Melanie Cole, MS (Host): Welcome to One on One with Regional One Health, your inside look at how we're building healthier tomorrows for our patients and our community. Join us as we get to know some of the individuals who help provide life-saving, life-changing care for our community and for expert insight that empowers you to achieve a lifetime of better health.

I'm your host, Melanie Cole. And today, we are learning about midwifery for each stage of a woman's life. Joining me is Davin Johnson. She's a certified nurse-midwife with Regional One Health. Davin, thank you so much for joining us today. Why don't you start by telling us a little bit of the basics of midwifery? What is unique about this model of care? Tell us a little bit about the training. What's a midwife?

Davin Johnson: So generally, when people think of midwifery, they think of childbirth. The term can actually refer to three separate entries into the profession. So, I'm a certified nurse midwife, which is an advanced practice nurse or nurse practitioner. We all have a bachelor's in nursing as well as a master's in nursing. Some of us even have a doctorate in nursing. We're licensed to prescribe. We can practice in hospitals and clinics and various areas of that matter. Some people sometimes get us confused with certified professional midwives that don't have a nursing degree. They do not prescribe. They generally work in birth centers or the home birth setting.

And then, there's also lay midwives who don't have any formal training. They practice under another lay midwife, but there's no licensure, there's no oversight, and they only generally deliver at home. So today, we're going to focus on certified nurse midwives, but I just wanted to let people know that there are other types of midwives out there and the distinction between the three.

Melanie Cole, MS: Well, thank you so much, Davin, for that because that is an important distinction. And we're going to talk about a few of the myths, but I think that you just broke up a few of them because that's where those distinctions are so important, and that's where they come to play. I think people have a lot of misconceptions about midwives, and you just separated out certified nurse midwives and why that's so important to know that distinction.

So, let's go through a little bit of the stage of a woman's life and talk about the services that you offer, starting with young women who are just starting puberty. When should a woman start to see a midwife, and what do you provide to our younger patients?

Davin Johnson: So, you can start to see a midwife at menarche or first menses or period. That's different ages for different women. But you can see us for well women care, so just routine physicals at that point. Whether you just choose to see a midwife or a pediatrician is completely up to you at that point. We can also help with issues related to menstruation or periods, such as painful or heavy periods, give advice in that area, and then any women's health needs, concerns, or questions someone might have from the time of that very first period.

Melanie Cole, MS: That's very comprehensive care and something that I think people really don't realize that midwives do provide. So now, let's talk about pregnancy for those patients who want a family. What do you provide in terms of prenatal care, childbirth support, and even postpartum care?

Davin Johnson: So, we focus on a holistic and physiologic view of birth to where we take care of the whole woman. We consider social issues that may affect health as well as their healthcare. We provide their prenatal care. We deliver their babies in the hospital. We're backed up by a team of physicians should we need their help in case of a complication.

But generally, in most cases, we provide their entire care from initial prenatal visit, ordering labs, referring for ultrasound, educating on pregnancy and childbirth, supporting breastfeeding, postpartum care, all of that is included in midwifery care for pregnancy.

Melanie Cole, MS: Wow. That is a lot of care. Now, I'd like to stick with the pregnancy thing for just a minute and break up a few of these myths and misconceptions. Now, you already cleared one of them up by saying lay midwives are really just involved in home births. So, certified nurse midwives, and you said, work in hospitals. And so, you can work in hospitals. Now, when we think of some of the myths, women can't have an epidural if they're working with a midwife. True or false?

Davin Johnson: False. It is actually anesthesia in the hospitals that provide the epidural, even if you were seeing an OB-GYN for your care. So, you have access to those same anesthesiologists or professionals that you would if you were seeing a physician.

Melanie Cole, MS: And how do midwives work with OB-GYNs? Is there a separation? Can they work together?

Davin Johnson: At Regional One, we have a collaborative relationship where there is a team of physicians on the unit as well as a midwife at all times. We manage our low-risk patients, but they support us. We sometimes co-manage patients if they need a slightly higher level of care but still want a midwifery-supported birth. And then in some cases, when a woman's risk is completely out of our care, they're seen by the physicians. But even then, we work with them as well to support physiologic birth.

Melanie Cole, MS: Well, that was my next misconception right there. So if someone is a higher risk pregnancy, you can still attend to them, you just are working with their high-risk physicians, yes?

