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Bill Klaproth: If you're pregnant and want to learn more about the benefits of utilizing a midwife delivery, we have the perfect podcast for you as we're going to cover all of your questions with Mary Newberry, a certified nurse midwife at Marin Health.

This is The Healing Podcast brought to you by Marin Health. I'm Bill Klaproth. Mary, thank you so much for your time. We appreciate it. So, first off, can you tell us a little bit about your background and your credentials?

Mary Newberry: Sure. I am a certified nurse midwife and also a women's health nurse practitioner. I have a Master's in science from UCSF in midwifery. I've been working as a full scope midwife for the last 20 years in the San Francisco Bay Area. Currently, I'm one of the co-lead midwives of the Marin Health Midwifery Services. I do teach UCSF midwifery students, medical students and also physician assistant students about midwifery, birth and postpartum care.

Bill Klaproth: Got it. So you are a certified midwife, a CNM. So can you tell us what is that? And tell us a little bit more about your training certification and the regulations as well.

Mary Newberry: Yeah So certified nurse midwives are RNs, registered nurses who then go on to get a graduate degree in midwifery. So we are mastered, trained nurses and some midwives also go on to get their doctorate in nursing as well. So our study is focused on midwifery, women's health, birth, pregnancy, et cetera. We do have to take a national certification exam and we have to regularly engage in continued education to maintain our licensure. We do carry a DEA license, which allows us to prescribe medications, and we are regulated by the Board of Nursing.

Bill Klaproth: Yeah, this is interesting. It's a controlled profession and it's not just like somebody can say, "Hey, guess what? I'm a certified midwife." I mean, there's a long process and education and training and certification that goes along with this. And Marin Health Medical Center is one of the only hospitals in Marin and San Francisco counties with both midwives and OB-GYNs on-site 24/7, which is really important. And at Marin Health, all of the midwives are certified nurse midwives. Is that correct?

Mary Newberry: Yes. We are all certified nurse midwives at Marin Health Medical Center, and yes, we have a 24/7 In-house midwifery service alongside a 24/7 obstetrical service. We also have pediatricians and anesthesiologists in-house 24/7. So really, you get the best of both worlds at Marin Health. It's much like many European countries where midwives provide the majority of care during pregnancy and childbirth. But sadly, in this country, midwives are not the norm and we only deliver about 10% of babies in this country. And yet what we know from good studies and comparing ourselves to other developed countries is that when there are midwives taking care of the majority of births, because the majority of births are low risk, we end up having the best outcomes. And Marin Health Medical Center has proven just that by having this 24/7 midwifery service.

We have lower cesarean rates at Marin General Hospital. We also have higher success rates of vaginal birth after cesarean also known as a VBAC. We have fewer episiotomies, less narcotic use. There's just generally fewer medical interventions during labor, higher rates of breastfeeding, better outcomes for patients facing racial disparities, better maternal and natal outcomes pretty much across the board. And patients are more satisfied with their birth experiences when cared for by a midwife with a backup of a physician when needed.

Bill Klaproth: Well, that's interesting. You said midwives provide the majority of care in European countries, but only 10% of babies are delivered via a midwife here in the United States. So tell us about your approach to delivery here. What is a midwive's approach to delivery?

Mary Newberry: Well, I think that main difference is midwives are trained and grounded in treating pregnancy and birth as a natural process rather than an illness or disease, whereas physicians who have extensive training but they largely learn about things that can go wrong and more kind of high-risk complications of pregnancy and childbirth. And midwives, although we of course screen for those things and then refer to that higher level of care when indicated, we start with a premise that for most women, childbirth and pregnancy is not a pathological condition.

We also really approach each woman her entirety. So she's not just this body giving birth but rather she's this whole woman who's got physical emotional and psychological considerations for the birth process. We do what's called a woman's center care as midwives. We really meet the woman where she's at and that might mean that if she wants to deliver her baby standing up, that will be fine or squatting. We kind of meet her with what's working for her rather than kind of dictate what she should or shouldn't do.

We encourage the natural kind of physiological unfolding of labor by encouraging women to move around in labor and to eat and drink should they want to, to be free of wires and IVs. We know that once women are kind of strapped to a bed with a lot of monitors and unable to move, that often leads to more interventions that are not always in her best interest.

We also work really hard to educate and empower women and their families to make educated choices for themselves So rather than a more kind of paternalistic traditional model of care where " "doctor knows best", midwives believe that women should be given agency to make decisions for themselves that's grounded in their own worldview and belief systems. And we really listen to women. We believe that women know what's right for them and their families and our job is to give them information and then let them make those choices for themselves

Bill Klaproth: Right. I'm sure you get this question a lot. What about pain management? Do midwives support the use of epidurals?

Mary Newberry: Absolutely. Midwives support choice and we're not dictating there's one way to give birth. We're not saying everybody should have natural childbirth. Our role is to give women information about what options are out there and then help them make that decision and then support them in that decision. So we believe epidurals are safe and if a woman chooses to use that, that's absolutely something we would support. We also have nitrous oxide at Marin Health Medical Center, which is not something a lot of hospitals have and that's also known as laughing, but that's something that a lot of women choose to use. We also can order IV narcotics for women. And then of course, we have a lot of natural remedies, everything from women getting in water during birth, whether it's showers or tubs or moving around or acupressure, massage, all sorts of things. But yes, we would support a woman in her choice to have an epidural.

