Ask Us Anything About… Midwifery

Two women sit across from each other, talking. A window is in the near background.

If natural childbirth is what you’re seeking and if it’s the best medical approach for you, a midwife can be an excellent option. Angela Klock, a certified nurse midwife with Penn State Health Obstetrics and Gynecology, answers questions and clears up confusion around this approach.

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Barbara Schindo – Good afternoon. And thank you very much for joining us here, on Facebook Today. You’re watching Ask Us Anything about Midwifery. I’m Barbara Schindo. So, for people considering getting pregnant and wondering about childbirth, having questions about the process, a midwife is something that is an excellent option for a lot of people. But, you know, the decision to use a midwife can often come with a lot of questions, a lot of confusion, some misconceptions about what a midwife does. So, we are here today, to talk about midwifery, and joining us today is Angela Klock, who is a certified nurse-midwife at Penn State Health, Milton S. Hershey Medical Center. Angela is here to answer some questions, and we welcome your questions for Angela. If you have a question about midwives, what they do, please feel free to post your question in the Comment Field below this post here, and we will get an answer for you. And in that, the questions will work, whether you’re watching this live or if you’re watching this on playback. So, Angela, thank you so much for joining us this afternoon.

>> Hello. Glad to be here.

Barbara Schindo – So, let’s start with a basic question. Tell us, you know, what is a midwife? What does a midwife do?

>> So, an midwife is a registered nurse who has additional education. Since the year 2010, it requires at minimum a Master’s Degree in Nursing, to be able to hold a midwife license. So, we have about two to three extra years of education, beyond our nursing education, to be able to hold this degree and this credential. A midwife takes care of women of all ages, from puberty and, you know, teenage years, all the way through menopause. We can take care of all of their women’s health reproductive needs. We can function as a primary care provider too, in a lot of settings.

Barbara Schindo – Okay. Thank you. Talk a little bit about what’s the relationship between a patient and a midwife like?

>> Well, it’s really meant to be a team-based approach. We are meant to be a partner in their — in their healthcare arena, as far as their women’s health needs are concerned. So, we kind of look at it as though we’re all on a team, and we don’t really make decisions for the patient. We help them explore their options, so they can come to a decision that is safe for them and that is something that they desire to do, or follow through with. And we’re just there as a resource, a lot of the time.

Barbara Schindo – Okay. So, for somebody who’s thinking about a midwife, who’s thinking about — if you might already be pregnant or is thinking about getting pregnant, what do you think is the big, you know, important message for them to know?

>> First and foremost, I would have to say, to try and get your chronic conditions managed, to try and be at an ideal weight, to eat healthy, exercise. I know it’s a tough time right now that everybody’s going through, with so many changes that can limit some things, but those would be the first things, and then to seek out a provider that you are comfortable with. That’s the main thing. Whether it’s the midwife or physician, or another advanced practice nurse, to see for your OB care, it doesn’t matter. You just really need to feel comfortable and make sure that the person is the appropriate person taking care of you, whether you’re low risk or high risk. And you can always come see us, and we can always point you in the right direction, is to get you the right care that’s appropriate for your needs.

Barbara Schindo – Okay. So, we will get to — in a few minutes. I have a few more questions about what might be considered some of the misconceptions about midwives. But before we get to that, you know, kind of more into that, tell me a little bit about — do midwives work together with physicians, as a part of, you know, a team-based of care, or how does that work? Like what should the patient know about working with a midwife and a physician?

>> So, there are some different scenarios, but midwives typically have a collaborative physician that they work with, that’s available to help them either co-manage or manage transfer of the patient if a higher risk need arises that’s beyond the midwife’s scope of practice. Here at Penn State Hershey, we have a team in labor and delivery that consists of physicians and midwives, and we work together. The midwife can completely manage the lower risk, healthy, full term pregnancies and deliveries. If something comes up that we need to co-manage with some physician advice or involvement, we can certainly do that. A lot of times, with the midwife still being able to provide the majority or most of the care, but having some physician input, in the event that things, you know, become much higher risk or need care beyond our scope of practice, the physicians are right here. It’s a seamless transition, and a lot of times, we can still be involved. We’re just not the ones making the medical decisions for management, especially if there are higher risks or chronic conditions.

Barbara Schindo – Okay. You are watching Ask Us Anything about Midwifery. I’m here with Angela Klock, who is a certified nurse-midwife at Penn State Health, Milton S. Hershey Medical Center. Angela’s happy to answer your questions here, on Facebook, whether you’re watching live or on playback. If you have a question for Angela, please post it in the Comment field below this post, and we will get an answer for you. So, one of the things we had already mentioned and, you know, we had talked about before we started doing this live, is there’s a lot of things about midwives that I didn’t know, and I think that maybe the general public doesn’t know, and I think there are also a lot of misconceptions. So, let’s start with one I think is a really common misconception about midwives, and that’s that midwives and doulas are the same thing. Can you talk about, you know, are they the same thing? And if not, you know, what’s the difference.

