May 13, 2015


Interviewer: We've all heard of midwives, but what do they do and what services do they actually provide? We'll find out, coming up next on The Scope.

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Interviewer: We're here in the studio today with Debra Penney, she's a certified nurse-midwife from the College of Nursing, and she's actually going to tell us a little bit about the types of midwives and what services they provide. I feel like there are some misconceptions going on. I've heard that there are two types of midwives; the direct entry midwife and then the certified, nurse-midwife, correct?

Debra: Correct. So, here in Utah we have certified nurse midwives, and they're nurses that have an advanced degree. And we also have the direct entry midwife, and she is apprenticed or she can have a formal education, but she has a little bit less of a scope of practice.

Interviewer: How does she differ from somebody who would be a certified nurse-midwife, like you are?

Debra: Her background is going to dictate her scope of practice; and her scope of practice mainly is around childbirth and postpartum care. She does about 1% of the births and she usually does the home births. She doesn't usually come into the hospital, doesn't have hospital privileges. So, the certified nurse-midwife does most of the births in the hospital and she has hospital privileges here in Utah. She also is educated to do home births, or birth center births as well, but majority of them are in the hospital.

Interviewer: So that is actually the large misconception because I've always figured the midwife helped deliver, or helped birth the baby at home, and doesn't really come to the hospital, doesn't really interact or mingle with the doctors and nurses in the hospital. But, from what you're telling me, that's actually not true.

Debra: Right, that's correct. So most of the midwifery births here are done by certified nurse-midwives, and we actually collaborate with the doctors in the hospital because, of course, we don't do C-Sections. But we do work as an integrated team within the hospital that we're working with, and most of us have a plan of care for backup in case the lady does need a C-Section.

So, we try to work along with nurses, doctors, pediatricians. And our scope of practice also includes not just birth, but prenatal care and well-women care, treating infections, common illnesses, doing some primary care, and then also menopause. So the whole lifespan basically. Also, a little care of the newborn in the first weeks of life.

Interviewer: Okay, so let's clear the air here, first of all because I'm still a bit confused as to... your telling me what midwives do, it sounds very similar to what a regular doctor here would do in the hospital for a pregnant mother. So, what is the difference?

Debra: So, basically. It boils down to our philosophy of care and how we look at pregnancy. We see pregnancy as a normal process, and it basically is for about 90% of the women who are pregnant. So we encourage the physiological processes that contribute to normal birth, like letting labor start on its own, and trying not to interfere with labor and not trying to push it to be faster than it needs to be. So we have a little more patience in the labor process.

The other thing I always tell patients is that, we're with them in labor. So actually the word, "midwife," means "with woman." So, we are with women throughout their labor, which makes a huge difference and we get to see the big picture of how things are progressing. We also have a toolset of little things that we can do to help the baby come down and be positioned correctly, and so changing position, and helping the mom in certain ways. We do less interventions, as well, as the doctors because we only will do those if it's necessary.

Interviewer: If there is a mother who's interested in having a midwife, walk her through her nine months of pregnancy, how does she get one, where can she find one?

Debra: Well, we are on the website, she would also want to check with her insurance and we are covered by insurance. So, she would want to check both of those, to see where there is a midwife in her community.

Interviewer: And does it vary? Because, I know that in Utah, we have specific names for our entry level and our certified midwives, but does it vary between states or countries?

Debra: So, across the US, certified nurse-midwife is recognized. There is also a midwife that is called a certified-midwife that we don't recognize here in Utah but she's everything that a certified nurse-midwife is, without being a nurse. She essentially passes the same board exams and these are national boards. In other states, the direct entry midwife might be called a certified professional midwife, and she may be required to go through special training to have her license.

Interviewer: So, to sum it up, midwifery is an actual process or a method or option, that pregnant woman can actually choose.

Debra: Right. Here in the US certified nurse midwives had prescriptive authority and have been marketed since the '70s with the women's movement, and we've kind of reemerged. But we have a history here since the 1920s, or even earlier. But as certified nurse midwives, we have been around for quite a while in the US.

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