Caitlin Whyte (Host): This is St. Joseph's Health MedCast. I'm Caitlin Whyte. With me is Sara Donnelly, a Certified Nurse Midwife from St. Joseph's Health. Join us as we talk about maternal health before, during, and after pregnancy.

Now, Sara, to start us off, what is a Certified Nurse Midwife and how does your role differ from an OB GYN?

Sara Donnelly, CNM: Sure. So a Certified Nurse Midwife is actually one way you can become a midwife that is in the legal scope of practice in New York state. So a Certified Nurse Midwife means that you've had a background in nursing, you have a registered nurse license, and have chosen to pursue an advanced degree to become a provider.

So similar to how people think of nurse practitioners, something like that except for the Certified Nurse Midwife scope is broader than that of like a nurse practitioner and that we work in the inpatient and outpatient setting through the care of women's health through, normal preventative care, GYN care, reproductive healthcare, and then again, prenatal care, labor, birth, delivery process, and postpartum.

 Most people don't realize we do GYN care on top of prenatal care. Most people associate midwives with babies and labor and birth. But we do all the normal preventative healthcare as well for women's health. The way that we differ from a physician is really in two main ways, the scope of our skillset, and then the model of care.

So in the scope of our skillset, midwives are really sort of trained in a niche space. So we do all the same clinical, medical training, background that physicians get in normal, healthy labor, pregnancy, birth process, that kind of thing. In the terms of GYN care, basic preventative healthcare, dealing with minor complications of GYN and reproductive health, but midwives do not have surgical skills, so we do not do GYN surgeries as management and treatment like physicians do.

We do not do C-sections as physicians do.So our skillset is smaller, and because of that we focus a lot on the healthy and normal process of healthcare in terms of management of health maintenance through the lifespan, from adolescence to post menopause and then through prenatal care and the labor and birth process.

 In terms of our model of care, physicians are really trained, in a model of identifying pathology or what's abnormal. Midwives are actually trained in looking at the person from a holistic standpoint. Just to clarify, holistic, a lot of people think that word means like non-medical or a lot of alternative measures. And while we do some of those alternative things and have that in our artillery in terms of our skillset; holistic really just means we look at the whole person, not just what's happening, like what you're there for particularly that visit. But how do other things play into it? How does your social, cultural influences in your particular life play into your care? Your ability to carry out a treatment plan that we set for you, your resources that you have? How does your understanding of healthcare and your health history and your health competency affect your ability to participate in your care?

 So holistic meaning the whole person. We also focus a lot on shared decision-making in our model of care as well assort of preserving that patient autonomy and protecting trauma-informed care. So really allowing the patient as the participant to work the plan of care with us while we guide the safety and the medical space and the clinical space.

And we rely on them to guide us in the space of their own body, their own family, their own social structure, and anything that's in their life contributing to it.

Host: And when it comes to those differing roles, how do midwives collaborate with physicians and other healthcare providers at St. Joseph's?

Sara Donnelly, CNM: So I think we have a really great model at St. Joe's, that where our physicians and our midwives have worked really collaboratively as a team to preserve a model that puts the patient first and allows for the safest, highest quality patient care. So, the patient really is the center of the focus. And when somebody's seeking midwifery care specifically, they want to see the midwives for that holistic, more personalized experience.

However, if complications arise in the pregnancy or we need physician consult or input, we work with our physician counterparts to collaborate and make a plan that is safest for the patient. In the outpatient setting that might look like us sharing care between the physicians and the midwives. If it's truly safer for the patient to see the physicians exclusively, then we recommend that and we transfer the care completely to the physicians.

 One of the benefits of care at St. Joe's is that in other practices, when you're seeing a midwife and something arises, you then just move to seeing the physicians exclusively. At St. Joe's, you can still have midwifery care and then you can have the additional higher risk expertise of the physicians to guide that care.

And you can still have a birth with the midwives with that physician consult and collaboration in the background. So it's kind of the best of both worlds.

Host: Well, why is it also so important to focus on care, not only during pregnancy, but before conception and after delivery?

