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Prakash Chandran:  Trying to decide whether to give birth at home with a midwife or in a hospital setting led by a doctor. Well, A common misconception is it has to be one or the other. And today we'll be talking about how you can get the best of both worlds. We're going to talk about it with Sarah Kelly, a certified nurse midwife at Sierra Vista regional medical center.

This is healthy conversations. The podcasts from tenant health central coast. My name is Prakash. And so first of all, Sarah, it is great to have you here today. Let's just start with the basics here and tell us what exactly a midwife is.

Sarah Kelly: thank you so much for having me on the podcast. And there’s several different types of midwives, but I'll be talking mostly, about certified nurse midwives. And so we are highly educated health professionals who have either a master's degree or a doctoral degree in midwifery and women's health.

And on the long standing tradition of midwifery, that birth is a normal physiological process.

Prakash Chandran: I see. And can you tell us a little bit about the background or the history of midwifery?

Sarah Kelly: Yeah. So midwives have been caring for women since the beginning of time. I guess as long as there have been babies being born there have been midwives helping them deliver their babies in their homes. And in the United States, Midwives were highly utilized like in colonial times. And then as obstetrics came to practice pregnancy and birth shifted and was thought of as being more of a pathological process that required more intervention.

And that's how we got things like forceps and. At a PZ autonomies and C-sections and many good things came out of trained obstetricians. But at that time, midwives started being less valued and birth shifted to the hospital scene and midwives were mostly taking care of. Women in poor communities.

So you'll hear of the granny midwives or the black midwives of that time that were still doing a lot of bursts, say in the 1940s, but you would rarely see, a midwife in the hospital scene. And then like during world war, to after the baby boom midwives entered the scene a little bit more at that time, because there were so many babies being born and they obstetricians needed help.

But midwifery was always just passed down from midwife to midwife. There wasn't a lot of formal training in the United States and that didn't really happen until the 1920s when we started training nurse midwives. And in the 1970s is really when midwives entered really started being more present at birth again as the.

The idea of physiological labor to cold again. And so that's what we're seeing today is the shift from, women being with women and labor, to like obstetrics being the normal to now this pendulum of hopefully continued growth as. Collaborative practice between midwives and physicians.

And so that's where we're at today.

Prakash Chandran: Yeah, let's talk about that a little bit. I'd love to understand a little bit more about how you see your role as the midwife versus the role of an obstacle.

Sarah Kelly: Yeah, that's a really good question. So midwives are the experts in normal, and I would say obstetricians are the experts in illness. And so the midwifery philosophy really. Believe that birth is normal, and that it doesn't always require intervention. And so sometimes midwifery is really about doing nothing versus always trying to do something.

So that could be a simple thing holding a patient's hand or rubbing their feet or encouraging them and supporting them and trying to preserve the physiological. Process that's happening in a woman's body. And so sometimes having a midwife in the practice just slows things down a little bit, realizing that not everything has to be fast or Rashed or changed, but sometimes we need to just let women do what their bodies naturally do.

And then there's times that things aren't normal. And midwives are really trained to recognize when things aren't going well. And hopefully we've established a really good relationship with that patient to help them, still go through this process empowered and oftentimes bringing in the physician at that point, either collaboratively or possibly transferring care, if the patient needs a medical intervention.

And so it's really a team effort. And honestly, I think it's the best way that we can PR practice when we have midwives and physicians working together and really understanding each other's roles and figuring out what each of us do best. And then we can provide a really great safe care to patients.

Prakash Chandran: Yeah. I guess my next question is around Leno midwife typically gets involved. Is it only at the hospital that people see you or do you get involved in the beginning of the pregnancy?

Sarah Kelly: Yeah. My scope of practice is really from like teams. So from Monarch to, post-menopausal, and I often have young people coming in to see me even in the clinic for their first GYN exam. And then certainly they, I see them in the clinic for their prenatal care and also during their.

And postpartum.

Prakash Chandran: Okay, so you really touch every stage of a woman's life. Wouldn't you say?

Sarah Kelly: I think so. I mean, that's the goal that people feel like they get good care and it's, then, their pregnancy is like this really unique time They feel ready oftentimes to be healthier. And so you can really take advantage of that during that time as they're growing their babies, to help them be. Healthier in all aspects, emotionally and physically which I think is really helped them in their labor and their birth experience.

Because I think the longer that I'm a midwife, the more that I realize that, it's less important of how somebody gives birth, but really it's. Important of how they perceive themselves and their journey to becoming mothers. so I think that happens as they inter health care women's health whether they're seeking, a discussion on gender identity or birth control or whatever that might be setting the stage for them to have healthy pregnancies and really empowered or.

Prakash Chandran: Yeah. That is an amazing observation. That is so important that I don't think is talked about enough. So thank you for highlighting that. I'm remembering when we had our daughter with just about a year and a half ago. We had a doula and. I remember that doula being very supportive, not only to my wife, but to me as well, just because I had never done this before.

I didn't know what to expect. I didn't know that the pain that my wife was going through was normal. There's a lot, I think that. Is involved, through not only the pregnancy, but the labor process. So the doula was very helpful in that way. So my question really is around how might a midwife's role be different or the same as that of a doula.

