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Midwifery, Choices, and Care in Kentucky · Talking FACS

• 0:01
  Welcome to Talking Facts, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello, and welcome to Talking Facts. I'm your guest host, Dr.
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  Courtney Luking, Extension Specialist for Maternal and Child Nutrition.
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  Today, I'm thrilled to host Hayden Meza.
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  She's a certified nurse midwife at the University of Kentucky and has served
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  in this role for over seven years.
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  She is a native of Lexington, Kentucky, and is passionate about empowering women
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  and birthing people to truly own their healthcare choices.
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  I am thrilled to have you here, Hayden, to talk about midwifery and where it
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  started, how it's going, and how people can find people like you.
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  So welcome. Thank you. It's good to be here.
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  Let's get started. I was recently at a conference, and I learned that Kentucky
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  has a prominent place in the history of midwifery.
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  So can you tell us what a midwife is and how you fit into the healthcare system?
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  Yeah, interestingly enough, Kentucky does have a strong midwifery presence now.
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  But first of all, a couple kind of midwives. So we'll specifically be talking
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  about CNMs or certified nurse midwives.
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  Midwives of that nature fit into the healthcare system as advanced practice
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  providers. So a lot of people are more familiar with an APRN or going to see a nurse practitioner.
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  The difference being that midwives specialize in women's health across the lifespan
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  with an emphasis on pregnancy, prenatal and postpartum care.
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  Great. I did not learn about midwives until I was starting to get into that
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  phase of wanting to have a child. And so is there a time where it's too soon
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  or too late to connect with a midwife?
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  That's a really good question. And so I don't think there is a time too soon.
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  Our youngest patients are, some of my patients haven't even gone through puberty
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  yet and just have a lot of questions.
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  So menarche or when you start having cycles, I think is a good time to establish
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  care and just kind of learn what's going on with your body and things like that of that nature.
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  But it's not uncommon that people show up in their childbearing years and that's
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  perfectly okay too. We do establish care visits for people that aren't quite
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  familiar with what we can offer.
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  I think it's really common, especially around here, to not understand the difference
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  in OB-GYN care and having a midwife and what that might look like.
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  So I'm glad we're talking about it today. Fantastic.
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  Okay. So before I get too sidetracked, let's the history, just because I love
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  when there's fun facts related to Kentucky.
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  What is the relationship of midwifery and Kentucky? So one of the first and
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  largest midwifery programs actually started in Kentucky back in 1925.
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  Mary Breckenridge, a fascinating character, if you want to look into that,
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  she started what was called the Frontier Nursing Service.
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  And this was of several providers, actually on horseback, that were providing
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  care in rural Appalachia, in Hyden, Kentucky, or Leslie County.
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  And so that's where it eventually evolved into Frontier Nursing University,
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  which is where I went and a lot of my colleagues went and is still a very robust midwifery program.
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  Very interesting that it started in Kentucky, but is educating now midwives
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  all over the country. And then they recently moved to Versailles, which is closer to where.
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  We are right now and a little bit more accessible for people.
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  But I think starting with that rich history of a focus on populations that are
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  underserved was one of the premises that drew me, but also to educate nurses further.
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  The thought was like, if they could do this there, you know, rural Appalachia,
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  that we could, you know, extend this model anywhere, that it could be something
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  that's really successful and something that people need in all parts of the
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  country and really the world.
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  Wow, that's fascinating. And 100 years, which seems like a long time,
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  but also a relatively short time when you think about the history of how long
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  our country's been around, for example.
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  So I love that connection. It makes me think of, I was clicking through television
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  recently and stumbled across the PBS show, The Midwife, and then that made me think of my grandma.
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  And I don't know how she loved to watch that show. And I don't know how similar
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  or different, but it's in the work that you do.
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  But let's get into what distinguishes you all from, say, other health care professionals
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  like the obstetricians and gynecologists who are also providing care during childbearing years.
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  That's a really good question and one that we get quite frequently,
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  even from patients who have already established care with us.
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  And so I think the model of care is a little bit different and our education
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  is different, of course, a short and skinny way to address it.
