What is Postpartum Depression?

Postpartum depression is a form of depression that affects women and can occur anytime up to one year after having a baby.  Women with postpartum depression have such strong feelings of sadness, despair, and anxiety. These feelings are so powerful that they make it difficult for the mother to perform normal daily activities such as taking care of themselves or their baby.  Postpartum depression affects about 1 in 10 women after giving birth to their baby.  Some reasons women get postpartum depression can be related to changes in your hormones following childbirth, if you have had depression in the past, fatigue, stressful life events, or other emotional factors.

Signs and symptoms of postpartum depression may include:

• loss of appetite
• insomnia
• irritability or anger
• overwhelming fatigue
• lack of joy in life
• feelings of shame, guilt, or inadequacy
• severe mood swings
• difficulty bonding with your baby
• withdrawal from family and friends
• thoughts of harming yourself or your baby

What are the baby blues?

The postpartum or baby blues begin about 2-3 days after the birth of a newborn and can last up to one to two weeks.  Women with the baby blues can feel depressed, anxious, and upset or angry with their partners, the baby, or other family members.  Some mothers have said, “I was watching a commercial on television and I started crying. What’s wrong with me?”  This is a very normal and typically goes away in a few days.

The signs of the baby blues may include:

• crying for no apparent reason
• anxiety
• mood swings
• sadness
• irritability
• crying
• decreased concentration
•  trouble sleeping

Where can I get help?

At HealthNet, we encourage and schedule all moms who have delivered to follow-up with their certified nurse midwife, women’s health nurse practitioner, or physician around 3-6 weeks following the birth of their baby for a postpartum visit. At this visit we will ask you questions to screen for postpartum depression. Treatment for postpartum depression is available and may include talking with a counselor or use of antidepressant medications (medications that balance the chemicals in the brain and control moods), or both.  HealthNet offers behavioral health counseling and psychiatric care services. For more information, call a HealthNet location near you.

Another excellent resource is Birdie Meyer, who is the Coordinator of the Perinatal Mood Disorders Program at Indiana University Health in Indianapolis, Indiana.  She is an RN with a Master’s Degree in Psychology/Counseling, who offers support groups for women with postpartum depression. She can be reached at 317-962-8191 or by email at bmeyer2@iuhealth.org.

If you are having intense feelings as describe above or any thoughts of harming yourself or anyone else call your provider immediately or go to the emergency room.  I want you to know you are not alone. Don’t be afraid to ask for help, we are here for you and ready to help.

Postpartum Depression Resources:

www.postpartum.net
www.postpartumstress.com
www.ppdsupportpage.com
www.postpartumdads.org

Post by Carrie F. Bonsack, CNM, MS

The percentage is even higher for young girls and for minorities. As long as people are sexually active, there will always be a chance that a pregnancy will occur. Certain methods of birth control are much more effective than others. Women and girls who do not want to get pregnant or who should not get pregnant due to health issues should be encouraged to look into LARCs.

LARC stands for Long Acting Reversible Contraception. Examples of LARCs include IUDs and hormonal implants. At HealthNet, many of our providers are trained to insert IUDs such as the Mirena, Paragard, and Skyla as well as the Nexplanon implant.

• The Mirena is a 5 year intrauterine device that contains the hormone progesterone.
• The Skyla is very similar, but it is smaller and only lasts for 3 years.  This is a good option for patients who have never had a baby.
• The Paragard is also an Intrauterine Device, but it does not have hormones.  It is made of copper and works for 10 years.
• The Nexplanon is a rod that is placed in the arm and slowly releases a hormone.  This method can offer protection for up to 3 years.

Why use long acting reversible contraception?

Long active reversible contraceptives are very effective forms of birth control.  Currently only about 6% of women and girls in the United States are using this method compared to 20-30%  in European, African and Asian countries.  The most common form of birth control in the United States is the birth control pill.  Unfortunately, this is considered one of the least effective forms of hormonal birth control.

