Latest / Meaningful Medicine with Novant Health / Midwifery 101: Everything You Need to Know About Midwife Care

Transcript

Midwifery 101: Everything You Need to Know About Midwife Care · Meaningful Medicine with Novant Health

• 0:03
  Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast bringing you
• 0:07
  access to leading doctors who answer questions they wish you would ask.
• 0:11
  From routine care to rare conditions, our physicians offer tips to navigate medical
• 0:16
  decisions and build a healthier future.
• 0:19
  I'm your host, Maggie McKay.
• 0:21
  Today, we're sitting down with Ann Iannitto, a certified nurse
• 0:25
  midwife, to explore everything you need to know about midwife care.
• 0:29
  Thank you so much for joining us.
• 0:32
  Ann Iannitto, CNM: Yes.
• 0:32
  Thanks for having me.
• 0:33
  It's good to be here.
• 0:34
  Host: Absolutely.
• 0:35
  So, let's just start with what is a midwife?
• 0:39
  Ann Iannitto, CNM: A midwife is, well, a nurse practitioner, so a
• 0:43
  mid-level care, usually someone who has done already an undergrad in
• 0:47
  either nursing or something else in the field that can relate to medicine.
• 0:51
  And then, they've gone and got their master's degree and can
• 0:55
  independently take care of patients.
• 0:57
  Our specialty is labor and prenatal care.
• 1:01
  However, what I don't think everybody knows is midwives take care of women from
• 1:06
  adolescence through menopause and beyond.
• 1:08
  So truly, we are those who care for women.
• 1:11
  I think the word midwife comes from old English for with women,
• 1:15
  and that's truly what we are.
• 1:17
  We're with women throughout their entire lifetime.
• 1:20
  So, you know, first periods all the way through last periods, and again,
• 1:23
  all the symptoms that go in between.
• 1:24
  So, it's not just babies and pregnancy, it's everything that we go through.
• 1:29
  Host: What education and training does a certified nurse midwife complete?
• 1:33
  Ann Iannitto, CNM: So, a certified nurse midwife already has a bachelor's degree.
• 1:37
  Typically, we'll see some sort of nursing background, but again, not always.
• 1:41
  Then, we go beyond, and we'll do a master's degree in nursing
• 1:45
  with the specialty of midwifery.
• 1:47
  Host: And I think there may be a misconception that
• 1:50
  midwives only provide OB care.
• 1:52
  Can you talk about the range of care a midwife offers patients?
• 1:57
  Ann Iannitto, CNM: Absolutely.
• 1:57
  And as I started to say before, you know, women from adolescence
• 2:00
  through menopause, but we specialize in everything from birth control.
• 2:07
  If your periods are too heavy, we can help you.
• 2:09
  If you're not having periods, we can help you.
• 2:11
  If you're having pelvic pain, we can help you.
• 2:14
  Annual well woman's exams, we look at your thyroid, we look at your
• 2:17
  breasts, we look at your mental health.
• 2:18
  And then, of course, we look at everything that happens with
• 2:21
  your uterus and your vagina.
• 2:22
  But all of these things that make up every part of our sort of
• 2:26
  day, we take care of all of that.
• 2:28
  Some women have only an appointment with their well woman's provider
• 2:33
  once a year, and we know that because of, you know, insurance, because
• 2:37
  of money, whatever the case may be.
• 2:38
  So, we really are there to take care of the whole woman, not
• 2:41
  just the parts that everyone associates with the OB-GYN office.
• 2:46
  We can go further and do courses in things like colposcopy.
• 2:50
  So whenever we get a Pap smear, if there's an abnormal Pap smear, there are
• 2:54
  midwives who specialize in doing the next steps, looking at your cervix through
• 2:59
  the microscope, taking biopsies, and helping to treat pre-cancerous lesions.
• 3:03
  And there's a lot of midwives that will have specialties in
• 3:06
  menopause, menopause care, care of all kinds of different things.
• 3:10
  So really and truly, we do the whole scope of care.
• 3:13
  One other thing to just add, a lot of the pelvic problems that women run
• 3:17
  into through life, you know, not enough periods, too many periods, pelvic pain.
• 3:21
  Of course, we're not surgeons.
• 3:23
  We have a different scope of care.
• 3:25
  But everything that surgeons do medically before that, we take care of as well, too.
• 3:29
  Again, those who are more specialized and/or have had
• 3:32
  more opportunity seeing that.
• 3:34
  But everything that you would go see an OB-GYN for, we can do the beginning
• 3:39
  parts of that and the less surgical interventions for, or the steps that you
• 3:43
  would do before surgical intervention.