Sara Donnelly, CNM: I can't emphasize enough how important things like preventative healthcare and lifestyle factors are in a healthy pregnancy and in terms of planning a healthy pregnancy, or even if you're not planning a pregnancy, knowing you're a reproductive agent, could potentially become pregnant. Preventative healthcare, seeing your PCP annually, identify and manage any current health conditions, getting recommended immunizations, recommended screeningsand also one of the most important forgotten pieces about general healthcare is managing mental health and stress. And this is through things like therapy, lifestyle modifications and medication support if it's needed.When we take a hold of our healthcare and are active participants in our healthcare, we optimize the health of our bodies so that when we try to become pregnant, then have a pregnancy, we can more easily conceive and sustain a healthy pregnancy. The preventative healthcare is huge.The other factors that play into it are lifestyle factors. So things that you wouldn't necessarily see a physician for or a provider for, but things that you do day to day, like focusing on diet, limiting processed foods, avoiding like high carb, high sugar diets, intentional activity that's incorporated into your day-to-day life and this is a lot of times you hear people say like, oh my gosh, I'm so active. I have toddlers at home. I work full time. This is like, I'm standing up all day. And while those things are very true, and we would never discount how much people's lives are active day to day because we all live in this busy, busy world.

 Intentional activity on top of your day to day is what's really important, like 150 minutes of intentional activity. And it doesn't have to be intense exercise, but it could be like a 30 minute walk, once a day or something like that, or a couple times a week on top of your day to day, limiting substance use or eliminating it.

Talking about smoking cessation, stress reduction is huge again, with the mental health piece and sleep. People just don't understand how much sleep is so critical to all of the other things I even just said.The importance of these factors as like a health maintenance before pregnancy really can change the course of your entire pregnancy in terms of the risk factors and the health of the pregnancy.

Host: Well, on that note, what steps can women and people take before becoming pregnant to improve their outcomes?

Sara Donnelly, CNM: So one of thebiggest pieces that I think is so underutilized is preconception care. So preconception care, if you're planning a pregnancy, looks like calling up your OB GYN practice that you see and saying, Hey, I'm thinking of becoming pregnant. I'd like to talk to somebody about that. And we bring you in and we can identify some of these risk factors or lifestyle changes that might need to happen to optimize health for the pregnancy. Another huge thing that's super easy is taking a prenatal vitamin. You can easily like three to six months prior to trying to conceive, I would recommend, that you take a prenatal vitamin, to sort of address any potential deficiencies, dietary deficiencies, things we don't even know are going on in our bodies.

And again, an optimized health for that early conception period. Most people don't realize that a lot of the early development of baby that happens that is critical to the ongoing health of that baby and function and development of a healthy system for that baby, happens in those first few weeks sometimes before you even know you're pregnant, a lot of those things are already developing. So starting a prenatal vitamin early can help with a lot of those things that we know support that healthy development. And on top of the again, the preventative healthcare I talked about, andthe lifestyle factors of diet and exercise, those are the main things I would say.

 Not everybody's planning a pregnancy. So I would say anybody that is able to become pregnant, that is of reproductive age, it is a really great idea to take a prenatal vitamin as your daily multivitamin anyway, in case you do become pregnant. Then again, talking to your providers at your annual visits about, health maintenance.

Because again, not everybody's actively trying to get pregnant, but when a pregnancy happens that is unplanned; if you've maintained some of these day-to-day health maintenance factors, and you're taking that prenatal vitamin, the chance that you will be in a better place once you get pregnant in terms of the health and development of the fetus is, is a lot stronger.

Host: Well, what does comprehensive prenatal care look like at St. Joseph's? How do you support pregnant people through high-risk pregnancies or complications?

Sara Donnelly, CNM: Ideally what would happen for comprehensive prenatal care is you would start with that preconception appointment if you are planning a pregnancy. So you come in, we talk about those risk factors. We talk about planning the pregnancy, timing wise, taking your prenatal vitamin, how to become pregnant. If you're not planning a pregnancy or you didn't make a preconception appointment, that's okay.We would wannt to see you in the first trimester.

And that means sometimes in that first, like 12 to 13 weeks by your estimation from your last period. Ideally we start seeing people between eight and 10 weeks. So a lot of times people are really excited. They call us up, they're like four or five weeks pregnant. It is okay to waitand typically we will because that first ultrasound is critical to dating and if we wait till that eight week range, we can typically see everything we need to see to confirm that we have a healthy developing normal pregnancy. Certainly, if you have concerns prior to that, we would love to see you before that to address those concerns. But from there, your pregnancy would continue on a schedule which amounts to around 12 to 14 visits during the pregnancy, with increasing frequency and, as the pregnancy gets closer to term. AtSt. Joe's, you can elect to see just the midwives, like I said, and we love, the strong presence of midwifery care we have here.But you can also see the physicians or our other mid-level providers, we do have an NP and a PA that also do care with us.

