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Vital Views is a weekly podcast created by UNLV School of Nursing to discuss health care from a Rebel Nursing perspective. We share stories and expert information on both nursing-specific and broader healthcare topics to bring attention to the health trends and issues that affect us. New episodes every Tuesday.
Feedback? Questions? Episode Ideas? Email vital.views@unlv.edu.
Unknown Speaker 0:20
Music.
Unknown Speaker 0:31
Welcome to another episode of vital views. I'm Dr Jennifer vanderlon, one of the faculty here at the UNLV School of Nursing. Today, I am with Dr Janice Enriquez, one of my fellow faculty, who's also a midwife, and Sarah richens, who is one of our student midwives in our midwifery program. And today we are celebrating National midwifery week. Janice, you and I are both nurse midwives. Listeners. Probably wonder, what is a nurse midwife and what does a nurse midwife do? How do you answer that question?
Unknown Speaker 1:06
That's a great question. Jennifer, normally, when I am talking to the public about what it is that I do, I tell them that I'm an advanced practice registered nurse. I provide primary care, sexual and reproductive health care, and in my specialty, I also provide maternity care. So I tell folks that what that means is, in addition to doing the functions of a nurse practitioner, I can actually take care of patients who are birthing babies in a hospital setting, in a home setting, or even in a birth center. So that sets us apart from the other specialties. I am duly prepared in nursing and in midwifery. So that's usually my answer.
Unknown Speaker 1:50
Thank you. Janice Sarah, as a student nurse midwife. How do you answer that question?
Unknown Speaker 1:56
I say something a little bit different. I compare it to an OB GYN, and I say that I can do pretty much anything an OB GYN can, except for cut. I'm not a trained surgeon, so I take care of people from first menses to post menopausal preconception care, prenatal care, and of course, I get to catch babies.
Unknown Speaker 2:17
Thank you.
Unknown Speaker 2:20
So Jennifer, we are both nurse midwives, but the work that we do is very different. I take care of patients in the clinic every week, and I catch babies. Can you tell the listeners what it is that you do as a nurse midwife?
Unknown Speaker 2:32
Sure, yeah. My role is different, because my primary role is as a nurse scientist at UNLV nursing, I am responsible for producing research. The research that I do is on our maternal health system, and I try to understand how we can improve access to care and our systems of maternal care so that we can have better health outcomes for moms and babies. And my area of research is actually a little bit unusual for a midwife, but I think it's really important for midwives to be part of that conversation about what changes we want to make to the maternal health system, and because I think so strongly about that, in addition to doing my research, I volunteer on state and federal committees so that I can share the knowledge and Experience of midwives and their patients in meetings where policy agendas are set. So I get to ask the next question, Janice, and I imagine that some listeners may not have realized that midwifery is still a part of care in the United States Health System, or that it's available here in Nevada. So given that they may be wondering, what is a day in the life of a nurse midwife like can you give us a little bit of an idea about what your work life looks like?
Unknown Speaker 3:48
Sure. So it's unique for me, because I teach full time here at UNLV, so a day in my life is very chaotic sometimes, but when I'm working as a midwife, I am actually in clinical care once a week, so I see patients in the office setting. I'm also on call at the hospital, like today, I'm working at UNLV, but I also have a patient in labor, so we can't predict when babies will arrive, but I have a group of people that I work with who can back me up. For instance, is when I'm here recording a podcast, so my patients can have inductions of labor, they usually will birth their babies in a hospital setting. So my practice is also hospital based. I'm not in a birth center and I'm not in a home birth setting. So when I'm attending births, catching babies that's going to look like admissions to the hospitals and birthing my patients in the hospital, midwives, we do a mix of cares, but some of my colleagues work as laborists, and others work in just gynecology and breast care. And in my experience. Is I actually worked in those specialties. So for a period of time, I caught babies when I first graduated from midwifery school, and then I changed it up a little bit. I went into working in reproductive health care. So I spent time working in Planned Parenthood. So I did that for a couple of years, and then I also specialized in breast care. So I also did that for a couple of years, and recently I returned to practice, so I'm re entry into practice, and it's been just about almost 10 months now that I've returned to practice, which means that for me, I need a little extra time catching babies again, kind of like a new grad. And so that's kind of what I what I do. It's certainly never boring.
