Not your grandmother's midwife: Common misperceptions about modern midwifery
January 3, 2019
Certified nurse midwife Cynthia Jacinthe coaches a pregnant patient through labor exercises on a birthing stool
More women today are choosing certified nurse midwives for safe and more comfortable labor experiences, but there are misconceptions about the care midwives provide other than home births. Experienced nurse midwives often find patients are surprised to learn that services may include in-hospital pain management, support during cesarean sections, and general gynecological and prenatal care. We asked certified nurse midwife Cynthia Jacinthe, DNP, APN, CNM, to help bust the myths about midwifery.
Q: What is a certified nurse midwife, and how are they different from other providers who assist during pregnancies?
A: Nurse midwives are advanced practice nurses (APNs) who have specialized training in women’s health care needs. We often care for healthy women throughout their lives, addressing general gynecologic issues, birth control, preconception planning, and, of course, pregnancy. In many ways, midwives provide care for uncomplicated problems that is very similar to the care provided by an obstetrician/gynecologist. Some differences, however, include less intervention, more patient education, and shared decision-making around alternative treatments. In fact, studies have shown that midwifery care of low-risk pregnancies lowers the rates of cesarean sections and the use of vacuum or forceps to deliver a baby. Often, we have more time than physicians to spend with pregnant women at low risk for complications, and are able to more holistically address both the patient’s mind and body.
Q: What does prenatal education by midwives look like?
A: Prenatal care comes in many forms and is adapted to what a woman needs. We provide prenatal care similar to that provided by doctors, but with a preference for less intervention in labor. Midwives are very supportive of a patient’s decision to engage in methods for low-intervention prenatal preparation, such as Lamaze and the Bradley method. We try to inform women of all their options, including pain medication or an epidural. We encourage parents and other loved ones to take prenatal classes and tour the birth center to be prepared for everything — from breastfeeding and infant CPR safety to proper car seat installation and sibling preparation.
Q: What else might expectant parents want to know about your services?
A: We have experience using supportive tools that women might need for pain relief and to facilitate labor. We use birthing and “peanut” balls to assist with position changes that can be critical for labor progress and managing discomfort. We even offer aromatherapy and wireless fetal monitoring. All of this means that our patients can be up and walking, rather than staying in bed during labor. Midwives also work closely with anesthesiologists in the event a woman chooses an epidural for pain relief, and are in continual contact with obstetricians, should a complication arise.
Q: What can a first-time patient expect when they visit your birth center?
A: Patients who want a midwifery approach will see one of our midwives for prenatal care, and one of us will support them during labor and delivery. This means that a midwife will be with them throughout the whole birth process. There tends to be a special relationship between an expectant mother and her midwife. Patients have spoken of an emotional connection when they hear their baby’s heartbeat for the very first time with their midwife, and felt confident that they could ask all their questions about why they feel the way they do during the pregnancy. It is important to know that you have someone who supports and understands your plan for labor. This trusting relationship can lead to a healthier, calmer labor, reduce rates of postpartum depression, and may increase the chance of a normal spontaneous delivery. It can also make women feel more empowered about their experiences, regardless of the outcome.
Q: What types of postpartum care do midwives offer?
A: Midwives help assist new parents with breastfeeding and proper skin-to-skin contact for healthy development and bonding. Traditionally, parents are told to check in with their care team six weeks after the birth. We like to see patients sooner, between one and two weeks, to quickly address any physical issues or mental health conditions such as postpartum depression. We feel that it is especially important to check in sooner with moms who have had a rough labor, to make sure that they are healing well, both in mind and body.
Hello, and welcome to the University of Chicago Medicine At the Forefront Live. Today our program is all about midwifery. We'll talk about the misconceptions surrounding midwifery, the role midwives play during pregnancy, and the care they offer beyond childbirth. Now, today, we have midwives Cynthia Jacinthe, Wendy Allen, and Sierra Ribero joining us to talk about what is offered here at U. Chicago Medicine.
Remember, we're taking your questions, so start typing in the comment section. We'll get to as many as possible throughout the program. As always, we want to remind our viewers that our program today is not designed to take the place of a medical consultation with your physician.
Let's start with each of you. Tell us a little bit about yourselves and what you do here at U. Chicago Medicine? And Wendy, you're on the end. So we'll start with you.
OK. I'm sorry. What did you ask me?
Just tell us a little bit about yourself and what you do here.
I've been a midwife for 16 years now, here at the University of Chicago for three years. I was one of the original members when the program started out.
