What is a midwife: Expert Q&A

[MUSIC PLAYING] Hello, and welcome to the University of Chicago Medicine At the Forefront Live Today our program is all about midwifery We’ll talk about the misconceptions surrounding midwifery, the role midwives play during pregnancy, and the care they offer beyond childbirth Now, today, we have midwives Cynthia Jacinthe, Wendy Allen, and Sierra Ribero joining us to talk about what is offered here at U. Chicago Medicine Remember, we’re taking your questions, so start typing in the comment section We’ll get to as many as possible throughout the program As always, we want to remind our viewers that our program today is not designed to take the place of a medical consultation with your physician Let’s start with each of you Tell us a little bit about yourselves and what you do here at U. Chicago Medicine? And Wendy, you’re on the end So we’ll start with you OK I’m sorry What did you ask me? Just tell us a little bit about yourself and what you do here I’ve been a midwife for 16 years now, here at the University of Chicago for three years I was one of the original members when the program started out Great My name is Cynthia Jacinthe I’m actually the director of midwifery I have been a midwife for 11 years now And I’ve been at the University of Chicago for two Hi I am Sierra Ribero And I have been at University of Chicago for about two years or so And I’ve been a midwife for almost seven years Great Now we’ll start off with a few questions We’ll get to our viewer questions here in just a moment There are a lot of misconceptions surrounding midwifery But of those that you hear often is that midwives are not trained And we know that’s not true, obviously Can you tell us a little bit about exactly what kind of training goes into becoming a midwife and what that means? As the least educated of the panel, I’ll start I have a Master’s degree in Nursing These two have doctorates So you have to have at least a master’s, and then pass a certification exam Then you get your state license And then you can practice Great And Cynthia, anything you want to add? So it is– like Wendy was saying, there’s master’s program You can go on to get a doctorate, like myself and Sierra did And then the training, it’s a national certification, so you’re board certified with the American College of Midwifery And let’s just kind of set the stage a little bit and tell us just what exactly is a midwife? I think a lot of people have heard the terminology before, but they don’t know what it means, and they don’t know what a midwife does to help women through pregnancy And Sierra, I don’t know if you want to take that one Sure So nurse midwives are advanced practice nurses And we are not meant to kind of take the place of a certain provider We are meant to kind of partner with the patient or with the person that’s pregnant, or not pregnant, and create an experience for them that is holistic, that’s more so individualized, and just kind of create something that patients feel empowered to continue on their pregnancy, and continue on within their life as well So not only do we provide care during the pregnancy, but we also provide care before pregnancy, after pregnancy, up until menopause as well So, yeah Fantastic And we want to remind our viewers, of course, we’re taking your questions live on the air So if you want to talk to a real-life midwife, you can do that by typing it in the question in the comments section And we’ll pass those along and try to get to as many as possible throughout the program So what are some of the benefits of choosing a midwife? And anybody can jump in to take that one So one of the benefits I feel like, or we all feel, as choosing a midwife is you actually– we get to spend a little bit more time with the patients, really empower you about your body, your health, your pregnancy As Sierra was saying, we also take care of patients who are not pregnant So my youngest patient actually was like a 13-year-old, just came into this for the talk, so to say, just to know about her body and her sexual health And my oldest patient was actually an 80-year-old, again same thing, was having some issues So we see women throughout the whole lifespan We empower them about their bodies We let them know of the normal changes, the abnormal changes And in pregnancy, we support them throughout labor, what they want to do in labor We encourage breastfeeding, skin to skin, and provide all those additional supports So that is– I think the great benefit of choosing a midwife is you really get that one-on-one support with your provider I think that’s a very interesting point that you just made Because I think a lot of people probably when they think of midwifery or midwives, they just think of pregnancy and childbirth and for that little space of time And that’s not necessarily true at all And I think the beauty of that, too, is you get to develop the relationship with your patient [INTERPOSING VOICES] And so what is it like as a midwife? I imagine it’s got to be very rewarding to develop those long-term relationships and work with patients

throughout the years And because I’ve only been here three years, it hasn’t happened yet, but in my last practice, I’d seen the same patient over– I think I was there a total of six years So you really get to– you see people for their first baby, their second baby, or their last baby, and then help them make the transition through menopause, which can be a challenge for a lot of women So it’s really nice And you see people repeatedly You get to know much more than just their body It’s more than they come in just a quick physical, and they’re out the door again And you already spoke a little bit about the benefits of choosing a midwife I want to see if you can expound on that a little bit more because I think we’ve kind of opened up a different avenue here as well with the relationship developed with the patients and their families And can you expound on that a little bit, as far as the beneficial aspects of having a midwife not just to guide you through pregnancy and childbirth, but beyond? I can take that one Yeah, go ahead So our philosophy of care is