Michele Mayer, DNP, CNM, and Donna Grand, CNM, MSN are practicing midwives at Huntington Hospital. They took some time to explain a little bit about their career and role in women’s health care.
What’s the difference between an OB/GYN and a midwife?
Donna Grand: We look at childbirth as a natural process. Women who want less medical intervention tend to be interested in midwifery; however, we also support women’s informed decisions regarding her care. We practice family-centered care and focus on meeting family needs.
We are similar to OB/GYNs in the sense that we follow the same practice standards as outlined in the American College of Obstetricians and Gynecologists (ACOG) guidelines. Our profession utilizes the standard of care developed by our professional organization, the American College of Nurse Midwives. We practice evidence-based care.
During prenatal care, we do similar testing that physicians use. We will collaborate with doctors when we have medical issues outside of normal care, transferring care when appropriate.
We differ from some physicians in that we do not usually induce patients before their expected due date other than for medical reasons. Most patients that seek our care do not want to be induced until they pass their expected due date.
How can midwives help with birth plans?
DG: Midwives encourage discussion of birth plans throughout prenatal care with an emphasis on this in the third trimester. The patient usually writes their plan down and then will bring it to the labor unit.
What are some things midwives encourage or discourage mothers to do?
DG: Midwives encourage early laboring at home with oral hydration. We do not perform as many episiotomies as physicians. We facilitate non-medical comfort measures such as walking around with intermittent monitoring, hydrotherapy and encouraging partner participation.
We discourage early epidurals.
When might a midwife require assistance from an OB/GYN?
DG: Medical interventions that may be necessary which include close collaboration with a physician include treatment for pre-eclampsia or diabetes; cesarean section; pre-existing maternal conditions; induction for medical reasons. For cesarean sections, certified nurse midwives will assist the surgeon with multiple births or an external version from breech position. Physician care is helpful in caring for mothers who have pre-existing conditions such as multiple sclerosis; severe hypothyroidism or hyperthyroidism; pre-gestational diabetes; and/or hypertension.
What kind of training do you go through to become a midwife?
Michele Mayer: Certified Nurse Midwives are educated in two disciplines: midwifery and nursing. A CNM is usually a registered nurse with a graduate education in midwifery who has passed a national certification exam and must be recertified every five years. Like myself, five percent of CNM's have gone on to obtain a doctorate degree.
What is the spectrum of services that midwives offer?
MM: Midwives are licensed independent healthcare practitioners offering services to women of all ages from adolescence through menopause, through all the stages of their life including pregnancy and childbirth care.
We can also provide primary care of the newborn. While midwives are known for attending births, it is only one of many roles.
Midwives are dedicated to the personalized healthcare experience. The midwifery model of care supports the normal physiologic process of labor and birth.
What do you think would surprise most people about the services you provide?
DG: When we’re not laboring with one of our patients, we support the Huntington Hospital labor and delivery and maternity units. We work collaboratively with the obstetrician who is on call for the day. We play an active role in supporting the education and training experience of the family practice residents and physician assistant students.
MM: Many people are surprised midwives deliver in a hospital. Most people think of us as delivering at home or a birthing center. In fact, in the United States, 90 percent of midwives deliver in a hospital.