Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm Melanie Cole. And today, we are midwife myth busters, separating fact from fiction. Joining me is Emily Ellington. She's a certified nurse midwife with Novant Health. Emily, welcome. Thank you so much for being with us today. So can you start by telling us what the difference between a midwife, an OB-GYN, or even a doula is? Tell us a little bit about midwifery.

Emily Ellington: Actually, I love that you're asking that question to start because it is very confusing for even our patients, and even people that I've worked with in the hospital for a long time. Sometimes I still remind coworkers kind of what my role is.

So, the difference between a midwife, a doctor, and a doula. A doctor is someone that went through medical school. They got their bachelor's degree, they went to medical school for four years, and then they picked a specialty, and they did a residency, most often specifically in one specialty or another.

A midwife is someone that usually starts as a nurse. You could go into it with just a bachelor's degree in maybe biology or other science, and then we go back to school. Usually, it's a master's or doctorate degree, specifically for both the nursing aspect of healthcare and then in addition, the midwifery aspect. So, a lot of education, but very only specifically to women's health and midwifery.

And then, a doula is somebody that's actually a non-licensed person Their education may be varied. Often they're community-trained. They don't have a license per se behind them. So, they don't really have any liability in the care of patients. In my experience, doulas are a fantastic support for somebody that's trying to have additional maybe education or support in the prenatal period through their delivery of their baby, and then in the postpartum period.

Melanie Cole, MS: That was a great explanation. Thank you so much. Now, before we become myth busters, because a lot of people have questions about midwifery, although it's been around for like 1,000 years, right? I'd like you to tell us a little bit about yourself. What inspired you to go into this line of work? Tell us your approach, your philosophical approach to patient care.

Emily Ellington: So, I took the long way around. When I was in school, I was very much into art. That was my background. I actually went to college first to get an interior design degree. And then, my senior year of high school, end of my senior year going into my first year of college, my dad was diagnosed with cancer. So, he was in and out of lots of hospitals. He ended up being part of a research program at Duke that actually gave him more years with us. And kind of seeing how much nursing care really impacted his overall outcome and how he felt just being taken care of in the hospital was what made me decide that actually nursing was really my passion.

So, I ended up leaving art school. I went to go get my nursing license. In the middle of it, got married, and then ended up pregnant kind of quickly thereafter. And then, my first baby was a preemie, and she needed to be in the NICU for almost three months. So, that was another turn in my path. I think originally I thought I was going to be a pediatric nurse. Kids are definitely a passion of mine. But I felt kind of ignored, I guess, in my own prenatal care. I was telling my provider that something didn't seem right, and ultimately was dismissed and ended up having my baby very, very early and three days later.

So, one of the things that I kind of have promised myself and prided myself on is how well I take care of our high-risk moms. I don't ever want a patient to leave a visit with me not feeling completely heard. We want women to advocate for themselves. We want them to learn to advocate for their new baby. And one of the ways we do that is by, like, empowering them and teaching them what is normal and what to be expected, but then also like, how to express concerns to their healthcare provider so that they are actually getting what they need at the end of the day.

Melanie Cole, MS: Wow, that's quite a story. Thank you so much for sharing that with us. Really, I appreciate that. So we're going to do a lightning round here. I'm going to give you some myths, and we're going to go back and forth and bust some of them up. So, let's just start with one of the big ones. Midwives only deliver babies at home. Is this true? What's it like having a hospital birth with a midwife? Tell us a little bit about that.

Emily Ellington: Sure. So actually, in a lot of states, midwives aren't really licensed to practice in the home, not in all states. So, you need to look at what the law is in your state itself. In North Carolina, to call yourself a midwife, you need to be a certified nurse midwife. So, that means somebody that went through the additional education, is licensed, has at least their master's degree, and can sign a birth certificate.

I would say 95% of the midwives that I'm familiar with only do hospital deliveries. A hospital delivery with a midwife can look very different than what it can look like with your physician. It also can look a lot like what your physician would have done. We take care of women all the way through their pregnancy. We can deliver their baby in the hospital. The only thing that we do differently than a physician is maybe we're not going to be your surgeon if you need a C-section. Our goal is to hopefully avoid a C-section with patients, but I do have plenty of patients that see me knowing that they've had a C-section in the past, and that's the route they want to go this time. And so, I'll take care of them all the way through their C-section, and then I'll be the person that's assisting the surgeon during their C-section and seeing them through postpartum.

