What Women Should Know About Certified Nurse Midwives

MemorialCare Health System Excellence in Healthcare presents Weekly Dose of Wellness Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today our guest is Patricia Evans, certified nurse midwife with MemorialCare Medical Group. Working in labor and delivery in Orange County since 1990, Pat realized how she could empower women to be the best they can be and to have the most positive birth experience possible. MemorialCare Medical Group recently welcomed a group of OBGYN physicians and certified nurse midwives, including Pat Evans. So we're thrilled to have her on our show today. Welcome, Pat.

Patricia Evans, CNM: Thank you very much. Glad to be here.

Deborah Howell (Host): Wonderful to have you. Can you tell us what is a midwife?

Patricia Evans, CNM: Certified nurse midwives, we are advanced health care providers. We most are commonly educated in both nursing, and midwifery, but we specialize in caring for women of all ages and backgrounds and throughout their entire lifetime. We place a special emphasis on pregnancy and childbirth, but we also do a lot of GYN and reproductive health. And we also, what's important to us is each woman's unique situation so we can provide personalized care to empower women to be the best that they can be. There's also a misconception that midwives only do home births when, in fact, 95% of midwives attended births are done in a hospital or a birth center.

Deborah Howell (Host): Oh, wow. I didn't know that. I really didn't. So how are midwives educated and trained?

Patricia Evans, CNM: There's about approximately 12,000 midwives currently practicing in the United States. And we come from a nursing background. So we have RN degrees. And then some of us, myself included, from there, then I went and became a women's health care nurse practitioner. And then it was just a natural progression to be a midwife. And it's generally once you have your RN, and then it's a graduate level entry into the midwifery program. And that's about two years. So we provide a full scope of women's health care, diagnosing and prescribing. And we also do a lot of treatments as well. And then after we finish school, we are required to take a national certification exam, and then we have to recertify every five years. And our governing board is the American College of Nurse Midwives. And we also have DEA licenses so we can prescribe and diagnose and just a full scope of women's health care.

Deborah Howell (Host): It sounds just wonderful for women. What exactly do midwives do?

Patricia Evans, CNM: So basically in the office, we work as nurse practitioners, but we're really best known for caring for women through pregnancy and childbirth. But we also provide primary care to women of all ages, from puberty to childbearing and into menopause. And we see, like on your first visit with a midwife, it's generally we'll pick them up, pick up patients for pregnancy. But then we also see teenagers, like a pediatrician may refer a teenager for menstrual problems. Our exams begin with a complete personalized history assessment, physical exam, including diagnostic and laboratory testing if needed. And then a lot of times the visit with a midwife is the only health care provider that a woman sees throughout the year. So we pick up medical conditions such as diabetes and high blood pressure, et cetera, and then we just refer them back to their primary cares to take care of that. We also do a lot of counseling on preconception, like before pregnancy, prenatal care, birth control, sexual health, STD counseling. But they are all very closely related and individual to the woman's unique experience.

Deborah Howell (Host): That is a wide range of services. What if I want to see an OBGYN for my care?

Patricia Evans, CNM: You can at any time. We are a complete group. So there are four OBs and about six midwives. And if any complex cases, we send on to the OBGYN and they'll handle those. We pick up a lot of the initial problems and then they handle the others. So women can see both us or the OB, whatever they are most comfortable with.

Deborah Howell (Host): Got it. Now, this is a big, big question for people. Are midwives covered by most insurances?

Patricia Evans, CNM: As long as they're covered with MemorialCare, they are covered, whatever their insurance is. If they come to our group, all providers are covered within the group.

Deborah Howell (Host): Okay. A lot of people are looking at the choice these days, midwife or OB. Can you speak to that?

Patricia Evans, CNM: Sure. Our goal, related to labor and delivery, our goal is for a woman to have the most positive growth experience that she can. And we work very, very closely with our OBGYNs. And, but that birth experience looks different for every woman. And if a woman is more comfortable having the OB, then absolutely, we have no problem with that. And it's just whatever, whatever they're most comfortable with and whatever kind of birth experience you want. We still take a holistic approach to labor and delivery and even in the office, but sometimes we have more time to spend with our patients, and that's kind of why women come to us more so than going straight to the OB.

Deborah Howell (Host): Understood. Now, what if my pregnancy is high risk?

Patricia Evans, CNM: You can choose. If a pregnancy is high risk, we will refer you to the OBGYN or to a perinatologist. However, we still work very closely with our OBs to provide the best care for a healthy mom and healthy baby. And oftentimes the midwife is still with you or with the woman during labor and delivery.

Deborah Howell (Host): Okay, got it. And Pat, you mentioned earlier that you take women of all ages. What kinds of services do midwives provide for women who are past the age of pregnancy?

Patricia Evans, CNM: We do all menopause, like hot flashes, hormone replacement, any type of thing. We do a lot of counseling women. Menopausal women have different issues than, say, women in their 20s or teenagers. So we address all of those and help them to get through that period very comfortably and healthy. We do a lot with that, talk a lot about diet, health styles, wellness, things like that.

Deborah Howell (Host): It really runs the gamut.

Patricia Evans, CNM: It does. And it's tailored to what their unique situation is, because everybody is different. So, but we're there to listen and to provide, you know, to have them, empower them to have the best type of life that they could have.

Deborah Howell (Host): It's almost like having an additional doctor, one you can really talk to.

Patricia Evans, CNM: Exactly. Exactly. And then if there is a problem that we can't handle, then our OBs are right there to step in if we need to.

Deborah Howell (Host): Right. What else should we know about midwifery? Is there still a stigma attached with it?

Patricia Evans, CNM: You know, there is. I don't think that because it's always that, oh, you do a home birth, you know, you deliver at home. No, no. We don't. Our particular group does not. But again, remember, 95% of births by a midwife are done in a hospital or a birth center. And that's what makes us unique because you can still have that midwife experience, but you have the safety of being in the hospital. Another thing that I should mention is that we also have, we delivered Orange Coast Memorial in Fountain Valley, And we do have a laborist on 24-7. A laborist is an OBGYN that stays in the hospital and is there as a backup should any emergency arise, which is great because we can also do VBAC, which is a vaginal birth after cesarean. And that's really great for a lot of women who had, say, a C-section for maybe a breach or for other reasons. So as long as they meet the criteria, they can have vaginal birth with a midwife. That is very safe.

Deborah Howell (Host): Fabulous news. And I love that you have a, what did you call it on hand?

Patricia Evans, CNM: They're called laborists. It's kind of a new term that's come around. But it's just great because there's any type of emergency in labor and delivery as the midwives, we don't perform C-sections, but we are the second assist. So we are still with you, like even if you do have to have a C-section. But the labor is if it's an emergency, sometimes you don't have a whole lot of time to get the baby delivered for safety. And so with having that labor there, we can deliver that baby very quickly for a healthy outcome.

Deborah Howell (Host): Fantastic. How can I learn more about midwifery? Midwifery, excuse me.

Patricia Evans, CNM: Midwifery, yeah, midwifery. A lot of people say midwifery. It's very, very common. But we do prefer midwifery. The best thing is to visit our website, MemorialCare, or just call us to make an appointment. We do... kind of meet and greet and would love to sit down and talk to you or give us a call. We can, you know, kind of counsel you over the phone with your unique situation to see if, you know, perhaps you do need to go to the OB first or you can come and see us first and we'll kind of diagnose and see what's going on and take it from there.

Deborah Howell (Host): Well, thanks so much, Pat, for your time today and for all the wonderful work you do on behalf of women and their families. We really do appreciate it. For more information or to listen to a podcast of this show, please go to memorialcare.org. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a great day.