more so patient or human centered It’s more holistic So not only are we paying attention and monitoring pregnancy and other conditions, but we’re also asking additional questions and spending a little bit more time with you and your partner or your other support person, just to kind of help involve them in the process Because not only would we be there during the labor, if that person is pregnant, but also that support person is really one of those people that we kind of want on this nice little team So, yeah, that’s the nice thing about midwifery We do get to spend some more time with our patients And patients really do appreciate it because we get to answer many questions that patients have Yeah Can I expand? Absolutely Just to expand on that is in addition to we really get to know you aside from what Wendy’s saying, just the body, we ask you questions about what’s going on at home How are your children? We try to get to know your kids’ names, if you have them, your pets’ names or anything that will encompass what you’re doing outside of those visits with us So we really want on all parts of your life to be involved because it does affect the health of your body and the pregnancy and how your mind and space will go into that labor and birth Let’s talk about pregnancy for a moment, because I think probably most people who tune in, that’s the immediate thing that they’ll think of What kind of support do midwives offer for pregnant women? How does that work? Walk us through the process, if you will To start from the initial visit, we spend a lot of time teaching, answering questions, explaining here’s what’s normal If a patient comes in with a problem, here are the options on how to treat it We don’t just give you here, here’s a pill Fix it No, there are multiple ways to handle things And here are all the options We help you figure out which one are you realistically going to use and what’s going to work best for you And I imagine that is kind of a not challenging, but it’s a very involved process because you really do have to listen to the patient And communication is key with this, I would imagine Absolutely Absolutely And there have been patients I’ve known well enough, even when I’m going through the list of various options, in my head, I’ve already pretty well decided or know what she’s going to decide But I’m still giving her all the options Every once in a while, people surprise you [LAUGHTER] I imagine that does happen I think– Go ahead I think the important thing is that, just like Cynthia said, we kind of ask those additional questions to get to know them just because some of the information that we receive can help us make a plan with you about what works best for you and what works best for your family Sometimes even when it comes to appointments, sometimes appointment times we need to be open a little bit later, just because you might work and get out a little bit later Those are all things that you would think that don’t affect your health, but they really do So, yeah And in terms of the schedule of care during pregnancy, it’s the same schedule of care in terms of whether you go to an OB provider or a midwife So that in terms of the schedule, all that stays the same It’s just the level of care and a little bit more intimacy that you get with a midwife And actually, it’s kind of interesting And I’m going to probably get a little bit more in depth with this here in a few minutes But the different pregnancy options, childbirth options that we offer here U. Chicago Medicine, it’s pretty all encompassing And it’s kind of neat to see some of the things that people can choose from and what they can choose on their journey So if you have a chronic health condition or your pregnancy is high risk, is it still OK to use a midwife? Absolutely So we work– most of us have worked with other facilities, in addition to University of Chicago, where we collaborate with our physician counterparts So if you do have what you may consider a high-risk condition,

maybe chronic hypertension, you have incoming diabetes, or you develop any of those complications in pregnancy, like diabetes, high blood pressure, your exacerbating asthma, a lot of those conditions we could still take care of you But we may want to co-manage with our physician counterparts Or if you have a high-risk situation, you may have one or two appointments with our amazing maternal-fetal medicine team So we could still kind of collaborate and co-manage Even if you don’t see all your visits with us, you can see some of your visits with us And in labor, we can still provide that labor support And one of the things we talk about here at U. Chicago Medicine all the time is the continuum of care and the fact that we do have our teams work together And they truly are teams Yes Mm-hm And as you work with your families through the process, you work with a lot of people Is that fair to say? Yes [LAUGHTER] Talk to us a little bit about that How does the process work? Well, it kind of depends on the person So a lot of it is just kind of getting the information ahead of time, during prenatal care, just be just because you do kind of want to see where the patient, where the person, where the family is, and then just kind of letting them know that this is how University of Chicago is We have this nice collaborative relationship or partnership with the physicians here, generalist OBs and then also the maternal-fetal medicine doc So that’s just one thing we kind of preface with our patients and just let them know ahead of time, just that they are there in case anything does happen We work very closely with them Even in labor sometimes, we tend to run things by them just to see if there’s anything else different we can do about the plan and then go back to the patient and see if that’s something that’s a little bit agreeable or that is agreeable Yeah One of the questions that we had, and you’ve already answered it, but I’m going to ask it again to allow you to expound on that a little bit, talk about post-pregnancy care So what happens? We have the family The woman comes in, has the child What happens at that point? So we’d like our patients to