My name is Cynthia Jacinthe. I'm actually the director of midwifery. I have been a midwife for 11 years now. And I've been at the University of Chicago for two.
Hi. I am Sierra Ribero. And I have been at University of Chicago for about two years or so. And I've been a midwife for almost seven years.
Great. Now we'll start off with a few questions. We'll get to our viewer questions here in just a moment. There are a lot of misconceptions surrounding midwifery. But of those that you hear often is that midwives are not trained. And we know that's not true, obviously. Can you tell us a little bit about exactly what kind of training goes into becoming a midwife and what that means?
As the least educated of the panel, I'll start. I have a Master's degree in Nursing. These two have doctorates. So you have to have at least a master's, and then pass a certification exam. Then you get your state license. And then you can practice.
Great. And Cynthia, anything you want to add?
So it is-- like Wendy was saying, there's master's program. You can go on to get a doctorate, like myself and Sierra did. And then the training, it's a national certification, so you're board certified with the American College of Midwifery.
And let's just kind of set the stage a little bit and tell us just what exactly is a midwife? I think a lot of people have heard the terminology before, but they don't know what it means, and they don't know what a midwife does to help women through pregnancy. And Sierra, I don't know if you want to take that one.
Sure. So nurse midwives are advanced practice nurses. And we are not meant to kind of take the place of a certain provider. We are meant to kind of partner with the patient or with the person that's pregnant, or not pregnant, and create an experience for them that is holistic, that's more so individualized, and just kind of create something that patients feel empowered to continue on their pregnancy, and continue on within their life as well. So not only do we provide care during the pregnancy, but we also provide care before pregnancy, after pregnancy, up until menopause as well. So, yeah.
Fantastic. And we want to remind our viewers, of course, we're taking your questions live on the air. So if you want to talk to a real-life midwife, you can do that by typing it in the question in the comments section. And we'll pass those along and try to get to as many as possible throughout the program. So what are some of the benefits of choosing a midwife? And anybody can jump in to take that one.
So one of the benefits I feel like, or we all feel, as choosing a midwife is you actually-- we get to spend a little bit more time with the patients, really empower you about your body, your health, your pregnancy. As Sierra was saying, we also take care of patients who are not pregnant. So my youngest patient actually was like a 13-year-old, just came into this for the talk, so to say, just to know about her body and her sexual health. And my oldest patient was actually an 80-year-old, again same thing, was having some issues.
So we see women throughout the whole lifespan. We empower them about their bodies. We let them know of the normal changes, the abnormal changes. And in pregnancy, we support them throughout labor, what they want to do in labor. We encourage breastfeeding, skin to skin, and provide all those additional supports. So that is-- I think the great benefit of choosing a midwife is you really get that one-on-one support with your provider.
I think that's a very interesting point that you just made. Because I think a lot of people probably when they think of midwifery or midwives, they just think of pregnancy and childbirth and for that little space of time. And that's not necessarily true at all. And I think the beauty of that, too, is you get to develop the relationship with your patient.
And so what is it like as a midwife? I imagine it's got to be very rewarding to develop those long-term relationships and work with patients throughout the years.
And because I've only been here three years, it hasn't happened yet, but in my last practice, I'd seen the same patient over-- I think I was there a total of six years. So you really get to-- you see people for their first baby, their second baby, or their last baby, and then help them make the transition through menopause, which can be a challenge for a lot of women.
So it's really nice. And you see people repeatedly. You get to know much more than just their body. It's more than they come in just a quick physical, and they're out the door again.
And you already spoke a little bit about the benefits of choosing a midwife. I want to see if you can expound on that a little bit more because I think we've kind of opened up a different avenue here as well with the relationship developed with the patients and their families. And can you expound on that a little bit, as far as the beneficial aspects of having a midwife not just to guide you through pregnancy and childbirth, but beyond?
I can take that one.
Yeah, go ahead.
So our philosophy of care is more so patient or human centered. It's more holistic. So not only are we paying attention and monitoring pregnancy and other conditions, but we're also asking additional questions and spending a little bit more time with you and your partner or your other support person, just to kind of help involve them in the process. Because not only would we be there during the labor, if that person is pregnant, but also that support person is really one of those people that we kind of want on this nice little team.
So, yeah, that's the nice thing about midwifery. We do get to spend some more time with our patients. And patients really do appreciate it because we get to answer many questions that patients have.
Yeah. Can I expand?
