TWAD: Wellness Brief: Midwifery Transcript
Jennifer Semenza
Hello everyone and welcome to talk with the Docs Wellness Brief, a podcast offering a quick dose of healthcare information on a wide range of trending topics in under 15 minutes. In recent years, there's been a noticeable increase in the popularity of midwifery care for children by variety of factors, including a desire for more personalized care, the natural birth movement, and changing perceptions about the safety. Efficacy of midlife blood births. I'm Jennifer Semenza and here with me today is Mary Mittel, medical director for midwifery Providence Swedish. Welcome. Thanks so much for joining us today.
Mary Mittel
I'm excited to talk with you. For having me.
Jennifer Semenza
While the profession. Midwifery has been around for centuries. There's a lot of misunderstanding about the full scope of what midwives do, and I really want to help our listeners get a clear understanding of the. Of a midwife. So what exactly is a midwife?
Mary Mittel
Great question. Within the Swedish Providence system, all of our midwives are what's called certified Nurse Midwives, which means that we are nurse practitioners with a masters degree and board certification in both pregnancy care. And in kind of, well, woman, gyne care. And so midwives, you can think of them as experts in, in normal and moderate risk pregnancy and any other healthcare needs really from. Puberty through menopause.
Jennifer Semenza
And what are the benefits of having a mid? Throughout your pregnancy.
Mary Mittel
Yeah, midweek free care is associated both with excellent outcomes. And lower intervention rates, which means that you have really healthy pregnancies and healthy births with fewer potentially unnecessary interventions.
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Thanks.
Jennifer Semenza
Mary what? You like people to know about midwives and the care they provide.
Mary Mittel
Midwives are really focused on providing personalized and customized care to the families we work with. We of course. Pregnancies and births to be safe and healthy. But we know that it's also a really emotional and important sort of event for the whole family, and we take a lot of time and make efforts to to get to know people personally, so we know what's important to them so that they can have a positive exper.
Jennifer Semenza
And I'm sure that the type of care that you can provide is different from their doctor. So how do midwives differ from obstetricians in terms of the care they can provide during pregnancy and childbirth?
Mary Mittel
Yeah, that's a great. There's a lot. That's the. So families that come to Swedish or Providence or their pregnancy care, they're going to get the same information, the same routine screenings, the same recommended immunizations, the same access to the hospital systems resources, whether they see an obstetrician. A midwife. Probably the two main differences that families would notice is 1 midwives generally have longer appointments. We ask more. We're curious about the like I said it more personal and emotional aspects of a persons pregnancy experience, and we really want to get to know them so that they feel comfortable and secure with us. The other difference is what we call scope of practice. Midwives are focused on low and moderate risk pregnancy care. There are things that sometimes people need that we don't do, such as. And so all of the midwives within our system also work with obstetrician and perinatology colleagues, so that if a midwifery patient needs additional care, those providers are immediately available for them as well.
Jennifer Semenza
So sounds like you're really working with women throughout the entire duration of their pregnancy, not just during labor and delivery. Really exciting.
Mary Mittel
Yeah. So women who are having low or moderate risk pregnancies can have all of their care from their first prenatal visit through their postpartum visit with a midwife and potentially never see a physician that they don't need the care that they.
Jennifer Semenza
Wow. So how do midwives support natural? And what are their approaches to pain management during labor? If if the birthing person really wants that?
Mary Mittel
Yeah. So certainly we do have families who want both midwifery care and an epidural, and that is. We're really here to support people in their decisions and help them have the birth experience that's best for them. But we do have lots of families that come to us because they are looking for unmedicated labor and minimal interventions. We use a whole range of strategies to help promote that. Of it starts during prenatal care, we. Do a lot of teaching and guidance and sharing resources so that families feel really prepared and have strategies like. Positioning and breathing techniques and massage to help them cope with labor. Also in the hospital, we often have tubs in the laboring room and birthings. And beds that can be changed into different positions and families generally find that midwives spend a lot of time with them during the labor, suggesting strategies both to help with coping and to. Labor progress.
