New Life with a Midwife: Delivering in a Hospital

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I'm Deborah Howell and today we'll be talking about new life with a midwife. Our guest today is Allison Molinski. Allison holds a bachelor's and a master's degree in nurse midwifery from Columbia University and a bachelor's degree in international development from UC Berkeley. Allison's been working at both Beach Cities Midwifery and Kaiser Permanente for the past three years. She's now full-time with Dr. James at Laguna Beach OBGYN in Laguna Beach, and delivering her patients here at Saddleback Memorial in Laguna Hills. Welcome, Allison.

Allison Molinski, CNM: Hi Deborah, good morning. Thanks for having me.

Deborah Howell (Host): Good morning to you. It's a pleasure. So using the services of a certified nurse midwife can add a personalized approach to a woman's delivery experience in the comfortable and safe environment of a hospital. Now you're here to help us learn a little bit about the unique care and support a midwife supports and provides during pregnancy and delivery. So first off, let's get down to brass tacks. What are nurse midwives?

Allison Molinski, CNM: Absolutely. So nurse midwives are healthcare providers that care for women across a lifespan from teenage years throughout menopause. Our education includes a bachelor's and a master's degree in nursing, which is the same as a nurse practitioner. While we're very much known for providing holistic care to women throughout pregnancy and childbirth, as you just alluded to, many people don't realize that we also offer primary care and gynecologic services. So we can see women for annual well-woman exams, STD testing, birth control counseling, pap smears, breast exams, so forth. We can order lab work, we can write prescriptions. We also tend to have a more holistic approach to well-woman care and childbirth, and we really encourage alternative treatments such as acupuncture and chiropractic care. We're also very focused on mental and emotional well-being.

Deborah Howell (Host): This is awesome. I love that there's this new option. It's wonderful. So you mentioned a little bit about the care and support. Did you want to talk about the care and support during pregnancy and delivery?

Allison Molinski, CNM: Yes. So in the context of pregnancy and birth, midwives generally care for low-risk women. We see pregnancy and birth as natural, safe, and normal life events, which is pretty different than an OBGYN's more medicalized view of pregnancy and birth. Safety is our number one priority, but having an empowering pregnancy and birth experience is a close second. The midwifery model of care is a personalized and intimate style of care, and it's very much based on a strong relationship and sense of trust between a midwife and the patients that she works with. And additionally, while we have access to many of the interventions and technologies used routinely in obstetrics, for example ultrasounds, fetal monitoring, and so forth, we tend to minimize their use and use them only when they're needed. I think our style of care is well summed up by the phrase "high touch and low tech." It's important though also to keep in mind that while women do come to midwives because they often want a natural and unmedicated birth, and we absolutely support that style of birthing, we definitely are happy to work with women who also want epidurals or pain medications in labor.

Deborah Howell (Host): Good to know, good to know. And what is in-hospital midwifery?

Allison Molinski, CNM: I think in-hospital midwifery allows a woman to receive the best of both worlds. A laboring woman can receive a midwife's supportive care and expertise in a comfortable birthing room, and yet have immediate access to emergency medical equipment and pain meds should they be needed. In-hospital midwifery strikes a nice balance between preserving normal aspects of childbirth and providing the quick access to technology and advanced care when it's needed for mother and baby.

Deborah Howell (Host): That does sound like the good one-two punch, doesn't it?

Allison Molinski, CNM: Yes.

Deborah Howell (Host): How do nurse midwives collaborate with OBGYNs?

Allison Molinski, CNM: Midwives work collaboratively with OBGYNs in most settings, so that our patients can have seamless care should complications arise in pregnancy or childbirth. I currently work in a private practice with an OBGYN, and we co-manage most of our patients, meaning that they can see both of us throughout their pregnancy. And I think our patients benefit tremendously from having access to both of us.

Deborah Howell (Host): Absolutely. The sort of the touchy-feely and the more natural approach that you offer and then the high-tech stuff that the OBGYNs have in their arsenal.

Allison Molinski, CNM: Absolutely.

Deborah Howell (Host): What is the birth experience like with a midwife in a hospital setting and how is it different from an at-home birth or a birthing center?