Just to expand on that is in addition to we really get to know you aside from what Wendy's saying, just the body, we ask you questions about what's going on at home. How are your children? We try to get to know your kids' names, if you have them, your pets' names or anything that will encompass what you're doing outside of those visits with us. So we really want on all parts of your life to be involved because it does affect the health of your body and the pregnancy and how your mind and space will go into that labor and birth.
Let's talk about pregnancy for a moment, because I think probably most people who tune in, that's the immediate thing that they'll think of. What kind of support do midwives offer for pregnant women? How does that work? Walk us through the process, if you will.
To start from the initial visit, we spend a lot of time teaching, answering questions, explaining here's what's normal. If a patient comes in with a problem, here are the options on how to treat it. We don't just give you here, here's a pill. Fix it. No, there are multiple ways to handle things. And here are all the options. We help you figure out which one are you realistically going to use and what's going to work best for you.
And I imagine that is kind of a not challenging, but it's a very involved process because you really do have to listen to the patient. And communication is key with this, I would imagine.
Absolutely. Absolutely. And there have been patients I've known well enough, even when I'm going through the list of various options, in my head, I've already pretty well decided or know what she's going to decide. But I'm still giving her all the options. Every once in a while, people surprise you.
I imagine that does happen.
I think the important thing is that, just like Cynthia said, we kind of ask those additional questions to get to know them just because some of the information that we receive can help us make a plan with you about what works best for you and what works best for your family. Sometimes even when it comes to appointments, sometimes appointment times we need to be open a little bit later, just because you might work and get out a little bit later. Those are all things that you would think that don't affect your health, but they really do. So, yeah.
And in terms of the schedule of care during pregnancy, it's the same schedule of care in terms of whether you go to an OB provider or a midwife. So that in terms of the schedule, all that stays the same. It's just the level of care and a little bit more intimacy that you get with a midwife.
And actually, it's kind of interesting. And I'm going to probably get a little bit more in depth with this here in a few minutes. But the different pregnancy options, childbirth options that we offer here U. Chicago Medicine, it's pretty all encompassing. And it's kind of neat to see some of the things that people can choose from and what they can choose on their journey. So if you have a chronic health condition or your pregnancy is high risk, is it still OK to use a midwife?
Absolutely. So we work-- most of us have worked with other facilities, in addition to University of Chicago, where we collaborate with our physician counterparts. So if you do have what you may consider a high-risk condition, maybe chronic hypertension, you have incoming diabetes, or you develop any of those complications in pregnancy, like diabetes, high blood pressure, your exacerbating asthma, a lot of those conditions we could still take care of you. But we may want to co-manage with our physician counterparts.
Or if you have a high-risk situation, you may have one or two appointments with our amazing maternal-fetal medicine team. So we could still kind of collaborate and co-manage. Even if you don't see all your visits with us, you can see some of your visits with us. And in labor, we can still provide that labor support.
And one of the things we talk about here at U. Chicago Medicine all the time is the continuum of care and the fact that we do have our teams work together. And they truly are teams.
And as you work with your families through the process, you work with a lot of people. Is that fair to say?
Talk to us a little bit about that. How does the process work?
Well, it kind of depends on the person. So a lot of it is just kind of getting the information ahead of time, during prenatal care, just be just because you do kind of want to see where the patient, where the person, where the family is, and then just kind of letting them know that this is how University of Chicago is. We have this nice collaborative relationship or partnership with the physicians here, generalist OBs and then also the maternal-fetal medicine doc.
So that's just one thing we kind of preface with our patients and just let them know ahead of time, just that they are there in case anything does happen. We work very closely with them. Even in labor sometimes, we tend to run things by them just to see if there's anything else different we can do about the plan and then go back to the patient and see if that's something that's a little bit agreeable or that is agreeable.
Yeah. One of the questions that we had, and you've already answered it, but I'm going to ask it again to allow you to expound on that a little bit, talk about post-pregnancy care. So what happens? We have the family. The woman comes in, has the child. What happens at that point?
So we'd like our patients to immediately-- just starting from Immediately after birth, we initiate skin to skin. We encourage breastfeeding. Here at the University of Chicago we have what we call a golden hour, where the patient, the partner, and the baby are the ones just in that room just really bonding for that hour, just to get to know each other and just really bond.
So afterwards, typically it's a 40-hour stay in the hospital. We come see you each of those days just to make sure you're OK and provide any assistance, answer any questions, and just make sure you're physically and mentally doing well. Some other practices, they may want to see you in about five to six weeks for that, what we call, postpartum checkup, again just to make sure any lacerations that you had made are healing well, any physical things that you want to discuss are going well, your bleeding is going well, your uterus is back down to size.