So you could see any of these providers depending on your preference and availability. And then, your visits typically they kind of look uneventful a lot of times, but we're doing a lot of things. We're checking your blood pressure, looking at your urine to see if there's any concerns with anything in there.

It gives us a good indicator of what's going on with your overall health, your kidneys. We measure the belly in terms of the fundal height, where we measure the size of the uterus. And we listen to the fetal heart rate. So these are all general screenings we do to make sure baby's doing well. So those things can take up a relatively short amount of time if all's going well.

 But the rest of the time is your time to really ask all your questions.Everybody likes to say, oh, this is TMI, like nothing is TMI. If you are wondering about it or anxious about something, we want you to ask it like nothing's off the table. There's a lot of doing people's own research online, looking at things or seeing things on social media that spike questions or concerns.

And we really want you to bring that to us. Like, I, I know that there's a stigma out there of like, Dr. Google or what, WebMD or whatever it is. I don't think we feel that way. Most providers that are good providers want you to say like, Hey, I did look this up. Because we want you to be invested in your own care.

 But bring it to us and let's talk about it because a lot of what you see online is not in any way monitored or controlled for, and the misinformation is rampant. So we do want to talk about it and say, is there any truth to that, And what is the concern? Or is that not really a thing that we worry about at all?

 Because we want you to have the information that you best need to make the best plan for yourself, and to participate in your care, like I talked about before, to find the best fit for you in terms of your experience and to have a safe and healthy pregnancy. In terms of like a complicated pregnancy, some complications arrive during the pregnancy.

What that's going to look like is you're going to probably have more frequent visits with us. We might do more screenings. We might look at more frequent ultrasounds, more frequent lab work for some conditions. There's a test called an NST, and what that is is when we put the monitors on and look at the baby's heart rate over, you know, 20 or 30 minutes, sometimes we do those more frequently.

And these are all just to monitor the health of the pregnancy and the health of the mother for any progressing complication. When a pregnancy becomes complicated to a point that we need to involve our physicians for more high-risk input; the next level would be our maternal fetal medicine specialists.

They are OBGYNs that work on the highest risk level patients. We have you see them and we have you partner with them to help guide a safe plan of care for your pregnancy. But again, one of the best things about St. Joe's is that, if you desire a more holistic model of care and you desire more personalized care, like with the midwives, but you're having complications in your pregnancy, we can do both here most of the time.

 And our physicians are really used to working in that model and really support that as well.

Host: Well, with all this talk of essential care, why is postpartum care often overlooked, and what should women and folks know about that?

Sara Donnelly, CNM: Yeah, I think that's a really important point because a lot of people focus on the pregnancy, itself. And then postpartum is sort ofwell you're done with the pregnancy, labor, and birth, was what it was. And now here we're on the other side of things. I think there's a misconception that once the baby's born all is well for mom and baby, and while in most cases that will be the case, I do think that people underestimate the risk level there still is, especially for women in the postpartum period, butalso for babies.

So obviously at St. Joe's, once you have your baby, the pediatrician you're seeing, or family practice provider you're seeing is caring for your baby and regular, well-child visits or, or newborn baby visits are going to be important for that.

But, for terms of the postpartum side for, like the birthing parent, we want to see patients postpartum to ensure that any, if any, risk factors have changed, and any concern for postpartum conditions. And by postpartum conditions; there's a few big ones that we want to monitor for.First, like postpartum hypertensive disorders.

So these are where blood pressure increases in the postpartum period rather than during the pregnancy. You've heard of things like preeclampsia or gestational hypertension. Those things can actually be uneventful during the pregnancy and creep up postpartum. And because hypertensive disorders are one of the number one conditions responsible for maternal mortality and or like death in the pregnancy and postpartum period, I think it's really important that people know that you can have that risk up to six weeks postpartum, sometimes even a little longer, in rare cases.

One of the other major things is we want to monitor for health conditions that were occurring during the pregnancy. One being those blood pressure disorders, but another being diabetes. We need to continue to monitor for that in the postpartum period. So if you've had gestational diabetes, your risk for a Type 2 diabetes increases substantially over your lifespan.

But we also need to rule out that you're not pre-diabetic or diabetic once those hormones have kind of shifted again, because if you are, we need to make sure that is well-known to like your primary care provider so that you can continue with normal health maintenance, lifestyle modifications to address that condition.

