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Tuesday, April 25, 2017

Midwife Resource Guide

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Every woman experiences pregnancy and anticipates birth in her own way.  When it comes to pregnancy and childbirth, there is no right or wrong way to go about it. We each have our own set of needs, desires, and expectations. Once the decision has been made to try to conceive, you will want to search for a healthcare provider to care for you during the pregnancy and the birth of your child. The type of provider that you may choose would depend on numerous factors such as accessibility, type of experience desired, cost/insurance, whether the pregnancy is high risk, relationship with the current healthcare provider, and the environment that you would like to give birth in. While ob-gyns and family physicians have been considered the norm, more women are choosing to use certified nurse-midwives and direct-entry midwives.

Main sections of this article:
Things to consider when choosing a healthcare provider
What is a midwife?
What does a midwife do?
Why choose a midwife?
Why not choose a midwife?
Midwifery myths
What you need to know about your midwife
How to find a midwife in your area
Richmond area midwifery resources

Things to Consider When Choosing a Healthcare Provider

Accessibility
One of the main factors in choosing a provider would be their accessibility. Not everyone lives in a location where all the different types of providers are available. Research to determine which providers are close to you. If providers are too far away, it may deter you from getting the necessary care that you and your baby need.

Type of Experience Desired
Everyone has a different approach to pregnancy and birth. You need to consider what is important to you and determine which provider will be able to meet your expectations. For example, you may desire a holistic approach to your pregnancy and birth with minimal interventions like continuous electronic fetal monitoring, epidurals, and etc. A midwife might meet your needs.

Cost/Insurance
Many people do not know that most health insurance companies cover Certified Nurse Midwife (CNM) services. Believe it or not, Medicaid reimbursements for CNM services are mandatory in every state. Even still, please check with your insurance company to verify coverage and reimbursements.

Pregnancy is High Risk
If you have any medical conditions that place your pregnancy in the high-risk category, it is recommended that you consider medical professionals such as ob-gyns and family physicians instead of a midwife. A midwife most likely would not have the resources available to handle possible scenarios associated with a high-risk pregnancy.

Current Medical Provider
Relationships and trust are crucial when it comes to pregnancy and birth. If you have a good relationship with your current medical provider and feel comfortable that he/she would respect your wishes, you may want to consider not switching. However, if you have any doubts that your current provider may not honor your wishes when it comes to the pregnancy and birth, it may be time to switch.

Environment
The environment can play a large role in the birth of your child. If you have a low-risk pregnancy and desire to give birth in a birthing center, at home, or other locations outside of a hospital, you may want to consider a midwife that works in these environments. Birthing centers are very receptive to natural births and are usually staffed by CNMs. For home births, you may either consider a CNM or a Direct-Entry Midwife. Direct-Entry Midwives are individuals that have been educated in midwifery through formal education, self-study or an apprenticeship.

 

What is a Midwife?

Midwives are trained professionals focused on providing expert care before, during and after childbirth. They may deliver babies at home, birthing centers, or even hospitals. There are two main categories of midwives practicing in the United States: Certified Nurse-Midwives (CNM), who hold advanced degrees and certifications in nursing and midwifery; and Direct-Entry Midwives, who have been educated in midwifery through formal education, self-study or an apprenticeship.

It is important to note that state laws and licensing requirements for midwifery vary. In Virginia, only two types of midwives are legally recognized:

Certified Nurse-Midwife (CNM): CNMs are professionals with a degree in nursing and midwifery from a school accredited by the Accreditation Commission for Midwifery Education (ACME) and certified by the American Midwifery Certification Board (AMCB). CNMs can practice legally in all 50 states and the District of Columbia. Most midwives in the United States fall under this category and can work in any setting, including private homes, hospitals, and birthing centers.

Certified Professional Midwife (CPM): As direct-entry midwives, CPMs are certified by the North American Registry of Midwives (NARM). CPMs receive their training through apprenticeship programs or through an accredited formal training program. Like CNMs, CPMs can work as independent practitioners both in private homes or formal settings; however, CPMs are the only midwives required to have specific training outside of medical/hospital environments. CPMs can provide prenatal, birth and postpartum care. Currently, CPMs are legally allowed to practice in 30 states.

Other types of Direct-Entry Midwives include:

Certified Midwife (CM): CMs typically have undergraduate degrees in fields other than nursing, but have completed a graduate-level midwifery program accredited by the ACME and have been certified by the AMCB. Currently, only five states recognize CMs: Delaware, Missouri, New Jersey, New York and Rhode Island. CMs are highly trained and have received education in health-related skills and midwifery identical to that of CNMs. Likewise, they can practice in the same variety of settings and, in New York and Rhode Island, are able to prescribe a number of medications and treatments.

