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

Paige McDaniel, Certified Nurse Midwife

In honor of National Midwifery Week, we met up with Paige McDaniel, one of HealthNet’s many excellent midwives! Paige recently traveled to Liberia, West Africa to conduct a needs assessment and help nursing staff in Liberia update protocols. Check out Paige’s incredible story about her trip to West Africa and delivering twin baby boys!

Q: Tell us about your recent trip to Liberia, West Africa?

A: I was in Monrovia, the capitol of Liberia for two weeks at the beginning of September with my faculty advisor from IU’s School of Nursing, getting started on the required Inquiry Project for my DNP program. I hope to transition my career into global midwifery education and development, and for this project, I plan to implement a midwifery education intervention around the issue of postpartum hemorrhage management. Liberia has one of the highest maternal mortality rates in the world because of bleeding during and after childbirth, so the need is very great.

Q: Walk us through a day in your shoes in Liberia.

A: For this first trip, I was working under my advisor as part of her larger USAID-funded grant to develop nursing and midwifery education in Liberia. My purpose on this visit was to conduct a clinical practice needs assessment pilot study to assess the clinical knowledge of the hospital nurses and midwives, and help the nursing staff there begin to refine outdated institutional protocols and identify clinical areas where new protocols need to be developed. I was not there as a patient provider per se, and much of my time was spent working with nursing and midwifery leadership at the country’s only tertiary facility, John F Kennedy Memorial Hospital. Specifically, I worked with midwife and nurse leaders to develop modules to assess staff competencies in three clinical areas, including a simulation involving postpartum hemorrhage for the hospital midwives.

Q: What was the most satisfying part about your trip?

A: I think the most satisfying part of my time in Monrovia was simply the relationships I built with the nurses and midwives at the hospital, as well as other Liberians I was privileged to meet. The country recently emerged from a brutal, 13 year Civil War so in addition to having to completely rebuild the country’s infrastructure, many people are still quite reserved and often guarded. Everyone I met was always welcoming and hospitable, but by the end of the two weeks, I knew that I had made some genuine friendships.  I will be back in Monrovia a few more times for this project, so truly getting to know some of the people there was very important to me.

Incidentally, I also had the surprise pleasure delivering twin boys as I was pulled into the delivery room one day during my first week by one of the midwives! This is something many CNMs practicing in the United States don’t have the opportunity to do, so I very much enjoyed this professional “first”! 

Q: What is the one thing you wish you could tell others about being a midwife?

A: Being a midwife is absolutely the most rewarding profession that I can imagine for myself. Regardless if I ultimately find myself in direct clinical care “catching babies”, educating a new generation of midwives in the classroom, or working in public policy to help strengthen health care for women and children, I will be forever honored to stand next to my sister midwives as we engage in the work of our hearts.

For more information on HealthNet midwives, please click here or call a location near you.

Kay: Jill, what made you decide to become a nurse midwife?

Jill:   It was truly a God-directed thing for me. I’ve always enjoyed caring for people. After high school, several things fell into place for me to go nursing school. During my last year, I had the chance to shadow a midwife for a week. It was really awesome to see the relationship she had built with those women. That experience stuck with me.

After I graduated, I worked as a medical/surgical nurse at a hospital for a short time before transferring to maternity services. I really enjoyed it, but I knew I wanted to help women not just when they’re in the hospital. I wanted to see them day in and day out — to build relationships and help guide them in making good decisions, while caring for themselves and their families. That’s why I went back to nursing school to become a certified nurse midwife. I wanted to be in a position to empower women.

Kay:  Is midwifery care becoming more popular these days?

Jill:  I think women are learning that pregnancy and childbirth are normal, healthy processes for which a woman’s body is well-designed. Yet each woman’s experience is unique. Some women are interested in water birth. Others prefer having a birth ball, shower, or rocking chair close by. And many simply want all of their relatives by their bedside. More and more mothers-to-be are having babies their way, with the help of a midwife who is there to do as much or as little as the woman wants.

Kay: Midwifery has been around for centuries, yet there are misperceptions about it. What ones do you encounter most often?

