Maggie McKay (Host): Meaningful Medicine is 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 your host, Maggie McKay.

Today, we're sitting down with Ann Iannitto, a certified nurse midwife, to explore everything you need to know about midwife care. Thank you so much for joining us.

Ann Iannitto, CNM: Yes. Thanks for having me. It's good to be here.

Host: Absolutely. So, let's just start with what is a midwife?

Ann Iannitto, CNM: A midwife is, well, a nurse practitioner, so a mid-level care, usually someone who has done already an undergrad in either nursing or something else in the field that can relate to medicine. And then, they've gone and got their master's degree and can independently take care of patients. Our specialty is labor and prenatal care.

However, what I don't think everybody knows is midwives take care of women from adolescence through menopause and beyond. So truly, we are those who care for women. I think the word midwife comes from old English for with women, and that's truly what we are. We're with women throughout their entire lifetime.

So, you know, first periods all the way through last periods, and again, all the symptoms that go in between. So, it's not just babies and pregnancy, it's everything that we go through.

Host: What education and training does a certified nurse midwife complete?

Ann Iannitto, CNM: So, a certified nurse midwife already has a bachelor's degree. Typically, we'll see some sort of nursing background, but again, not always. Then, we go beyond, and we'll do a master's degree in nursing with the specialty of midwifery.

Host: And I think there may be a misconception that midwives only provide OB care. Can you talk about the range of care a midwife offers patients?

Ann Iannitto, CNM: Absolutely. And as I started to say before, you know, women from adolescence through menopause, but we specialize in everything from birth control. If your periods are too heavy, we can help you. If you're not having periods, we can help you. If you're having pelvic pain, we can help you. Annual well woman's exams, we look at your thyroid, we look at your breasts, we look at your mental health. And then, of course, we look at everything that happens with your uterus and your vagina.

But all of these things that make up every part of our sort of day, we take care of all of that. Some women have only an appointment with their well woman's provider once a year, and we know that because of, you know, insurance, because of money, whatever the case may be. So, we really are there to take care of the whole woman, not just the parts that everyone associates with the OB-GYN office.

We can go further and do courses in things like colposcopy. So whenever we get a Pap smear, if there's an abnormal Pap smear, there are midwives who specialize in doing the next steps, looking at your cervix through the microscope, taking biopsies, and helping to treat pre-cancerous lesions. And there's a lot of midwives that will have specialties in menopause, menopause care, care of all kinds of different things. So really and truly, we do the whole scope of care.

One other thing to just add, a lot of the pelvic problems that women run into through life, you know, not enough periods, too many periods, pelvic pain. Of course, we're not surgeons. We have a different scope of care. But everything that surgeons do medically before that, we take care of as well, too. Again, those who are more specialized and/or have had more opportunity seeing that. But everything that you would go see an OB-GYN for, we can do the beginning parts of that and the less surgical interventions for, or the steps that you would do before surgical intervention.

Host: And what about birth control counseling? I know you touched on it a little bit, but can you tell us about what you offer?

Ann Iannitto, CNM: Of course, yeah. Birth control counseling is a big thing that we offer, because there's a lot of women who don't want to get pregnant, and we have plenty of ways, not just the old-school birth control pills that everybody thinks of when we think of birth control pills. We have a lot of great things with less side effects, less bleeding side effects, and that really do work well with our bodies. So, we love to talk about birth control.

It also helps us control our bleeding and that's something that we women who are a little more active really want to do. So, birth control counseling is something we do a lot of. And when people hear of how much it can help us have less periods or have lighter periods or less pain and cramping. It's just the world opens up. So, we really and truly love to talk about birth control. Again, it's not just for that anymore. So, please ask us about it because we really want to get these things out to patients who need them and want them.

Host: And can patients see both a midwife and an OB-GYN or do you have to just see one or the other?

Ann Iannitto, CNM: Most practices for certified nurse midwives are embedded next to or in with an OB-GYN. But we always have an OB close by if necessary, if things need to turn surgical or they come up with a problem in pregnancy that makes them a little out of our scope.

So yes, you can see them for a counseling, or if a woman has had a C-section before and wants to have a vaginal delivery following that, it's not my scope to counsel them. So of course, we would see them in conjunction with an OB-GYN, so we could go back and forth. And also, when it comes to any of the GYN issues, again, if someone's bleeding too much, not bleeding enough, we can get them to a certain point where maybe surgery is the next answer. But we've done all of the workup and all of the other things beforehand and can then give them a very nice, warm handoff that has all the information that they need so the patient can get the next thing that goes beyond our service. But yes, you can do both. But if you fall under one, especially in pregnancy midwifery care, we are going to see you, we are going to deliver you, unless, again, something comes up where you really have fallen out of a scope of care that we can't take care of you anymore.

