From supporting a woman during delivery to providing primary care, nurse midwives can be found throughout the spectrum of women’s healthcare. Midwifery is a beautiful healthcare partnership designed to help women realize their potential to be a force for optimal health and wellness.
JoAnne Burris, APRN, CNM shares fascinating information about the field of midwifery, including debunking many of the myths associated with midwifery.
Hallmarks of Midwifery
Featured Speaker:
complete her associate's degree in nursing, then acquired the years of labor and delivery nursing experience required before attending midwifery school.
JoAnne B. Burris, APRN, CNM
JoAnn Burris found the experience of giving birth to her second child--with the help of a certified nurse midwife--such a profoundly different experience from the way her first child had been born that she felt called to become a CNM herself. She knew she wanted to help other women experience pregnancy and birth as a natural life stage and realize their potential to remain in control of their health. A year after her son was born, Burris quit her 9-to-5 job and started the process of becoming a CNM. She returned to college tocomplete her associate's degree in nursing, then acquired the years of labor and delivery nursing experience required before attending midwifery school.
Transcription:
Melanie Cole: When you find out you're pregnant, it's such an exciting time, but you want to start looking for a practitioner to care for you during pregnancy, the birth of your baby and beyond. Many people know what an obstetrician/gynecologist is, but not everyone knows what a midwife does. Here to tell us about midwifery is JoAnne Burris. She's a certified nurse midwife with UK Healthcare. Briefly explain to us what a midwife is. What are some of the hallmarks of midwifery?
JoAnne B. Burris, APRN, CNM: A midwife is a nurse who has returned to graduate school and taken a national board certifying that she is an advanced practiced to registered nurse, a certified nurse midwife and he or she are educated in the two disciplines or midwifery and nursing.
Melanie: What are some of the services that you provide?
JoAnne: People might be surprised to learn that midwives provide primary health care services for women from adolescence beyond menopause. They include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and postpartum, and then the care of even newborns for the first 28 days of life. At UK, we tend to leave that to the specialists – the pediatricians – but that is included in our training.
Melanie: How is delivering a baby and being pregnant and seeing a midwife different than it is with a physician? Can you prescribe prescriptions for things?
JoAnne: We definitely can prescribe prescriptions and midwives who have been in training for over a year can also prescribe controlled substances. Some differences that women may appreciate when seeing a midwife include a little bit longer appointments. We really try to focus on women holistically, so not just her pregnancy, but who she is, what her goals are, and we really work hard to meet her where she is. I should also say that there are many physicians who do the same thing. One of the hallmarks of midwifery is that we practice no intervention in the absence of complications. We see pregnant and birth as a very normal healthy thing that happens in the lifespan of a woman and we like to treat women that way. Of course, if they have complications or issues that arise, we have been highly trained to be able to watch out for those and refer or bring a physician into her care whenever that is necessary.
Melanie: Let's break up a few myths about midwives and first that people think back in the day hundreds of years ago midwives would only do home births. Is that still the case?
JoAnne: That is probably the number one myth about nurse midwives. While nurse-midwives do attend births in homes, only about 4% attend births in homes. The other 94% of nurse-midwives in the United States attend births in hospitals. That’s a big myth if you think about 94% of us working in hospitals. The other 2% are attending births in birth centers.
Melanie: Another big myth that I think sometimes make women a little bit hesitant is that you can't have an epidural if you are working with a midwife or pain medication. Clear that one up for us.
JoAnne: That is another pervasive myth and also untrue. Women who are birthing in a hospital have access to all the anesthesia care that a woman whose birthing with a physician has. If they would like IV medication or if they would like an epidural, they definitely have access to that. What midwives want is to support a woman in birthing the way she wants to birth. If an epidural is her desire, we support her 100% and that method of birthing is fine with us.
Melanie: That leads us to the next myth that midwives have their own agenda, like if you choose not to breastfeed or you want an epidural or any of these kinds of things. You said you work for what the woman wants, so clear up that one as well.
JoAnne: We really try to meet women where they are and we have a heavy focus and emphasis on education, so we spend a lot of time in our appointments, educating them, making sure they're aware of the latest evidence-based medicine. We give them all the information that is available and then work in partnership with them to make great decisions for their health. This isn't a situation where we’re telling them exactly what they have to do or require to do. We like to work in partnership and make sure they know they're able to make very well-informed choices and the choice is theirs ultimately.
Melanie: What a great way of putting it. Such an important point. If somebody is told they have a high risk of pregnancy, can they still see a midwife?
JoAnne: It depends on the risk. A woman who is older than the age 35 has a risk factor of just her age alone, but if there are no other risk factors present, that is in our scope of practice to be able to care for her. As women develop additional risk factors, then we definitely will want to at least collaborate with the physician. In some cases, that's appropriate. In other cases, it's a complete transfer of care. It's more appropriate when the risk factors are more significant.
