Cheryl Martin (Host): Some expectant mothers want a more natural approach to pregnancy and childbirth and a more relaxed birthing experience. One option, choosing a midwife healthcare provider. With us to explain what a midwife is and the midwifery model of care is Samantha Crouch. She is a Certified Nurse Midwife at UAMS Northwest.

 This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Cheryl Martin. Samantha, thanks for coming on.

Samantha Crouch, DNP, CNM, IBCLC: Yeah. Thank you so much for having me.

Host: First of all, explain what a midwife is and what kind of care a midwife can provide.

Samantha Crouch, DNP, CNM, IBCLC: Yeah, so a Certified Nurse Midwife is an Advanced Practice Nurse. We offer care to women across the lifespan from adolescence all the way through menopause. So, whether that's a 15-year-old with irregular periods or, a mother through her pregnancy and postpartum all the way through, menopause and hormone therapy and everything that comes at that stage of life. And so we really offer care across the lifespan.

Host: So why would someone go see a midwife?

Samantha Crouch, DNP, CNM, IBCLC: So there are a few different reasons that somebody may go to see a midwife. Some people are really drawn to the midwifery philosophy of care. There's a heavy emphasis on respect for human rights and dignity and bodily autonomy and really viewing healthcare as the partnership between the provider and the patient.

We also really emphasize physiologic processes and low intervention. So, particularly when it comes to pregnancy; viewing it as a normal, healthy part of life, and something that oftentimes can transpire without us intervening too much. That said, we do monitor, pregnancies closely.

We do follow all of the same recommendations and evidence and guidelines any other obstetric provider, but just tend to have a more holistic and low intervention approach when it comes to pregnancy.

Host: Where do midwives offer care?

Samantha Crouch, DNP, CNM, IBCLC: So nurse midwives can offer care in a variety of settings. Most CNMs, certified nurse midwives practice in hospital settings. So about 95% of nurse midwives, practice in hospitals and clinics across the country. But we also can offer care in homes or community settings or birth centers. So, you can see nurse midwives in a variety of settings.

Host: Now, do midwife patients still have the option of pain medication if needed?

Samantha Crouch, DNP, CNM, IBCLC: Yes. So it is common for us, in midwifery to have patients come to us and say, I, really think that I want this low intervention birth, or I really think that I want to have an unmedicated birth. But what if I change my mind? Or what if I get into the middle of it and it's more than I bargained for, can I still have pain medication?

And the answer is yes, of course. Particularly if we're in the hospital setting, right? Of course, midwives that practice in a home birth setting or a birth center setting may have more limited options in terms of what kind of pain management they can offer. But for those nurse midwives that are offering care in a hospital setting, their patients have the same access to epidurals and IV pain medications and all the other things that any other patient would have.

Host: Do you find that your patients prefer home versus at the hospital?

Samantha Crouch, DNP, CNM, IBCLC: Most nurse midwives either do one or the other. So whatever your practice is set up to be. Some, go into a home birth practice, some go into a hospital practice. I myself, have always been hospital practice based, so the patients that I attract are then only hospital patients.

 There is a home birth practice that is made up of certified nurse midwives in northwest Arkansas. And I know that they are very busy and at capacity just about every month. So, there's a definite subsect of patients who have a preference for a home birth, but I would say the vast majority do tend to choose, a hospital birth.

Now also, I feel like I need to mention that there's that middle ground as well, which is birth centers, where somebody has more of that home-like feeling, but still in more of a medically capable facility at times. And unfortunately Arkansas does not have any birth centers right now.

We did have one for a number of years that closed maybe seven years ago now or so. And so since then we don't have any birth centers in Arkansas and we could stand to explore options for how we could get back to some birth centers operating in the state.

Host: So you've mentioned home midwives or those who serve in hospitals. Are there also different kinds of midwives in addition to that difference?

Samantha Crouch, DNP, CNM, IBCLC: Yes, and I think that this can cause some confusion among the patient population, among hospitals, among other providers. There are different kinds of midwives, out in practice. Here today we're talking about certified nurse midwives, and we are the advanced practice nurses. We have a master's or a doctoral degree in nursing practice, you know, prescriptive authority, independent practice in the state of Arkansas.

And we're recognized in all states and by all insurance carriers, as an advanced practice registered nurse. As I mentioned, certified nurse midwives can practice in hospitals or birth centers or home birth settings. Now there are also certified professional midwives and, these midwives are trained through apprenticeship.

They may or may not have graduate degrees in any number of things, but their training and their certification is through apprenticeship. And then they take their own certifying exam, that certifies them to be certified professional midwives, or CPMs. Those CPMs offer care specifically for pregnancy.

So, prenatal, delivery and postpartum. They have a different scope of practice than we do as certified nurse midwives. And they offer care exclusively in home and birth center settings.

Host: So being a CNM, is that considered like the highest level?

Samantha Crouch, DNP, CNM, IBCLC: The different kinds of midwives that exist have different skills and different knowledge and different things that we bring to the table. So I wouldn't say that one is higher than the other. I would say that ours does require a higher educational degree, and we do have a wider scope of practice and therefore more ability to offer a wider range of services.