>> I think we can provide some of the same care, but there is a difference in level of education and scope of practice. So, a doula is a birth partner. It is a support person that a lot — some women do employ for their labor experience. Often, they will meet with them a handful of times or so, depending on the doula’s practice. They’ll meet with them prior to delivery, and kind of get a plan together. And then the doula can accompany them typically to the hospital and provide labor support — massages and distraction techniques, relaxation techniques. You know, just coaching and verbal support, moral support, things to help them relax and manage the discomfort during labor and birth. They typically will have either like an apprenticeship or some, maybe online, certification, kind of information that they’ll go through. The difference with the midwife, is that we can be your labor and delivery provider. So, we can order your medications that you need, your lab work that you need, when you’re here in labor, and deliver the baby. We can care for you postpartum, all the way up through discharge. So, we have kind of a broader scope, and we can, you know, handle things that come up, that need medical attention, that a doula wouldn’t be having in her scope.

Barbara Schindo – Okay. Thank you very much for that. So, we do have a couple of viewer questions coming in now, so we will start with a question from Vanessa, and Vanessa’s asking what does a midwife provide for — I think it means for the patient here. What does a midwife provide for the patient, and how often will we we meet or, you know, how often would you see a patient?

>> Sure. So, there are some general guidelines, as far as frequency of prenatal care for pregnancies, and the general guideline is about once a month through the first seven months, and then every two to three weeks or so, until the last month of pregnancy. And then typically in the last month of pregnancy, ladies are seen weekly until they deliver. That can be more or less, depending on things that are going on with that particular pregnancy, as far as, you know, it developing and progressing low risk or higher risk. And then during the labor and delivery process, we’re there, to help support them through the labor. We can provide, you know, one-on-one comfort measures that help reposition, find physicians for labor and birth, that are going to help her not only feel comfortable, but hopefully, keep the labor progressing as smoothly as possible. And, you know, if someone wants to choose pain medication, we can talk about that and institute that at some point, if that’s the desire, all the way through the delivery process. So, we’re in and out of the room as frequently as we need to be. More, if the woman wants. We also respectively will give her private, quiet time and not just be in there, you know, distracting her from the work she’s doing during the labor.

Barbara Schindo – Sure. So, it sounds like, you know, you get to know each other, you know, pretty well, like you have a [computer static occurring] before, during, after —

>> Yeah.

Barbara Schindo – — during pregnancy, after childbirth. So,

>> We mostly see them back in the clinic postpartum as well, for their postpartum needs. And, then, you know, they can elect to come to us for their annual exams, before and after. So, it really can be a lifelong relationship.

Barbara Schindo – I appreciate that, and I’m sure Vanessa also appreciates that. And as — Vanessa, we appreciate your questions as well. And I know Vanessa has another one here, that I’m going to ask. And Vanessa wants to know, you know — as a midwife, what are your expectations for the mom? Like how do you — what does — what should she know about you going in, and what would you expect it to [computer static occurring] relationships.

>> Going in, I think is just, you know, feeling free to ask any questions, at any point along the way, to know that we’re there to listen and to answer and provide resources, if there’s something that we need to help her get connected with, that’s beyond our initial scope of practice, we certainly can do that. You know, and just kind of being open to suggestions and thoughts and the team approach. Other than that, it’s really just being present. You know, taking charge of their own bodies and their own prenatal care, and coming to their appointments, so that they and their babies can be as healthy as can be.

Barbara Schindo – So, moms are just as involved in, you know, the decision-making and the process, and what they want, and what, you know, what kind of birth experience they desire. Just be open about it, you know, talk to them [multiple speakers].

>> Some ladies will develop a birth plan ahead of time. Many don’t. Many, it’s an evolving process, as things happen. You know, midwives are really good at listening to patients, and being a team supporter, just kind of working together. So, I think that’s the most important thing.

Barbara Schindo – You are asking — sorry. You are watching Ask Us Anything about Midwifery, with Angela Klock, who is a certified nurse-midwife, at Penn State Health, Milton S. Hersey Medical Center. We welcome your questions for Angela, whether you’re watching live or on playback. If you have a question, you can put it in the comment field, below this post, and we will get an answer for you. Now, Angela, you had — you have already addressed a few of these things in some of your answers, as we’re talking a little bit about misconceptions in some of your other answers here. But I think it’s kind of important to just, you know, hone in on some of these things. Because one of the things you had mentioned, which surprised me, is that midwives aren’t only involved in pregnancy and birth. Right? That’s kind of a misconception, that a midwife is just here to help you through your pregnancy and through childbirth. But that’s not true. Right?

