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Midwife Mythbusters: Separating Fact From Fiction, Part 2 · Meaningful Medicine with Novant Health

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  Melanie Cole, MS (Host): Welcome back to Meaningful Medicine, a
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  Novant Health podcast, bringing you access to leading doctors who answer
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  questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Melanie Cole.
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  And in our last episode, we spoke with Emily Ellington, a certified nurse
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  midwife with Novant Health, on common myths and misconceptions about midwifery.
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  Now, it's time for part two of our conversation.
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  We hope you'll enjoy it.
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  Emily, can a patient switch between providers during pregnancy if needed?
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  If someone starts with their OB-GYN and they want that more
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  time, they can switch to you.
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  But then, if they feel like they have questions for their OB-GYN,
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  they can see them as well.
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  Can you work together?
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  Emily Ellington: Absolutely.
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  And we actually do that, I think, I would say, in our practice pretty well.
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  All of us practice very similarly, whether we're a doctor or whether we're a midwife,
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  we kind of handle pregnancy the same way.
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  There are certain guidelines you should be following in pregnancy.
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  There are certain testing and things that need to be done around a certain time.
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  So, we already have that rote kind of schedule for when we
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  should be seeing patients.
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  Obviously, if you want to see a midwife only, you can totally do that.
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  If you want to see a doctor only, you can totally do that.
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  You can plan to see me, and then you can see a doctor, and then you can see
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  me, and then you can see a doctor, and then you can see another midwife here.
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  All of us should be moving through the pregnancy with the same goals and the
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  same kind of status updates that need to happen periodically through the pregnancy.
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  Also, if someone needs to be seen same day, you know, if they're pregnant, we're
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  seeing them, we're seeing them that day.
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  And so if you only
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  see midwives, you may need to see a doctor when you come in.
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  Also, it may be that you've only ever seen a doctor, and then you have a visit
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  with the midwife, and then you decide that care is more where your gut, like
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  where your where your goals are aligned.
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  And we all share patients none of us are ever having like our
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  feelings hurt because a patient decided that they liked seeing Dr.
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  So and So instead of me or vice versa.
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  We just, want the best for our patients, and the best is where they feel heard.
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  The best is where they're getting what they need and they're getting good care.
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  And I know for a fact all of our providers in my clinic provide great care, so
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  I'm happy for them to see anybody.
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  Melanie Cole, MS: What a lovely way to say that and such a comprehensive approach.
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  Now, with all of that, and I'm so glad that you pointed out that none
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  of you get hurt feelings, because a lot of times, especially when we're
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  in that phase of labor and delivery or throughout pregnancy, we know
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  hormones can mess around, we get nervous, we get a little fearful.
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  It's an exciting time, but it can also be a little scary.
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  But then, we don't want to worry about that.
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  So, thank you for pointing that out.
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  I think that's so important for new mothers to hear.
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  And tell us about the advantages that you have seen with that team approach.
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  You have other team members, you have the physicians, you have the nurses.
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  Tell us the advantage for the new family-to-be with that team approach.
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  Emily Ellington: Yeah.
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  I mean, I'm sure you've heard the expression it takes a
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  village, and that's serious.
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  Like, that means so much to us in lots of things.
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  It means a lot in the raising of your children.
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  It means a lot in just your healthcare alone.
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  I don't know everything.
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  I actually taught one of our physicians something the other
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  day, and it made me so happy.
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  I used a medical term he had never heard before, and I was like, "It's a…"
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  I don't even remember the situation.
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  He was like, "What is that?"
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  And I was like, "Oh, I know something you don't know."
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  And I loved that I knew something he didn't know.
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  So, we don't know everything.
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  None of us think we know everything.
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  And it's great that we're continuing to learn.
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  You know, we bring different life experience to the table.
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  I feel like one of my big strengths is helping moms with breastfeeding
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  and helping with postpartum anxiety.
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  Those are some of my bigger strengths, but those are the
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  some of the things I struggled with the most myself as a mother.
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  And so, those are things I'm passionate about.
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  I'm also really passionate about antenatal care and making sure that my patients
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  are recognizing when something seems off.
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  I have another partner that's amazing at what they do.
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  I have another partner that's a boss at ultrasound.
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  And then, we do have people that are newer to ultrasound.
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  And so, what I care
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  about is that my patient is getting what they need, whether
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  it's with me or not with me.