Melanie: That leads perfectly into the next question. If someone is already seeing a doctor, is it too late to consider a midwife or can they see both? If they want that extra care that you offer but maybe they are a high risk or maybe they're a little older and concerned or they have some health concerns where they want a physician involved, can they use you both for the needs they have?
JoAnne: At the UK Midwife Clinic, we have the availability to do telemedicine with our high-risk physicians or maternal-fetal medicine physicians and so our patients can come for their regular prenatal appointments and then on a regular basis speak with a physician in real-time using telemedicine and get recommendations and questions answered so that collaboration is pretty seamless. Like I said, there are times where telemedicine just isn't quite enough. They need to be seeing a physician weekly or even multiple times a week, and when that is the case, that transfer of care happens, but we try the best we can to work in partnership with not only the woman but also physicians.
Melanie: A pretty popular question women have is what if there's an emergency during birth? What if a cesarean section is required? What happens then? What's that like?
JoAnne: At the UK birth center, our nurses, physicians, residents are highly trained to recognize and respond to emergencies and I think UK provides the best place. If an emergency is going to happen, we have a wonderful team of neonatologists, physicians, all available 24/7 to be able to handle those kinds of critical situations. It really is very reassuring as a midwife knowing that I am working collaboratively with a team of experts who are able to respond when it's necessary for a woman and her baby.
Melanie: What about insurance? Do they recognize midwives?
JoAnne: Medicaid is required nationally to reimburse for midwives and we know that about 50% of births in the United States are covered by Medicaid. Some private insurances may be different so it’s important for women to check with their particular insurance before they make an appointment with a midwife, but all insurances cover midwives.
Melanie: Let's talk about beyond. You’ve helped this woman through her pregnancy and her delivery and then you said you can care for a woman right in through menopause. What's that beyond look like as far as primary care?
JoAnne: We have many women who have developed a very close relationship with us throughout their pregnancies and they're very comfortable in our clinic and with our staff and they choose to continue to see us for their annual exams, their pap smears, if they need sexually transmitted infection testing, if they are approaching menopause and are having difficulties with imbalances of hormones, we can manage that. All of those things are included in our scope of practice. Because we work so hard with education and developing relationships with our patients, they feel very comfortable continuing to see us for whether it’s strep throat or they need hormone replacement or just an annual exam. They really enjoy coming back to us for that care.
Melanie: What a lovely model of care that you work in. Wrap it up for us with what you want listeners to know about what you do for a living that they may not know about you.
JoAnne: Nurse-midwives have a deep belief in the basic human rights of all people, especially women, especially because women tend to bear the burden of risk when these risks are violated and that's coming directly from the philosophy of care from the American College of Nurse Midwives or the ACNM. We honor women, our goal is to uplift and empower women and we want to feel like they have an active role, an active responsibility in their health care, and we feel that impact can move beyond not just them but to their families, to their friends, people around them and empower women to make great choices in other areas of their life as well.
Melanie: Thank you so much for being on with us today for sharing your expertise and clearing up some of these myths that surround midwives. You're listening to UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks so much for tuning in.
Melanie Cole: When you find out you're pregnant, it's such an exciting time, but you want to start looking for a practitioner to care for you during pregnancy, the birth of your baby and beyond. Many people know what an obstetrician/gynecologist is, but not everyone knows what a midwife does. Here to tell us about midwifery is JoAnne Burris. She's a certified nurse midwife with UK Healthcare. Briefly explain to us what a midwife is. What are some of the hallmarks of midwifery?
JoAnne B. Burris, APRN, CNM: A midwife is a nurse who has returned to graduate school and taken a national board certifying that she is an advanced practiced to registered nurse, a certified nurse midwife and he or she are educated in the two disciplines or midwifery and nursing.
Melanie: What are some of the services that you provide?
JoAnne: People might be surprised to learn that midwives provide primary health care services for women from adolescence beyond menopause. They include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and postpartum, and then the care of even newborns for the first 28 days of life. At UK, we tend to leave that to the specialists – the pediatricians – but that is included in our training.
Melanie: How is delivering a baby and being pregnant and seeing a midwife different than it is with a physician? Can you prescribe prescriptions for things?
JoAnne: We definitely can prescribe prescriptions and midwives who have been in training for over a year can also prescribe controlled substances. Some differences that women may appreciate when seeing a midwife include a little bit longer appointments. We really try to focus on women holistically, so not just her pregnancy, but who she is, what her goals are, and we really work hard to meet her where she is. I should also say that there are many physicians who do the same thing. One of the hallmarks of midwifery is that we practice no intervention in the absence of complications. We see pregnant and birth as a very normal healthy thing that happens in the lifespan of a woman and we like to treat women that way. Of course, if they have complications or issues that arise, we have been highly trained to be able to watch out for those and refer or bring a physician into her care whenever that is necessary.
Melanie: Let's break up a few myths about midwives and first that people think back in the day hundreds of years ago midwives would only do home births. Is that still the case?
