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Melanie Cole (Host): Certified nurse midwives care for women throughout their lives and provide holistic patient/family centered and evidence-based care. Midwives work with women and families during pregnancy, birth, routine well-woman exams, and menopause. My guest today is Catherine Simon. She’s a board certified nurse midwife at Allina Health East Lake Street and Hopkins Clinic locations. Welcome to the show, Catherine. Tell us: what is a midwife? They’ve been around for a very long time and people don’t even really know what you do.

Catherine Simon (Guest): Good morning, Melanie. Thanks for having me today. As a certified nurse midwife, I have training as a registered nurse and that I've gone beyond that to get my advance practice nurse in an emphasis with midwifery. We believe that caring for women is really a function of education, support and advocacy--support throughout their lifespan. Usually, women are finding us when they’re pregnant and they continue their care through their menopause years.

Melanie: So, how does somebody go about finding a midwife? Usually, you think of going to your gynecologist or whatever. So, how would you find a midwife?

Catherine: So, usually women find us through their friends. The web now is a great place for resources. People are becoming pregnant and finding what kind of pregnancy and birth they’re looking for and that’s how most women find us.

Melanie: So, what kind of birth and pregnancy would a woman be looking for if she was looking for a midwife? What’s different between you and, say, just going to our gynecologist?

Catherine: So, women who seek out midwifery care are looking for more of a natural physiological birth experience, they want to be empowered and be a proponent of advocacy for their birth. They’re looking for a natural experience but yet still be able to have the resources of a hospital or physician care if they would need it.

Melanie: So, that’s probably one of the biggest questions I would imagine people ask you is, can a midwife work through the hospital? And, if you are going to deliver their baby or be their pregnancy caregiver, what if something goes wrong?

Catherine: So, as a midwife, I have a team that I work with--a team that involves physicians that are obstetricians, physicians that are perinatologists, nutritionists, radiologists--a whole team of people that are able to support a pregnancy that might change from low-risk to high-risk. That care is seamless for the woman, they don’t have to find another team provider, and the communication throughout the team is very concise. It enables the woman to have that full spectrum of care.

Melanie: And, so, what does that mean? If someone is going to have a baby and they start to see you throughout their pregnancy, can you prescribe prenatal vitamins and give them good nutrition advice, and work with them though the pregnancy? And, then, what is birth like with a midwife? Does it have to be at home?

Catherine: So, there are some midwives that do birth at home. Our practice is a hospital-based practice, and we have chosen that route to be able to care for more women--women that maybe have a high-risk pregnancy but want a low-risk pregnancy experience. They can birth in a position that might feel comfortable for them, have people at their birth that are empowering for them and supportive. They can have a birth experience that puts them, their baby and their experience at the forefront. Yet, if they need expert care, they can still have that within that same birth experience.

Melanie: If you’re working with a midwife, can you have an epidural?

Catherine: Absolutely.

Melanie: Okay. So, that’s good to know because I think people think it has to be all natural childbirth. And, then, what if something goes wrong? You can get a physician onboard pretty quickly?

Catherine: Absolutely. We can have a physician there to care for you within minutes. We have a great team. We’re in communication at all times through what’s going on with the patient and the baby so that there’s that information before we would need them in the room.

Melanie: So, you also work with women in menopause. What’s that like working with a midwife as a woman goes through that change? What do you do with them?

Catherine: So, as a midwife ages, her patient population actually ages with her. There are many women I've been with through their pregnancies and now, as we’re both aging, we tend to experience those experiences together to some extent. What we do is we empower what’s natural; what’s normal. How do you navigate that pathway with having maybe medicine for support, alternative medicines, alternative therapies, and how do we embrace that change in our life?

Melanie: So, when a woman comes to you and has all of these issues and you may or may not be going through these things yourself, is this something that you work through with other forms of meditation, yoga, exercise? What do you tell women about going through that time?

Catherine: We first talk about what is your body doing--what’s normal and what’s not normal--because it’s important to differentiate a pathology which would be disease versus a normal physiological change of your body. And, then, how do we support those changes to limit the impact it is on their life. We use alternative medicines and therapies. We work with Penny George Institute to help those women as well and then we talk through nutrition support and how to embrace that change.

Melanie: And, what is the philosophy, Catherine, of a midwife, that would make it so that these things are all natural but yet still evidence-based.

Catherine: So, as midwives, we promote normal physiological birth, lifestyle choices. We want to empower women. We want to give them the support that they need through evidence, through education support to achieve whatever their health goals are.

Melanie: Can men be midwives?

Catherine: Actually, there are some male midwives--one in this state, and there are across the country.

Melanie: That’s very cool. And, do you have to be a nurse to be a midwife?

Catherine: So, there are couple tracks but nurse midwives are always a four-year nurse degree, and then an advanced practice degree which is now at doctorate level as well as a master’s level.

Melanie: So, to be a midwife, do you have to be a nurse, or can you--is there a certain certification to be a midwife?

Catherine: There are. So, there’s certifications that involve a traditional midwife or a certified nurse midwife. But, to hold the title of certified nurse midwife, you would have to be a nurse first.

Melanie: Going back to birth for a minute, people hear about all different kinds of births and you mentioned under water or with friends around so they really get to plan their own birth. What do you tell them about thinking about that and afterwards?

Catherine: So, as we meet during the prenatal course--and thankfully we get a long time to be able to develop this relationship--we talk with families, what are the emotional needs, what are the physical and spiritual needs of any family as they go into this birth? As we think about birth, it’s really the birth of a family. We want to address what are your worries and concerns, what are your hopes and aspirations so that we can facilitate that pathway. The other process is learning about how to take care of the body, how to take care for the baby so that those birth experiences can be realized and achieved.

Melanie: And after the baby is born, then do they continue to see you and what if you suspect a little postpartum depression, then what?

Catherine: You know, postpartum depression is so common and I think in our healthcare system, we have such a connected prenatal care and then after the baby comes, there’s a little bit of a change there. We still communicate with our families. We touch base with them and make sure that they’re doing well. When they come in for their postpartum visit, we encourage them to bring the baby. We have a lot of resources in this state and with Allina to help women go through that transition. Postpartum depression is first the recognizing of the symptoms but also the support that a woman would need. And that support comes through, sometimes, medication, therapy--acupuncture has been shown to be very helpful as well.

Melanie: So, wrap it up for us, then, and explain to people what you do as a midwife throughout the life of a woman and help her to start that new life as a mother.

Catherine: So, as a midwife, I think I’m very blessed. I've been invited into a very special time in a family, and at that moment of relationship building, we’re learning about each other and how to support. Birth is just part of the experience. It’s really about just becoming a woman and becoming a mother, and I think every lesson learned from each of these, we take on as we think about how we’re going to parent our children, how we’re going to support our families as our parents age and as our children get sick or need healthcare services as well. But, when I see these families come back time and time again for their subsequent births, it’s just so empowering to see them take that little moment of a message that we had during birth and to use that as they go forward in their life. And, it’s really such a wonderful relationship. I always say, a midwife, we’re not doing deliveries, we’re actually catching babies and we’re changing families.

Melanie: How lovely. Thank you very much for being with us today, Catherine. You’re listening to The WELLcast with Allina Health. for more information, you can go to www.allinahealth.org. That’s www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.