Latest / Meaningful Medicine with Novant Health / Midwife Mythbusters: Separating Fact From Fiction, Part 1

Transcript

Midwife Mythbusters: Separating Fact From Fiction, Part 1 · Meaningful Medicine with Novant Health

• 0:04
  Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant
• 0:06
  Health podcast, bringing you access to leading doctors who answer
• 0:10
  questions they wish you would ask.
• 0:12
  From routine care to rare conditions, our physicians offer tips to navigate medical
• 0:18
  decisions and build a healthier future.
• 0:21
  I'm Melanie Cole.
• 0:22
  And today, we are midwife myth busters, separating fact from fiction.
• 0:27
  Joining me is Emily Ellington.
• 0:30
  She's a certified nurse midwife with Novant Health.
• 0:34
  Emily, welcome.
• 0:35
  Thank you so much for being with us today.
• 0:37
  So can you start by telling us what the difference between a midwife,
• 0:41
  an OB-GYN, or even a doula is?
• 0:44
  Tell us a little bit about midwifery.
• 0:47
  Emily Ellington: Actually, I love that you're asking that question to start
• 0:49
  because it is very confusing for even our patients, and even people that I've worked
• 0:54
  with in the hospital for a long time.
• 0:55
  Sometimes I still remind coworkers kind of what my role is.
• 0:59
  So, the difference between a midwife, a doctor, and a doula.
• 1:04
  A doctor is someone that went through medical school.
• 1:08
  They got their bachelor's degree, they went to medical school for four years,
• 1:13
  and then they picked a specialty, and they did a residency, most often
• 1:17
  specifically in one specialty or another.
• 1:19
  A midwife is someone that usually starts as a nurse.
• 1:23
  You could go into it with just a bachelor's degree in maybe
• 1:26
  biology or other science, and then we go back to school.
• 1:29
  Usually, it's a master's or doctorate degree, specifically for both the
• 1:36
  nursing aspect of healthcare and then in addition, the midwifery aspect.
• 1:43
  So, a lot of education, but very only specifically to
• 1:47
  women's health and midwifery.
• 1:49
  And then, a doula is somebody that's actually a non-licensed person
• 1:52
  Their education may be varied.
• 1:54
  Often they're community-trained.
• 1:59
  They don't have a license per se behind them.
• 2:03
  So, they don't really have any liability in the care of patients.
• 2:10
  In my experience, doulas are a fantastic support for somebody that's trying
• 2:16
  to have additional maybe education or support in the prenatal period
• 2:21
  through their delivery of their baby, and then in the postpartum period.
• 2:25
  Melanie Cole, MS: That was a great explanation.
• 2:27
  Thank you so much.
• 2:28
  Now, before we become myth busters, because a lot of people have questions
• 2:32
  about midwifery, although it's been around for like 1,000 years, right?
• 2:37
  I'd like you to tell us a little bit about yourself.
• 2:39
  What inspired you to go into this line of work?
• 2:43
  Tell us your approach, your philosophical approach to patient care.
• 2:48
  Emily Ellington: So, I took the long way around.
• 2:50
  When I was in school, I was very much into art.
• 2:52
  That was my background.
• 2:54
  I actually went to college first to get an interior design degree.
• 2:58
  And then, my senior year of high school, end of my senior year going
• 3:02
  into my first year of college, my dad was diagnosed with cancer.
• 3:05
  So, he was in and out of lots of hospitals.
• 3:08
  He ended up being part of a research program at Duke that actually
• 3:11
  gave him more years with us.
• 3:13
  And kind of seeing how much nursing care really impacted his overall outcome and
• 3:22
  how he felt just being taken care of in the hospital was what made me decide that
• 3:27
  actually nursing was really my passion.
• 3:30
  So, I ended up leaving art school.
• 3:33
  I went to go get my nursing license.
• 3:35
  In the middle of it, got married, and then ended up pregnant
• 3:39
  kind of quickly thereafter.
• 3:41
  And then, my first baby was a preemie, and she needed to be in
• 3:44
  the NICU for almost three months.
• 3:46
  So, that was another turn in my path.
• 3:50
  I think originally I thought I was going to be a pediatric nurse.
• 3:53
  Kids are definitely a passion of mine.
• 3:55
  But I felt kind of ignored, I guess, in my own prenatal care.
• 4:03
  I was telling my provider that something didn't seem right, and ultimately was
• 4:09
  dismissed and ended up having my baby very, very early and three days later.
• 4:14
  So, one of the things that I kind of have promised myself and
• 4:19
  prided myself on is how well I take care of our high-risk moms.
• 4:23
  I don't ever want a patient to leave a visit with me not
• 4:27
  feeling completely heard.