But with the midwifery group, we've noticed that having patients come a little bit sooner would really kind of help with that bonding and that health experience postpartum. So we really want to see our patients about one to two weeks after delivery just to address any physical issues. Any mental health issues, postpartum depression issues, breastfeeding, anything like that. So we want to see you a little bit sooner.
That's great. Let's talk a little bit about-- you mentioned the golden hour and skin to skin and how important that is. Kind of describe that? I mean, that's got to become a magical time for a mother.
And it's important.
It's something the hospitals just initiated. And in that first hour after delivery-- and the hour starts not from the minute the baby's born, but after everybody's done doing all of their things, and the bed's all put back together and everything. So during that hour, nobody gets to come in. There are no guests get to come into the room to see mom and baby.
If they make phone calls, that's on them. But the only person that comes in and out is the nurse to check on mom and baby, make sure they're OK. So we really leave them alone to get, as Cynthia said, to get to know each other, provide the baby with the opportunity to breastfeed. Because most newborns in that first hour are wide awake and really want to breastfeed, and they do a fantastic job during that hour.
And the skin to skin is important because it's just that contact is so critical.
It is. It helps babies maintain their temperature, their blood sugar levels, and helps mom and baby really get to know each other.
That's fascinating. Because if you've read any of the studies on that, which I'm sure you have, obviously, it's almost kind of a magical thing, the skin-to-skin contact and what it does for the child And the mother is it's pretty neat, really. And that's different from the old days, when people used to have babies. They baby would be whisked away.
And so it was kind of an empty feeling afterwards.
I can speak to that because I have older children. And you got to keep your baby for that first hour. But baby was all bundled up and wrapped up in a blanket. You got to look at the baby, and then the baby got whisked away to the nursery for six hours.
And from an emotional standpoint for mom, that's got to be kind of tough. And so this is so much better.
And to be honest, with the first one, I was exhausted. So--
[INAUDIBLE]. A little time away was OK. Then I was like, can I have my baby back?
That's wonderful. And it's neat that things have progressed as much as they have because it does make, I believe, a tremendous difference--
--for the mom. We do have a question from a viewer that's come in just a moment ago. And it's, are you open to having doulas with your moms? So how does that work?
We love doulas.
Yes, we love doulas.
Please bring your doulas. Please.
Tell us what a doula is, first, and then kind of explain how that works.
Do you want to take that?
Yeah, I can take it. So doulas are-- so a lot of people get confused, midwives and doulas. So first, doulas are like a personal support person that's there just for you. And the entire time, once that labor starts kicking in, once you call that person, they're there to help to support you, get you through some of those really tough times, and just be kind of that person whispering in your ear that you can do this.
We, as midwives, we do do that as well. But we also have additional patients that we kind of are running back and forth in between. So it'd be nice while we're not in the room to have someone there to help be kind of like your cheerleader. So that's one of the things that we-- and we love working with doulas just because we encourage different positions for patients. And doulas are really good with, getting patients to kind of switch it up, sometimes getting in the shower, sometimes walking around as much as possible. And sometimes that just kind of helps get things going.
It helps keep the pelvis open and helps keep the baby coming the way it needs to be coming down in the pelvis. So yeah, we love working with doulas. They're awesome.
Yeah. And in addition, again, to being that person in your ear, they just provide that extra additional labor support that helps us out as midwives because you've already built that relationship. Ideally, doulas, I think, are-- like, you find a doula early on in your pregnancy, and you build that relationship. You have a discussion of how you want your labor to look like, who do you want in the room, what the plan is, what do you want to help bring you back into focus.
Some people do hypno-birthing, or hypnosis, or different phrases. A lot of patients bring in music. We love a play list, FYI. So they bring in music. They bring in aromatherapy. Massage is really good. So that doula--
Hyrdrotherapy as well.
Hydrotherapy as well. So that douls, that person is, like Sierra said, just focused completely on you and getting you through those stages of labor.
We've got a follow-up question from one of our viewers. Maybe it's the same one. I'm not sure but wants to know if the hospital actually partners with doulas? Is that something you need to find yourself? Or is it something you can help?
Yeah, you have to find that yourself. We do encourage you to bring your own doula. But there's no particular partnership that we have with any doula service.
Right. And we have a list of doulas in the Chicagoland area that we share with our patients.
Fantastic. That's helpful, then. Another viewer question, so if the birthing family would like more than the allotted one hour, the golden hour, is there any pushback against that?