Host: Let's talk about the big day, labor. What role does a midwife play during labor?

Ann Iannitto, CNM: That's a good question because a lot of people, there's a lot of different answers. But certified nurse midwives that are delivering in the hospital, we have multiple patients that are happening during a shift. So, we are not at the bedside breathing and doing everything with you every moment. That doesn't mean we're not there. Because when I can be there, I will be there through labor when necessary. But we rely on our nurses to do a lot of the typical moment to moment, hour to hour things. They help turn the patients. They help support the patients as well. When one of our patients shows up, we see them in triage. If it's time to admit them, we send them over to labor and delivery. We make sure we've done all of our history, and then we pop in and pop out. A lot of the times, I'm the kind of midwife that'll be in there chit-chatting with them for quite some time because that's just what our patients know and like about us. I don't think we're as busy of a service as others at the hospital.

But yes, there are times where once a patient's comfortable, maybe with an epidural, and the nurse kind of has her on autopilot, I might pop in every, every few hours depending on how things are going. So, that's really kind of where we are. We're there for the birth, of course. It's a very low number of people in the room, and then we'll see you postpartum and check in on you, and any time in between as needed. So, you see us a lot.

Host: When would an OB-GYN become involved during delivery?

Ann Iannitto, CNM: That's a great question. So when labor isn't going in the way we want it to. Specifically if baby's heartbeat, let's say baby's just not tolerating labor very well and we're concerned for baby's well-being. That's when we would bring a doctor in. Before, of course, we're going to do all the interventions and things, we can do prior to bringing a doctor in.

But, you know, if we need to change our method of delivering baby. So if we need to go back for a C-section, either emergently or, again, because maybe labor isn't going in the direction or cervix isn't changing the way it should be or if, again, baby isn't tolerating labor, we want the OB-GYNs at the bedside. We want that level of care that can safely expedite a delivery and get a baby out sooner. So, that's typically when you'll see them, though.

Around delivery time, again, if do change over to a C-section, if we need an assisted delivery like a vacuum or forceps. Or if your baby's heart rate drops down, and I'm in the room, the nurses are in the room, sometimes it's nice to have the doctor in the room as well, too, to help look at things.

After baby comes out as well, if you're bleeding too much, and we've done all the things we know to control it and can't, you're going to see one of them come in and give us a hand as well. And then, also if you have a big tear that is just something that you would like a surgeon to fix instead of a midwife, 100%, I would rather have a surgeon there, too.

Host: And in closing, what inspired you to become a midwife?

Ann Iannitto, CNM: Really long story short, I wanted to do anesthesia, and I was in the Navy for some time, and they said, "Nope, you're going to be a labor and delivery nurse." And I didn't like it, and I didn't want to do it. And I did other things before that. You know, I did some critical care, and then I deployed as a critical care nurse in that setting.

And when I got back, I said, "You know what? I'm so thrilled to have patients thank me and just be so grateful, even if they don't say it." And that's the difference taking care of pregnant women versus people in other—you know, especially in maybe not so fun situations of medicine.

Why a midwife from there? Again, really long story short, I loved watching the independence of midwives. They were better at things. They first taught me things that I was a better labor nurse because the midwives taught me the physiology of a human coming out of a pelvis. And I wanted to be that good. I wanted to be as good as the midwives. The midwives, their patients always loved to see them. They always got babies out of the vagina. And they were always the ringer. They came in and at the nth hour, it was like, "Nope, we're going to do it, and your baby's going to come out." And that's what I loved watching, and I loved being able to be that, and then learn all this stuff and teach it to the patient.

So, I didn't grow up wanting to be a midwife. It was never in the cards, but I think it found me when it was supposed to, and I really and truly feel like it's what I'm supposed to be doing. And I love being a part of all of this, because I love taking care of my people. I love taking care of women, and I love empowering women in so many different ways, I guess, is really the best way to say it.

Host: It's got to be so rewarding and fulfilling. Thank you so much for sharing your expertise. This has been so educational. We really appreciate your time.

Ann Iannitto, CNM: Right. No, it was great to be here. And again, I appreciate that I get to speak for us in a way that people learn more about us.

Host: Again, that's Ann Ioannito. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.