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  And back to what you were saying before, speaking to that anxiety and
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  those hormones and the feelings you have when you're pregnant, we all know
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  that we're seeing women in some of the most vulnerable moments of their life.
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  And the last thing that they need to be thinking about is whether or not they're
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  hurting my feelings by seeing the provider that they feel most comfortable with.
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  Melanie Cole, MS: That is just great to hear.
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  Now, biggest myth that I've heard in all of my years doing all of these kinds
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  of things is that you can't have an epidural if you're going to use a midwife.
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  I mean, that's a big one, right?
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  So, is that true?
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  Can patients receive pain management?
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  Can they have an epidural?
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  And how do you help women make that decision about pain relief?
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  It's not true, right, that midwives try and push you to have a
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  natural birth with no pain relief.
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  Emily Ellington: No, our goal is to support a woman's desire
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  for her birth experience, but an epidural is a great tool.
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  There has absolutely never been a time in my practice that I've ever tried to
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  push somebody away from using an epidural or ever thought about withholding it.
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  I would say probably midwives are better than a lot of providers at
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  helping with pain management and all the different options that are
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  available before you get to an epidural, because we start as nurses, you know.
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  A lot of midwives start as a labor and delivery nurse, and we've
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  been with the patients that are struggling to make those decisions.
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  And, you know, there are lots of options between your first contraction, when
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  you're in transitional labor, and when it's time to deliver your baby.
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  Some of those options are nitrous oxide.
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  We have IV pain medication.
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  Certain movements are really helpful.
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  We're super fortunate, and we have jetted tubs here, and they're
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  wonderful for someone that's experiencing back pain in labor.
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  So, there are lots of options before an epidural, but I'm a
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  hundred percent pro-epidural if my patient wants an epidural.
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  If my patient doesn't want an epidural, then I'm going to be there to support
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  them and give them suggestions for how they're going to manage
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  what they're feeling during labor.
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  I think a lot of the education that we do ahead of time can help women
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  make those decisions for themselves.
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  I think a lot of moms are curious to say, you know, "What would it be
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  like if I didn't have an epidural?"
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  There's also a huge difference between is it your first baby
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  or your sixth baby, you know.
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  We know the timing of labor determines a lot.
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  We know if you tell a mom, "Hey, you're moving quick.
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  You might only have to do this for an hour," she might be able to go
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  without an epidural, and if that's her goal, we'll help her get there.
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  But if she tells me at some point, "No, I don't care.
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  I don't care that was what I said I wanted.
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  I want an epidural," absolutely, we're moving towards an epidural, and I'm going
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  to help you get there fast, you know.
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  So, our job is to support what our patients want as long as we're keeping
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  them safe and keeping their baby safe.
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  Melanie Cole, MS: And is it possible then to combine natural labor
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  techniques, like you mentioned the jetted tubs, and medical pain management?
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  Can a woman, like you just said, can they change their mind mid-birth?
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  Emily Ellington: Absolutely.
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  They all do, right?
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  We plan for what we think we want, but we know there's other tools in the toolbox.
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  So if we get there, we pull those tools out.
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  If we don't, then we didn't.
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  I think knowing what the options are, making sure that we're kind
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  of giving anticipatory guidance, "Hey, you're five centimeters now.
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  Things seem to be moving a little bit quicker.
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  It's totally possible you could be ready to push your baby out in an hour.
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  If you want an epidural, now's the time to get it, if that's your goal.
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  If it's not, let's start getting some movement.
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  Let's get you in the tub."
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  We can help by being able to do a clinical assessment and see
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  the progress a patient's making.
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  Also, with the experience level I would say we have a good kind of idea of what's
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  happening with our patients to help guide them into making those decisions.
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  But 1,000%, they can change their mind.
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  They can change their mind to the moment their baby's coming
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  out, and that's not up to me.
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  My job is to help them to get where they need to get to have their baby.
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  Melanie Cole, MS: Well, we all know that we are allowed to
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  change our minds whenever we want.
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  So thank you for reassuring and reiterating that because Lord
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  knows we definitely sometimes want to change our minds.
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  But now another myth that I've heard over the years, and we've talked a little
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  bit about high risk, and you yourself told us your story that midwives can't
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  really attend to a high-risk patient.
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  Tell us about patient selection for midwifery care.
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  Is everybody a candidate?
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  And if someone is high risk, Emily, are there parts that you can take care of
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  and then maybe their physician specialist helps with some of the other parts?
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  Emily Ellington: I would say anyone can see a midwife.
