Caitlin Whyte (Host): One on One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health.

Women have unique and evolving healthcare needs, so it's important to develop a genuine relationship with a healthcare provider. Certified nurse midwife, Amanda Williams, is here to talk about how midwifery is a great option for patients who want a personalized approach and empowering care and education. Thanks for being here, Amanda.

Amanda Williams: No, thank you for inviting me.

Host: Wonderful. Well, let's start off with a bit about yourself. What motivated you to become a certified nurse midwife, and what do you enjoy about the work you do?

Amanda Williams: Oh, sure. I actually started out wanting to do Psychology, and I took this wonderful course called Births in Four Cultures. And I was just absolutely enthralled. And so, I went back and got my RN and worked Labor and Delivery and Postpartum for like 13 years and then realized I could give even better care as a provider with that midwifery model. And I've been a midwife now for eight years. I have my doctorate because I love implementing quality changes. So, I don't know, that's just part of providing that better care that I wanted. So yeah, eight years later, here I am.

Host: Oh, I love that. What a great story. Well, a lot of people associate midwifery with just pregnancy and birth, but that's not all that you offer. So, what types of care do you provide? And then what can patients expect when they receive their care from a nurse midwife?

Amanda Williams: Sure. So, we love the title midwife because it means with woman. And it's just this wonderful traditional title that's held a lot of emotional weight for so many centuries. But essentially, we're nurse practitioners who are responsible for women's reproductive health. From the time you get your cycle to the time we pop the champagne and say goodbye, including menopausal care, we take care of the full spectrum. And that includes STI testing, contraception, if there's any reproductive concerns that can be treated medically, we manage that as well. And then during your pregnancies, we manage the pregnancy itself, birth, and the postpartum period.

The difference between our care and a physician's care could be the level of acuity, even though we're very fortunate because we co-manage a lot with our physician group. But if there's a certain level of comorbidity or illness that would put the woman at extreme risk, of course, that is better managed by a physician, or if there's a surgical solution that's required. While we can first assist with cesareans and things like that, we are not surgeons. And so, that's kind of our schtick.

Host: Gosh, there's already so much I'm learning as a woman myself. I feel like there's so much I don't know about women's healthcare in general. So, thank you for sharing this already. The idea that midwifery is only for pregnancy, that's just one of the myths associated with what you do, and there are so many others. So, take us through some of the biggest misunderstandings people have about midwifery.

Amanda Williams: Oh, yeah. So, that we're all like dirty hippies that just want to cure everything with doTERRA oils, right? No shade to doTERRA. Or that we only attend home births, or that we are in direct opposition to physician care, you know, or that we are the same as doulas. And doula themselves, they're their own professional. They are not medical providers. They are sort of this amalgamation of advocate and physical therapists that are certified by their own group that then they provide like a different level of care that's not medical care. But we often work side by side with them so we get, you know, lumped together. But that is absolutely not the case. I mean, there are plenty of bougie metropolitan midwives. There are still those that wear the Birkenstocks, right? But you get full Western American care. But yeah, there's a lot of the, you know, witchery involved with midwives. In fact, we had to really gently educate our residents, because we also work with physician residents. They were so sweet and supportive, but they got this habit of saying, like, midwifery magic or magical midwives. And I appreciated that they were being supportive, but it implies there's not good science behind it in my mind. So, I was like, "Well, it's more like physics, ladies and gentlemen," so we're going to embrace the physics and physiology of birth, right? And so, working through that social and historical relationship with the, you know, physician groups, as well as society.

Host: Yeah. That is so fascinating. I had a friend recently who worked with a midwife and she told us in the group chat what she was doing. And we were like, "Oh, so are you doing a water birth or what are you doing exactly?" She's like, "No, no. It's going to be, you know, in the hospital and stuff," but just having that extra set of hands and guidance seems to be really, really helpful for some people.