• 3:45
  Host: And what about birth control counseling?
• 3:47
  I know you touched on it a little bit, but can you tell us about what you offer?
• 3:51
  Ann Iannitto, CNM: Of course, yeah.
• 3:52
  Birth control counseling is a big thing that we offer, because there's
• 3:56
  a lot of women who don't want to get pregnant, and we have plenty of ways,
• 3:59
  not just the old-school birth control pills that everybody thinks of when
• 4:03
  we think of birth control pills.
• 4:04
  We have a lot of great things with less side effects, less bleeding
• 4:07
  side effects, and that really do work well with our bodies.
• 4:10
  So, we love to talk about birth control.
• 4:13
  It also helps us control our bleeding and that's something that we women who are
• 4:17
  a little more active really want to do.
• 4:19
  So, birth control counseling is something we do a lot of.
• 4:22
  And when people hear of how much it can help us have less periods or have
• 4:26
  lighter periods or less pain and cramping.
• 4:30
  It's just the world opens up.
• 4:31
  So, we really and truly love to talk about birth control.
• 4:34
  Again, it's not just for that anymore.
• 4:35
  So, please ask us about it because we really want to get these things out to
• 4:39
  patients who need them and want them.
• 4:41
  Host: And can patients see both a midwife and an OB-GYN or do you
• 4:46
  have to just see one or the other?
• 4:47
  Ann Iannitto, CNM: Most practices for certified nurse midwives are
• 4:51
  embedded next to or in with an OB-GYN.
• 4:55
  But we always have an OB close by if necessary, if things need to
• 4:58
  turn surgical or they come up with a problem in pregnancy that makes
• 5:03
  them a little out of our scope.
• 5:05
  So yes, you can see them for a counseling, or if a woman has had a
• 5:09
  C-section before and wants to have a vaginal delivery following that,
• 5:12
  it's not my scope to counsel them.
• 5:14
  So of course, we would see them in conjunction with an OB-GYN,
• 5:17
  so we could go back and forth.
• 5:19
  And also, when it comes to any of the GYN issues, again, if someone's
• 5:22
  bleeding too much, not bleeding enough, we can get them to a certain point
• 5:25
  where maybe surgery is the next answer.
• 5:27
  But we've done all of the workup and all of the other things beforehand and can
• 5:30
  then give them a very nice, warm handoff that has all the information that they
• 5:34
  need so the patient can get the next thing that goes beyond our service.
• 5:38
  But yes, you can do both.
• 5:40
  But if you fall under one, especially in pregnancy midwifery care, we are
• 5:44
  going to see you, we are going to deliver you, unless, again, something
• 5:47
  comes up where you really have fallen out of a scope of care that
• 5:50
  we can't take care of you anymore.
• 5:51
  Host: Let's talk about the big day, labor.
• 5:54
  What role does a midwife play during labor?
• 5:58
  Ann Iannitto, CNM: That's a good question because a lot of people,
• 6:01
  there's a lot of different answers.
• 6:02
  But certified nurse midwives that are delivering in the hospital,
• 6:06
  we have multiple patients that are happening during a shift.
• 6:10
  So, we are not at the bedside breathing and doing everything
• 6:14
  with you every moment.
• 6:15
  That doesn't mean we're not there.
• 6:16
  Because when I can be there, I will be there through labor when necessary.
• 6:22
  But we rely on our nurses to do a lot of the typical moment
• 6:26
  to moment, hour to hour things.
• 6:28
  They help turn the patients.
• 6:29
  They help support the patients as well.
• 6:33
  When one of our patients shows up, we see them in triage.
• 6:35
  If it's time to admit them, we send them over to labor and delivery.
• 6:39
  We make sure we've done all of our history, and then we pop in and pop out.
• 6:43
  A lot of the times, I'm the kind of midwife that'll be in there
• 6:45
  chit-chatting with them for quite some time because that's just what
• 6:49
  our patients know and like about us.
• 6:51
  I don't think we're as busy of a service as others at the hospital.
• 6:56
  But yes, there are times where once a patient's comfortable, maybe with an
• 6:59
  epidural, and the nurse kind of has her on autopilot, I might pop in every, every few
• 7:04
  hours depending on how things are going.
• 7:07
  So, that's really kind of where we are.
• 7:10
  We're there for the birth, of course.
• 7:11
  It's a very low number of people in the room, and then we'll see
• 7:14
  you postpartum and check in on you, and any time in between as needed.
