Have you bought into the common misconceptions about midwifery? In case you’re still wondering, yes, you can have an epidural if you have a midwife. You can also have a midwife if your pregnancy is considered high risk. And no, you don’t have to give birth at home. In fact, most midwife-attended births occur in hospitals where midwives work collaboratively with OB/GYNs to deliver personalized care. This kind of collaboration takes place at Riddle Hospital every day, where doctors have welcomed certified nurse-midwife, Denise Wilks, into their practice.
“Collaborative care is absolutely key,” says Patricia N. Ischiropoulos, MD, of the relationship. “Integrating midwifery care into our practice has enabled us to elevate the care we offer women today. Now women have the opportunity of longer prenatal appointments with Denise, which are focused on education and planning of their birthing experience. If complications arise, women can also be reassured they will continue to receive compassionate, personalized care by the collaborative team that addresses the medical issue at hand while still supporting her psycho/social needs and birthing wishes.” Dr. Ischiropoulos further states that the practice as a whole supports and respects the midwifery model of care and promotion of physiologic birth.
What a midwife does
According to the American College of Nurse Midwives, “Midwives approach health care using science and evidence. They base their expert personalized care, on their education and experience.” Midwives are highly trained in pregnancy, labor, birth and newborn care, and this care of mother and baby extends from prenatal to postpartum with midwives giving each woman their time, attention and education along the way. While midwives are mostly associated with maternity care, they also provide health services to women from the time of first menstruation into the elder years. This includes general preventive health care, annual gynecologic exams, family planning and education, treatment of sexually transmitted disease, and menopausal care.
In her role at Riddle, Wilks spends time getting to know patients individually and understanding their beliefs and values when it comes to childbirth. Coming from a midwifery mindset—that pregnancy, labor and birth are normal processes and generally not emergencies—Wilks empowers moms to trust their bodies and the birthing process. In the delivery room, she provides a calming presence and guidance. “Midwives are able to spend additional time with women in labor, and use movement, positioning, and touch to help a woman through her birth experience,” she explains.
Some patients are not familiar with the midwifery model of care while others are seeking it out. Dr. Ischiropoulos remarks that as a physician group, her practice is very receptive to midwifery care, not seeing it as a threat or competition, but part of overall quality care. She encourages all patients to have appointments with everyone in the practice, including the nurse practitioner and nurse-midwife. “You never know who’ll be on call when you’re in labor,” she explains, “so it’s important to get to know every member of the care team.”
Giving birth with a midwife has many evidence-based benefits. According to the American College of Nurse Midwives, women cared for by certified nurse-midwives compared to women of the same risk status cared for by physicians alone, had:
- Lower cesarean rates
- Lower rates of labor induction and augmentation
- Significant reduction in third and fourth degree perineal tears
- Less use of regional anesthesia (e.g., epidural)
- Higher rates of breastfeeding
Which is not to say physicians aren’t needed.
“The labor and delivery environment is a very dynamic place,” explains Dr. Ischiropoulos. “It’s like a firehouse, with nothing happening one minute then everyone running around the next. But I can’t be in three places at once. If someone’s in normal active labor and a high-risk patient comes in needing my time and attention, everyone’s still getting personalized care instead of me being split three or four ways.” Having a midwife as part of the collaborative team on the labor floor enables low-risk women to achieve the birthing experience they desire, while those that are higher risk benefit from having both an obstetrician and midwife.
As an example of this collaborative care model, if a patient is considered low risk, then Wilks is able to continue to focus on that patient, supporting her through normal labor and birth, and possibly with fewer interventions. If a routine pregnancy or birth changes and requires greater medical attention, the doctor is there to provide whatever is needed and Wilks is still a part of that care. “It’s not like you have to have one or the other,” says Dr. Ischiropoulos. “That’s the beauty of collaboration.”
Wilks appreciates the collaborative spirit as well. “We’ve all checked our egos at the door,” she adds. “We’re all dedicated to providing the best and safest birth experience for our patients.”