 Certified professional midwives often bring a lot of really quality knowledge in terms of supplements and herbs and complimentary therapies, and certified nurse midwives often bring a wider array of knowledge in terms of pharmacology and pathophysiology and kind of more of your traditional medical background.

Host: And again, if you want to have your child at the hospital, it would be a certified nurse midwife.

Samantha Crouch, DNP, CNM, IBCLC: Yes, that's right.

Host: Now, how can you find out if there's a midwife practicing near you?

Samantha Crouch, DNP, CNM, IBCLC: So if you're trying to figure out if there is a certified nurse midwife that's practicing in your area, you can go to midwife.org and that is the website for the American College of Nurse Midwives, which is the professional body that represents nurse midwives. Within that website you can click find a midwife and then search by zip code, city, state, whatever and find a CNM near you.

Host: Now, if a woman decides to have her child at the hospital and to have a CNM, will her cost be less than if she were using an OBGYN?

Samantha Crouch, DNP, CNM, IBCLC: So what is the cost associated with seeing a nurse midwife? For folks who see a nurse midwife, through their clinic or through their hospital, it runs through insurance the same way that it would if you saw an OBGYN. So whatever your maternity care package looks like, the cost to the patient should look the same regardless of the provider that they're seeing.

There's good research to show that on the whole, care with nurse midwives costs our healthcare structure less than care with an OBGYN. And so when we look at the economic burden of pregnancy or the cost of the system per pregnancy, we see lower overall costs in care with a CNM. But that is not something that the patient would necessarily see so much as the healthcare institution.

Host: Now what if someone listening to this podcast, Samantha wants to be a certified nurse midwife, what are the steps?

Samantha Crouch, DNP, CNM, IBCLC: Yeah, so if somebody wanted to be a certified nurse midwife themself, the first step is to get a Bachelor's of Science in Nursing or a BSN, and become licensed as a registered nurse. So in order to be a CNM, you have to be an RN first. From there I'm happy to report that UAMS is now pre accredited to begin our nurse midwifery program starting in August of 2026.

So we will be taking applicants who have a BSN, who have practiced as a registered nurse and, take them through the program, which will be two and a half years in length. At which point they'll come out with a Master's of science in nursing. They'll take their board certification and then can go out and practice as a certified nurse midwife.

Host: Great. Now, do you have to be in Little Rock to apply or complete the nurse midwifery program at UAMS?

Samantha Crouch, DNP, CNM, IBCLC: No, you do not have to be in Little Rock to apply or complete our nurse midwifery program at UAMS. I myself am in northwest Arkansas, and I'm the program director for the nurse midwifery program. The program is designed to be largely remote. It's a hybrid program, with most of our didactic material, and core courses online. We will have in-person skills days, on the Little Rock campus once or twice a semester, once students enter into their specialty courses, which is the third semester that they would start that. From there, in addition to their didactic work, they also begin their clinical practicums. And the clinicals can take place, any number of places. Most of our clinical placements are in Northwest Arkansas or Little Rock, but we also have some in Jonesborough and also some in Texarkana, and a few outside of state lines as well.

So it is possible that folks will have to travel for clinical placements depending on where they're located. But we do have a number of options across the state and we'll do our best to accommodate where folks are coming from.

Host: Do you get feedback from patients who are electing to have a midwife or those who maybe the first pregnancy was the standard OBGYN hospital versus, and if so, what are some of their comments?

Samantha Crouch, DNP, CNM, IBCLC: When patients see a nurse midwife, something that we really often hear is, I feel listened to for the first time. Or I feel like my midwife actually spent time getting to know me and getting to know my fears and my values throughout my pregnancy and going into birth. And that extends to beyond just pregnancy. The anxious 21-year-old getting her first PAP smear, or the perimenopausal woman who is maybe embarrassed about the symptoms that she's having. And it's all new territory. So people consistently who see a nurse midwife for their gynecologic or their maternal healthcare commonly come back with, I just felt like I was listened to and that my concerns were taken seriously. Which we just have a very busy healthcare landscape these days and many patients to see and not enough healthcare providers to see them. And I think at times folks feel unseen or rushed through their healthcare visits. And I'm not, here to say that that will never happen with a nurse midwife, but really core to our identity and our philosophy of care is really spending time with patients and making sure that they feel heard and valued and respected in their care.

Host: And again, once again, someone can reach out to you for gynecological services only.

Samantha Crouch, DNP, CNM, IBCLC: Yes, absolutely. Patients can see us for just gynecologic needs. They can see us for just postpartum needs. Many nurse midwives also hold board certifications or specialties in lactation or breastfeeding support. So really a wide range of care across the women's health lifespan can be addressed by a nurse midwife.

Host: Samantha Crouch, thanks for educating us on midwives and the midwifery model of care. Very informative. Thank you so much.

Samantha Crouch, DNP, CNM, IBCLC: Of course, thank you so much for having me.

Host: For more information, please reach out to SCCrouch@uams.edu. If you found this podcast helpful, please tell others about it and share it on your social media. You may find other topics of interest to you when you check out our entire podcast library. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.

Thanks for listening.