Jill:   I wish the general public knew that nurse midwives do not only deliver babies at home. They also deliver babies at the hospital and in birth centers. Most people are surprised to find out I work at a health center and deliver babies at a hospital.

Kay: What other misperceptions come to mind?

Jill:   Midwifery care is a safe option for women, especially for those who want to be cared for by someone who views birth as a natural process.

CNMs are nurses first. I went through four years of training to become a nurse, then went back to school for extra training focused specifically on labor and delivery, before and after childbirth care and OB/GYN. We are certified by the American Midwifery Certification Board. At HealthNet, we are credentialed by the hospital and work side-by-side with OB/GYNs. We view things more naturally, but when we need to intervene for the health of the mom or baby, we will.

Kay: There’s been a lot of talk in the news about the national Caesarean section rate being on the uptick, and how that may not be the best thing. What are your thoughts about it?

Jill:   In the 1960s, the national c-section rate was approximately 5%. These days, it hovers around 30%. I feel like we as midwives are helping to reverse that trend.

A woman’s due date is really just an estimation. In general, we wait until 10 days past the due date to induce labor. In most cases there needs to be a medical reason to induce sooner. When a woman goes into labor on her own, the labor usually goes more quickly and smoothly. Often times when you introduce medicines to speed up the process the woman’s body isn’t ready yet or the baby is not able to tolerate it well. Anytime you give the body the chance to do it on its own, it will go a lot better than trying to force it.

Kay:  You are expecting your second baby soon. Did being a nurse midwife change your outlook on your own birth experience?

Jill:   Absolutely! It really made me look at my own pregnancy and labor very differently. I had my first child naturally. He was a big baby too — 9 lbs. 3 oz.! I like being able to share appropriately from my personal experience to encourage moms who are considering natural childbirth.

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HealthNet Midwifery Services is the largest midwifery practice in the state, assisting in the birth of more than 2,400 babies each year at IU Health Methodist. The program’s 24 nurse midwives work with the OB/GYN physicians on staff to provide prenatal care, postpartum care, well-woman care, family planning and more for women at HealthNet’s six community health centers and one OB/GYN care center. The program celebrates its 20^th year this year.

Lisa Glazik has been working for HealthNet for over 6 years.  She started out working in different centers during the week but now she is stationed at the hospital downton.  And, from one quick phone call she made me happy to boast about HealthNet’s Midwives!

Willie: Lisa, why did you become a Nurse Midwife?

Lisa: I was always interested in women’s health.  When I had the chance to start shadowing other nurses in OB programs while at Illinois, I noticed that they were missing out on a BIG piece of a woman’s pregnancy, THE BIRTH! To spend almost an entire pregnancy with a patient and to not be in the room for that special moment made me feel as if I’d be missing on some closure in the process.

Willie: What is the most satisfying part of your job?

Lisa: Being a part of that special moment.  Seeing the culmination of teaching a mother about pregnancy, what to expect and healthy lifestyle choices is very rewarding.

Willie: What is the biggest challenge you face when dealing with a patient?

Lisa: When someone comes to us uneducated about healthy lifestyle choices, it makes it really hard to get them to make new ones.  Change is hard for EVERYONE, but learning about the changes that need to be made can be even harder.  It is a challenge to get the new information to sink in when a patient already has set habits.  But it is awesome to see them succeed!

Willie: What do you all do to celebrate National Midwifery Week?

Lisa: The fall brings a slower period, so we usually plan a retreat day for ALL of us to get together, relax, but also learn from what has been happening all year.  This year, however, we couldn’t plan it until November. 

I like Midwifery Week, though, because I get a lot of questions directed my way about what exactly a midwife does.  I enjoy educating others, even some IN health care, and dispelling some of the old stereotypes that some may have about midwives.

Willie: If you could sum up your goal, in one sentence, to make sure a pregnancy is a success, what would it be?

Lisa: I would tell the mother-to-be, “Your birth experience is YOURS, I am here to give you THAT experience in the best way possible with a healthy mom and a healthy child as an end result.”

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To learn more about Nurse Midwives at HealthNet, stay tuned to our Twitter feed and Facebook page to get statistics and tidbits all week!