How Certified Nurse-Midwives Work with Patients Before, During and After Delivery





Midwives have been an important a part of the birthing course of for hundreds of years. In the previous a number of many years, the popularity of midwives has increased substantially. However, there are nonetheless some questions on how a midwife, OB/GYN, and doula differ, in addition to how they collaborate for mother-centered care.

According to Lesley Bates, a Certified Nurse Midwife (CMN) at Penn OB/GYN and Midwifery South Philadelphia and Washington Square, there are three varieties of midwives: lay midwives, licensed skilled midwives, and licensed nurse-midwives. The variations among the many three are their instructional background, expertise, and coaching.

What is a Certified Nurse-Midwife?

Certified nurse-midwives are skilled registered nurses who’ve accomplished an accredited schooling program in nurse-midwifery and handed a nationwide certifying examination. At Penn Medicine, all midwives are CNMs. They will be the only real well being care supplier – just like an OB/GYN – for wholesome ladies with uncomplicated pregnancies earlier than, throughout and after giving beginning. Certified nurse-midwives additionally present complete ladies’s well being care in any respect ages and levels – from puberty via menopause.

“We believe that midwifery program at Penn Medicine is a partnership between families and midwives. It is centered around love, trust, and mutual respect,” stated Michele LaMarr-Suggs, CNM, who additionally cares for ladies at Penn OB/GYN and Midwifery South Philadelphia and Washington Square. “We spend time getting to know each woman’s story, needs and desires. We attempt to relieve fears surrounding the pregnancy and birth process. We often care for multiple generations within families.”

Midwives supply moms a holistic strategy to the childbirth course of, permitting beginning to progress naturally each time doable. They imagine pure beginning is decided by the mom’s freedom and the autonomy to determine what they really feel is pure.

“There are certain cornerstones of midwifery that we practice at Penn, such as patient autonomy, decision making, evidence-based practice, and education,” Bates stated. “Instead of telling mothers, ‘this is what we’re going to do,’ we give them options, recommendations and the reasoning behind it, to ensure they’re on board. Midwifery is truly an institution in the City of Philadelphia.”

LaMarr-Suggs agreed, noting that sufferers who select midwifery care are capable of keep pregnant for as much as 42 weeks in the event that they need, so long as mom and child are wholesome at 41 weeks.

“We believe that 90 percent of the time birth and pregnancy is happy, healthy, normal, and is not a medicalized problem,” LaMarr-Suggs stated. “We let the physique function by itself – we don’t conduct interventions which might be unneeded.”

“Certified nurse-midwives are licensed to take care of patients from the time of conception through delivery. If a patient requires a C-section an OB/GYN can step in to administer the surgery; a midwife will continue to support the patient during her cesarean birth.”

Understanding How Midwives, OB/GYNs and Doulas Work Together

Certified nurse-midwives, OB/GYNs and doulas can work collectively to supply optimum take care of expectant moms. However, in contrast to an OB/GYN and a midwife, a doula’s function is to supply bodily and emotional help, not precise medical care.

At Penn Medicine, a midwife and/or an OB/GYN have to be part of your birthing journey and current throughout supply.

OB/GYNs are medical docs who concentrate on ladies’s well being and are licensed to carry out surgical procedures and different medical care throughout being pregnant and supply.

Meeting Patients’ Physical, Mental and Emotional Needs

Midwives care for brand new moms throughout the postpartum interval and past to make sure that their bodily, psychological and emotional wants are met.

“Newer studies have shown an increase of postpartum depression in many women,” LaMarr-Suggs stated, noting that sufferers who rating excessive on a despair screening earlier than being discharged are inspired to have extra common follow-up visits within the weeks after giving beginning.

Pam Kane, CNM, MSN, who works alongside Bates and LaMarr-Suggs added, “Women whose despair screens are excessive are at elevated threat of postpartum despair and anxiousness, which may considerably affect their potential to bond with and nurture their little one, keep different essential relationships of their lives, and operate nicely at dwelling and at work.

“Early identification of postpartum depression and anxiety leads to prompt intervention – additional family/community support and a referral to a mental health professional – which then prevents more serious complications.”

Midwifery Care in South Philadelphia

Penn Medicine midwifery program has been in apply for greater than 35 years and expanded in July 2020 to incorporate a South Philadelphia location.

“Our midwifery program has two locations: Washington Square and South Philadelphia and a team of 14 midwives – three at South Philadelphia,” Bates stated. “South Philly is a great extension to our practice. We’re increasing access to Penn care, and we’re increasing access to midwifery care.”

Midwifery Care in Times of COVID-19

During the COVID-19 pandemic, moms are allowed just one help particular person within the supply room. As of mid-September 2020, doulas are as soon as once more allowed to be bodily current in Pennsylvania Hospital to supply labor help, along with a mom’s main help particular person.

Mothers are examined for COVID-19 earlier than they’re admitted to the hospital to have their child, and COVID-19 optimistic sufferers have separate labor, supply and restoration rooms. All different labor and supply providers have remained the identical. Learn extra about Penn Medicine’s response to COVID-19 and verify with your care workforce for extra info as we proceed to observe the scenario and modify insurance policies to make sure affected person well being and security.

Midwifery Facts

  • In different international locations, midwives attend 90 % of all vaginal deliveries.
  • Certified nurse-midwives can assist ladies with low-risk births with out an OB/GYN current.
  • Women with sure medical and obstetric situations are at increased threat of problems throughout being pregnant and childbirth and are required to see an OB/GYN for his or her care, nevertheless, they might request midwifery care in labor. This consists of ladies who:
    • Have preexisting diabetes
    • Develop diabetes throughout the being pregnant and want treatment to manage their glucose ranges
    • Are on treatment for power hypertension
    • Develop preeclampsia throughout being pregnant
    • Are carrying a being pregnant with multiple child
    • Are 45 or older
    • Have a BMI of fifty or increased at first of the being pregnant
    • Have different well being situations akin to seizure dysfunction and sure autoimmune situations 
  • 45 % of sufferers who’re cared for in labor by Pennsylvania Hospital midwives have their infants with out an epidural. The midwives additionally care for a lot of ladies who select to have epidural anesthesia in labor. 



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