One of the biggest problems with the most commonly used birth control methods is compliance. We live busy lives. We forget to take the pill or show up for our Depo appointment or to change out the ring. With LARC devices, we see these issues less often because once it is placed, it works whether we remember it or not.  If you are not planning on having a baby in the near future, a LARC device can be the most effective method available.  Another advantage of these LARC devices is that they can be used for most women. Some women are not able to use certain birth control methods due to medical issues. Now we have options for these women. According to the CDC, these patients should be counseled about LARC methods and encouraged to use them to prevent unwanted pregnancies.

Why are LARCs important? 

By increasing the use of LARCs, we can reduce the incidence of unintended pregnancies.  By reducing unintended pregnancies we can also help keep young girls in school and help give these girls the chance to attend college or begin their careers. We have to continue to provide access to birth control for these ladies. Plans in the Health Insurance Marketplace must cover family planning services.  If you are interested in talking with someone about your birth control options, contact a HealthNet location near you to make an appointment with one of our midwives or OBGYN doctors!

Post by Megan McDonald, CNM

Midwifery is one of the oldest professions in the world.  They were the main birth attendants, even in this country, up until the 19^th century.  As modern medicine began to quickly evolve, women began seeking the care of doctors for the birth of their babies.  Midwives mainly served patients who were poor or who lived in remote areas.  As the melting pot continued to grow and more cultures were bringing more traditions and ideas to the table, it became apparent that developing a model of education was needed.  In the early 1900s, midwifery programs began to emerge.  In 1955 the American College of Nurse-Midwives (our professional organization) was established.  Even today there are different ideas about where the midwifery model should be used and how midwives should be regulated, but we are now a growing field again.

Advanced Practice Nurses/Nurse Practitioners are becoming more and more popular in the healthcare field and Certified Nurse Midwives fit into this group.  While physicians are extremely talented and trained to deliver babies in many different ways, the midwifery model is helpful for reducing interventions and offering better outcomes to low risk women. We live in the age of technology, and our healthcare costs continue to rise.  Unfortunately the increased spending in the area of obstetrics has not reduced our mortality rate.   In fact, it continues to rise.  Part of this is due to the declining health of the American people due to unhealthy choices. Midwives specialize in prevention and wellness.  If we can encourage wellness and prevent chronic diseases, we will see less high-risk pregnancies and in turn, have better outcomes.  Another culprit of our increasing mortality rate is the unnecessary use of interventions.  Many of the interventions that are available to us are wonderful tools when we need them, but we now know that disturbing the normal birth process, trying to rush it, or stopping it for convenience sake is not only non-evidenced based, it can also be dangerous.  Utilizing the midwifery model and recognizing normal processes in pregnancy and birth will help to decrease the use of interventions and help us have better outcomes for mommies and babies.

In closing, I wanted to highlight HealthNet’s Midwifery practice.  Our midwives have been practicing here in Indianapolis since 1991!  We are the largest midwifery practice in the state of Indiana and we helped over 2,422 babies into the world last year. In our practice, we work extremely closely with our physicians to ensure safety for our patients and give them the best experience possible. Even with our high risk population we are well below the national average for C-Sections and maternal and infant mortality.  We recognize that we can always do better, however, and we continue to look for ways to better our practice.

For more information about our midwifery program, visit www.indyhealthnet.org/OBGYN or call a HealthNet location near you.

Post by Megan McDonald, CNM

One option is the use of water during labor and birth.  I personally chose to have a waterbirth with my first child.

It was the most exhilarating experience I have ever had in my life.

I felt so empowered and strong! I would have had a waterbirth with my second child, but alas she came out so fast that I didn’t have time to make it to the tub, let alone a bed!  Several of the nurse-midwives in our practice have also chosen waterbirth for the birth of their babies.

What is waterbirth?  Water birth is the birth of a newborn under water.

What is hydrotherapy (also called water immersion)? Hydrotherapy in labor is the immersion of the laboring mother in water, often used in an effort to delay or prevent use of pain medicine either through an IV or with an epidural. Hydrotherapy can be accomplished in a tub or a shower to help the woman relax and cope with labor pains.

How long have women been delivering their babies in water?   Waterbirth has been around for centuries. The first documented waterbirth was in France in 1805. From the years of 1985 to 1999 over 150,000 waterbirths occurred around the world.  More research is underway across the nation to help better understand how many women have waterbirths in the US.

