When deciding the care and birth plan you want for your pregnancy there are a lot of different directions you can take. SSM Health wants expectant mothers to know the different avenues available. Jessica, a midwife at SSM was kind enough to elaborate more on the key players that are often used during pregnancy and birth; and describe their different roles. Here’s the questions and answers she provided.
What is the difference between a midwife, doula and OB physician?
Midwives: There are three different types of midwives: community midwives (sometimes known as “lay” midwives), certified professional midwives (CPM) and certified nurse midwives (CNM). The training and education requirements are different for each type, and they practice in a variety of settings. All of the midwives at SSM Health are Certified Nurse Midwives (CNM). Certified Nurse Midwives have a degree in nursing and have gone on to continue their education through either a Master’s or Doctoral program specializing in midwifery. CNMs have graduated from an accredited nurse-midwifery education program and passed a national certification board exam. Certified Nurse Midwives have a state license to practice midwifery and can practice in hospitals, birth centers, medical offices, and clinics. CNMs provide general women’s healthcare throughout the lifespan, care for women during labor and birth, and prescribe medications.
Doulas: Doulas provide physical and emotional support for women and their families during pregnancies, labor, and birth and are wonderful at this. You can also refer to this article we recently did which elaborates in more depth the wonderful services doulas provide. Midwives provide emotional support, as well, but are also your medical providers. Some women choose to have a doula and a midwife, and our CNMs are always happy to work with doulas.
Physician: A physician is a skilled surgeon, which midwives are not. Physicians manage high risk pregnancies skillfully, and perform surgeries (like C sections) when it is appropriate to do so. We work with our physician colleagues in partnership when issues during pregnancy necessitate their involvement. For the most part, in a healthy low risk pregnancy, we do not need their assistance. If you choose midwifery care for your pregnancy and delivery, your midwives will provide your prenatal care and attend your birth at the hospital. The majority of women will not need to see a physician during their pregnancy/birth if they are seeing midwives. If a complication occurs during pregnancy and/or delivery, your midwives will work very closely with SSM Health physicians to determine whether a consultation or transfer of care is needed.
Please share some positive experiences being a midwife?
This year we have had many successful vaginal births after cesarean (VBAC) which have been very empowering to our patients. Some of them had their first birth with us, which ended in a cesarean section (some of them due to suspected malposition of the baby which can hold up the labor progress), and came back to us for their subsequent pregnancies with the intent on having a VBAC. We worked very hard during their last month of pregnancy by doing daily positioning exercises (from a resource called Spinning Babies) intended to help the baby get into an optimal position for a physiologic labor and birth. Almost all of our Patients hoping for a VBAC had a fast labor and successful vaginal birth. The recovery time was shorter and they felt validated that their bodies can birth babies vaginally, and not just via c-section. These births are so meaningful to be a part of. We form such strong bonds with these families- sometimes all they need is a little encouragement to trust their bodies.
Testimonies are such a great way to learn from someone’s personal experience. Molly had a successful VBAC (vaginal birth after cesarean) at SSM Health this past summer. She has been so gracious to share more about herself, her birth story and experience with her midwives.
How many kids do you have?
I have 2 children. A girl, Adley, who is just about to turn 3, and a boy, Brady, who is almost 5 months.
Please tell us about your experience seeing a midwife?
Prior to having children, I would see them for my well woman visits. I always felt so comfortable discussing my questions and concerns with them. I never felt judged or shamed, and they always spent time with me discussing any concerns I had about my health. Because of my positive experiences, I knew I wanted to go with them once I became pregnant. I love their low intervention approach, but also how, if care needs to be escalated, they can and will do it. Also, as an advanced practice nurse myself, I love supporting my colleagues and their approach to patient care.
Can you share your birth stories?
My first born’s birth was long and exhausting; 48 hours of labor that ultimately ended in a C-section. This was not for lack of trying, we attempted multiple different positioning techniques and even some belly jiggling. Our midwife, was there for us the entire time, both on the phone when I was laboring at home, and immediately upon our arrival to the hospital. Unfortunately, despite our best efforts, the baby was in a suboptimal position and would not budge. We collectively decided to consult the OB on call, who skillfully delivered our beautiful baby girl. Though an unplanned cesarean was not in my original birth plan, the effective communication and teamwork between the midwives and the rest of the SSM team was second to none.
When I became pregnant the second time, I started seeing the midwives again for prenatal care. I was open to considering a VBAC or scheduled C section; the one thing I knew for sure was that I did not want a repeat of my first experience. The midwives guided me through that decision making process; putting me in touch with the right surgeons to discuss the risks and benefits and being very patient with me when listening to all my concerns and questions. In truth, I really did not want to schedule anything, but rather let the baby decide how and when he wanted to enter the world. Even though that is not always possible, when I expressed that opinion to the midwives, it was always met with understanding, and an explanation that no decision was binding, and I could change my mind at any point. I always felt that the decision was mine to make, even though there were plenty of times that I wanted them to just make it for me.
I began having pre-labor pains about 4 days before my son was born. I kept the midwives updated throughout, and they always answered my calls promptly and thoroughly. I was told that until things become consistent, I could stay at home. Of course, if I ever felt uncomfortable or if things changed, I could come to the hospital. When things finally became consistent (at 3AM), I alerted the midwives, and we made the decision that I would come to the hospital later that morning. By 6:45, I was in triage, and to my surprise, I was 9.5cm dilated. The nurses brought me to delivery, where the midwives (Karen) met me. I originally thought I wanted an epidural, however, in talking it over with Karen, we decided against it because I did not want to have to sit still, and, because I was so far along, it may not have had the desired effect.
Jess came on shift at 8AM, I remember her telling me that she was going to give me a series of position changes. She said that everything she told me to do was intentional and with the goal of getting the baby out safely. Jess had seen me many times prenatally in the clinic, so she knew my anxiety about the baby getting stuck or needing to have surgery. Throughout the labor and whenever I became nervous about how things were progressing, she calmly and confidently told me that I was safe, and to let them help me. She coached me throughout the whole process, telling me where to focus my energy, how and when “little pushes” were necessary, and what to expect. Everything she said and did was so helpful for me and gave me permission to surrender, trust the process, and ultimately deliver a 9lb 9oz beautiful baby boy. After delivery and skin to skin time, Jess sat on my bed to talk, recapping the events of the day and forecasting what to expect in the recovering process. It was an incredible experience.
My birth stories, although very different, were both beautiful and truly demonstrate the breadth of knowledge of the midwives and the value they bring to the birthing team.
Would you recommend a midwife to family and friends?
100%. I am forever grateful to the midwives and the entire staff (nurses, physicians, techs) at SSM for always taking such good care of me and my family.
We are thankful to both women for sharing their experiences and helping us learn more about midwives! If you are looking for additional information on midwives at SSM Health, please refer to the midwife website.
This post is in partnership with SSM Health – we value the expertise they bring to our audience!