Because diabetes is such a complicated and and progressive process, if not taken care of through the lifespan. And then one of the things I'm really passionate about, what I talk about often with patient's and families is postpartum mood disorders. It's a really, really big deal that people don't even realize sometimes occurring for them.

So postpartum depression, postpartum anxiety, and in the worst cases, like severe depressive disorders or postpartum psychosis, in the postpartum period are often unidentified or left untreated. Because we often attribute it to lack of sleep, life transition, the new high demand on your time, attention for this newborn that needs all of your care.

 And while those things are true; there's a space in which that is a normal process of sometimes overwhelm, exhaustion, you know, just kind of getting through the day to day. And then there's a space in which it begins to interfere with functioning. Mental health really begins to decline, and the sooner we can identify those,those issues And the sooner we can intervene, the less those issues are going to progress. And we can provide support there. It is when those things go unaddressed, that they become severe, and then we see the things like severe depressive disorder, postpartum psychosis, and those things will then result in prolonged hospital stays that then do separate people from their babies or even worse, like self-harm or harm to other's, in the rarest cases, but also the most extreme cases that do go unaddressed.

 People don't realize one of the biggest risks for postpartum psychosis is, a postpartum depression or anxiety coupled with sleep deprivation. And I don't really know any new parents that aren't sleep deprived. So,it's a really serious condition we want to monitor. So, once we see you postpartum it, and we will see you as many times as you need. So typically that's a six week visit. We can see people sooner to monitor for some of these things.

And then ongoing. Postpartum depression, sometimes we're seeing people for months, postpartum depression can occur and be diagnosed technically within a year's time of that birth. All of us, if you've ever had a baby or if you have been a parent or are in this field, we know that it's most likely longer than that, just on an anecdotal level.

So we absolutely are willing to see people as long as it takes to kind of work, like provide that support and monitor that process until things are in a better place. So postpartum care is so overlooked in terms of how important it is for ongoing health, the health of not only the birthing parent, the mother, and the entire family, just because if the primary caregiver is not doing well, nobody's going to do well.

Host: That is such a good point. And that brings me into my next question, even though we just dove into it a bit. But how important is it for new mothers and parents to take care of themselves, indulge in some self-care? And what kind of support should they be surrounded with as well?

Sara Donnelly, CNM: Oh my gosh. This is something I talk about all the time.I think it's important to note that, here in the US we just don't do postpartum well. We just don't do that well. There's not sufficient maternity leave, paternity leave for families. There's just not sufficient focus on the health and wellbeing of the mother, the primary caregiver, and the family.

 We don't rally around our people at the early stages of postpartum, like, like other cultures do, and it really, really shows. One of the reasons we have a higher maternal mortality and infant mortality rate in the US compared to other developed countries is in part due to this, the lack of support and resources for pregnant, postpartum, newborn period for people.

It's significant. So, I talk a lot to families about, you know, kind of creating your village, seeing who's there for support, and not who's going to come over and like, ogle over the baby for a little bit and visit and leave. People who will truly come over, give parents a break, allow maybe parents to take a shower or a nap.

 Do some chores around the house.Really provide that support and really build your village. The other thing is that oftentimes the other partner's going back to work at some point while the birthing parent is at home on leave. And so if that partner goes back to work, the sentiment is often, well, they need to sleep to be able to work the next day, but really; if you have only one baby, it's still a 24/7 job. If you have more than one child and you have a newborn, it's a 24/7 seven job times however many kids you have. So the work of caregiving never stops and the caregiver needs to also have sleep to work.

So we talk a lot about sleeping in shifts. If there's a breastfeeding parent, can she breastfeed, hand the baby off to the partner, go to sleep in the evening? That partner maybe does the first you know, either feeding or brings the baby into feed and then rock's, baby back to sleep, changes them, whatever. Then they can go to sleep so that the primary caregiver has gotten the stretch of sleep of maybe three to five hours, depending before they have to be up doing consistent care.

 And then that person who's going to work the next day does get that stretch of sleep before going in as well. So sleeping in shifts, caregiving in shifts, because nobody can do everything all the time, you know. I do believe women are super strong. Women run households, run this world like, are responsible for the raising of like the entirety of humanity for the most part.

I mean in general. Yeah. But nobody can do everything all the time. So self-care time and your time away is not time to grocery shop or do laundry or your time away is time away too sleep, nurture yourself with things that feed your soul. If that's reading a book, if that's, going out and taking a walk, if that's seeing a friend or talking to a friend or a support person on the phone or whatever it is, something that is not in the responsibility, in the realm of caregiving or housekeeping, that will help pour into you.