Jennifer Semenza
Those barking balls are no joke, my daughter, youth club and boy, that was just. It was just such a benefit to have that in their room and available to her.
Mary Mittel
Yeah. Sometimes the simplest. Things they they help you sort of stay upright and mobile and changing position and all of that's good both for progress but also just keeps you feeling you know not just stuck in bed suffering through the contractions but that you're you're participating in this really intense but amazing. Process.
Jennifer Semenza
Absolutely, yeah. What kind of prenatal care can a person expect from a midwife?
Mary Mittel
There's a lot. If somebody had gone to an obstetrician in their first pregnancy and then came to a midwife for, say, this next pregnancy, there would be a lot that seemed similar. The. The baby's throat and listen to the baby's. We check blood pressures and do routine lab tests and offer evidence based immunizations. A lot would seem the same, I think. Thing that stands out to families. Most is. We also just spend a lot of time talking with people to get to know them. This is important. Because every family is different and what their priorities are, or their fears are are unique to them. But also we just know that feeling at ease with the person who's caring for you, for your pregnancy and your birth contributes so much to decreasing stress and that that Gener. Makes the experience go. Better, so it's helpful for us to know the families, but it's also really helpful for the families to feel like they're known and that they're getting individualized, personalized care.
Jennifer Semenza
Absolutely. It's all about building that relationship, I imagine.
Mary Mittel
Absolutely.
Speaker
More.
Jennifer Semenza
And I'm sure that there's a lot of misconceptions out there about midwives and the services that that they can perform. So how do midwives handle? Because we know not everything goes according to plan. Are there protocols in place to ensure that patient's safety?
Mary Mittel
I. Absolutely. So midwives are trained. Care for the? Common of the pregnancy complications. So somebody who develops high blood pressure or diabetes during their pregnancy can stay in middle free care. If at the time. Birth. A problem with the baby's heartbeat or heavy bleeding after the baby's born. Midwives know how to manage that, but. Providence Swedish sister. Midwives are also always working in a hospital setting with a full complement of the care team around them, so there are additional nurses, obstetricians, perinatologists, anesthesiologists who are part of the whole care team, and those providers are as immediately available for midwifery patients as they are for their. And so we just pull in the provider who has the skills that. Needs.
Jennifer Semenza
It's so comforting to know that there's that safety net there.
Mary Mittel
Absolutely, yeah. You know, labor. There often really normal and in low intervention can be appropriate, but also unpredictable things happen and the stakes are really high. Wanna do everything we can to keep parents and babies and families healthy?
Jennifer Semenza
Absolutely. It sounds like there's a lot of collaboration there.
Mary Mittel
Yeah, I'm really impressed. Working within the Swedish system about how collegial and supportive everyone is.
Jennifer Semenza
That's great. How do I support breastfeeding and the postpartum recovery process?
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Yes.
Mary Mittel
Yeah. I think oftentimes when we're talking about pregnancy and childbirth, we talk about pregnancy and childbirth when the truth is, is that sometimes the most complicated and challenging and intense part is those early postpartum days and weeks. Rise to a lot of close follow up to check in both on physical recovery. Just. Is the family navigating those intense early sleep deprived days with a newborn? We also work again with other specialist lactation consultants, for example, to help support sometimes those common breastfeeding challenges. Then we're. Really connected with the community about new parent support groups and sometimes therapist or mental health counselors who work specifically with postpartum families. Because people. Meet a wide range of support in those early days.
Jennifer Semenza
Yeah, and thinking about someone who is expecting a. What should they be looking for when choosing a midwife, and what questions should they ask during that first consultation?
Mary Mittel
There are lots of different models for midwifery care. There are group practices and then there are sometimes individual or smaller practices sometimes. Say to me that what's really important to them is to get to know one provider, 1 midwife, and know that that midwife will be at that birth. And there's a lot that's great for that kind of continuity, but there are also some challenges that come with that. For instance, if that midwife is doing that for you, it means they're doing that for their other families.