• 4:30
  We want women to advocate for themselves.
• 4:32
  We want them to learn to advocate for their new baby.
• 4:36
  And one of the ways we do that is by, like, empowering them and teaching them
• 4:41
  what is normal and what to be expected, but then also like, how to express
• 4:48
  concerns to their healthcare provider so that they are actually getting
• 4:52
  what they need at the end of the day.
• 4:54
  Melanie Cole, MS: Wow, that's quite a story.
• 4:57
  Thank you so much for sharing that with us.
• 5:00
  Really, I appreciate that.
• 5:01
  So we're going to do a lightning round here.
• 5:03
  I'm going to give you some myths, and we're going to go back and
• 5:06
  forth and bust some of them up.
• 5:08
  So, let's just start with one of the big ones.
• 5:11
  Midwives only deliver babies at home.
• 5:14
  Is this true?
• 5:15
  What's it like having a hospital birth with a midwife?
• 5:19
  Tell us a little bit about that.
• 5:20
  Emily Ellington: Sure.
• 5:21
  So actually, in a lot of states,
• 5:27
  midwives aren't really licensed to practice in the home, not in all states.
• 5:30
  So, you need to look at what the law is in your state itself.
• 5:34
  In North Carolina, to call yourself a midwife, you need to
• 5:38
  be a certified nurse midwife.
• 5:40
  So, that means somebody that went through the additional education, is
• 5:43
  licensed, has at least their master's degree, and can sign a birth certificate.
• 5:48
  I would say 95% of the midwives that I'm familiar with only do hospital deliveries.
• 5:55
  A hospital delivery with a midwife can look very different than what it
• 5:58
  can look like with your physician.
• 6:00
  It also can look a lot like what your physician would have done.
• 6:03
  We take care of women all the way through their pregnancy.
• 6:08
  We can deliver their baby in the hospital.
• 6:10
  The only thing that we do differently than a physician is maybe we're not going to
• 6:14
  be your surgeon if you need a C-section.
• 6:18
  Our goal is to hopefully avoid a C-section with patients, but I do have plenty of
• 6:21
  patients that see me knowing that they've had a C-section in the past, and that's
• 6:25
  the route they want to go this time.
• 6:27
  And so, I'll take care of them all the way through their C-section, and then
• 6:30
  I'll be the person that's assisting the surgeon during their C-section
• 6:34
  and seeing them through postpartum.
• 6:36
  So, we are always taking care of our patients in collaboration with
• 6:40
  a physician, especially if someone risks into high risk, like maybe they
• 6:44
  may be severely preeclamptic or have other medical kind of comorbidities
• 6:49
  that are impacting their care.
• 6:50
  But our goal is to keep things as patient-centered and as
• 6:55
  family-centered as possible, and to have healthy outcomes for our moms.
• 6:59
  And I would say, I'm probably speaking for a lot of midwives, we try to
• 7:05
  be as low intervention as possible.
• 7:07
  We're not going to add interventions to the mix to hurry things along.
• 7:11
  We're going to give a woman every shot that she can to try to have a vaginal
• 7:17
  delivery and to try to make the experience what she's hoping for, so that she goes
• 7:22
  home feeling empowered after her delivery.
• 7:26
  Melanie Cole, MS: So then, how do you work alongside physicians
• 7:30
  in the hospital setting?
• 7:31
  And you said that if there's a risk stratification and that rises, then
• 7:36
  the physician steps in at that point.
• 7:38
  Tell us a little bit about how all of that does work.
• 7:41
  Emily Ellington: So, they don't necessarily step in.
• 7:44
  I'll tell you the way we work in our clinic.
• 7:46
  I am on 24-hour call once a week.
• 7:48
  Sometimes a little bit more depending on like what's going on with my own patients.
• 7:53
  I know, like, let's say I'm on call next Tuesday.
• 7:55
  I know I'm going to come in at 7:00 AM.
• 7:57
  I'm going to get a report from the physician and the midwife that
• 8:01
  were on the previous 24 hours.
• 8:04
  We're going to learn about all the patients that we have that day.
• 8:07
  I'm likely going to take care of all of the patients that are laboring.
• 8:10
  If there's somebody at some point that something—let's say all of a
• 8:16
  sudden she's preeclamptic and her blood pressure is much worse, and we
• 8:20
  need to move towards delivery, I'm going to speak to the physician, make
• 8:24
  sure they agree with my plan of care.
• 8:26
  Maybe we'll change her medications.
• 8:28
  Maybe we'll move to a C-section, depending on how sick that patient is.
• 8:32
  That's a rare situation.
• 8:34
  But in that way, we're collaborating with the physician.