And sometimes that ends up being in five minute increments here and there when the day to day is hard.But it has to be a focus. Because truly, again, like I said before, if the mother is the primary caregiver and primary director, manager of the home, if she is not doing well, that is all going to fall apart.

Imagine our boss, like our boss that runs the whole company, is struggling. They're not sleeping, they're not eating, they're not able to take care of their own body, their mental health. That company will collapse. People are going to start quitting. They're going to not be having confidence in this person to run things.

 This person might be more irritable, more reactive to things because they're exhausted. Nobody wants to work for somebody like that. So it's the same thing in your home when the person who's running things is not doing well, they're not thriving, nobody's thriving.

Host: Well what resources does St. Joe's offer for mental health, recovery and lactation support?

Sara Donnelly, CNM: St. Joe's has the benefit of having a wholepsychology, psychiatry, behavioral health department. Not all institutions have that. So we do have therapy services and we refer to those a lot through St. Joe's for our patient's. We also have, obviously we have psychiatry that can help with med management.

 We can do basic med management through our own office as well. And we have emergency mental health services as well through St. Joe's, where we have the psychiatric emergency department patients can go to when there is a time of crisis. But barring that, support for mental health services is there in the outpatient setting as well.

And we can talk extensively with patients about those if they need it. In lactation, our lactation support is amazing, and we are a baby friendly institution, which means we've met certain criteria that show that we are a breastfeeding forward institution.

And while we want all patients to feed in a way that they feel is best for their situation, we do have a lot of lactation support that does help support the initiation and maintenance of breastfeeding longer than would be typical in our culture because of our lactation support. So in the hospital, our lactation consultants see all our breastfeeding patients.

Sometimes they see our non breastfeeding patients and they will help initiate feeds, troubleshoot any issues with feedings, teach about the baby's normal process of learning to breastfeed. There's a lot of support there. And then some people feel like, oh no, when I go home, I'm not going to have this.

But our lactation is so available to our outpatient patients, once they go home, they are available by phone. They will automatically call and check in and see how things are going. Then they can set you up to come in and have a lactation appointment in-person if you're still struggling.

Or they can help troubleshoot things over the phone if coming in-person is just really too difficult and will work with whatever you need. Our lactation support is great in terms of, seeing a lot of our patients, particularly in our clinic inthe prenatal period as well, so we can start helping to answer some of these questions and teaching about the breastfeeding process.

So, it is less intimidating when parents get to it, immediately postpartum if they've never breastfed before or even if they have, and this baby is just a little bit different in terms of issues with latch and stuff. So our lactation is really, really great. And in the recovery, I mean, we talked a lot already about the importance of support, really communicating with your number one support person, if that's your partner or somebody else in your home, about how postpartum recovery is going to look to best support, not only caregiving for the baby; but the recovery for the birthing person or the mother. The birthing person, or the mother has gone through a massive transition when we're talking about a medical clinical standpoint;in terms of the shift in hormones, the shift in the like the cardiac workload. We have so much extra blood volume when we're pregnant to support baby and placenta and ourselves.

That then has to downshift and that's a big feat for the body. We have, you know, active,if you think of the placental site in the uterus, like it's an active open wound that's closing and healing and it's a large wound. If that was on the outside of our body, we would treat that a lot differently in terms of, because you could see it, in terms of rest and recovery than we do for the postpartum mom, because we can't see it. It's like, oh, your body's just doing it. Well, yeah, but you need to pour into yourself with like, rest, hydration, nutrition. On top of yes, the demands of caring for this newborn. So, it's not easy. It's really not easy, and that's why other cultures have so much support surrounding this postpartum and recovery process.

 And the renewed focus on that is something we talk about a lot with families because it's really critical to medically, like clinically healing in terms of the health of the mother overall, but also just feeling well sooner in the postpartum period to be able to adjust to the demands of this life transition.

Host: Absolutely. And lastly, Sara, how do you see midwifery shaping the future of women's healthcare?