Sarah Kelly: Yeah. I'm glad that you got that experience because I think that doulas are so important in our system and I really hope that. We can help to integrate them more into our hospital as well. But they can definitely be Really amazing for a birth experience because they're typically, coming to your house and early labor and then following you through a future transition to the hospital and they can be there for you postpartum, which is really great.

And so I would say that their role is more of a supportive role, like you highlighted where they're able to. Give both of you ideas of what kind of things to do. And I would say that, midwives and doulas really complement each other in that way that, we may have some of the same supportive measures, but a midwife might not be able to be at your bedside, the whole entire labor, cause we may be taking care of other patients too, and may have to leave.

But I think Our goals are the same of recognizing that women have better outcomes when they have support. And we actually know from research that having a support person, another woman in the room when you're giving birth reduces your risk of C-section and helps you to cope. Yeah.

It's really a complimentary role. The doulas, aren't really there to give medical advice where a midwife can do that. They're not medically trained, but they're certainly trained in their expertise of supporting women. And then, they don't deliver the baby or catch the baby like midwives stew, or do you know.

Laceration repairs and that kind of thing. But it's certainly a complimentary role, just like there's a complimentary role between midwives and doctors as well.

And of the nurses. We can't forget the nurses on the unit either because they are so integral to everything and the team, you know, when you have a good team of, people that all have their expertise, then you get the woman is at the center of her care and she gets the best care possible, which is ideal.

Prakash Chandran: Yeah, absolutely. And I think that you explained it well, I think the missions are the same between a doula and a midwife. but you know, in terms of what the doula can offer, it's a little bit different, they may not necessarily be medically trained, but they can be at your side more often than a midwife can, but then the midwife can do things like catch the baby in that laceration repair that you're talking about.

And I think that joint mission of just helping women have better outcomes through support is really one that the entire team. Can get behind. So let's talk about how a midwife might integrate into a woman's birth plan. I remember that when my wife and I were preparing for the birth we were told to write a list out of the way that we wanted things to go.

So at what point do you get involved?

Sarah Kelly: Yeah. Generally this is talked about when the woman is ready to talk about it. And sometimes it's earlier a later, but usually I'm trying to bring up the topic of birth, by 28 weeks or so. And women are sometimes taking classes and. Finding ways to prepare themselves, for their birth.

And oftentimes they do want to come up with a plan. And as we know, birth can't really be planned. So it's really more of a preference. But what I really try to help women do is to have a lot of tools in their toolbox so that they. Have things that they can do in labor, because whether or not they're planning, a natural childbirth or they're planning medication or an epidural, there will usually be a time and labor that you need to do.

Find ways of coping. And so we can, discuss that of what kind of tools they might use in coping. And that may be having a doula that may be attending, a specialized child birth class, if they're interested in something. But I try to help women form. A preference of what they would kind of like, and some women come in with really specific goals, that they really want an unmedicated birth.

I want to make sure that they're going to have that support. And so then I would try to help give them that support in their labors.

Prakash Chandran: Yeah, that makes a lot of sense. So when it comes to the delivery itself, what role does the midwife play in that OB GYN team during birth?

Sarah Kelly: So we independently take care of many women when they're admitted to the hospital and throughout their labor and throughout their, birth. And as they deliver their baby. So sometimes it's just an independent. Management or, caretaking of that particular patient.

Sometimes patients that. May still really benefit from midwifery care, but maybe they have some medical problems like gestational diabetes or high blood pressure. And so sometimes then it's a collaborative, caretaking. So I might be there with them during their labor and also deliver the baby.

But the physician might be involved in. Managing the blood pressure or the diabetes medication or that kind of thing. Some women will have complications that require a C-section. And so I can assist with the C-section so that that patient that I've established a relationship with, I can still be a part of their birth.

With the C-section so it can be on all different levels.  

Prakash Chandran: Absolutely. And, just as we close here, one thing I always like to ask is, in your role, Sarah, you have worked with many women and I'm sure you've seen the range of different situations and emotional dispositions. And so if there was one thing that you wish more women knew.

Before they came into the hospital or just before they engaged with you, what might that be?

Sarah Kelly: It makes me think back to my own experience when I had my first baby, which is what sort of drove me to be a midwife. And I had my baby with a midwife and she was so amazing. She was with me during that labor, she spent endless amounts of time. Spraying my back down with the nozzle and the shower to help relieve my pain.

And she really taught me and helped me to believe in myself that I could give birth and I felt very empowered by that experience. And I feel like that has guided me on my own journey as a midwife. And I think that I would want to give that. Back to women that they are strong and that they can force their babies and that they should feel like they can speak up and labor and up, there are part of the decision making in their birth and it should be okay.

Experience that they feel satisfied with and happy with versus, something that they felt like they weren't a part of or that they didn't have any voice in.

Prakash Chandran: well, Sarah, I think that is the perfect place to end. Thank you so much for sharing your story and sharing all of the information today about midwifery. I truly learned a lot, so thank you so much. That's Sarah Kelly, a certified nurse midwife at Sierra Vista regional medical center. For more information, it, go to tenant health central coast.com And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been healthy conversations, the podcast from tenant health central coast. Thank you so much. And we'll talk next time.