lot to offer.

Host: So, speaking of which, for you, Tara, why would you say a patient might opt for midwifery care instead of an obstetrician?

Tara Fitzgerald: I think, especially what you just mentioned about considering all pregnancies and births, high risk, you know, I think midwives don't view pregnancy and birth that way. I think we view pregnancy and birth as a normal process that the body naturally knows how to do, but we are very aware of the problems that can go wrong and we're prepared for things that can go wrong and ready to intervene when necessary. But our initial focus right off the bat is to kind of support the normal process that the body's trying to do. So, a lot of people are trying to lean into what their body's naturally trying to do, rather than just focusing on everything that can go wrong.

Host: So, it sounds like what you're saying there is that a big part of the difference between midwife and obstetrician is philosophical, right?

Tara Fitzgerald: I think definitely philosophical, but also, the way that we're trained, OB-GYNs are trained in the emergency and the things that can go wrong, which is extremely important. But midwives are trained in what's normal and supporting that. So together, we make an amazing team and lead to the best care outcomes for women.

Host: Absolutely. So Kristen, this is the question I've really been waiting to get to for both of you. What are some common misconceptions about midwives that you can dispel for us here?

Kristen Frost: Sure, yeah. There are many. I think one of the most common ones that comes to mind is the misconception that midwives only attend home births and that midwives can't care for those with higher risk pregnancies. Midwives really do work in a variety of birthing environments and care for a variety of different people. As we discussed, those with higher risk pregnancies can be safely managed by midwives in collaboration with an obstetrician, because although we're really well trained in what's normal, we also have a really good respect for and an understanding of all the things that can go wrong.

Another misconception that's out there commonly is that people think midwives can't prescribe medications or order tests. But in many states, including New York State, midwives are independent practitioners, so we are able to prescribe any medication you may need and we can order diagnostic testing such as ultrasounds and mammograms. We can independently provide GYN, prenatal, and postpartum care as well as attend births.

Host: Tara, keeping with the misconception theme here, how do you and yours would you say address these misconceptions? As a midwife, but also collectively as a profession, how do you get the right word out as opposed to whatever the wrong message might be about what people think?

Tara Fitzgerald: I think it's always about educating yourself and dispelling those misconceptions. You know, it gets confusing because things are different state to state, but just continuing to learn more and more about what midwives are and continuing to support midwifery education in New York State so there are more midwives available for women. The more midwives there are, the more people will know what they do and know how important they are. And then, all those misconceptions will be in the past.

Host: So in summary here, I want to ask you both this, what's the coolest part of being a midwife for you? First, you, Kristen.

Kristen Frost: So, I think the coolest part is really what sort of led me to fall in love with midwifery as a patient of midwives and that is being able to watch a woman prenatal into midwifery care, maybe pregnant for the first time and scared, or seeking pregnancy for the first time, or even trying to avoid it. But watching them transition through all the phases of their lives and I watched the midwife who delivered my children and also mentored me a lot through my journey, deliver the grandchildren of her patients and just watching her be a part of these women's lives throughout their lifespan and really just get to know them and give them the best quality care was just amazing, and that's what I want to be able to do.

Host: And you, Tara?

Tara Fitzgerald: I think definitely building off of that. You know, for us, it's our job day to day, but for our patients, It's a huge life transition and experience when they give birth to, you know, their first baby or third baby or whatever, when you're watching their family grow and you see that really intimate, special experience. It's really amazing and honoring to be a part of that experience. So really, that's the best part for me, is being able to be a part of that.

Host: That sounds great. Well, folks, we trust you're now more familiar with the role of midwives. Kristen and Tara, certainly very educational. Thanks so much again.

Kristen Frost: Thank you for having us.

Tara Fitzgerald: Thank you.

Host: And for more information, please visit guthrie.org/services-treatments/womens-health. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Medical Minds, conversations with Guthrie experts.