Eight Questions Answered From a Certified Nurse Midwife
First off, thank you to everyone who submitted really great questions! I think it’s so important for us as women to have an arena where we feel we can ask questions about our health and our bodies and receive valid, evidence- based answers.
I will preface this by saying that I am a Certified Nurse Midwife (CNM) with a masters degree in the science of nursing. I will offer evidenced based answers as well as my own personal opinion, in which case I will specify the difference. If you have additional questions, I urge you to ask your health care provider.
Q: Daily vitamins for Women?
There are specific nutrients that are important for women to incorporate into their daily vitamin, especially when considering becoming pregnant.
Folic Acid: This nutrient is vitally important in helping prevent neural tube defects in infants. (mainly: spina bifida). The recommended daily amount is 0.4mg unless you have other medical conditions such as a previous child with a history of neural tube defects, are pregnant with multiples or are taking seizure medication. Most vitamins will contain 1 mg.
Recommended daily amount: .4mg unless otherwise specified (see above)
Calcium: This nutrient helps build strong bones and prevent against osteoporosis in older age women. It is also important to take in pregnancy to promote strong bone growth in your baby and regulate your central nervous system appropriately.
Recommended daily amount: 1,000 milligrams. Teenagers: 1,300milligrams.
Vitamin D: works in coordination with Calcium to build strong bones.
Recommended daily amount: 600 IU’s
Iron: This nutrient helps to prevent against anemia which can happen in pregnancy or after menstrual cycles if your cycles are really heavy. Iron helps your body make hemoglobin (a protein that carries oxygen in your red blood cells). If you are low in this nutrient you can have symptoms like fatigue, shortness of breath and even heart palpitations.
Recommended daily amount: 18 milligrams Pregnant: 27 milligrams.
Q: Does birth control cause extreme mood changes in women?
It can.
And honestly this question can be complex to answer because even though most women refer to pills when talking about “birth control” there are many different variations of birth control and birth control hormones. There are estrogen and progesterone methods and then progesterone only methods and within those, many different progestogens and subsequently different side effects to each.
Additionally, the amount of estrogen and progesterone within a birth control pill, or progesterone within a hormonal IUD varies as well as the type of progesterone in some pill packs. All of these factors contribute to how a woman responds to these different contraception options. Progesterone is a main cause for mood swings (think PMS- your progesterone is really high right before your cycle starts). If you’re really sensitive to progesterone, you may have mood swings or feel irritable. However, in some women, it doesn’t cause any of these symptoms.
Again, if you’re having these symptoms, It’s important you talk to your provider and discuss what options or methods may work better for you.
Q: What does a Midwife do & how does that compare to OB/GYNs?
To answer this question I will start by saying that there are different types of Midwives. These are the different types:
Certified Nurse Midwife (CNM): Receives a nursing degree and a masters degree in nursing as well as a doctorate in some cases. A CNM is recognized & certified in all states to practice in hospitals, birth centers, and homes if desired.
Certified Professional Midwife (CPM): Can be attained by completing an entry level evaluation program and undergoing an apprenticeship with a CPM. CPM’s are not recognized in all states or allowed to legally practice in all states. CPMs practice in birth centers or at homes in the states that recognize them.
Lay Midwife: One that has received training strictly through the community or self study and receives no formal education. Lay Midwives are often seen practicing in homes.
Because I am a Certified Nurse Midwife, I will only be speaking to my education, experience and answering these questions with respect to CNMs only.
With that being said, a CNM cares for woman in all stages of life from the onset of having a menstrual cycle all the way through and past menopause. This includes pregnancy, childbirth and the postpartum state as well as an array of different clinical situations and diagnoses. Ultimately, CNM’s honor the changes women go through as natural, life occurrences that happen over the lifespan. Specifically, seeing childbirth as a normal, physiological part of life and not a medical problem until proven otherwise.
Although CNMs specialize in the lower risk pregnant patient, I will say I have seen an increase in higher risk patients due to my own personal patient population.
The biggest difference between CNMs and OBGYNs is that OBGYNs go to medical school and CNMs go to graduate school in nursing. OBGYN’s are surgeons and CNM’s are not. So as a result of that, OBGYNs will receive the higher risk patients that may require surgery, either for gynecological problems or obstetric reasons (such as a cesarean birth). OBGYNs can furthermore go into specific specialties that may include fertility, gynecology oncology, maternal fetal medicine etc.
In many clinical situations, CNMs work alongside OBGYNs. I personally do in the practice I currently work in. So in many situations, I will care for patients while working in collaboration with an OBGYN and transfer care if warranted. Additionally, CNM’s may obtain certifications in first assisting during cesarean surgeries so that collaborative care can be continued through all types of birth.