Are there benefits to using the tub for labor and birth?  Studies have shown that women feel more buoyant, better able to relax or feel calm, and some women feel less fear and stress. Other studies have compared the use of pain medicine between water and land births, and have found water birth moms use less pain medicine. More research is being done to better understand the benefits of hydrotherapy and waterbirth. 

Is waterbirth safe?  Thousands of waterbirths have been studied over the years, and researchers found waterbirth to be as safe as land birth. The studies compared waterbirth to land birth and concluded, “There is no evidence of increased adverse effects to the fetus/neonate or woman from laboring in water or water birth” (Cluett & Burns, p.2, 2009).  Pain medication use, length of labor, vaginal tears, infections of the mom and baby, and patient satisfaction were some of the areas studied.  

What are the reasons I would not be able to use the tub for labor and delivery?  In our delivering facility, we have a policy on hydrotherapy and waterbirth.  Use of the tub is for women with healthy, normal, and full term pregnancies with normal labor patterns. Contraindications (reasons you would not be able to use the tub) include: suspected infection, maternal fever, active genital herpes, untreated skin infection or open wound, abnormal tracing of the baby’s heart rate, too much vaginal bleeding, recent pain medicine use, any positive Hepatitis or HIV results, morbid obesity (BMI >40), less than 37 weeks gestational age, and having less than 4 prenatal visits.

How warm is the water?  The water temperature in the tub is warm and is similar to your own body temperature. Women can get warm in the tub, which is why staying hydrated during your labor is important.

Are the tubs clean? Our tubs are cleaned following strict recommendations from the tub manufacturer, and have been approved by the Indiana State Board of Health. Hospital personnel responsible for cleaning the tubs follow these strict guidelines, receive initial training, and complete competency check offs.

What if I have a bowel movement while I am in the tub? Many women have bowel movements during labor and especially during the pushing stage of birth whether or not they are in the tub or on land. Women who use hydrotherapy and waterbirth are mobile, and can get out of the tub to use the restroom.  If you have a bowel movement in the tub, the stool is removed from the water. If the water is very messy you can get out of the tub, and it can be drained and refilled.

Where can I go to have a waterbirth? The Indiana University Maternity Center at Methodist Hospital offers both hydrotherapy and waterbirth. All of our nurse-midwives practice at Methodist Hospital, and are well trained in helping you safely give birth in water.  We have been safely offering waterbirth at Methodist Hospital for nearly 15 years. At this time, we are the only hospital offering hydrotherapy and waterbirth in Indianapolis.

For more information about HealthNet’s Midwifery Services, please click here.

Post by Carrie Bonsack, CNM, MS

Pregnancy can be hard on the body.  In order to compensate for the growing baby, a woman’s blood volume increases, her hormones shift and she must compensate for the extra weight she is carrying in her belly.  Our bodies are pretty amazing, and they do a good job of compensating, but sometimes this can cause us to feel more tired, nauseated and sore.  Although we consider these things “normal,” it does not mean that we should accept these things without question.  Below, I’ve listed some tips that could make this time more comfortable and enjoyable.

Body Mechanics
Body mechanics is a term that describes how we use our bodies for daily activities.  We tend to want to move with the least amount of effort whenever possible.  This ability is great most of the time as it helps us to multitask. Without this ability, we would not be able to coordinate breathing, thinking, processing, using muscles, etc.  The problem with this is that we often ignore important muscle groups that need to be used in order to conserve energy.  If we don’t move muscles, they do not get stretched or strengthened.  Over time, the muscles become weak and they are not much good to us.  This can lead to injury too.

My challenge to you is to become aware of your movements. 

During pregnancy, it is especially important to be aware of your movements.  Your growing belly is already prone to putting strain your back and other ligaments that normally you would not be aware of.  Poor body mechanics can lead to muscle strain and while most of the time this is not a harm to the pregnancy, it can make for an uncomfortable mommy.

One of the main complaints I hear from patients is round ligament pain.  The round ligaments hold up the uterus in the front of the body.  As the uterus grows quickly during pregnancy, the round ligaments also stretch quickly.  Preventing injury is key.  Slow position changes and paying attention to your movements can help keep you comfortable.  For example, when you get out of bed in the morning, try rolling to your side, sitting up, putting your feet on the ground and then standing, rather than making this one swift movement.  Good posture will also help by taking some of the weight off of the ligaments and putting it on muscles that are more capable of bearing the weight, if properly strengthened.  This brings me to my next point.