immediately– just starting from Immediately after birth, we initiate skin to skin We encourage breastfeeding Here at the University of Chicago we have what we call a golden hour, where the patient, the partner, and the baby are the ones just in that room just really bonding for that hour, just to get to know each other and just really bond So afterwards, typically it’s a 40-hour stay in the hospital We come see you each of those days just to make sure you’re OK and provide any assistance, answer any questions, and just make sure you’re physically and mentally doing well Some other practices, they may want to see you in about five to six weeks for that, what we call, postpartum checkup, again just to make sure any lacerations that you had made are healing well, any physical things that you want to discuss are going well, your bleeding is going well, your uterus is back down to size But with the midwifery group, we’ve noticed that having patients come a little bit sooner would really kind of help with that bonding and that health experience postpartum So we really want to see our patients about one to two weeks after delivery just to address any physical issues Any mental health issues, postpartum depression issues, breastfeeding, anything like that So we want to see you a little bit sooner That’s great Let’s talk a little bit about– you mentioned the golden hour and skin to skin and how important that is Kind of describe that? I mean, that’s got to become a magical time for a mother Absolutely And it’s important Yes It’s something the hospitals just initiated And in that first hour after delivery– and the hour starts not from the minute the baby’s born, but after everybody’s done doing all of their things, and the bed’s all put back together and everything So during that hour, nobody gets to come in There are no guests get to come into the room to see mom and baby If they make phone calls, that’s on them But the only person that comes in and out is the nurse to check on mom and baby, make sure they’re OK So we really leave them alone to get, as Cynthia said, to get to know each other, provide the baby with the opportunity to breastfeed Because most newborns in that first hour are wide awake and really want to breastfeed, and they do a fantastic job during that hour And the skin to skin is important because it’s just that contact is so critical It is It helps babies maintain their temperature, their blood sugar levels, and helps mom and baby really get to know each other That’s fascinating Because if you’ve read any of the studies on that, which I’m sure you have, obviously, it’s almost kind of a magical thing, the skin-to-skin contact and what it does for the child And the mother is it’s pretty neat, really And that’s different from the old days, when people used to have babies They baby would be whisked away Exactly And so it was kind of an empty feeling afterwards Right Mm-hmm I can speak to that because I have older children And you got to keep your baby for that first hour

But baby was all bundled up and wrapped up in a blanket You got to look at the baby, and then the baby got whisked away to the nursery for six hours And from an emotional standpoint for mom, that’s got to be kind of tough And so this is so much better And to be honest, with the first one, I was exhausted So– [LAUGHTER] [INAUDIBLE] A little time away was OK Then I was like, can I have my baby back? [LAUGHTER] That’s wonderful And it’s neat that things have progressed as much as they have because it does make, I believe, a tremendous difference– It does It does Right –for the mom We do have a question from a viewer that’s come in just a moment ago And it’s, are you open to having doulas with your moms? So how does that work? We love doulas Yes, we love doulas Please bring your doulas Please [LAUGHTER] Tell us what a doula is, first, and then kind of explain how that works Do you want to take that? Yeah, I can take it So doulas are– so a lot of people get confused, midwives and doulas So first, doulas are like a personal support person that’s there just for you And the entire time, once that labor starts kicking in, once you call that person, they’re there to help to support you, get you through some of those really tough times, and just be kind of that person whispering in your ear that you can do this We, as midwives, we do do that as well But we also have additional patients that we kind of are running back and forth in between So it’d be nice while we’re not in the room to have someone there to help be kind of like your cheerleader So that’s one of the things that we– and we love working with doulas just because we encourage different positions for patients And doulas are really good with, getting patients to kind of switch it up, sometimes getting in the shower, sometimes walking around as much as possible And sometimes that just kind of helps get things going It helps keep the pelvis open and helps keep the baby coming the way it needs to be coming down in the pelvis So yeah, we love working with doulas They’re awesome Yeah And in addition, again, to being that person in your ear, they just provide that extra additional labor support that helps us out as midwives because you’ve already built that relationship Ideally, doulas, I think, are– like, you find a doula early on in your pregnancy, and you build that relationship You have a discussion of how you want your labor to look like, who do you want in the room, what the plan is, what do you want to help bring you back into focus Some people do hypno-birthing, or hypnosis, or different phrases A lot of patients bring in music We love a play list, FYI So they bring in music They bring in aromatherapy Massage is really good So that doula– Hyrdrotherapy as well Hydrotherapy as well So that douls, that person is, like Sierra said, just focused completely on you and getting you through those stages of labor We’ve got a follow-up question from one of our viewers Maybe it’s the same one I’m not sure but wants to know if the hospital actually partners with doulas? Is that something you need to find yourself? Or is it something you can help? Yeah, you have to find that yourself