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  You know, even the most high-risk patient would be able to get
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  midwifery care during their pregnancy.
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  People aren't having to address high-risk issues at every part of their pregnancy.
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  They may be only really addressing those issues at the very beginning or even
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  maybe the very end of their pregnancy.
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  I deliver high-risk patients every week.
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  The delivery itself is not necessarily what makes somebody high risk.
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  Someone that needs a C-section should see a physician.
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  I can't do that for them.
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  I can be there to help their physician, but that's the one thing I can't do.
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  I think if you're planning to do a VBAC, like let's say you've had a cesarean
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  section in the past, and your goal is to have a vaginal delivery after the
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  C-section, I think it's wise to meet with a physician at least one time
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  during the pregnancy and go over your previous op note to look and see what
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  your incision looked like, what your C-section complications may or may not
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  have been, and see whether that person's a really good candidate for VBAC.
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  But beyond that, the midwives take care of those patients.
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  I delivered a VBAC patient three days ago and she had a great outcome.
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  But I have the safety net built in for myself that I know I
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  have a surgeon all the time.
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  So, I kind of feel like my job, I get the best of both worlds.
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  I have a safety net, but I also get to practice at the top of my license and
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  really affect my patients' outcomes.
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  Midwifery care has been proven to decrease C-section rates in
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  all markets where they're used.
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  Doula care has been proven to help with vaginal delivery rate as well, so that's
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  something to really consider if you are wanting to be a low intervention birth,
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  and if your goal is to avoid an epidural, that's something that you could consider.
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  I think those are all conversations that are great to have around the beginning
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  of the third trimester in a pregnancy.
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  But as far as who can and can't see a midwife, there's not
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  a clear-cut answer on that.
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  I would say you should be probably using the guidance of your care team.
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  For instance—sorry I'm, like, going a long way about this answer.
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  If I had a patient that was like, "I've had two C-sections, and I really,
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  want to have a vaginal delivery for this next delivery," I would, say
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  to them, "I think we, should have a conversation with the physician.
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  Either we can do that together, or you can plan to see them for your next visit."
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  And then, I would go to that physician and say, "Hey, just so you know,
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  I'm sending this patient to you.
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  This is what they're planning on talking about."
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  Similar things can happen with GYN care as well.
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  I saw a patient this morning for fertility.
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  I've been seeing her for a few months now, and she's at the point where
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  she's wanting to go to next steps.
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  She needs a procedure, and I don't do surgery.
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  And so, I have scheduled her for a visit with one of my physician
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  colleagues, and I've let him know that this is why she's coming to see him.
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  And I know he's going to take great care of her, and he'll do the procedure she
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  needs, and then she'll come back to me.
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  Melanie Cole, MS: That's really reassuring to know that everybody's involved and
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  it's really about the whole person, this mother-to-be and that exciting time.
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  Tell us a little bit, Emily, about prenatal care.
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  What do you provide?
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  How does someone work with you in those prenatal times?
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  Emily Ellington: So, we will see women from the very beginning of
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  their pregnancy—well, actually, we can see you planning for a pregnancy
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  before you ever become pregnant.
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  A lot of people now are doing preconception visits, and that's where
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  we may talk about what risk factors you may have, what medications you
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  may be on that maybe wouldn't be safe for the beginning of a pregnancy.
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  And we can talk about optimizing nutrition and kind of lifestyle
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  modifications that might be wise when you're planning to try for conception.
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  And then, we'll see you when you have a positive pregnancy test.
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  Usually, our clinic starts with around eight weeks.
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  Sometimes people will see us sooner just because they want some
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  reassurance, and that's absolutely fine.
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  We're happy to provide that.
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  But people will come in and see us at eight weeks for an ultrasound.
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  We'll get their dating to make sure that we're all on board, that we
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  have exactly the due date that we're expecting based on the ultrasound and
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  based on her last menstrual cycle.
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  And then, we set up visits there out.
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  We'll plan for a nurse visit at some point to do lab work, and then we
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  start seeing them every four weeks.
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  Melanie Cole, MS: Now, what about postpartum?
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  What does that look like?
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  Emily Ellington: For postpartum in our clinic, we see you following your
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  delivery at least the day after and sometimes two days after your delivery.
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  We usually have a phone call with you sometime in the first
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  week or two just to check in.
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  If you're someone that's been dealing with some anxiety or depression later in
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  your pregnancy or it's something you've dealt with really any time in your later
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  adolescence, adult life, we'll plan to see you two or three weeks out after
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  your delivery just to get a good kind of feel for how you're coping emotionally.