Amanda Williams: Oh, right. And midwives work in all settings. Don't get me wrong. We do attend home birth, freestanding birth centers in the hospital at all levels. And water birth is a very valid birth for someone who is appropriately risked for it, right? I think that goes into a lot of the philosophy of midwifery care, is making sure that we are individualizing care for women and making sure that we are not dismissing their concerns and their input in their own care. Because I feel like historically, women are often diminished, right? I mean, the whole idea of they created hysteria as a diagnosis for women sort of says it all. So, I think re-centering women's voices in their own care and acknowledging their input and their desires makes a huge difference in the way that women are cared for and in their outcomes. We see that all the time, you know, the impact of systemic racism and the impact of misogynistic patriarchal societies, and how women can be caught and victimized by those processes. And instead, we want to make this a space where we provide equitable and accessible care for these women, where they are heard and seen and acknowledged. Again, if nothing else, just for better outcomes, for safer, better outcomes.

Host: Yes. Well, let's talk about that now, that individualized care and how you empower patients through your work. How exactly do you do that, and how does it benefit a patient not only through a pregnancy and birth stage, but throughout all stages of their life?

Amanda Williams: Sure. I mean, a big tag word for it these days would be like trauma-informed care or therapeutic interviews, these are terms used. But really, the idea is acknowledging the patient and their autonomy in their care and presenting information in a truly informed consent format. An acronym I like to use is something called BRAIN and that's where you're truly discussing benefits, risks, alternatives; letting the patient use what could be termed their intuition or really their like perception and filter, like how they process their own information; and then nothing, right? What if we just did expected management? And then, really laying that out as opposed to giving some sort of biased preference, like, "Well, I'd like to do this for you," you know what I mean?

So, just really just from that baseline, truly giving people the options and letting them make their own decisions makes all the difference because then women feel heard, which is so funny because there's been for years now the study called Listening to Moms. I know it seems very common sense, but it's not, right? Like the idea of like, we don't listen to people, we blow them off, or we discount what they're saying because what do they know, you know, what kind of level of health literacy do they have, what kind of education do they have. And so, I think that bias has colored medical care for decades or centuries, probably. So, changing that relationship with your client and respecting them as a human being with control over their body and with a say in their care, makes all the difference. I mean, I always tell, you know, my clients, "I'm like, Hey, these are the options. These are the things I'd like to argue about because I think it will keep you alive." I was like, "But in the end, I respect what you want," right? You know, these are all services. This is not an authoritarian relationship. My authority is in the knowledge I provide. And so, I'm offering a service and that knowledge behind it, and you do what you will with that information.

Host: Gotcha. Well, wrapping up here, Amanda, it sounds like Regional One Health's midwifery practice is unique. You provide group prenatal care. It's the only hospital where patients can deliver with a midwife, and you see patients for well woman care as well. So, tell us about all of those options and what else can patients experience at Regional One Health?

Amanda Williams: Oh, we're super fortunate actually. We work as a sort of a sprawling system in Memphis, so we have locations all through the city, trying to be convenient, right? And we are fortunate enough that we work with several layers of obstetrical care as well. We work with generalists, as well as menopause specialists, as well as maternal-fetal medicine specialists. So, not only do you have access to midwifery care and all that involves, but if you need a referral or if you need co management, again, if you had like a high-risk pregnancy, or if you had some sort of comorbidity that need to be co-managed gynecologically, then we have those options as well. And we're very fortunate in the sense that our physician group is also very supportive of that midwifery model and the idea of equity in care and accessibility in care. And so, I feel like we provide this really amazing space for care for women in Memphis.

Host: Absolutely. Well, Amanda, thank you so much for joining us today, for all the work you do, and for sharing this important information with us.

Amanda Williams: That was my pleasure. Thank you so much. Clearly, I could talk about it all day.

Host: We love that. Thank you. And thank you for listening and for making One on One with Regional One Health part of your journey to better health. Join us next time for the Regional One Health podcast as we cover another important topic to keep you on the path to a healthier tomorrow.

Learn more about our midwifery team at regionalonehealth.org. You can schedule an appointment at our East Campus by calling 901-515-3100 or at Hollywood Primary Care by calling 901-545-6969.