>> Correct. Correct. Yes, we can — we do birth control counseling. Some of us have experience and are certified to place Nexplanon implants and remove them, for birth control, place and remove IUDs, for birth control or bleeding purposes. We can do annual exams and pap smears. We can assist with breastfeeding, and breastfeeding education, prenatal education. Some of us even have some advanced certifications to perform [computer static occurring], even assist physicians in the OR, if you would need to have a C-Section.

Barbara Schindo – Thank you. Like I said, that — I’m so glad to be having this conversation with you and learning about this, because I didn’t know that, and I think that’s so helpful to know, and that’s such kind of a, you know, just another option for women or for people who need this kind of care, to help [computer static occurring]. So, I very much appreciate you, you know, letting us know about that. So, another kind of misconception I wanted to ask you about, is I think when people picture a midwife in their head, they’re picturing, you know, home birth only. They’re picturing a completely natural birth. But that’s not what you do, is it?

>> No. I — the latest statistic I’ve heard is about 90 percent of the midwives in the U.S. do deliver — as certified nurse-midwives, I have to be specific — do deliver in a hospital or birth center setting. There are different levels of midwives, but you’re specifically asking about the certified nurse-midwife. So, there are some lay midwives and some certified midwives of varying abilities, depending on which state you’re in. But the mass majority of us are certified nurse- midwives. There’s a little over 13,000 of us right now, in the U.S.

Barbara Schindo – Okay. And one other misconception I wanted to ask you about, that I had read about, is that somebody who might have a chronic health condition or who might be considered a high risk pregnancy, shouldn’t see a midwife. But you are, you know, well-prepared to care for those types of patients, as well. Correct?

>> Sure. Yeah, absolutely. And sometimes, there are very high risk pregnancies, where we’re not as involved, and we can certainly care for the women before and after pregnancy, for their well annual visits. But many chronic conditions, such as blood pressure issues or diabetes management, we can certainly, at minimum, co-manage with our physician counterparts. You know, we each have our own areas of expertise. So, we certainly can do the prenatal care. We can still assist them in labor and delivery, and often do, just with some input and co-management with our physician counterparts. So, that’s where that team approach really comes into play, so that we can each kind of practice to our level of expertise, and make sure that momma and baby gets the best care that they can.

Barbara Schindo – Okay. Is there any — are there any other, you know, misconceptions or beliefs about midwives, that you, you know, that you think are wrong, that I have not asked you about.

>> The only thing I — sometimes, people are not aware that we are independent prescribers. So, we can prescribe your birth control and other medications, if there’s — oftentimes, women get used to infections or other, you know, vaginal infections, and we can certainly diagnose and treat those, prescribe, monitor, those kinds of things. So, you don’t have to, you know, go to someone else to get your prescriptions, if you need them.

Barbara Schindo – You have been so informative today. I feel like I have learned so much during this and, you know, I posted a whole bunch of these, which are always enjoyable, and I always feel like I learned a lot, but I feel I was those people who had these misconceptions and didn’t know all these things about midwives and midwifery. To be honest, I wasn’t even sure before, that I was pronouncing that word correctly, but [inaudible] helped me with the midwifery word. So, thank you so much for joining us here today, to talk about this. I think it’s been very informative, and for anybody who is watching us on playback, we still will have an opportunity to get you some answers to questions. So, if you are watching this on playback, and you have a question for Angela, just put it in the Comment field, and we will follow up with you. But Angela, thank you so much for joining us today, and thank you for watching. [inaudible] thinking about — oh, wait. I’m saying — I’m speaking too soon.

>> One more question, I though there were no more questions.

Barbara Schindo – We have one more question coming in, so our last question here, it’s from Vanessa, and she wants to know, the question on everyone’s minds — this is a good question. Is midwifery available, via insurance?

>> Absolutely. We are credentialed through the majority of insurance companies. So, if you have a question about a specific policy, you may want to check with your insurance company first, but we are considered primary OBGYN providers. So, I myself am credentialed through more insurance companies, that I can even count. So, typically, when you’re hired, they get as many as they can. Sometimes, someone moving into this area for the first time, that may have an outside insurance that’s a little bit different from what we see, typically around the Pennsylvania area, you may just want to check with your insurance. But the overwhelming majority of insurances will reimburse for midwifery care. So, you do have that choice.

Barbara Schindo – That is very good news, I’m sure. Thank you so much. And again, Angela, thank you for joining us. Thank you for all this informative discussion today. It’s been really fun, so I appreciate your time, and for those watching, thank you so much for getting in to Ask Us Anything about Midwifery.

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