The Connections of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks
G. Promotion of continuity of care
P. Collaboration with other members of the interprofessional
health care team
Teamwork. Collaboration. Both hot topics in modern media, and the favorite subject of business consultants. Both ideas that get so much attention in our society. We all know we should want them, we all know they should be utilized in whatever we do. We also know they can be hard to achieve. We know that people make hundreds of thousands of dollars a year teaching others how to collaborate and work together in teams. Why do we care so much about these words, and put so much effort into achieving them?
No one functions at their optimum level when they are working alone. For decades, and really centuries, midwives have been alone in their field, struggling with their burdens, trying to carry the weight of their calling. This has been brought about by circumstance, by system design, by interprofessional sabotage, and often by midwives themselves, who set themselves apart from an established system and then had to struggle to find a way to function within it, or at least on the periphery. Finally, remarkably, the tides are changing. The number of midwife attended births is increasing in most areas of the United States. Certified Nurse Midwives and/or Certified Professional Midwives can be found in most states, and in all settings, from home birth practices, to large tertiary care centers. We are acknowledged by the public, able to bill insurances, and recognized as colleagues within hospital systems. Still there is much work to be done.
And here we are, left with clear choices, and huge tasks before us. Do we do this alone? Or do we do this together? These are big questions that plague midwives across the country, and across the world. Midwives come from so many different paths, is it even possible to allow these paths to cross? Is it possible to learn from each other and take on characteristics of the other, while still preserving what is central to each different model?
I don’t pretend to have the answers to this for midwifery as a whole. I do know the simple answer for what is right and good for OUR midwives, for OUR mothers and babies, for OUR birth center. And I can tell you, we have found our sweet spot. We have found that place of collaboration that leaves us feeling nothing but supported and uplifted. We have found that nurse midwives and professional midwives working together provide the best of both models for our clients. That we have so much to learn from one another, and so much to give to the world of midwifery.
In addition, over the 30 years our practice has been in Fairbanks, we have developed and grown relationships with midwives and physicians within our hospital system that leave us no doubt about the quality of care our clients will receive if they risk out of our care and need a hospital birth. We ask all of our clients to establish a hospital provider, and we have close relationships with most of the practices in town, whose midwives and physicians will happily see our client for one prenatal visit, and then accept her into their care if she transfers to the hospital. If problems arise before birth that may risk her out of our care, we are in close collaboration with the hospital provider, and we develop a plan of care together with them and the client for follow up and transfer if needed. This gives us, and our clients, an enormous amount of reassurance.
I am always so grateful to be able to tell a client, “I’m so sorry we have to transfer you. But you have seen this provider, and I know she/he will provide you with excellent care as close to the birth center model as possible.” I am so relieved when we call the accepting provider and let them know we are headed in, and we talk about a basic plan of care before we even arrive. The collaboration doesn’t end here. We have close relationships with the hospital as well, and when our clients transfer, their choices are treated with respect and care, and as many of them as can be honored are. This is not just about comfort and emotional support. This close working relationship leaves our mothers and babies safer.
Numerous studies have shown out of hospital birth is safest when done within a system that has processes in place for transfer. Both out of hospital and in hospital midwives will tell you, they feel safer and more supported when they know these systems are in place. The close working relationships benefit every party involved, and leave midwives and clients feeling connected and part of a system of quality care on a continuum. Less bad outcomes occur, for both mother and baby, with collaborative care that provides continuity. Not fractured care, but a smooth system of transfer from one place of care to another, with full communication between providers. Every mother, and every midwife, should get to feel this safe and supported from all sides.
As the week closes, I would like to send out a thank you to the network of midwives, physicians, and nurses I work with, that has grown me and held me up. Both near and far, in hospital and out, we have shown that when you work together, great, great things can be accomplished. May we continue to show the world the power of midwives, united in mission and solidarity, is an unstoppable force that will accomplish the good we have set out to achieve.
In faith, love, and gratitude
“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf
“Smooth Transitions: Enhancing the Safety of Planned Out of Hospital Birth Transfers.” Washington State Perinatal Collaborative. March 2015. http://www.washingtonmidwives.org/documents/Smooth-Transitions-Hospital-Transport-QI-Project.pdf. Accessed May 4, 2018