How Certified Nurse-Midwives Work with Patients Before, During and After Delivery

Nurse midwife with patient

Midwives have been a vital part of the birthing process for centuries. In the past several decades, the popularity of midwives has increased substantially. However, there are still some questions about how a midwife, OB/GYN, and doula differ, as well as how they collaborate for mother-centered care.

According to Lesley Bates, a Certified Nurse Midwife (CMN) at Penn OB/GYN and Midwifery South Philadelphia and Washington Square, there are three types of midwives: lay midwives, certified professional midwives, and certified nurse-midwives. The differences among the three are their educational background, experience, and training.

What is a Certified Nurse-Midwife?

Certified nurse-midwives are experienced registered nurses who have completed an accredited education program in nurse-midwifery and passed a national certifying exam. At Penn Medicine, all midwives are CNMs. They can be the sole health care provider – similar to an OB/GYN – for healthy women with uncomplicated pregnancies before, during and after giving birth. Certified nurse-midwives also provide comprehensive women’s health care at all ages and stages – from puberty through menopause.

“We believe that midwifery program at Penn Medicine is a partnership between families and midwives. It is centered around love, trust, and mutual respect,” said Michele LaMarr-Suggs, CNM, who also cares for women at Penn OB/GYN and Midwifery South Philadelphia and Washington Square. “We spend time getting to know each woman's story, needs and desires. We attempt to relieve fears surrounding the pregnancy and birth process. We often care for multiple generations within families.”

Midwives offer mothers a holistic approach to the childbirth process, allowing birth to progress naturally whenever possible. They believe natural birth is determined by the mother’s freedom and the autonomy to decide what they feel is natural.

“There are certain cornerstones of midwifery that we practice at Penn, such as patient autonomy, decision making, evidence-based practice, and education,” Bates said. “Instead of telling mothers, ‘this is what we're going to do,’ we give them options, recommendations and the reasoning behind it, to ensure they’re on board. Midwifery is truly an institution in the City of Philadelphia.”

LaMarr-Suggs agreed, noting that patients who choose midwifery care are able to stay pregnant for up to 42 weeks if they desire, as long as mother and baby are healthy at 41 weeks.

“We believe that 90 percent of the time birth and pregnancy is happy, healthy, normal, and is not a medicalized problem,” LaMarr-Suggs said. “We let the body operate on its own – we don’t conduct interventions that are unneeded."

“Certified nurse-midwives are licensed to take care of patients from the time of conception through delivery. If a patient requires a C-section an OB/GYN can step in to administer the surgery; a midwife will continue to support the patient during her cesarean birth.”

Understanding How Midwives, OB/GYNs and Doulas Work Together

Certified nurse-midwives, OB/GYNs and doulas can work together to provide optimal care for expectant mothers. However, unlike an OB/GYN and a midwife, a doula’s role is to provide physical and emotional support, not actual medical care.

At Penn Medicine, a midwife and/or an OB/GYN must be a part of your birthing journey and present during delivery.

OB/GYNs are medical doctors who specialize in women’s health and are licensed to perform surgical procedures and other medical care during pregnancy and delivery.

Meeting Patients’ Physical, Mental and Emotional Needs

Midwives care for new mothers during the postpartum period and beyond to ensure that their physical, mental and emotional needs are met.

“Newer studies have shown an increase of postpartum depression in many women,” LaMarr-Suggs said, noting that patients who score high on a depression screening before being discharged are encouraged to have more regular follow-up visits in the weeks after giving birth.

Pam Kane, CNM, MSN, who works alongside Bates and LaMarr-Suggs added, “Women whose depression screens are high are at increased risk of postpartum depression and anxiety, which can significantly impact their ability to bond with and nurture their child, maintain other important relationships in their lives, and function well at home and at work.

“Early identification of postpartum depression and anxiety leads to prompt intervention – additional family/community support and a referral to a mental health professional – which then prevents more serious complications.”

Midwifery Care in South Philadelphia

Penn Medicine midwifery program has been in practice for more than 35 years and expanded in July 2020 to include a South Philadelphia location.

“Our midwifery program has two locations: Washington Square and South Philadelphia and a team of 14 midwives – three at South Philadelphia,” Bates said. “South Philly is a great extension to our practice. We're increasing access to Penn care, and we're increasing access to midwifery care.”

Midwifery Care in Times of COVID-19

During the COVID-19 pandemic, mothers are allowed only one support person in the delivery room. As of mid-September 2020, doulas are once again allowed to be physically present in Pennsylvania Hospital to provide labor support, in addition to a mother’s primary support person.

Mothers are tested for COVID-19 before they are admitted to the hospital to have their baby, and COVID-19 positive patients have separate labor, delivery and recovery rooms. All other labor and delivery services have remained the same. Learn more about Penn Medicine’s response to COVID-19 and check with your care team for more information as we continue to monitor the situation and adjust policies to ensure patient health and safety.

Midwifery Facts

  • In other countries, midwives attend 90 percent of all vaginal deliveries.
  • Certified nurse-midwives can help women with low-risk births without an OB/GYN present.
  • Women with certain medical and obstetric conditions are at higher risk of complications during pregnancy and childbirth and are required to see an OB/GYN for their care, however, they may request midwifery care in labor. This includes women who:
    • Have preexisting diabetes
    • Develop diabetes during the pregnancy and need medication to control their glucose levels
    • Are on medication for chronic hypertension
    • Develop preeclampsia during pregnancy
    • Are carrying a pregnancy with more than one baby
    • Are 45 or older
    • Have a BMI of 50 or higher at the start of the pregnancy
    • Have other health conditions such as seizure disorder and certain autoimmune conditions 
  • 45 percent of patients who are cared for in labor by Pennsylvania Hospital midwives have their babies without an epidural. The midwives also care for many women who choose to have epidural anesthesia in labor. 

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