Q: What are pros/cons of midwifery care vs. care from an OB/GYN?
The pros and cons between midwifery care and care from an OB/GYN are individual. In which case, I mean a pro to one mom may be a con to another. I will explain the differences in a factual way.
As CNMs we are taught from a nursing perspective where an OBGYN is taught from a medical perspective. As a result of that, there can be differences in the way care is carried out.
Midwives are much more experienced in providing care for individuals who want to undergo a natural birth without medication. We are trained in school to help tolerate/alleviate pain with other modalities than medication including position changes, breathing exercises, mindful exercises and pressure point alleviation. However, we provide care to all women regardless of their pain management option including those who choose to have an epidural.
On the flip side, OBGYNs are more experienced in providing care for individuals who are high risk and those who require cesarean birth. For instance, pre-existing medical conditions or complex medical conditions in the context of pregnancy are better addressed with OBGYN or maternal fetal specialist care.
As a result of what’s stated above, CNM’s are trained to deliver in many settings including a hospital, birth center and home in some cases. OBGYN’s are only trained to deliver in hospitals. If the place in which you deliver is important to you, this is something to take into consideration.
This is a very short list of the differences between midwifery care vs obstetric care and not in any way comprehensive.
I do think its important to remember that grouping individuals into categories based on their degree/occupation is unfair. These principles are generally true but individuality between providers is a large part of provider care. It’s important you receive care from a provider you feel comfortable with, you feel heard from, and one that educates you on your decisions and supports you in the ones you choose.
Q: If I were pregnant would I need to see a Dr. in addition to seeing a midwife?
The answer all depends on who you are. Generally speaking, if you do not have any high risk medical complications, you do not need to see a doctor in addition to a midwife. Risk assessment is done with each of your return visits. If something pre-qualifies you to “high risk” most of the time, you would be referred to maternal fetal medicine OBGYNs which specialize in high risk obstetrical care.
Q: How long did you have to go to school to be a midwife?
My undergraduate university did not have a nursing major so my amount of schooling is influenced by that.
Undergrad: 4 years
Nursing school: 1 year accelerated program
Midwifery school: 16 months with clinical rotations in addition at the end
Total: 6.5 years; 19 semesters. (I took summer semesters so I could stay on campus and train in the summers given my position on my university’s track & field team)
Q: What are ways you keep from burning out?
This is a really good question.
My schedule operates on a 40 hour work week that typically includes 2 office days and one 24 hour call shift. There is so much diversity among midwives schedules and patient population so this can’t necessarily be applied to other CNM’s by default.
Although the hours may not be too far off from another field, I find that working in healthcare and caring for patients can be really taxing at times. So, on my days off, it’s super important I spend them well in order to prevent burn out or “compassion fatigue”.
Ways I fill my own cup:
1. I make sure to get enough sleep. That is huge for my job as you can be up all hours of the nights sometimes. If i’m not well rested, i’m not a nice human and therefore tend to burn out of anything.
2. I utilize my own version of self-care. My quiet time, journaling, spending time with my husband, epsom salt baths, working out, cooking foods I like and getting out of the house.
3. I actually have to spread myself out, but not thin. This may be contrary to what anyone else will tell you but I have to involve myself in things outside of work to not feel like I am only doing work which contributes to burn out for me. It’s definitely a fine line but when I find the balance it is really what keeps me content in all that I am doing!
4. Lastly, I remember why I started this career. To step alongside women in every phase of life, to be with them as they bring life into the world and to guide them in the decisions they have to make for themselves and their bodies.
Q: How do you help women cope with their birth story when it doesn’t end the way they had hoped for/expected?
I listen to them.
And I talk things out with them.
This is one of the best things that can be done. Its important to understand a women’s expectations and then re-visit what happened and how that compared to what she had hoped for.
Regardless of what happens, it’s most important that a woman feels heard and that her feelings are validated.
Birth stories can’t necessarily be re-written but they can be retold.
While talking with women leading up to birth, I touch on birth preferences or birth expectations and visit fears they may have. During that time, I always emphasize that while it’s great to have plans set in place, in the birthing world they don’t always go the way we think and therefore, birth preferences allows for thinking through plan A, B, C and D.
For women who have had past traumatic experiences, it’s even more important to revisit those experiences and talk through ways to decrease the chance or to decrease the anxiety of that specific event occurring with their subsequent deliveries.
If you’re a mom who had this happen to you. I’m sorry. Talking through it with your provider may help you process your birth, emotions and events that occurred thereafter.
With love and some answers,
Stay well momma, you’re worth it!
Skyler Jacobs, CNM