• 8:36
  We always have a backup.
• 8:38
  So, there's always a physician in-house 24 hours a day in case something were
• 8:43
  to need to be expedited for delivery.
• 8:46
  Melanie Cole, MS: So, what surprises people most when they
• 8:49
  learn about your credentials?
• 8:51
  What types of medical care can midwives actually provide?
• 8:55
  Tell us a little bit about that.
• 8:57
  Emily Ellington: So, we see women all the way from, like, prepubescent
• 9:01
  all the way through menopause.
• 9:03
  I have patients that are 13 years old that are just struggling
• 9:06
  with heavy menstrual cycles.
• 9:09
  And then, I see women and treat them for, like, hormone replacement
• 9:13
  therapy, post-menopausal.
• 9:16
  We see women for all things in between.
• 9:20
  So, I would say
• 9:25
  definitely a midwife is a great tool to use if you're wanting to
• 9:30
  have a kind of low-intervention pregnancy delivery situation.
• 9:36
  But definitely, you can come to a midwife just to see them
• 9:39
  for your annual Pap smear.
• 9:40
  You can come to see us for a breast exam if you have a breast concern.
• 9:44
  You can come to see us if you need birth control.
• 9:46
  Lots of us are really passionate about making sure women have all
• 9:50
  the education they can upfront.
• 9:52
  And so, if you feel like you need a little bit of extra from your visit
• 9:57
  and maybe you want a little bit of hand-holding to make decisions,
• 10:01
  midwives are a great tool for that.
• 10:03
  Melanie Cole, MS: It really is about that compassionate care and
• 10:06
  feeling heard, feeling seen and that's such an important aspect.
• 10:12
  Now, what about the outcomes?
• 10:14
  Do we know about the research with how the outcomes are and satisfaction for
• 10:20
  the mother in her whole birth experience when a midwife attends to the pregnancy?
• 10:25
  And how do you monitor mothers during not only the birth,
• 10:29
  but throughout the pregnancy?
• 10:32
  Emily Ellington: Sure.
• 10:32
  So, we see our patients just as much as you would see a physician if
• 10:37
  you're in your normal prenatal care.
• 10:40
  So, the way we're monitoring and keeping a close eye on our moms is we're
• 10:44
  going to see them at least every month until about seven months pregnant, and
• 10:49
  then we start to see them every two weeks, and then we move to every week.
• 10:53
  Definitely, we encourage our patients to call us if anything seems amiss.
• 10:56
  So, that education is a big piece of what we do.
• 11:00
  We want them to be able to be at home and recognize if something doesn't seem
• 11:04
  quite right so that they can let us know if they need to be seen sooner.
• 11:08
  We always will educate our patients that we would much rather them be
• 11:12
  seen, have some reassurance, instead of sitting at home wondering if something
• 11:16
  is wrong or they should have called.
• 11:18
  And then.
• 11:18
  We also, you know, obviously, hopefully we're the ones doing
• 11:21
  their delivery, and then we'll see them the next day postpartum.
• 11:24
  And then, we plan to see them depending on their risk factors, depending on if maybe
• 11:28
  they are somebody that's more predisposed to things like postpartum depression,
• 11:32
  we may see them two or three weeks out.
• 11:34
  We'll definitely have a phone call with them at some time in between
• 11:37
  there to check in, and then we'll see them at their six-week visit.
• 11:41
  Normally, at that six-week visit, then we're kind of making plans for
• 11:44
  when we're going to see them again.
• 11:45
  Are we going to see them again in six months because
• 11:47
  they're due for their annual?
• 11:49
  Do we need to see them back in a couple weeks because they want
• 11:50
  to talk about contraception?
• 11:52
  We really love actually keeping those relationships alive with our patients.
• 11:57
  I don't ever finish a pregnancy with somebody and then just
• 12:00
  say, "Great, I'll see you.
• 12:02
  See you, you know, whenever."
• 12:04
  I'm like, "I want to see you back in four months, and we'll get
• 12:06
  your Pap smear up to date, and then we'll talk about next steps.
• 12:09
  And then, if you're thinking about another baby in the
• 12:11
  future, let's talk about that."
• 12:13
  Melanie Cole, MS: Thanks for listening to part one of our
• 12:14
  episode on midwifery myth busters.
• 12:17
  Check out our next episode of Meaningful Medicine with Novant Health as we
• 12:21
  delve into more with Emily Ellington.
• 12:23
  To find a physician, visit novanthealth.org.
• 12:26
  And for more health and wellness information from our experts,
• 12:30
  please visit healthyheadlines.org.
• 12:32
  That concludes this episode of Meaningful Medicine, a podcast from
• 12:36
  the specialists at Novant Health.