Sit up!
I know I probably sound like your grandmother, but I’m sorry to say, she was right.  For some reason, we like to slouch.  Like I mentioned before, we don’t like to engage a lot of muscle groups so we hold ourselves up with the least amount of effort.  Good posture helps engage the muscle groups throughout your torso.  It might not be comfortable in the beginning but once the core is strengthened, it will help you hold up your growing belly without as much strain.  As the pregnancy goes on, this practice might also help you to breathe with more ease.  Good posture opens up the chest and gives your lungs more room to expand and baby more room to do her thing.  Try sitting on the floor whenever possible or on a chair without a back.  This will encourage you to sit up and use your core muscles as opposed to sitting on a fluffy chair or couch that does all of the work.  You can also try sitting on an exercise/birthing ball.  This will encourage good posture and help you as you train for your labor day!

Try squatting
Have you ever watched little kids that have recently learned to walk?  Their ability to squat is amazing.  Once again, this is an activity that we have replaced with a seemingly easier activity we call bending. Somewhere between 12 months and 12 years old, we seem to lose this important movement.  I’m sure the majority of us have been told to lift with our legs and not with our backs, which of course requires squatting, so we know this is an important movement, but alas, we bend…and strain.

Squatting is especially beneficial in pregnancy as it stretches the muscle groups that facilitate delivery of the baby.  Your pelvic floor muscles are about to be stretched more than they ever have before.  These muscles were made to do this, but healthy muscles stretch easier.  Think about a rubber band. A rubber band with good elasticity is going to go back to its original size and shape much easier than a rubber band that has lost its elasticity.

Join a prenatal yoga class
A yoga class is a great way to stretch and practice moving your body in healthy ways.  These poses can also help to strengthen your muscles.  Yoga is great for super athletes as well as beginners.  Group classes are also good for people who need a little extra motivation and support.   A structured class is also a good place to practice new movements in the correct way to avoid injury.

For more information on HealthNet’s Women’s Services, visit www.indyhealthnet.org.

Why is this important?

The annual exam is an opportunity for your certified nurse midwife, woman’s health nurse practitioner, or ob/gyn physician to physically assess, screen and evaluate your health and provide counseling on preventive care based upon your age and risk factors.  Although you don’t need a pap every year, you should have an annual exam. It is also a wonderful opportunity to develop a long-term relationship with your provider, as you may choose to see this provider throughout your life span for birth control, pregnancies, and postmenopausal care.

Who needs an annual exam?

All females beginning at age 13 should start having an annual physical exam.  The exam, screening, immunizations, and counseling will vary based upon age and risk factors.       

What happens during an annual “well woman” exam?

The annual exam is composed of an update of your health history, a physical exam, laboratory or other testing, and evaluation and counseling.

The health history may include questions about your health status based upon your medical, surgical, menstrual, and reproductive history. Questions about family medical history may also be asked. Questions related to your nutritional habits, physical activity, your sexual practice and orientation, number of sexual partners, use alcohol, tobacco, or other drugs, and abuse or neglect may be discussed. (ACOG, 2012)

The physical exam may include measuring your height, weight, body mass index (BMI), and blood pressure, assessing your thyroid gland on your neck, palpating your lymph nodes, listening to your heart and lungs, and examining your abdomen. A clinical breast exam may be performed on women every one to three years beginning at age 20, and every year beginning at age 40. (ACOG, 2012)

What about the pelvic exam, what is it and do I have to have one?