Sara Donnelly, CNM: It's well-known that there is a like a medical staffing shortage in our country that's growing. And in this, in particular, a physician shortage to meet the growing demands of healthcare needs of the citizens of the country. So,in that too, with the, you know, political climate we're in; Women's health is not a desirable field necessarily for a lot of, physicians coming into the fold. But of course, there's always people that are very passionate about it and are going to come into this space no matter what. Like a lot of people that are currently in it. However, because of that shortage, the providers such as midwives and then other mid-level providers like NPs, PAs, they're going to be relied upon more heavily in all fields, especially in in OB GYN, through women's health because it is a particularly niche field that isn't drawing a ton of new providers into the fold.

 With the increasing presence of midwives, I really think that you're going to see a shift and we have seen a shift and I think people can attest to this and we hear it often.Maybe, grandmothers to these babies or great-grandmothers are saying like, oh my gosh, it was so different when I had my baby.

Because it wasn't as family centered. It wasn't as patient centered. It was, we do what we need to do to get the baby out, kind of thing, to have a healthy mom and baby. And honestly, when we're notincluding the patient in their plan of care and in shared decision-making, we're actually creating more risk when we think we're doing well.

So the shift of midwives is really a cultural shift, I think in a lot of ways where the model of care changes, where we focus more on that shared decision-making with the patient, the collaborative care where we focus on trauma-informed care. Trauma-informed care, meaning we get your consent to do a procedure, to go ahead with whatever plan of care it is and collaborate with you while guiding you with the informed consent being like we discuss the risks, the benefits, the options, and together we make that plan of care. And also we, it is our job to inform you when the plan that you want is unsafe.

So really it's more patient centered, I think is is going to be a big shift and has been, we already see. And then again, and I sort of touched on before the discussion of like patient's doing their own research online and things like that. Honoring that, honoring those questions that, the fact that somebody's invested in their health enough to go look something up is what we want as providers. As midwives, I think we try to focus on decreasing that stigma. Like, we don't care if you went on Instagram and saw something and we're not judging for that. We're, we are wanting to discuss what you saw.

 Because healthcare historically has operated in a way where,it was like the physician makes the plan of care. That's the plan of care. It's like that's what it is. It's carried out. Because that's the safest plan of care. And like the physician decided that. And then the stigma around patients wanting to push back on that and saying like, oh, well we're the medically trained ones.

Yes, of course we are, we are experts in our field. But they're experts in their own bodies and they're experts in their social circumstances, their culture, their religious background, their family. They know best themselves and we know best the clinical information. So we work together. I think that culture shift is a big, a big deal. On top of a culture shift, it's well-established that where there's a lot of midwifery presence, there's better outcomes. And that is in part related to some of this culture shift, the attentiveness, the patient-centered care, the shared decision-making and informed consent with patients. So improving the outcomes.

Again, like I mentioned, the US has an abysmal maternal and neonatal, and perinatal mortality rate for it being a developed country. There's so many factors that play into that. But we do know, and that's a whole other conversation, we do know that when there's a stronger presence of midwives, those outcomes are better.

 Part of the reason and this also plays into like declining costs that midwives create in the healthcare system. We just don't have the skillset Physicians have, like I mentioned, we don't do surgery. So while a surgeon might look at a potential situation and say, okay, this is what the situation is, we're going to fix it by just doing a C-section, just doing the surgery because they can, because they have that in their tool belt.

And that's not to say that's the wrong choice in that situation. That's case by case. But midwives do not have that in our library of tools. What we do have is a lot of other ways to address what would be looked at as maybe like abnormalities in a labor process or something like that. And those ways oftentimes work and we don't need a c-section.

 Certainly if the risk is there and there's a safety issue, we would always recommend like birth a different way or intervening a different way and, and we consult with our physicians that way. But because midwives as a whole have a different skillset, we address some of these abnormalities differently, and it ends up lowering interventions, lowering rates of C-section delivery, which in turn lowers risk for future pregnancies.

So overall, you're gettinga lower cost in the healthcare because of the lesser interventions. And then lower risk going into next future pregnancies or future health maintenance because you have avoided some of these interventions that create a lifelong, risk to your health or risk to pregnancies at times.

So, while we don't want this physician shortage that's happening or this healthcare shortage that's happening, the shift that will happen culturally cost-wise to the healthcare system is a positive one with a larger presence of midwives.

Host: Sara, thank you so much for your work and for joining us today. Sara is located at St. Joseph's Physician's Primary Care Center, OB GYN next to the hospital.

You can call 315-703-5200 to make an appointment with a midwife. And for even more information, head on over to sjhsyr.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for more topics of interest to you. I'm Caitlin Whyte, and this is St. Joseph's Health MedCast. Thank you for listening.