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Go to.
Mary Mittel
So maybe your appointment will get that you've been waiting for is going to get cancelled because the midwife needs to be with someone else who's in labor. Our practices are group models, which means that it's a whole team of midwives who are working together to take care of you.
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Go to.
Mary Mittel
It means meeting different people, but we make a big effort to. All work together and it ensures that when a midlife is scheduled to be in clinic, she's going to be there and not get pulled into the hospital because that's a. Person that day.
Jennifer Semenza
So what are some of the key differences between giving birth in a hospital with a midwife versus a birthing center? Even a home.
Mary Mittel
Yeah. So I would say that home and birth center births are are the safest for people who meet very strict criteria about their baseline health and the health of their pregnancy. Really, for the lowest risk pregnant. Seeds and for people who are really committed to minimal intervention, I think the benefit of giving birth in a hospital is that a wider range of people can get midwifery care because in that hospital setting we have that wider scope of practice where we can take care of. Some of the common pregnancy complications, and it just means that there's more continuity. For a family, they start with a midwife at and the Swedish providers system. Even if some of those common pregnancy complications happen, they're really likely to be able to continue their care with the same team.
Jennifer Semenza
Mary, we know not everybody is treated the same or has the same experience when it comes to pregnancy and then labor and delivery. What efforts are midwives making to address those disparities in maternal and infant health outcomes, especially among our marginalized communities?
Mary Mittel
Yeah, that's such an important question. You know, I think when midwifery is at its best, like I said, we take a lot of time to spend with families, to build relationships. Interested not just in the medical. Of their care. But also just in their specific personal needs and when we think about that from an equity perspective. It means talking with people about what have your previous experiences with the healthcare system been like. Have you experienced racism? You experienced. Do you have specific concerns around that, and if so, how can we address them? Understanding people's cultural backgrounds are you, for instance, a Muslim family and you want special care in. Liberty Room so that you can say a prayer with the baby when they're first born. Getting to know people on that personal level and building in the time to have a lot of curiosity about their needs and make extra efforts to meet their needs. And that's benefits everyone, because everybody not, there's not one model of care that works for every family, but it's especially important for families from marginalized communities because we know that there's just more likely. To be a gap between what typical care looks like and what they need.
Jennifer Semenza
And you beat me to my last question, but but I want. I want to make. That people hear that answer. So there are cultural considerations that midwives can take into account. That what I'm.
Mary Mittel
Absolutely. Again, I think there's. I think about it sometimes from the the there's a medical level of the care right. Wants the baby's heart. To stay in a normal range and they're bleeding to not be too heavy and their blood pressure to not go too high like everyone wants safe medical care. But that's not enough, because birth is this intense emotional. Life event and we really need to tend to people's sense of safety and security and being known and being supported in their values. So taking the time to know what is important to people helps us provide the care that feels that creates a positive memory, even if some unpredictable things happen along the way.
Jennifer Semenza
Mary, thank you so much. Learned a lot. Sure. Listeners learned a lot about the role of midwives in safe and supportive births, and I'm sure a lot of our listeners are now considering a midwife for their next birth. Least we hope.
Mary Mittel
Yeah. Thank you so much for taking the time to talk with me. Really enjoyed our conversation. Yeah, that's.
Jennifer Semenza
Yeah, this is great. I also want to thank our audience for joining us today on talk with the Docs Wellness brief. We look forward to continuing the important conversation on health and Wellness with more experts from Providence and sharing our mission of help for. World. To get continued information on other. Important healthcare topics please subscribe to talk with the doc on your favorite podcast platform and on social media. With us on Facebook. Talk ANX at Providence and on Instagram and LinkedIn under Providence Health. To learn more about our mission programs and services, go to providence.org for all of this and more, please download the Providence app on your smartphone. And Please remember the information provided during this program is for educational purposes. You should always consult your healthcare provider if you have any questions regarding a medical condition or treatment. For listening.
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