Bill Klaproth: And then, Mary, I know you already mentioned VBAC, which is vaginal birth after cesarean. Can you talk more about that and how midwives are equipped to help women with that?

Mary Newberry: Sure. There used to be a rule really in this country where once sec C-section, always a C-section. But we have learned that VBACs, vaginal birth after C-sections, for the vast majority of women is a safe option. And so we again empower women with information to make that decision for themselves If they would choose to have a repeat C-section or what we call a TOLAC, a trial of labor after C-section, which is an attempted VBAC. And then, if they successfully have the vaginal birth, that's called the VBAC. So yes, as midwives, we support that. We are a very safe hospital to have a VBAC at as we have surgeons available should we need them. We have two operating rooms in our new birth center. As I said before, anesthesiologists are always available. We would support women in their VBACs.

I actually had a patient that had originally come from Nevada. She had had two C-sections in Nevada because in that state, they believe that once a C-section, always a C-section and so she assumed she had to have another C-section for her third baby. But I explained that actually we can offer her a VBAC even after two C-sections. And she successfully did have a vaginal birth with us of a 9-1/2-pound baby. And that was just a real great success story.

I also like to dispel some of the misunderstandings, which is you can't induce somebody who's already had a C-section. It used to be a belief that you should not do that, but we can do that and we can do it safely. And it's also possible to have a VBAC and have natural childbirth. Some people think that is mutually exclusive. But we have many women who maybe even need to be induced. They've had a history of a C-section and, if they desire natural childbirth, that is still possible

Bill Klaproth: And then, let me ask you this, what if something goes wrong during delivery? Can women still get care from a doctor if needed?

Mary Newberry: Absolutely. And again, I do want to emphasize that the vast majority of women are low risk and can have their birth without the assistance of a doctor. And that's how the vast majority of women deliver at Marin Health Medical Center. But in those cases where we do need an obstetrician to perform a C-section or a vacuum-assisted birth or a forcep-assisted birth, et cetera, our doctors are immediately available. As we talked about, they are in-house and they certainly can step in in those situations.

Bill Klaproth: And then how about your role during pregnancy leading up to the birth? Do midwives provide ultrasounds and other prenatal care?

Mary Newberry: Yes. So midwives also do gynecological care and pregnancy care, so I see women as young as 14 and I see women as old as 94 years old and take care of their well-woman care, their gynecological needs, obviously prenatal care, postpartum care or family planning, et cetera. We do ultrasounds and midwives can do what's called a confirmation ultrasound. So the vast majority of women have ultrasounds between seven and ten weeks of pregnancy to confirm pregnancy and date a pregnancy. There are some more specialized ultrasounds that look at anatomy of the baby that can screen for things like Down syndrome and those are done by perinatologists or special sonographers who are trained in that, but midwives can do your general kind of office ultrasound.

Bill Klaproth: Right. Well, that's good to know and then how about beyond pregnancy and childbirth? What other services do midwives provide?

Mary Newberry: Yeah. So we do a lot of gynecological care. So there's women, you know, I've delivered their two or three babies and then I see them annually for their well-woman exam, Pap smears, breast exams, help them through the menopausal transition and beyond.

Bill Klaproth: Well, you've done a great job, Mary, of painting a wonderful picture of how a midwife can benefit a woman during pregnancy. Is there anything else you'd like to tell us about midwifery?

Mary Newberry: I just want to say that I think that midwifery can be a part of the solution to some of our most glaring issues of today, especially of racial disparities in health outcomes. There's a lot in the news these days about how African-American women experienced two to four times higher risks than white women for maternal and infant mortality and midwifery care, as we've talked about, has been shown to narrow that disparity.

The US also spends more on maternity care and healthcare in general than any other developed nation or any other nation. And yet sadly, our mortality rates for both women and infants are significantly higher than in other wealthy countries. Our C-section rate is also unacceptably high. It's about 32% in the US and the World Health Organization considers the ideal rate to be more like 10% to 15%. And midwifery care has been shown to address all of these issues. Again, narrow the gap between racial disparities in healthcare, we are a low cost alternative to maternity care and midwifery care has been shown to lower cesarean section rates. And as an example, Marin Health Medical Center with our 24/7 midwifery service has a C-section rate of about 16.5% last year, so about half what it is in many US hospitals

Bill Klaproth: Well, thank you for painting this very clear picture of the benefits of having a midwife. So hopefully, more women will understand this and look into this and consider using a midwife in their birth plan. Well, Mary, thank you so much for your time. This has really been informative. Thanks again

Mary Newberry: Thank you, Bill.

Bill Klaproth: That's Mary Newberry. And to learn more, visit my MarinHealth.org. And to book an appointment with an OB-GYN or a midwife, call +1 (415) 461-7800. That's (415) 461-7800. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is The Healing Podcast brought to you by Marin Health. I'm Bill Klaproth. Thanks for listening.