We do encourage you to bring your own doula But there’s no particular partnership that we have with any doula service Right And we have a list of doulas in the Chicagoland area that we share with our patients Fantastic That’s helpful, then Another viewer question, so if the birthing family would like more than the allotted one hour, the golden hour, is there any pushback against that? Absolutely not No No As long as baby looks good, yeah, we’re good Take as much time as you need, yeah I would imagine you encourage that Yeah Definitely [INTERPOSING VOICES] Just to reiterate on that golden hour, we do just want the patient, the partner, and just the baby Because I know sometimes after birth, everybody’s getting really excited All the family wants to come in and see the baby So we just want to emphasize it’s just that little triad that we really want to bond and get to know each other So after that hour, if people want to come in afterwards, that’s fine If you want to take that additional 30 minutes, you want to hold off, we’ll let your family members and your support people know, like, they want a little bit more time I think that’s just a really neat thing to do So what kinds of well-woman care do midwives offer and help with? All kinds of well-women care We do preconception counseling, contraception counseling We do well-women annual exams, GYNs, PAP smears, STD testing, postmenopausal care, any kind of changes in your vaginal floor that you’re not comfortable with, you just have questions on anything, or breast pain or breast discomfort Anything that’s related to your sexual and reproductive health, we can see And so if a parent wants to even have their young daughter start and build a relationship with a midwife, that’s probably a positive thing to do and work through the [INAUDIBLE] We highly encourage that I did have a mom at one of my other practices who brought her 13-year-old is to see me And that again, we build that relationship We want them to be open and be honest with us about those discussions about our bodies And sometimes, especially as teenagers, they feel a bit more comfortable not talking to a parent

They could be a little bit open with you And again, it’s a good way to build that relationship on the ground level So did you have something I want to add to that? No [LAUGHTER] I saw you kind of look towards the camera, so I just wanted to make sure that I gave you an opportunity So let’s talk about the Family Birth Center at U. Chicago Medicine We’re proud of that And I kind of alluded to this a little bit earlier in the program, that there are a lot of options there for mom And that’s, I think, again, very important because we want to give options We want to develop the plan with the mom and communicate So tell us a little bit about that, if you will We have two labor rooms that have a hydrotherapy tubs We don’t do deliveries in the tub But you can certainly labor in the tub All the other rooms have showers We have portable telemetry monitoring units, so we can monitor baby while mom is up and moving about We have what we call our toys, which are birth balls and peanut balls, which are exactly what they sound like Yeah, explain what exactly would you do with that? Well, the birth ball, you sit on while you’re in labor And it’s spread– because you sit very unladylike And it opens the pelvis and allows the baby to descend And a lot of women find it’s easier to handle the contractions if they bounce while they’re on the ball or just kind of rock back and forth on it Interesting The peanut ball is shaped like a peanut And it’s great for women who have an epidural, in that it’s kind of like squatting while you’re laying on your side because we place it so that you’re– again, your legs are kind of flexed, and your pelvis is opened nice– Hips are kind of open Right, again to let that baby come through We have a birth stool We don’t get a lot of use out of that, but we do have one I’ve used it a couple times Right And the push bar, too Oh, yeah, and the squat bar The squat bar So the squat bar, all the beds, I believe, all the laboring beds have them So it’s just a bar that goes across the laboring bed that you can kind of hold on to And you can literally, as it implies, squat down and kind of have your baby And again, we encourage any kind of position to birth That’s another misconception Another good option that when you come to midwife is it’s not the typical like you see on TV, like pull your legs back and push, push, push, like yelling in your face and things like that So we encourage you to just let your body kind of move into the position that is best for you so you could have had your baby We’ve had babies come upside down, on your hands and knees, on your side, at the side of the bed, at the side of the tub You know, you just got out the tub, and you’re ready to push So we just kind of listen to your body and just go with what your body is telling you So are there other office locations besides Hyde Park where people can get an appointment to talk to a midwife? Yes We have a the South Loop location We have a Hyde Park location And to be determined when we’re also going to be going to the Orland Park location as well So we have three locations where you could see one of the midwife Great And as people learn about you and the services you offer, I’m sure that will be in big demand Yes, we hope so [LAUGHTER] You guys are fantastic You’re a lot of fun Thank you. thanks for having us I learned a lot today, too It really is nice to see that some of the things that are offered are offered because I think it’s very important for families And it’s neat to see So thank you Thank you Thank you That’s all the time we have for the program today We want to thank you for watching If you want more information about the benefits of modern midwives, please visit our website site, at uchicagomedicine.org/womens health, or you can call 888-824-0200 We have a full schedule of At the Forefront Live programming in January, so make sure to watch our Facebook page for more information on coming programs Thanks again for watching At the Forefront Live And have a great week Thank you Thanks