Introduction: Comprehensive care from preconception to pediatrics to geriatrics, it's Conversations with MIT Health. Here's Melanie Cole.

Melanie Cole: When you find out you're pregnant, you want to start looking for a practitioner to care for you during pregnancy and birth. Many people know what an obstetrician gynecologist is, but not everyone knows what a midwife does. Welcome to conversations with MIT Health. I'm Melanie Cole and today we're discussing midwifery. Joining me is Jennifer Shark. She's a certified nurse midwife at MIT Health Jennifer, I'm so glad to have you join us today. What a great profession that you're in. Tell us a little bit about your career path before coming to MIT health. 

Jennifer Shark: So before coming to MIT Health, I worked at Mount Auburn Hospital, which is a local community hospital, deliver babies, and take care of pregnant women. And prior to that, I had been working in a tertiary care center in Brooklyn, which gave me a lot of crazy experiences. But even before that, I was actually a classically trained singer and did that for many years before kind of coming to this calling of midwifery. And I think you'll find that many people who are midwives say it's a calling and not just a career or a job.

Host: How interesting. Well, thank you so much for telling us about that. So tell us what is a certified nurse midwife? Briefly explain what it is, what are some of the hallmarks of midwifery and what care and support you provide during pregnancy and delivery, and after?

Jennifer Shark: So a certified nurse midwife is a registered nurse with advanced training in obstetrics and gynecology, and the hallmarks of midwifery care, midwifes actually means with woman, in kind of old English. And so it's really about the focus being on the woman in front of you and making sure that she is well informed, well educated, as making decisions based on the best evidence and being a partner with her in her care, both in pregnancy birth and beyond. And even before, we also care for women throughout their lifespan. From the time they get their first periods until long after menopause. So midwifery care doesn't have to be confined to just the year that you have a baby.

Host: So then tell us how parents at MIT Health work with midwives from prenatal through delivery, tell us what you do?

Jennifer Shark: So when a person becomes pregnant, they will initiate prenatal care at MIT Health, and they will meet with a provider at their first visit. So it could be a midwife, it could be a doctor and they get to choose if would prefer to have their care with a midwife or a physician. And so we usually encourage people who don't know to try a visit with each and get a better understanding what that means for them, and then make that choice. Some people come in knowing that they want to choose a midwife. Some people come in knowing they want to choose a physician. But the main difference that we kind of tried to explain to them, or the main difference really that we see is the continuity of care you get with a midwife. So people who opt to see a midwife for their pregnancy will see the same person for their prenatal care every single time they come to the office. When you choose a physician, you'll alternate your care with your physician and the full time office midwife, which happens to be me.

Host: So how do you collaborate with OB GYNs? How does a midwife work with other prenatal providers such as obstetricians?

Jennifer Shark: So in our practice, the obstetricians are available for consult and for evaluation as needed. And that's the case in most midwifery physician practices, the healthy pregnant woman will never need to see a physician most likely during her pregnancy. But if complications arise, the midwife can have a consult with a physician. They can just kind of have a chat with them. You know, what do you think is going on? They could do a formal consult, or if the patient becomes too high risk, then that patient can be, their care can be transferred to physician care. And that can happen at any time during the course of the pregnancy and childbirth. So with complications arrive at the hospital, that might require something that is outside of the scope of a midwife, such as the sectarian section or a forceps or vacuum assisted delivery. The physician who's working with them that day would come in and assist with that delivery.

Host: One of the biggest myths that I've heard about midwives over the years, Jennifer, is that they only do home births and that you can't have an epidural if you see a midwife, will you clear those up, please?

Jennifer Shark: Of course, in fact, the vast majority of midwives in the United States work in hospitals and the vast majority of those midwives work with underserved populations. So yes, there are midwives who do home birth and home birth has varying legal status from state to state. But the truth is that most of us do work in hospitals. You can have any method of pain relief that you want with a midwife. Midwives wants you to have whatever option you feel is going to make your birth, the positive experience that you need it to be. Whether you want to have no pain medication, whether you want to use some pain medications or you want to go whole hog and get that epidural, we're there to support you and make sure that you are making an informed choice.

Host: Well, thank you for clearing that up. So now explain how this process works during COVID-19 because everything is up ended. These are unprecedented times and for women about to have a baby, it can be a very scary time.

Jennifer Shark: It is. And it's scary for us too, as providers, because we are learning about COVID right alongside our patients. And most of the time when a patient comes to me and wants a definitive answer about a certain virus or bacteria or something that's going on with their pregnancy, I can give it to them. But because the situation with COVID is evolving almost on a day to day basis, and we really don't have any kind of backlog of data to support any kind of really good answer. We just encourage people to be careful, be safe. You know, where your mask, when you go out, wash your hands frequently, you know, social distance, all the things that we're telling, the general population we are telling pregnant women to do. And as well, that, you know, maybe just add that extra touch of caution because we really don't have the data yet to tell us what the true impact of COVID on pregnancy and birth is.