So, we are always taking care of our patients in collaboration with a physician, especially if someone risks into high risk, like maybe they may be severely preeclamptic or have other medical kind of comorbidities that are impacting their care. But our goal is to keep things as patient-centered and as family-centered as possible, and to have healthy outcomes for our moms.

And I would say, I'm probably speaking for a lot of midwives, we try to be as low intervention as possible. We're not going to add interventions to the mix to hurry things along. We're going to give a woman every shot that she can to try to have a vaginal delivery and to try to make the experience what she's hoping for, so that she goes home feeling empowered after her delivery.

Melanie Cole, MS: So then, how do you work alongside physicians in the hospital setting? And you said that if there's a risk stratification and that rises, then the physician steps in at that point. Tell us a little bit about how all of that does work.

Emily Ellington: So, they don't necessarily step in. I'll tell you the way we work in our clinic. I am on 24-hour call once a week. Sometimes a little bit more depending on like what's going on with my own patients. I know, like, let's say I'm on call next Tuesday. I know I'm going to come in at 7:00 AM. I'm going to get a report from the physician and the midwife that were on the previous 24 hours.

We're going to learn about all the patients that we have that day. I'm likely going to take care of all of the patients that are laboring. If there's somebody at some point that something—let's say all of a sudden she's preeclamptic and her blood pressure is much worse, and we need to move towards delivery, I'm going to speak to the physician, make sure they agree with my plan of care. Maybe we'll change her medications. Maybe we'll move to a C-section, depending on how sick that patient is. That's a rare situation. But in that way, we're collaborating with the physician. We always have a backup. So, there's always a physician in-house 24 hours a day in case something were to need to be expedited for delivery.

Melanie Cole, MS: So, what surprises people most when they learn about your credentials? What types of medical care can midwives actually provide? Tell us a little bit about that.

Emily Ellington: So, we see women all the way from, like, prepubescent all the way through menopause. I have patients that are 13 years old that are just struggling with heavy menstrual cycles. And then, I see women and treat them for, like, hormone replacement therapy, post-menopausal. We see women for all things in between.

So, I would say definitely a midwife is a great tool to use if you're wanting to have a kind of low-intervention pregnancy delivery situation. But definitely, you can come to a midwife just to see them for your annual Pap smear. You can come to see us for a breast exam if you have a breast concern. You can come to see us if you need birth control. Lots of us are really passionate about making sure women have all the education they can upfront. And so, if you feel like you need a little bit of extra from your visit and maybe you want a little bit of hand-holding to make decisions, midwives are a great tool for that.

Melanie Cole, MS: It really is about that compassionate care and feeling heard, feeling seen and that's such an important aspect. Now, what about the outcomes? Do we know about the research with how the outcomes are and satisfaction for the mother in her whole birth experience when a midwife attends to the pregnancy? And how do you monitor mothers during not only the birth, but throughout the pregnancy?

Emily Ellington: Sure. So, we see our patients just as much as you would see a physician if you're in your normal prenatal care. So, the way we're monitoring and keeping a close eye on our moms is we're going to see them at least every month until about seven months pregnant, and then we start to see them every two weeks, and then we move to every week.

Definitely, we encourage our patients to call us if anything seems amiss. So, that education is a big piece of what we do. We want them to be able to be at home and recognize if something doesn't seem quite right so that they can let us know if they need to be seen sooner. We always will educate our patients that we would much rather them be seen, have some reassurance, instead of sitting at home wondering if something is wrong or they should have called. And then. We also, you know, obviously, hopefully we're the ones doing their delivery, and then we'll see them the next day postpartum. And then, we plan to see them depending on their risk factors, depending on if maybe they are somebody that's more predisposed to things like postpartum depression, we may see them two or three weeks out.

We'll definitely have a phone call with them at some time in between there to check in, and then we'll see them at their six-week visit. Normally, at that six-week visit, then we're kind of making plans for when we're going to see them again. Are we going to see them again in six months because they're due for their annual? Do we need to see them back in a couple weeks because they want to talk about contraception? We really love actually keeping those relationships alive with our patients. I don't ever finish a pregnancy with somebody and then just say, "Great, I'll see you. See you, you know, whenever." I'm like, "I want to see you back in four months, and we'll get your Pap smear up to date, and then we'll talk about next steps. And then, if you're thinking about another baby in the future, let's talk about that."

Melanie Cole, MS: Thanks for listening to part one of our episode on midwifery myth busters. Check out our next episode of Meaningful Medicine with Novant Health as we delve into more with Emily Ellington. To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, please visit healthyheadlines.org. That concludes this episode of Meaningful Medicine, a podcast from the specialists at Novant Health.