As long as baby looks good, yeah, we're good.
Take as much time as you need, yeah.
I would imagine you encourage that.
Just to reiterate on that golden hour, we do just want the patient, the partner, and just the baby. Because I know sometimes after birth, everybody's getting really excited. All the family wants to come in and see the baby.
So we just want to emphasize it's just that little triad that we really want to bond and get to know each other. So after that hour, if people want to come in afterwards, that's fine. If you want to take that additional 30 minutes, you want to hold off, we'll let your family members and your support people know, like, they want a little bit more time.
I think that's just a really neat thing to do. So what kinds of well-woman care do midwives offer and help with?
All kinds of well-women care. We do preconception counseling, contraception counseling. We do well-women annual exams, GYNs, PAP smears, STD testing, postmenopausal care, any kind of changes in your vaginal floor that you're not comfortable with, you just have questions on anything, or breast pain or breast discomfort. Anything that's related to your sexual and reproductive health, we can see.
And so if a parent wants to even have their young daughter start and build a relationship with a midwife, that's probably a positive thing to do and work through the [inaudible].
We highly encourage that. I did have a mom at one of my other practices who brought her 13-year-old is to see me. And that again, we build that relationship. We want them to be open and be honest with us about those discussions about our bodies. And sometimes, especially as teenagers, they feel a bit more comfortable not talking to a parent. They could be a little bit open with you. And again, it's a good way to build that relationship on the ground level.
So did you have something I want to add to that?
I saw you kind of look towards the camera, so I just wanted to make sure that I gave you an opportunity. So let's talk about the Family Birth Center at U. Chicago Medicine. We're proud of that. And I kind of alluded to this a little bit earlier in the program, that there are a lot of options there for mom. And that's, I think, again, very important because we want to give options. We want to develop the plan with the mom and communicate. So tell us a little bit about that, if you will.
We have two labor rooms that have a hydrotherapy tubs. We don't do deliveries in the tub. But you can certainly labor in the tub. All the other rooms have showers. We have portable telemetry monitoring units, so we can monitor baby while mom is up and moving about. We have what we call our toys, which are birth balls and peanut balls, which are exactly what they sound like.
Yeah, explain what exactly would you do with that?
Well, the birth ball, you sit on while you're in labor. And it's spread-- because you sit very unladylike. And it opens the pelvis and allows the baby to descend. And a lot of women find it's easier to handle the contractions if they bounce while they're on the ball or just kind of rock back and forth on it.
The peanut ball is shaped like a peanut. And it's great for women who have an epidural, in that it's kind of like squatting while you're laying on your side because we place it so that you're-- again, your legs are kind of flexed, and your pelvis is opened nice--
Hips are kind of open.
Right, again to let that baby come through. We have a birth stool. We don't get a lot of use out of that, but we do have one.
I've used it a couple times.
And the push bar, too.
Oh, yeah, and the squat bar.
The squat bar.
So the squat bar, all the beds, I believe, all the laboring beds have them. So it's just a bar that goes across the laboring bed that you can kind of hold on to. And you can literally, as it implies, squat down and kind of have your baby. And again, we encourage any kind of position to birth.
That's another misconception. Another good option that when you come to midwife is it's not the typical like you see on TV, like pull your legs back and push, push, push, like yelling in your face and things like that. So we encourage you to just let your body kind of move into the position that is best for you so you could have had your baby.
We've had babies come upside down, on your hands and knees, on your side, at the side of the bed, at the side of the tub. You know, you just got out the tub, and you're ready to push. So we just kind of listen to your body and just go with what your body is telling you.
So are there other office locations besides Hyde Park where people can get an appointment to talk to a midwife?
Yes. We have a the South Loop location. We have a Hyde Park location. And to be determined when we're also going to be going to the Orland Park location as well. So we have three locations where you could see one of the midwife.
Great. And as people learn about you and the services you offer, I'm sure that will be in big demand.
Yes, we hope so.
You guys are fantastic. You're a lot of fun.
Thank you. thanks for having us.
I learned a lot today, too. It really is nice to see that some of the things that are offered are offered because I think it's very important for families. And it's neat to see. So thank you.
That's all the time we have for the program today. We want to thank you for watching. If you want more information about the benefits of modern midwives, please visit our website site, at uchicagomedicine.org/womens-health, or you can call 888-824-0200.
We have a full schedule of At the Forefront Live programming in January, so make sure to watch our Facebook page for more information on coming programs. Thanks again for watching At the Forefront Live. And have a great week.
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