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  And then, we plan to see you six weeks out from your delivery as well.
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  We'll do an exam if you had any kind of laceration or if you had any kind
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  of complications with your pregnancy to make sure physically you're healing well.
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  And then, we usually talk about contraception at that visit as well.
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  Melanie Cole, MS: One last myth, Emily, and you've mentioned a few
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  times that you can even see someone as they start going into puberty
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  and women through post-menopause.
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  You know, that would certainly be someone like me.
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  But one of the biggest myths about midwives is that you are really only
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  involved in that pregnancy time and that birth time, and now even we're
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  learning that the postnatal time.
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  But that's not really true, right?
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  You can see women from start to finish, right?
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  Tell us little bit about the midwifery model.
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  Emily Ellington: Yes, we can see women of all ages.
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  I would say most people probably do start care with a midwife because
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  they're pregnant or planning to become pregnant, and that's the kind
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  of care that they think they want.
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  And then, we build great relationships with our patients, and so we will
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  see them through their pregnancy.
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  We'll see them postpartum.
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  We'll usually see them for their annual exam.
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  Maybe they're thinking about having another baby by that time, and we'll
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  see them back for another pregnancy.
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  I have patients now, I've been practicing long enough, where I've done maybe three
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  of their deliveries, and I've seen them in between for annual visits as well.
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  I love when they bring the babies and getting to see them and seeing how
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  big they are and getting a Christmas card to put on the bulletin board.
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  Really, I love the relationships that I have with my patients.
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  But, I mean, I've seen some people through when they were getting birth
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  control in high school, and now they're thinking about having families, and
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  I'm seeing them for preconception visits because they just got married,
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  and they're thinking about next steps.
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  Oh, another story.
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  I have a bunch of sistersso I have a group of three sisters I've been seeing.
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  I've done all their deliveries thus far, and I just saw their mom for
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  menopause care a couple weeks ago.
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  I know.
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  I love it.
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  And they're so cute, and they're sweet, and they're, like,
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  super supportive of each other.
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  And I met their mom at one of their deliveries.
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  I think that's neat.
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  So, I get to see her for menopause care.
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  Melanie Cole, MS: That really is awesome.
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  And I love the babies too.
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  Oh my, so cute.
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  Now, Emily, gosh, you've given us so much great information.
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  You have busted up a bunch of myths that people have always kind of thought about
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  midwives, but not really ever understood this very ancient practice to help women.
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  So gosh, it's so important what you do, and I can hear the passion
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  in your voice and the compassion.
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  Your patients are lucky to have you.
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  I can see that.
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  I can feel it from everything you're saying.
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  I'd love you to give us some final thoughts.
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  What would you like the women and the people that love them listening to know
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  about midwifery care at Novant Health?
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  Emily Ellington: well, first of all, it's okay to ask these questions.
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  I have patients that will bring their moms with them to their first visit
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  because they want to make sure that their child or their baby is being
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  taken care of as well as they can.
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  So, it's absolutely fine to bring family members to your visits if they want to
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  see what kind of care you're getting.
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  So first and foremost, don't ever feel weird about that.
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  You can absolutely do that.
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  Midwives are a great tool.
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  We're a great kind of go-between.
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  You're going to have personalized care with the midwife.
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  It may not be that you see just one midwife.
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  You may choose to see all the midwives in one practice.
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  I'm fortunate right now to have a great partner, and then we're
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  about to hire another one at some point, so thrilled to have a third.
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  I think if you're looking for patient-centered, educationally
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  heavy, all-around kind of women's health encompassing, you know,
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  GYN care, pregnancy, lactation,
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  annual visits, and even into menopause care, I think that a midwife is a really
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  great place to start knowing that you're going to get good care, but there's
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  also a safety net at the end of the day.
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  There is a doc at the end of the line in case we need something that a midwife's,
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  you know, not in scope to handle.
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  Melanie Cole, MS: Thank you so much, Emily.
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  You are lovely.
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  And thank you for joining us and sharing your incredible expertise for us today.
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  That was just really such an informative episode.
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  Thank you so much.
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  And to find a physician, you can always visit novanthealth.org.
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  And for more health and wellness information from our experts, you
• 19:48
  can visit healthyheadlines.org.
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  That concludes this episode of Meaningful Medicine, a podcast from
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  the specialists at Novant Health.