The pelvic exam includes an inspection of the outside of female genitalia, an inside exam using a speculum, and an inside/outside exam called the “bimanual exam” to feel the cervix, uterus, and ovaries.  (ACOG, 2012)

There is limited data on when and how often to have a pelvic exam done. The American College of Obstetrics and Gynecologists (ACOG) recommends that a pelvic exam be done for women every year beginning at the age of 21.  However, women who do not have any signs or symptoms of vaginal discharge, problems with their periods, or pelvic pain may not need a pelvic exam. The decision whether to do a pelvic exam or not can be made together between the patient and their provider based on your symptoms and risk factors.  Tests to screen for sexually transmitted infections can now be done with your urine or vaginal swabs without a speculum exam.  Women do not need a pelvic exam before starting on birth control. (ACOG, 2012)

Laboratory and other tests vary based upon your age and risk status. The labs or tests may include screening for cervical cancer based upon your age, and screening for sexually transmitted infections. Other tests based upon your age and if you have other high risk medical factors may include: mammograms, bone mineral density testing, colorectal cancer screening, diabetes screening, lipid/cholesterol testing, thyroid testing, hepatitis C virus testing, and tuberculosis skin testing (PPD).  (ACOG, 2012)

Evaluation and Counseling may include family planning (birth control or preconception planning), prevention of sexually transmitted disease, weight management for obesity or prevention of obesity (nutrition and exercise counseling) and evaluation for eating disorders, use of calcium, vitamin D and folic acid as nutritional supplements, mental health evaluation (stress, depression symptoms, behavioral health counseling), skin cancer awareness (exposure and ultraviolet rays), breast exam awareness, hygiene, and smoking cessation counseling. Your provider may also refer you to another provider such as a dermatologist or dietician when indicated. (ACOG, 2012)

Although we don’t need a pap every year we do need annual “well woman” exams. Please make an appoint with your HealthNet provider for your annual exam, so that we may help your understand your body, your risk factors, and help you achieve overall better health. Cheers and happy New Year to all!

For more information about HealthNet’s OB/GYN services, please visit www.indyhealthnet.org. 

Did you know January is Cervical Cancer Awareness Month? Honor Cervical Cancer Awareness Month by educating yourself on cervical cancer and how you can help protect yourself. HealthNet Certified Nurse Midwife, Carrie Bonsack teaches you everything you need to know about cervical cancer and answers some of the most common questions!

A pap smear is a test used to screen for cervical cancer. Many of you have had a pap smear every year since you were a teenager. Well, those days are over. It’s a new year and time for celebration that we are all done with yearly pap smears!  Some women are worried and feel they need a test every year, but let me reassure you that you do not need a pap smear every year.  Read on to find more about pap smears, HPV, and the importance of an annual “well woman” exam.

Why do I no longer get a Pap smear test every year with my annual exam?

In March of 2012, new pap screening guidelines were developed by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society, American Society for Colposcopy and Cervical Pathology, American Society for Clinical Pathology (ACS/ASCCP/ASCP) based upon the woman’s age.  Basically, all of these organizations looked at research evidence and found that women do not need yearly pap smears and here is why:

• Cervical cancer is rare, especially in young women.
• Precancerous cells are caused by HPV and it will go away in most young healthy women.
• Testing for cervical cancer may lead to more treatment (more tests, more biopsies, and more surgeries) than necessary and may be doing more harm than good.
• Over treatment may lead to unnecessary short-term anxiety or concern.
• Over treatment may lead to pain, bleeding, or vaginal discharge after certain procedures.
• Over treatment may lead to problems with future pregnancies such as preterm birth and low birth weight babies.
  (Moyer, 2012)

When do I start getting screened for cervical cancer?

A woman should begin having a pap smear at the age of 21. Women between the ages of 21-29 should have a pap smear every three years. Women ages 30-65 should have either a pap only every three years or pap with HPV screening every five years. Women under the age of 21 should not have a pap.  (USPSTF/ACS/ASCCP/ASCP, 2012)

When do I stop getting screened for cervical cancer?

If you are age 65 and have had three negative pap smears in a row or two negative pap with HPV tests within ten years, or have no history of CIN 2 within the past twenty years, then you can stop having pap smears. (USPSTF/ACS/ASCCP/ASCP, 2012)

What is Human Papillomavirus (HPV)?

HPV is the most common sexually transmitted infection among both men and women. HPV more commonly infects the genital area, but can also infect the mouth or throat. Nearly everyone who is sexually active will get HPV at some point in his or her lifetime because it is so common. Around 90% of HPV infections can clear on their own within two years.  There are over 100 different types of HPV and some can cause genital warts and certain cancers, such as cervical cancer.  (CDC, 2013)

 Can I prevent HPV?