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  And then there's a longer, so I'll try to be as brief but thorough as possible.
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  So certified nurse midwives are nurses who have gone back to a master's program
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  and then done certification through a national ACNM certifying body.
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  So again, like a nurse practitioner preparation where OBGYNs are going to medical
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  school and then a residency and have a much longer education and focus.
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  So midwives specialize in low risk and have a really big emphasis on promoting
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  normal and non-intervention and really educating, coming alongside our community.
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  Patients and clients, where physicians or OBGYNs are taught a wider range of
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  complications and are really, they're trained surgically, which is a big difference.
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  And so that looks different operationally.
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  In the hospital, for example, we work side by side. And contrary to some belief,
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  we are not at odds with each other.
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  It's not like one or the other model of care.
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  It really should be coexisting and with an emphasis on what the specialty is.
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  So midwives are specializing or we're specialists in low risk and OB-GYNs specialize
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  in higher risk, not always the highest.
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  There's different kind of hierarchies there.
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  You know, you have MFM or maternal fetal medicine, which deals in exceptionally high risk.
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  But really, so education-wise and then model of care, just looking at that emphasis
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  on physiologic developmental processes.
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  Midwives are really focused on advocating for patients and really coming alongside them.
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  So sometimes while very much needed, there's a difference in the way that we
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  approach even talking to our patients about, I'm just here to give you this
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  information and I'm here to show you what the evidence says.
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  You know, we practice evidence-based medicine just like OBGYNs,
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  but I think sometimes physician-led care takes a little bit more of an authoritative stance of,
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  here's what I think you should do, where midwifery is, you're my patient,
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  but you're also an autonomous human being that can make this decision for yourself.
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  And it may not be what I've chosen, but here's some alternative things that we see in the evidence.
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  And so we really let our patients drive those healthcare decisions,
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  whether that's with their family planning or with pregnancy and birth.
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  There's so many choices. And I think that,
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  is a really big hallmark of midwifery. I'm so glad you brought that up.
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  I actually have a little story I can share to kind of show that in action.
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  And oddly enough, it was an interaction I had with you.
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  This is totally unplanned. You also hate and does not know I'm going to share this.
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  But I was getting ready to have my second child and we were going to do like
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  a low stakes intervention to try to see if we could get the labor process going.
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  And when I was waiting in the waiting room that day.
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  I got a call from my oldest child's school
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  and they said she has a fever and this
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  was in the height of the trifecta of the COVID pandemic still oh my goodness
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  fluenza and RSV and I was like oh my gosh I have a kid with a fever and I'm
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  about to bring a newborn and the newborn can only wait so long because I was
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  pretty much full term at that point so I was full term at that point and,
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  I was in tears, like so stressed out making calls, you know,
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  my parents were getting ready to come in.
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  And then I landed in the room with you and I was clearly upset.
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  And like your calm presence and just kind of like talking through the options.
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  And you're like, we don't have to do anything today. You know,
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  we can try again on Friday or something.
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  And that's what we did. Like we scheduled an appointment for Friday.
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  We just did a regular checkup, kind of helped me calm me down.
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  And it was so helpful because I had really just been thrown off.
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  Kind of what I had in my head was going to be the chain of events.
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  And really, there's control in that anyway.
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  But it was so reassuring to just feel like, okay, you sat and you gave me time
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  to process and like, let's figure this out together.
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  I'm pretty sure words, if not those exact ones, similar to that are what came
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  out of your mouth. And so...
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  I appreciated that. I think that brings to mind, like one of the points on midwifery
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  hallmarks is the value of human presence, which I think in medicine sometimes gets missed.
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  You know, we get the bottom line and we get numbers and we get,
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  you know, insurance and all these things that are competing for how much we need to do.
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  But midwifery, we really get a little bit more room and margin.
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  And it's one of our focuses to really just be with women.
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  That's what midwife means is with women. And so that is a perfect story,
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  I think, to kind of model that, just like human presence. I don't remember this story, but.
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  No, why would you? You interact with so many people, and this was almost three years ago.