Traditional Midwife: Also known as “lay midwives,” these practitioners have obtained a detailed knowledge of midwifery through self-study, an apprenticeship or formal training, but for religious, social or philosophical reasons, choose not to become certified or licensed. Traditional midwives are found at private home births or other out-of-hospital environments and provide a high level of personal care. However, it is important to note that in states like Virginia, only CNMs and CPMs are legally allowed to attend a home birth.

Licensed Midwife (LM): LMs have been trained, formally or informally, in the practice of midwifery and have passed requirements and testing set forth by the state’s medical board licensing division, but do not necessarily have national certifications. While some states, like Oregon, require no licensing, others, including Virginia, do not allow LMs to practice without national certifications.

The majority of midwives attending both home and in-hospital births are CNMs, as they account for the largest population of midwives.

What Does a Midwife Do?

Every individual will have her own experience – even when using a midwife. However, most midwives provide extensive care throughout the childbearing cycle. Whether you choose a home birth or a more formal birthing center or hospital, you can expect both prenatal and postpartum care that includes regular prenatal visits; comprehensive labor and delivery care; and newborn health and wellness care.

Since Virginia only allows CNMs (Certified Nurse-Midwives) and CPMs (Certified Professional Midwives) to practice, it helps to know some of the differences between these types of providers.  For more midwifery laws in each state, click here.

Because of their high levels of medical training, CNMs can provide women’s health care far beyond just childbirth. They also provide check-ups, annual gynecologic exams, fertility programs, pre- and post-conception care, newborn care and menopausal management; as well as prescribing medications and treatments.

Like CNMs, CPMs are also highly trained, although less formally. CPMs most commonly work in private homes or birthing centers and tend to carry a smaller case load, allowing for very personal and comprehensive care throughout pregnancy and childbirth. While they cannot prescribe medicine, they are trained to help healthy women throughout the birthing process based on the Midwives Model of Care.

Here are some additional services that a midwife can provide:

  • Family planning and preconception care
  • Perform prenatal exams and order tests
  • Monitor physical and mental health
  • Admit and discharge you from hospital

Why Choose a Midwife?

Women may want to consider a midwife if they desire to have a more natural form of childbirth with minimal medical intervention such as fetal monitoring, episiotomy, epidurals, labor inductions, and etc.  Midwives are also flexible in the location where the childbirth will occur.  They perform deliveries in the home, birthing centers, and hospitals (most common).  In addition to a more natural childbirth, midwives also provide emotional, mental, and practical support for a more personalized experience.  Although many obstetricians provide high levels of emotional, as well as medical support, for most women, the benefits of working with a midwife include greater control of the birthing process, having a care provider that is more personally connected and a more interactive birthing experience from start to finish.

Whatever your personal reasons, knowing your options and choosing the path that is right for you and your family will make all the difference as you go through your pregnancy, delivery and postpartum experience.

Why Not Choose a Midwife?

A midwife is not recommend in all situations.  If a woman is classified to have a high-risk pregnancy due to health conditions, a medical professional such as an obstetrician or a specialist is needed to ensure the safety of the mom and the baby.  A midwife will not have all of the resources and training to handle complex medical difficulties that may arise from a high-risk pregnancy.  Also if you have a good relationship with an ob-gyn or family physician, you may want to consider continue using them for your pregnancy and childbirth.  You would already have an established level of comfort with them and they have a better understanding of your medical history.

Midwifery Myths

For a long time, people assumed that midwives were only for those off-the-grid types who chose home births – you know – hippies. And while the 60’s and 70’s certainly brought an increase in traditional midwife services and home births, times have changed. Not only are more women from every walk of life choosing midwife-assisted birth, today’s professional midwives are found working side-by-side with doctors and other medical professionals at hospitals, as well as in private homes and birthing centers.

Another common misconception about midwifery is that, while midwives might be gentle, soothing souls, they may not be qualified to provide healthcare comparable to that of a trained physician. But, in certain cases, midwives have been shown to provide increased safety for healthy women and babies.

The American College of Nurse-Midwives reports that midwives provide benefits including:

  • Decreased rate of Cesarean births
  • Reduced risk of induction or intervention
  • Increased rates of natural pain management
  • Lower infant mortality rates
  • Fewer preterm births
  • Lower costs for clients and insurance companies
  • Higher breastfeeding success rates

Of course, complications can arise in any pregnancy, which is why most midwives have relationships with physicians and hospitals should a woman need to be transferred in an emergency situation.

What You Need to Know About Your Midwife

As with any healthcare provider, verifying your choice of midwife is important. Knowing the type of care you desire, as well as the services your midwife provides, is essential to a positive birthing experience. When deciding on a midwife, here are a few questions you might want to ask:

  1. What is your education and training?
  2. Do you work with birthing assistants? What is their background?
  3. What happens if you are sick or on vacation when I go into labor?
  4. Do you do prenatal screenings, such gestational diabetes testing?
  5. Do you offer post-partum care? What type?
  6. What are your fees and what services do they include?
  7. Do you accept insurance?
  8. What are your policies for handling complications? (e.g., breech, pre-term labor, pre-eclampsia, etc.)
  9. Are you trained in neo-natal resuscitation?
  10. At what point would you consider referring me to a physician or transferring me to a hospital during pregnancy and/or labor?
  11. Do you have a relationship with a physician or hospital in the event of an emergency or complications beyond your comfort/skill level?
  12. If I have to go to the hospital during labor, would you go with me?