Unknown Speaker 5:43
It sounds very busy. And the thing that I like the most about what you've said is that you've been able to change your career as it fit your life, that you moved from gynecologic care to breast care back to catching babies. Sarah, when you have your practice as a midwife. Are you going to specialize? Do you want to do the full spectrum of care? What do you want your career to look like?
Unknown Speaker 6:07
I want to catch babies, really. That's where my passion is. The United States has one of the worst maternal health rates in the first world country. Sorry words escape me, and that was very disheartening for me. As a mom of seven children, I didn't have any dramatic births or whatever, but a lot of my friends did, and I caught my passion with my fifth baby, where I wanted to be a part of the system that helped fix how we labor and birth babies in America, and I felt like I couldn't do that as a nurse. I'm a registered nurse now, working in labor and delivery, but my voice is not heard, and I felt like becoming a midwife. My voice can be heard and I can make that change within the hospital system, starting with me.
Unknown Speaker 6:57
That's fabulous. Thank you for doing I'm glad you're a student, I'm glad you're going to be able to advocate for the families that we care for.
Unknown Speaker 7:06
So Jennifer, I do have a question for you. Yes. Janice, last year, you completed the American College of nurse midwives, midwifery workforce study. I love all the material, materials you prepared. Listeners, you should go and check that out. Head to the American College of nurse midwives website and look at the workforce materials. But what I want to know is, what is your big takeaway from this study?
Unknown Speaker 7:30
Oh, I get that question all the time. Janice, it's a great question. The problem is, there's so much that we learned in that study. As you know, because you're a nurse midwife. We started that project because the growth of the midwifery workforce in the United States has been pretty slow, and this is a problem because midwives are often presented as a solution to the problem of access to maternity care. If I don't know if our listeners will be familiar with this, but we have a lot of parts of our country that are considered maternity care deserts, which means there's no maternity care for families that live in those counties. What we found when we looked specifically at the midwifery workforce was that we only have 12 states where the policy and regulatory frameworks allow midwives to work to their full potential in capacity those 12 states are getting the benefit of midwives, but in every other state, there's restrictions that are preventing the population from getting the benefit of the midwives. And what's really most disheartening is to know that even if midwives are in a state where the regulatory framework allows them to work autonomously, midwives may still be prevented from working in a community if they can't admit their patients to the hospital because of outdated hospital bylaws,
Unknown Speaker 8:48
outdated So Jennifer, can you expect expand a little bit on what that means?
Unknown Speaker 8:53
Sure, there was a time when hospitals needed to limit admitting privileges to physicians to comply with Medicare reimbursement requirements. That rule was only for Medicare patients, not for everybody, but for some states, they actually wrote that into their hospital licensing regulations. There are work arounds for this rule, but basically that work around means that a nurse midwives needs to have a physician to co sign their records for their patients, essentially having two providers doing the work of one. I'm guessing Janice that this is how most of your career as a midwife in Nevada has been having a physician co sign your hospital records.
Unknown Speaker 9:34
Yes, anytime I've had hospital privileges. That's exactly how it goes.
Unknown Speaker 9:38
And it wastes your physician time. It does. It's a lot. It's
Unknown Speaker 9:42
a lot of work, extra work that probably doesn't need to be done.
Unknown Speaker 9:47
I agree. I agree, and so do the Centers for Medicare and Medicaid Services, because that Medicare rule was formally changed in 2019 Nevada was actually one of the states that. Had that requirement that you had to be a physician to admit patients into the hospital licensing statutes, but the legislature changed that in 2023 and they we now allow nurse midwives to admit their patients without having to get a physician to co sign the record. But the problem is some of our hospitals still are going to have that written into their bylaws and so they can't take advantage of the work that nurse midwives can do. Right? Sarah, you took a class with Janice and I on professional issues in nurse midwifery. What is your big takeaway about regulatory barriers for midwives?