Allison Molinski, CNM: That's a great question. For women that want pain medication and labor, or who perhaps need to be in a hospital setting for a medical reason, in-hospital midwifery allows a woman to have access to those resources that she needs, but to also get the benefits of midwifery care. Now for women that desire an unmedicated birth, we can really create an intimate and quiet setting within the hospital to labor and birth in. At Saddleback Memorial, for example, we dim the lights to create a dark and intimate experience. Women will often bring aromatherapy, flameless candles, music, birth balls to their birth. Midwives offer a lot of labor support, and we try to be present for much of the labor once a woman has been admitted to the birthing suite. We encourage showers, baths, massage, acupressure techniques, and position changes to ease the pains of labor. When it comes time to push, we often encourage pushing in different positions, for example, we may recommend pushing in a hands and knees position or in a deep squat. When the baby is born, we try to minimize interventions that would distract from immediate bonding that takes place, and we really encourage skin-to-skin and breastfeeding as quickly as possible, so long as mom and baby are stable. So births that occur in the home or in birth centers with a nurse midwife are very much as I described above, and are often wonderful and safe experiences, but the hospital setting allows for immediate access to emergency resources for mom and baby as needed. Obstetric emergencies don't often happen in a low-risk population, but when they do, they can be unexpected and require rapid attention, so birthing in the hospital is a great option for many women.

Deborah Howell (Host): I just am sitting here thinking there are so many women listening to this going, oh I wish I had that when I was pregnant.

Allison Molinski, CNM: I think it can really be a fabulous experience, best of both worlds.

Deborah Howell (Host): And we covered some of these reasons, but why might someone choose a midwife who delivers in a hospital and what are those benefits?

Allison Molinski, CNM: Sure. So generally speaking, there's been a ton of research to support the midwifery model of care. Research shows that women who have a midwife are less likely to use epidurals, less likely to have births requiring forceps or vacuum, less likely to have an episiotomy, less likely to experience preterm birth. Additionally, research shows that women who work with a midwife actually have higher rates of satisfaction with the childbirth experience. So I think there's a lot of research out there to support actually working with a midwife, ideally a midwife who works in collaboration with an OBGYN.

Deborah Howell (Host): So that maybe part of that process could be joyful along the way.

Allison Molinski, CNM: Absolutely, yes.

Deborah Howell (Host): What is important for parents to know when choosing a midwife?

Allison Molinski, CNM: So not all midwives have the same education and training. What I've talked about today are specifically nurse midwives. There are other kinds of midwives in the community, and while they can be wonderful for some women and families, not always are they a good option for everyone. So I always recommend checking the credentials and the experience of the midwife you are considering working with. Most importantly, however, midwifery care is based on relationships, so it's important to find someone you like and trust. This allows you to have the best experience possible, even if things don't always go as planned, which sometimes they don't in labor and birth.

Deborah Howell (Host): And again, nurse midwives have both a master's and a PhD?

Allison Molinski, CNM: So we have a bachelor's and a master's, and some of us do have PhDs. Yes.

Deborah Howell (Host): Okay. So you can, I'm sure most people have personal websites or they can go to a hospital website and look at the credentials of midwives there?

Allison Molinski, CNM: Exactly. Yes, there's lots of resources out there, and at Saddleback Memorial we do offer a couple of in-hospital midwifery services.

Deborah Howell (Host): Okay. And where would you send people to do some research?

Allison Molinski, CNM: I think that Yelp can be a great place to see what other women's experiences have been with midwives in the community, and at Saddleback Memorial, and I think that Saddleback Memorial also offers a great listing of the two midwife options that are available there.

Deborah Howell (Host): Excellent. And Allison, my last question to you is what's the one takeaway you would want a woman considering this to have after she turns off the radio and has listened to us? What's the one key reason that she should consider midwifery?

Allison Molinski, CNM: I think that women's healthcare can be a really beautiful and powerful experience, and I think so often it's not. Turning to a midwife for your well-woman care or for pregnancy and childbirth is really about trusting your body and finding somebody who supports what your body is designed to do, and really having a provider that creates a space to talk about your intimate questions and concerns. I think midwives really offer that and can make it a very empowering experience.

Deborah Howell (Host): Awesome. Thank you so much Allison for your time today and for demystifying what is a midwife and why should we consider them when looking at a birth situation. Thank you so much.

Allison Molinski, CNM: Of course. Thanks Deborah.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please go to memorialcare.org. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a great day.