Davin Johnson: Yes. At Regional One, we have specific guidelines on what we can co-manage with the physicians, what we can manage independently versus what has to be transferred entirely to physician care. But in most cases, we are able to co-manage or manage independently for low to mid-risk patients. Occasionally, there's a patient that will get transferred completely to physician care, but our physicians are very supportive of the midwifery model of care, so they still get a supportive birth

Melanie Cole, MS: Isn't that lovely? I love to hear that because I think that that multidisciplinary and really integrated care is so important for that woman when she's going through that such exciting time of her life. So now, let's talk about general wellness care for women. When after birth, and we talked about postpartum care, tell us a little bit about what you offer for postpartum because there is issues. You mentioned breastfeeding. There's also certain mental health issues that come with postpartum care. Tell us what you offer for women after they have a baby.

Davin Johnson: So at our practice at Regional One, we round on our postpartum patients inpatient, whether they were vaginal or even if they received a C-section by the physicians. If they got midwifery care through their pregnancy, they still get a midwife postpartum. So, that would include incision care if they had a C-section. We screen all of our postpartum moms multiple times, both in the hospital and the clinic for depression. We offer breastfeeding support, and we also have lactation consultants in the hospital that specifically work with them on lactation. We refer them to service support services such as WIC. WIC can help with food or formula if they choose not to breastfeed.

And then clinic-wise, we like to see our patients at least two to three times outpatient postpartum to follow up and provide that support is, again, screening for depression, providing lactation consults, looking for potential complications such as bleeding or infection, and educating our patients on those things so that they know what is normal versus abnormal and when to seek care.

Melanie Cole, MS: It's such a great model of care, Davin. It really is. And so compassionate as well. How often should women see you, and how does the care evolve as a woman ages? I mean, I am a post-menopausal woman in her 60s. So, tell us a little bit about how care changes through the years.

Davin Johnson: So generally, bare minimum would be at least once a year for a routine physical. So, well woman care, which we provide as well. So, that can be anything from just routine labs for cholesterol, screening for diabetes, checking your thyroid. You should do that at least once a year for routine physical, and as a woman, that can be with a midwife.

Then, we have patients who see us intermittently for contraception or birth control needs, for women's health issues such as heavier painful periods that may arise, for STI testing or screening for sexually transmitted infections and problems such as that that may come up.

Also, when we're initiating birth control, we may see you for a follow-up appointment to make sure that that birth control option works well for you and that you're happy with it, or depending on the type of birth control, such as the Depo-Provera injection, you may be coming in every three months for repeat doses.

Even women who are post-menopausal, there's still recommendations for cervical cancer screening up to age 65 if you've had all previous normals. So, we do cervical cancer screenings or Pap smears. We do breast exams. We do referrals for mammograms. We encompass well woman healthcare. And if need be, we have a team of physicians that we can refer to if you have a problem that may require surgery or something that a midwife can't provide, because we have a collaborative model of care at Regional One.

Melanie Cole, MS: Well, it certainly is a collaborative model of care. Now, tell us a little bit about you, your team. What inspired you, Davin, to get into this line of work? And tell us about your philosophical approach to care, to patient care for women as a whole person.

Davin Johnson: So, one of my biggest things is patient education and advocacy, because the more you know, the better you can take care of yourself, the better you can advocate for yourself in healthcare settings.

As far as what inspired me to get into this, I honestly feel like it was always in me and it was my calling. There's even a picture of me from second grade where I say, "I want to deliver babies," and I'm in a little white nurse's uniform with a stethoscope. So, I feel like this has just always been meant for me to do, and I'm really compassionate about helping women, about empowering them with knowledge about their bodies, what's normal, what's abnormal, and ensuring that when they get care, they feel safe and that they feel like they can talk about any concerns without feeling judgment, without feeling fear, or without being forced, because I advocate for choice.

Even if I don't necessarily agree with your choices or if you choose something that's outside of medical recommendations, it's my job to make sure that you know what the medical recommendations are and the reason. But ultimately, you get to choose what care you get or don't get at any particular visit.

Melanie Cole, MS: Wow, that was beautifully said. Davin, thank you so much for joining us and not only sharing your incredible expertise and compassion for our listeners, but also for explaining what midwifery really is and clearing up some of those misconceptions. That was so important. Thank you again. And for more information, please visit our website at regionalonehealth.org/midwifery to get connected with one of our providers.

I'm your host, Melanie Cole. And thanks for making One on One with Regional One Health part of your journey to better health. Join us next time as we introduce you to another member of the Regional One Health family and cover another topic to keep you on the path to a healthier tomorrow.