JoAnne: That is probably the number one myth about nurse midwives. While nurse-midwives do attend births in homes, only about 4% attend births in homes. The other 94% of nurse-midwives in the United States attend births in hospitals. That’s a big myth if you think about 94% of us working in hospitals. The other 2% are attending births in birth centers.
Melanie: Another big myth that I think sometimes make women a little bit hesitant is that you can't have an epidural if you are working with a midwife or pain medication. Clear that one up for us.
JoAnne: That is another pervasive myth and also untrue. Women who are birthing in a hospital have access to all the anesthesia care that a woman whose birthing with a physician has. If they would like IV medication or if they would like an epidural, they definitely have access to that. What midwives want is to support a woman in birthing the way she wants to birth. If an epidural is her desire, we support her 100% and that method of birthing is fine with us.
Melanie: That leads us to the next myth that midwives have their own agenda, like if you choose not to breastfeed or you want an epidural or any of these kinds of things. You said you work for what the woman wants, so clear up that one as well.
JoAnne: We really try to meet women where they are and we have a heavy focus and emphasis on education, so we spend a lot of time in our appointments, educating them, making sure they're aware of the latest evidence-based medicine. We give them all the information that is available and then work in partnership with them to make great decisions for their health. This isn't a situation where we’re telling them exactly what they have to do or require to do. We like to work in partnership and make sure they know they're able to make very well-informed choices and the choice is theirs ultimately.
Melanie: What a great way of putting it. Such an important point. If somebody is told they have a high risk of pregnancy, can they still see a midwife?
JoAnne: It depends on the risk. A woman who is older than the age 35 has a risk factor of just her age alone, but if there are no other risk factors present, that is in our scope of practice to be able to care for her. As women develop additional risk factors, then we definitely will want to at least collaborate with the physician. In some cases, that's appropriate. In other cases, it's a complete transfer of care. It's more appropriate when the risk factors are more significant.
Melanie: That leads perfectly into the next question. If someone is already seeing a doctor, is it too late to consider a midwife or can they see both? If they want that extra care that you offer but maybe they are a high risk or maybe they're a little older and concerned or they have some health concerns where they want a physician involved, can they use you both for the needs they have?
JoAnne: At the UK Midwife Clinic, we have the availability to do telemedicine with our high-risk physicians or maternal-fetal medicine physicians and so our patients can come for their regular prenatal appointments and then on a regular basis speak with a physician in real-time using telemedicine and get recommendations and questions answered so that collaboration is pretty seamless. Like I said, there are times where telemedicine just isn't quite enough. They need to be seeing a physician weekly or even multiple times a week, and when that is the case, that transfer of care happens, but we try the best we can to work in partnership with not only the woman but also physicians.
Melanie: A pretty popular question women have is what if there's an emergency during birth? What if a cesarean section is required? What happens then? What's that like?
JoAnne: At the UK birth center, our nurses, physicians, residents are highly trained to recognize and respond to emergencies and I think UK provides the best place. If an emergency is going to happen, we have a wonderful team of neonatologists, physicians, all available 24/7 to be able to handle those kinds of critical situations. It really is very reassuring as a midwife knowing that I am working collaboratively with a team of experts who are able to respond when it's necessary for a woman and her baby.
Melanie: What about insurance? Do they recognize midwives?
JoAnne: Medicaid is required nationally to reimburse for midwives and we know that about 50% of births in the United States are covered by Medicaid. Some private insurances may be different so it’s important for women to check with their particular insurance before they make an appointment with a midwife, but all insurances cover midwives.
Melanie: Let's talk about beyond. You’ve helped this woman through her pregnancy and her delivery and then you said you can care for a woman right in through menopause. What's that beyond look like as far as primary care?
JoAnne: We have many women who have developed a very close relationship with us throughout their pregnancies and they're very comfortable in our clinic and with our staff and they choose to continue to see us for their annual exams, their pap smears, if they need sexually transmitted infection testing, if they are approaching menopause and are having difficulties with imbalances of hormones, we can manage that. All of those things are included in our scope of practice. Because we work so hard with education and developing relationships with our patients, they feel very comfortable continuing to see us for whether it’s strep throat or they need hormone replacement or just an annual exam. They really enjoy coming back to us for that care.
Melanie: What a lovely model of care that you work in. Wrap it up for us with what you want listeners to know about what you do for a living that they may not know about you.
JoAnne: Nurse-midwives have a deep belief in the basic human rights of all people, especially women, especially because women tend to bear the burden of risk when these risks are violated and that's coming directly from the philosophy of care from the American College of Nurse Midwives or the ACNM. We honor women, our goal is to uplift and empower women and we want to feel like they have an active role, an active responsibility in their health care, and we feel that impact can move beyond not just them but to their families, to their friends, people around them and empower women to make great choices in other areas of their life as well.
Melanie: Thank you so much for being on with us today for sharing your expertise and clearing up some of these myths that surround midwives. You're listening to UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks so much for tuning in.