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  But those vulnerable periods of time, which there can be a lot of that in women's
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  health experiences, I would think. And so I love that. Well,
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  you know, I think this is kind of a nice segue to the myths, right?
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  Like when you're talking about that value of human presence,
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  but what are those myths that you would like to dispel about midwives?
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  Oh, there's so many. Another caveat story that you could use or not,
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  but I actually was accepted into school into women's health nurse practitioner,
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  which is a little bit different role.
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  And so I believe some of these myths myself.
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  And I remember telling another student so we
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  kind of go with the midwifery students it's like this introduction when
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  you got accepted to Frontier and I remember making the comment why do you all
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  want to just be out here having babies and bathtubs and all of this crazy stuff
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  and I just thought midwifery was the craziest thing and believed these myths
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  of I don't know I don't know where I got these,
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  but I was really uneducated and uninformed about what midwives actually do and
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  believed some of those myths myself.
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  But getting into that, I think it's common that people think midwives practice
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  only at home, only with unmedicated clients, and that is not true at all.
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  Over 95% of midwife-led deliveries occur in the hospital.
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  That's not to say home birth does not have a place, so midwives practice in
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  home birth settings, that is definitely true, but not the majority even.
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  This kind of thought that midwifery is like hippie voodoo version of medicine
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  also is really common. But we practice evidence-based care.
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  We look at all the new studies coming out. It is very parallel to modern medicine.
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  And I think that there are small sects of different flavors,
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  I guess you will, where people will use tinctures instead of Western medicine.
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  And my patients ask about those things, and I'm prepared to talk about those things.
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  But I think that's a common myth, that midwives are in people's houses and giving
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  them herbs and, you know, having babies in bathtubs, which is not true.
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  Okay. Okay. Well, I appreciate that. Yeah, because I guess for any topic,
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  right, you can hear a word and then have an image that comes to your mind. So it's helpful to hear.
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  And I so appreciate you sharing that, like, you held some of these and how you
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  changed your mind. Like that's human to do, right?
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  Absolutely. Are there any other myths that we need to dispel about Midwest?
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  I think...
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  In that vein, some people are under the belief that having a midwife is kind
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  of going rogue or unsafe.
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  But if you look at this evidence, midwifery-led care actually has better maternal
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  child outcomes than higher OB-led care.
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  One, that's because we specialize in low-risk, so we're going to have lower-risk
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  situations. But I think there's a lot to be said for our model of care and the
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  evidence that we do practice by. So the outcomes are actually better under midwifery-led care.
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  I mean, that's for actual metrics that are used in the healthcare system and
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  also patient satisfaction.
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  That's been proven like time and time again.
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  Another one is that the word midwife is the same, which is difficult,
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  I think, for consumers to kind of weed out what that means.
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  But as I alluded to at the beginning of our talk, that there are different types
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  of midwives. And I think it's important that patients and consumers really understand
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  the difference and what the capabilities are of their providers that they're choosing.
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  So there are CNMs, which I am, and all the midwives at UK are certified nurse
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  midwives, nurse bankers.
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  There are CPMs, certified professional midwives.
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  So they are accredited through a different accrediting body.
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  They do not have a nursing background, but do have an education system and a
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  national test and accrediting body.
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  And they generally specialize in out-of-hospital birth center or home births.
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  There's very few left, but there's certified midwives.
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  I won't talk much about them because it's very, very few numbers nowadays.
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  And then there are several, even sprinkled in Kentucky, unlicensed people who
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  practice what they consider midwifery.
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  Sometimes you'll find these in smaller communities, such as Amish communities,
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  and really their training is kind of an apprenticeship or I've been to a lot of births.
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  So I think it's important to differentiate, is this a.
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  Birth worker? Is this a doula? What are the capabilities of this provider?
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  What is the education of this provider?
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  And in the event that something is abnormal, how are they prepared to help me or transfer?
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  How do they collaborate with other healthcare providers? I think that's important.
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  That's so helpful. I appreciate kind of walking through the variety of options
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  because there's no single best fit for everyone.
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  And so are there other tips that you have for someone who's considering or trying
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  to figure out which healthcare model might be the best fit for them?