Host: So how is the process working as far as women that come in for delivery now is, does Mount Auburn Hospital have rapid testing for parents who are delivering during COVID? Are there any visitors allowed or can the spouse or partner be present for the birth? Tell us a little bit about that process.

Jennifer Shark: When people are admitted in labor, they are tested for COVID, they are allowed one visitor. So one support person. So usually it's the spouse. Occasionally it's an alternate person and they are basically considered a one person unit at that point, where the pregnant woman or new mom goes, the partner goes with them. So they're admitted to a labor room. They stay in the labor room together. When the baby is born, they go to the postpartum unit together, the partner cannot leave the hospital and return until mom is discharged. So if the partner has to leave, say to go home to take care of other children at home, then the mom cannot have other visitors and that partner can not return to the hospital. So that's kind of how that is working now. And people, their test result is usually back by the time they are discharged from the hospital, which is generally two days after delivery.

Host: Thank you for telling us about that. And what about parents who may have high risk pregnancies? Are they good candidates to work with midwives? And how does that work?

Jennifer Shark: Yeah, that is a multilayered kind of question because there are many types of high-risk conditions, but if has something like a preexisting condition like preexisting diabetes, preexisting high blood pressure, they would not be a good candidate for midwifery care. They should see a physician during their pregnancy. The good news that MIT Health is that they do get a little bit of a touch of midwifery care because of that alternating visit structure, where they see their, their physician on one visit. And then they might see me for the next visit. So, you know, as a certified nurse midwife myself, they do still get some touch of midwifery care, but their main management of their care is managed by their physician and they would be delivered by a physician as well. There are some high risk things that people consider to be high risk that, you know, are not really truly high risk, like diet control, gestational diabetes, being older at the time of delivery. Those are kinds of things that people think automatically makes them high risk, but in fact are not necessarily things that require a physician's care.

Host: What's the role of a midwife after birth, Jennifer?

Jennifer Shark: In our practice, the midwife will have visits with the new parents, usually twice in the first six weeks after birth. So usually at two and six weeks, and that is to monitor both just really the health and wellness of the mother. So we're really watching both our physical and mental state during this time. We do not do newborn care in our practice. That is we have a pediatric practice in our facility who takes care of the babies. So we're very, very focused on moms physical and mental wellbeing in that first six weeks, but even beyond the first six weeks, because things like postpartum depression can arise as late as a year or more after birth. So we often maintain a relationship with these women or these families after they deliver. And then into the years beyond they continue to come to us for care because of that relationship that we've developed during the pregnancy.

Host: Isn't that wonderful. What a great job you have. What do you like about working at MIT Health?

Jennifer Shark: I think one of the best things about working at MIT Health is the truly collaborative teamwork that we have from our medical assistants to our nurse and our physicians and midwives. We are really a team and we're very close and there's a lot of respect across all the lines. So there's, no, it doesn't feel like a hierarchical structure it's that we are all equals working together and we all have strengths that we can, you know, help our colleagues with. So there are certain things that might be more in my wheelhouse of expertise, but then something else that one of our physicians might really be, you know, have a fount of knowledge about. And we are all able to collaborate with each other very openly. And to me, that is what makes our practice so special and makes me not really ever want to leave.

Host: Jennifer, please wrap it up for us with your best advice for expectant parents, what you would like them to know about working with a midwife at MIT Health and what you're doing to keep the community safe at this unprecedented yet very exciting time for new parents.

Jennifer Shark: So what I want people to know about having a midwife at MIT is that most people who are pregnant can have a midwife care for them. There is a small subset of people who will need a physician, but midwifery care is available to the vast majority of people. And if they want that continuity and that, that kind of hands on high touch care, then they can choose a midwife. And to keep them safe during COVID, we have put procedures in place where we have a small number of practitioners in the office at any one time. So no more than two providers in the office at any one time, typically it's one per day. This allows us to make sure that patients are socially distanced from each other, and that they are not coming into contact with more people than they need to. We are also, unfortunately not allowing partners to come into prenatal visits right now to protect both the other patients in the building and to protect our staff. So one patient per patient room, and minimal amount of staff onsite, enough to keep our patients safe, but not enough to give them additional exposure to the virus.

Host: Thank you so much. What great information and so important. As we said, it's such an exciting time, but it can also be a little bit scary right now in these unprecedented times. Thank you Jennifer, for coming on and telling us about midwifery. Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.