Unknown Speaker 10:40
It really prevents our ability to practice at our full potential, even, like as a nurse, there are some states that limit our scope of practice. And moving into Nevada, my scope of practice has changed a whole lot, too much, like I'm a little uncomfortable with it. It's just because I haven't practiced that way. So seeing that our scope of practice is limited within the state of Nevada, it's kind of shooting yourself in the foot. We don't get to help our patients as much as we should. There shouldn't have to be another person saying, Hey, you can do this when we are on all levels the same level of provider.
Unknown Speaker 11:16
I agree. I agree. Sarah, it is my turn to ask a question. Janice, I get to ask the last question at UNLV. Obviously, we
Unknown Speaker 11:27
have a nurse midwifery program. It's a graduate program, so students need to already be a registered nurse to attend our program. Janice and I, you both teach in this program. Sarah, you're a student in this program right now. So what I want to know from both of you is, why do you think that future nurse midwives should attend our program at UNLV instead of another midwifery program?
Unknown Speaker 11:51
I'll go first. Okay. And so for me, I think what makes us awesome is that we have Kate Weber, who is a leader in midwifery education, so she she is amazing, even as a new faculty member, I have watched her teach our students, but also take the time to teach me how to teach them. So she's like patient. She brings in evidence based practice. She makes things relatable, which is automatic for me, because I do that on a regular with patients, but at a student level, I've really been able to grow under Kate's, you know, guidance, and Karen also with yours, Jennifer, because you've also mentored me through a lot of my my process and learning how to teach. We also have a lot of good community partner relationships. I mean, great community partner relationships. And so for us, we are partnered with UMC. We have the birth center, so we have lots of locations for our students to gain experience. And with our program, you can actually study at home. So if you're a listener up in the north, if you decided that midwifery was your jam. Well, you can study the stuff from your home in Reno, and we can set up relationships to help you find a preceptor site in Reno as well. And then it's a master's entry into practice. So you don't have to have a doctoral degree. You can complete your master's degree in nursing, in midwifery, and there's no requirement to have your doctorate in order to practice as a midwife here in the state or in any state really.
Unknown Speaker 13:28
I Yes, I think that's a really big deal for midwifery programs too, Janice, because it's a faster entry to practice as a midwife, and you can always go on to get the doctorate if you need it for your practice, but you can be in that work catching babies in just two years. Yes, yes, Sarah, what about you? What is, what do you think is special about UNLV midwifery?
Unknown Speaker 13:53
I love it. Kate and Janice, they're freaking fantastic. I love you guys so much. And Jennifer, you are wonderful. I mean, you turned me into more of a feminist than I already was. But I love the idea of such a first it's brand new program. I'm in the first cohort, and I love the idea that it's small. You know who I am. You know my issues, you know all the things that's happening in my life. I'm not just a name on a paper. I'm not a number. I got into another midwifery program that offers the same kind of at home learning, and I could have even done my clinicals in Washington State, but Washington is flooded with midwives, and nothing against my home state. I knew I couldn't be able to get a job where I wanted, and I knew Nevada needed me so my family, we accepted my acceptance into UNLV, and just the summer we moved down here, and it's because of that first nine months of the love and attention that I got from all three of you. I cannot say enough about how wonderfully, okay, I'm gonna start crying guys, just how wonderful you guys are, and the girls in our cohort we have, like this wonderful sister. Hood. I wish my friend Rachel was here, but she's super busy. But we're like sisters. I actually live three minutes away from her, and we went out yesterday to get Sonic because I had a rough weekend and she had a rough weekend, and we could just commiserate and be there for one another, and we do that for the other girls who are part timers. So this program is not just I'm just not a name, I'm not just a number. I'm not graduate class of 224 whatever the number is. I'm Sarah and my friend Rachel, and we're going to graduate in May. And you know who I am, and you know who she is, and I love it. So even as this program grows, I think that same love and intention is going to be continue to each individual who comes through
Unknown Speaker 15:44
your program. Absolutely yes. Thank you for sharing that. Yeah,
Unknown Speaker 15:49
thanks for making me cry. Oh, so sorry.
Unknown Speaker 15:54
I didn't know that was a crying question. So thank you everybody for joining us for national midwifery week, we actually have to run right now because Janice has a patient in labor and she needs to get to the hospital. But thank you so much for Joining us with vital views.
Unknown Speaker 16:22
Applause.
Transcribed by https://otter.ai