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  That's a really good question.
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  So I think the majority of the
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  population would benefit from midwifery-led care in some form or fashion.
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  But the overarching thing is the risk model.
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  And we have situations all the time, you know, among the midwives where we say
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  we're midwives each other through whether that's family loss or things like that.
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  So midwifing in general can look many different ways. But when you're looking
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  at women's health or health across lifespan, I think it's important to look
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  at personal health goals and the current status.
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  So we do have specific guidelines.
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  And I think that's important, too, that we're not going to take extraordinary
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  risks just so the patient can have an experience if that's not the safest thing.
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  So safety is a really big priority.
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  And sometimes that's a hard conversation to have with patients.
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  But if we're on the front side of this, I think looking at your personal health
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  goals and current health status, like are you super high risk and you have a
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  lot of complicated health conditions?
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  A low-risk specialist is probably not the right thing for you,
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  although at UK, we have a unique ability to collaborate with some of our high-risk
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  physicians where patients are really, really wanting midwifery-led care,
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  especially for their birth, and, for example,
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  have type 1 diabetes and things that are generally outside of my scope.
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  We do have the ability to co-manage that, which is a really unique ability,
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  but also what you hope to get out of your care. I will never forget one of my
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  best friends from childhood had her first baby in a different state and she used midwives.
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  And kind of talking through her experience, it was fascinating to me that what
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  she really wanted was this kind of more authoritative approach.
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  She said, I was so frustrated all the time about the midwife asking me what
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  I wanted to do at this juncture. And she's like, I don't know.
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  How am I supposed to know? You know, and she really didn't want,
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  she didn't value getting to make all those healthcare decisions.
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  And so that was fascinating to me. And I really appreciated that different perspective.
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  And so just asking yourself that as well, like what approach works best for
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  you in other aspects of life? Are you somebody who really values that shared
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  decision, that partnership?
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  Or when it comes to healthcare, are you just kind of want to take a different
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  approach to it? I think that is important too.
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  Yes. And I think that resonates. So just thinking about how people have approached
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  it previously can provide great insight into maybe making a decision for this phase.
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  Wonderful. Okay. So if someone is interested in seeing a midwife,
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  you've talked a little bit about the range in credentials, but how can they find one?
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  It's a good question. So...
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  Locally, if we're talking just in Kentucky, there is a search.
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  I think that you'll provide links
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  to this, but there is actually a search where you can find a midwife.
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  I think the search specifically is more focused on home birth,
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  again, depending on the practice setting that you want.
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  But I think it's important to look when you're searching OB care,
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  you know, just a simple Google search of midwives in my area or CNMs,
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  looking at the hospital that you plan or to be affiliated with or that's nearby,
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  what is their, even if it's marketed as an OB office, there are a lot of times,
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  CNMs or midwives that work with the OBs.
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  So just because they don't have a midwifery practice, which is unique area that
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  we have at the UK midwives,
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  it's a midwife led practice, But a lot of OB offices will be owned by or have
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  several OB-GYNs on staff, and then they'll also have midwifery, too.
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  So I think it's important to look at, you know, all care providers in those GYN settings.
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  Fantastic. I didn't realize that they could be integrated in the same practice,
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  but that makes a lot of sense based on how you've talked about levels of risk
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  can change depending on where you are in your journey.
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  Absolutely. You're good. This has been so lovely, Hayden.
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  I so appreciate you kind of walking us through the various options and shedding
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  light on maybe a less familiar healthcare professional across our state.
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  Is there anything else that you'd like to leave us with today?
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  Also, we refer to women's health a lot, but this does encompass people assigned
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  female at birth who may not identify as women. We're definitely very open to
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  meeting patients where they're at, whatever that might look like.
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  So whenever I have said women in this whole kind of recording and women's health,
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  women's health nurse practitioner, that is the term that is used a lot,
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  but we are referring to people who are assigned female at birth.
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  Great. Thank you for providing that clarification. Yeah.
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  Well, fantastic. Thank you, Hayden. And we appreciate all of you who were tuning in to Talking Facts.
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