HPV vaccines can help prevent certain types of HPV, and are available and recommended for 11 and 12 year old boys and girls. Gardasil, an HPV vaccine, is available for males and females. Cervarix is available for females. Women, men, boys and girls between the ages of 13 and 26 can also get these vaccines if they did not get it when they were younger. The HPV vaccines are a series of three shots given over a six-month period.  Condoms can help protect against HPV when used from start to finish of the sex act, however, HPV can infect areas not covered by a condom.  Limiting your number of sex partners can decrease your risk of sexually transmitted infections. (CDC, 2013)

As a certified nurse midwife and a mom of two, I can attest to the misery of morning sickness. I was lucky or shall I say, very unlucky to have it with both of my pregnancies.  I still have a strong sensory aversion to the scent of cucumber melon! I had a car deodorizer in this scent and every time I would drive to work I would throw up. I even had to keep gallon size Ziploc bags in my car for emergencies!

You may be feeling like you are hugging the toilet more than your loved ones, but don’t worry it will eventually go away so that you may experience the joy of pregnancy! Let’s go over a few facts about morning sickness.

What is it?

Nausea and vomiting is a common condition in pregnancy also known as “morning sickness”.   This condition is so common that is has been shown to affect 70-85% of pregnant women[1].  Morning sickness can occur at any time during the day. Some women may have nausea only, while others have both nausea and vomiting.

In most cases, morning sickness will not harm you or your baby.  A severe form of morning sickness, Hyperemesis, is where the woman can’t stop vomiting, lose at least 5% of pre-pregnancy weight, and presence of ketones in the urine. Women with hyperemesis need medical attention.

Why am I sick and how long will this last?

Hormones are thought to be a cause of morning sickness, although the true reason is unknown. Women, who are pregnant with twins, have had it with a previous pregnancy, or who have a history of migraines or motion sickness are more likely to have nausea and vomiting.

Symptoms usually start between the 4^th and 9^th week of pregnancy, and typically last until between the 12^th and 16^th week of pregnancy[2] .  There is no magic cure, but here are some helpful hints.

What can I do that helps me feel better?

Taking a multivitamin before getting pregnant can reduce the severity of morning sickness symptoms.

• Rest as much as possible
• Powdered Ginger capsules (250mg) one capsule during the day and one at bedtime may help[3].
• Eat small, frequent meals (5-6 times/day rather than 3 big meals)
• Eat high protein snacks (milk, yogurt, peanut butter)
• Eating crackers or dry cereal before getting out of bed in the morning may help
• Taking folic acid and a multivitamin vitamin or chewable/gummy children’s vitamin without iron for the first trimester may help.
•  Acupressure wrist bands (Sea Bands) may help[4]
•   “Preggy Pops” are lolly pops made of brown rice syrup, sugar and essential oils, that come in several different flavors created to help relieve morning sickness.
• Slices of lemon with salt are used by some women
• Your medical provider may decide to place you on a medication such as Vitamin B6 (Pyridoxine) and/or Doxylamine (an antihistamine), or other antiemetics such as Phenergan or Zofran if these measures don’t help.

What should I avoid doing?

• Certain smells can trigger nausea or vomiting, so try avoid bad smells.
• Avoiding fatty and spicy foods may help

When should I seek help from a medical provider?

If you have tried the above recommendations for nausea and vomiting and are still feeling sick you may need to seek medical treatment from your HealthNet midwife, nurse-practitioner, or physician. At the health center, your provider will find out if you are having morning sickness or if something else is causing your nausea and vomiting.  Your provider will work with you to determine if you need medications to help relieve the sickness. If you are dehydrated, you may need to have fluids placed in your body through an intravenous line (IV).

Call for these symptoms of dehydration (not enough fluids in your body):

• You cannot keep down food or fluids for 24 hours
• Your urine is dark and you are not urinating very much
• You are dizzy or feel like you might faint
• You are vomiting blood

Christina Graham, Certified Nurse Midwife

If you had told me when I was growing up that I would be a Nurse-Midwife, I wouldn’t have believed you.  But now, after practicing midwifery for 6 years, I can’t imagine doing anything else.  When people find out you are a midwife there is a certain look that you get.  And then you inevitably get a plethora of similar questions.  Even amongst those in the medical community there isn’t a good knowledge of what a nurse midwife is or what exactly we do.  So here’s a rundown of the most common things I get asked about when people learn what I do for a living.