You may also want to try BabyCenter.com’s printable Midwife Interview Sheet to help keep your thoughts organized when meeting with your midwife for the first time.

How to Find a Midwife in Your Area

There are several ways to find a midwife for your pregnancy and childbirth.  You can ask friends and family who have used a midwife for a recommendation.  Since they know you, they will be able to have better insight into which midwife would be best.  You can also ask a trusted medical provider who supports your decision to have a midwife-attended birth.  This may be your family doctor or ob-gyn.  Finally, you can also search for midwives online.  Please make sure to interview the midwives to determine fit.  Here are a couple of national sites to help you in your search:

American College of Nurse-Midwives
Mothers Naturally

For local resources, please see next section.

Regardless of how you start your search, establishing trust and a personal rapport with your chosen provider is essential to ensuring the best possible outcome for you and your baby.

Richmond Area Midwifery Resources

Below, you’ll find some of Richmond’s top midwives, including those in private practice, as well as hospitals and birthing centers offering midwifery.

Private Midwives (specializing in home and water birth):

Mary Callendar, CPM, LM
Richmond Virginia Home Birth
(804) 382-8222

Nancy Giglio, CNM
Richmond Birth Services, Inc.
220 Roslyn Hills Drive
Richmond, VA 23229
(804) 282-8471

Adrianna Ross, CPM, LM
Community Birth Services
8401 Mayland Dr. Suite C
Richmond, VA 23294
(804)258-2719

Kimberly Smith, CNM, IBCLC (International Board Certified Lactation Consultant)
Selah Midwifery Services
4906 Millridge Parkway E
Midlothian, VA 23112
(804) 477-5418

Glenda Turner, CPM, LM
With Woman Midwifery Care
Richmond (Bon Air), Virginia
(804) 937-6517

 

Hospitals:

Chippenham Hospital
Midwifery at Chippenham Hospital
Ashlie Buell, CNM, WHNP
Jennifer Walker, CNM, WHNP
7101 Jahnke Road
Richmond, VA 23225
(804) 320-3911

Henrico Doctor’s Hospital – Forest Campus
West End Midwifery
Rebecca Franco, CNM, WHNP (Women’s Health Nurse Practitioner)
7603 Forest Avenue
Courtyard Office Building
Suite 207
Richmond, VA 23229
(804) 523-3712

Henrico Doctors’ Hospital – Main
Midwifery Services
Meghann Batten, DNP, CNM, Director of Midwifery Program
Amber Price, sDNP, CNM
Lois Hancock, CNM
Rhonda Johnson, sDNP, CNM
1602 Skipwith Rd
Richmond, VA 23229
Phone: (804) 289-4500

St. Francis Hospital
The Women’s Center
Laura Alberg, CNM
Kimberly Caylor, CNM
Jean Curtacci, CNM
Brenda Radford, CNM
13710 St. Francis Boulevard
Midlothian, VA 23114
(804) 340-BABY

VCU
Department of Obstetrics and Gynecology
Leslie Fehan, MS, CNM, WHNP-BC (Board Certified)
Elizabeth Markey, CNM, MSN (Master of Science in Nursing)
Ashley Mirmak, CNM, MSN
Melanie Hartman, CNM
Holly McGroary, CNM

 

Patient Offices:

Women’s Health at Nelson Clinic
401 North 11th Street, Suite 600 (corner of 11th and Marshall)
Richmond, Virginia 23298
(804) 828-4409

Women’s HealthCare at Stony Point
9000 Stony Point Parkway
Richmond, VA 23235
(804) 560-8950

 

 

Birthing Centers:

Embrace Midwifery Care and Birth Center
Corina Hasle, CPM
130 Buford Road
Richmond, VA 23235
(804) 596-2229

 

Glossary of Certifications:

CNM – Certified Nurse-Midwife
CPM – Certified Professional Midwife
DNP – Doctor of Nursing Practice
IBCLC – International Board Certified Lactation Consultant
LM – Licensed Midwife
MSN – Master of Science in Nursing
WHNP – Women’s Health Nurse Practitioner
WHNP-BC – Women’s Health Nurse Practitioner – Board Certified

 

Additional resources:

American College of Nurse Midwives

North American Registry of Midwives

Midwives Alliance North America

Our Moment of Truth (by ACNM)

The American Midwifery Certification Board (includes a link for verifying midwife certifications)

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