• 7:18
  So, you see us a lot.
• 7:20
  Host: When would an OB-GYN become involved during delivery?
• 7:24
  Ann Iannitto, CNM: That's a great question.
• 7:25
  So when labor isn't going in the way we want it to.
• 7:27
  Specifically if baby's heartbeat, let's say baby's just not
• 7:31
  tolerating labor very well and we're concerned for baby's well-being.
• 7:35
  That's when we would bring a doctor in.
• 7:37
  Before, of course, we're going to do all the interventions and things, we
• 7:40
  can do prior to bringing a doctor in.
• 7:42
  But, you know, if we need to change our method of delivering baby.
• 7:46
  So if we need to go back for a C-section, either emergently or, again, because maybe
• 7:51
  labor isn't going in the direction or cervix isn't changing the way it should
• 7:56
  be or if, again, baby isn't tolerating labor, we want the OB-GYNs at the bedside.
• 8:00
  We want that level of care that can safely expedite a delivery
• 8:04
  and get a baby out sooner.
• 8:06
  So, that's typically when you'll see them, though.
• 8:08
  Around delivery time, again, if do change over to a C-section,
• 8:13
  if we need an assisted delivery like a vacuum or forceps.
• 8:16
  Or if your baby's heart rate drops down, and I'm in the room, the nurses
• 8:20
  are in the room, sometimes it's nice to have the doctor in the room as
• 8:22
  well, too, to help look at things.
• 8:24
  After baby comes out as well, if you're bleeding too much, and we've done all
• 8:28
  the things we know to control it and can't, you're going to see one of them
• 8:31
  come in and give us a hand as well.
• 8:33
  And then, also if you have a big tear that is just something that you would like a
• 8:37
  surgeon to fix instead of a midwife, 100%, I would rather have a surgeon there, too.
• 8:43
  Host: And in closing, what inspired you to become a midwife?
• 8:46
  Ann Iannitto, CNM: Really long story short, I wanted to do anesthesia,
• 8:51
  and I was in the Navy for some time, and they said, "Nope, you're going
• 8:56
  to be a labor and delivery nurse."
• 8:58
  And I didn't like it, and I didn't want to do it.
• 9:01
  And I did other things before that.
• 9:03
  You know, I did some critical care, and then I deployed as a
• 9:05
  critical care nurse in that setting.
• 9:07
  And when I got back, I said, "You know what?
• 9:09
  I'm so thrilled to have patients thank me and just be so grateful,
• 9:14
  even if they don't say it."
• 9:14
  And that's the difference taking care of pregnant women versus people in
• 9:19
  other—you know, especially in maybe not so fun situations of medicine.
• 9:24
  Why a midwife from there?
• 9:27
  Again, really long story short, I loved watching the independence of midwives.
• 9:33
  They were better at things.
• 9:35
  They first taught me things that I was a better labor nurse because the
• 9:41
  midwives taught me the physiology of a human coming out of a pelvis.
• 9:48
  And I wanted to be that good.
• 9:50
  I wanted to be as good as the midwives.
• 9:53
  The midwives, their patients always loved to see them.
• 9:56
  They always got babies out of the vagina.
• 9:58
  And they were always the ringer.
• 10:01
  They came in and at the nth hour, it was like, "Nope, we're going to do it,
• 10:04
  and your baby's going to come out."
• 10:05
  And that's what I loved watching, and I loved being able to be
• 10:10
  that, and then learn all this stuff and teach it to the patient.
• 10:13
  So, I didn't grow up wanting to be a midwife.
• 10:16
  It was never in the cards, but I think it found me when it was supposed
• 10:19
  to, and I really and truly feel like it's what I'm supposed to be doing.
• 10:23
  And I love being a part of all of this, because I love taking care of my people.
• 10:28
  I love taking care of women, and I love empowering women in so
• 10:34
  many different ways, I guess, is really the best way to say it.
• 10:36
  Host: It's got to be so rewarding and fulfilling.
• 10:39
  Thank you so much for sharing your expertise.
• 10:41
  This has been so educational.
• 10:42
  We really appreciate your time.
• 10:44
  Ann Iannitto, CNM: Right.
• 10:44
  No, it was great to be here.
• 10:45
  And again, I appreciate that I get to speak for us in a way
• 10:50
  that people learn more about us.
• 10:54
  Host: Again, that's Ann Ioannito.
• 10:56
  To find a physician, visit novanthealth.org.
• 10:59
  For more health and wellness information from our experts,
• 11:02
  visit healthyheadlines.org.