1.) Why are there so many kinds of midwives? 

The entry into the field of midwifery can vary. A Certified Nurse Midwife (CNM) (like the ones that practice at Methodist Hospital with HealthNet) all have nursing degrees and then continue their education by getting a masters degree specializing in nurse-midwifery.  They are licensed by the State of Indiana and can write prescriptions.  They are regulated by the American College of Nurse Midwives.  For more information about CNMs click here.

A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.  If you’d like to read more about CPMs visit http://narm.org.

A lay midwife may not have any formal education.  Instead they are educated through an apprenticeship model of learning.

2.) What? You have a male midwife in your practice? 

Contrary to popular belief, a male midwife is NOT called a ‘midhusband.’  While the presence of men in obstetrics and gynecology has traditionally been accepted in the role of physician, midwifery does still remain female dominated.   In the United States approximately 0.6% of midwives are men.  Additionally, 90% of midwives are white females.  We are fortunate in our practice here at HealthNet to have a wonderful male midwife!  He brings a much-needed balance to our female dominated practice.  If you’d like to read more about the evolution of males in midwifery a very interesting article can be found here.

3.)  You do more than deliver babies? 

Certified Nurse Midwives are considered experts on normal, well woman care from the time that women start menstruating through menopause.  We perform annual well woman exams, pap smears, and birth control consults, and address common gynecological issues.  This is all in addition to being able to take care of pregnant women from the time of conception through delivery!  At Methodist Hospital we are fortunate to collaborate with physicians who love working with CNMs and are available to us whenever a problem or need may arise.   For more about what CNMs can do click here.

All deliveries by a HealthNet midwife take place at Methodist Hospital’s Maternity Center. We do not offer home births. All HealthNet midwives are registered nurses with additional education in midwifery and national certification by the American Midwifery Certification Board. For more information about our midwifery program, click here or call us at (317) 957-2000. 

Jill Kocher, Certified Nurse Midwife

To continue in the spirit of National Midwifery Week, HealthNet midwife Jill Kocher wrote today’s blog post to set the record straight about nurse-midwives. There are many myths surrounding the practice of midwifery, so do you know the facts? Check out the truth about midwives below!

Myth #1: Midwives only do home births.
Midwives deliver babies at home, birth centers, and the hospital. The nurse-midwives at HealthNet currently only deliver babies at Methodist Hospital. As the largest midwifery practice in the state of Indiana, we have 24 certified nurse-midwives on staff ready to help!

Myth #2: If you use a midwife, you aren’t allowed any pain medication.
Some people ask if we allow pain medication while a patient is in labor. The answer is Yes! We are there to support women in the way that they want to be supported, whether that is with an Epidural, IV pain medication, or water birth. Your birth preferences are up to you!

Myth #3: Midwives don’t have a formal education.
FALSE! There are a few different ways that a midwife can become certified. I went Indiana Wesleyan University for four years and obtained my bachelors in nursing degree. I then took an exam to become a registered nurse. I knew that I wanted to become a midwife, so my next step was completing my master’s degree at the University of Indianapolis, which took 2 1/2 years. After graduating I took another exam through the American College of Nurse Midwives to become a Certified Nurse Midwife.

Myth #4: You have to pay for a midwife out of pocket because your insurance won’t cover it. 
Most insurance companies reimburse nurse-midwives, so your care is covered. I would encourage anyone thinking about midwifery care to call one of our offices to talk with our financial support staff.

Myth #5: Midwives don’t do surgery, so if you have to have a C-section your midwife will leave. 
Some people wonder what happens if they need a cesarean section, since midwives do not do surgery. We have that covered at HealthNet! When you sign up for care with us you get midwives and physicians. We work as a team to help women receive the type of care they desire.

HealthNet midwives and OB/GYN providers are available at all HealthNet locations. For more information on HealthNet midwives, please click here or call a location near you.