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What Is a 'Normal' Birth?No woman wants an 'unnatural childbirth.' But what is defined as a 'natural' or 'normal' birth? Women's expert Dr. Kirtly Parker Jones talks with a certified nurse…
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November 02, 2017
Womens Health Dr. Jones: Natural child birth, what is that? No woman wants an unnatural birth. But let's talk about normal labor or physiologic labor and how we can support it. This is Dr. Kirtly Jones from obstetrics-gynecology at University of Utah Health and this is The Scope. Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope. Dr. Jones: Today in The Scope studio, we're talking about normal or physiologic birth with Celeste Thomas, a certified nurse midwife and clinical director of birth care health care with the University of Utah College of Nursing. Welcome Celeste. So we all want a normal birth, but humans have these big babies and as a former of OB, all births looked a little risky to me, so let's talk about normal vaginal birth, or you use the word physiologic birth. Celeste: Yeah, I prefer physiologic, because all birth is normal, right? Dr. Jones: Yeah. Sort of. Celeste: I mean, kind of. I mean, for us humans you're right, we do have big brains and so we have to come out sooner than a lot of mammals have to. So let's talk about physiologic birth though, right? Because when we talk about physiologic birth, we're talking about the things that drive birth, which are the hormones. Dr. Jones: Oh, I'm all about hormones. Go for it. Celeste: Right? So we're always about hormones at many different parts of our lives. So a lot of this stuff about keeping the room calm or comfortable sounds really nice, right? But it also serves a physiologic end, which is that when hormones are doing what they need to do, then birth runs more smoothly. We know this, because we know that there are things like: prostaglandins, oxytocin, beta endorphins, catecholamines, norepinephrine, epinephrine. All of these things actually build up and change as birth gets nearer, as spontaneous labor gets nearer, and they really serve good purposes. So we know for instance that epinephrine and norepinephrine and cortisol have effects on the fetal brain, pre-labor effects, so things that happen in the brain that are prepping that baby's brain for birth itself. Dr. Jones: You mean like for getting squeezed? Celeste: Yeah, for dealing with less oxygen. Dr. Jones: Wow. I'd always wondered that we aren't weren't born with traumatic brain injury. Celeste: Yeah. So they have preparations that happen in the fetal brain for dealing with less oxygen, because birth does lead to decreased oxygen for most babies just in the normal process and babies' brains ideally need to withstand that. And we know that there are synthetic versions of things that we use. For instance oxytocin, we will sometimes use a synthetic version called Pitocin, that's in the hospital, but we know also that the synthetic version of oxytocin doesn't necessarily act in the exact same way as naturally occurring oxytocin. For instance, the synthetic version of oxytocin which causes contractions doesn't easily cross the blood-brain barrier. So this barrier to get into the brain in the same way that naturally occurring oxytocin that comes from the mother does. So there are things about that that are not exactly the same. So I think that the question is, what in the process . . . So sometimes there are ways to kind of safeguard the physiologic process even when things don't go exactly in the way that we were hoping, right, or even when things kind of go differently. So some of the ways though that we can safeguard that process and allow these hormones to do what they need to do is we can allow labor to begin on its own when we are able to. We can allow labor to begin that way. And that means that we get this pre-labor up regulation in the uterus and allows that uterus to contract more efficiently with the oxytocin. We can get that pre-labor up regulation in the baby's brain as well to withstand decreased oxygen during labor. It also means we want to avoid excessive stress in labor. So a certain amount of stress in labor is normal and can actually beneficial but if that stress reaches a level that is excessive we've seen in a lot of studies that labor can actually shut down. Dr. Jones: Well, so there's some good reason for that. I mean when you think about how long labors can be in humans. And maybe the tigers are coming or maybe you need to run away. And the fact that you could actually in early labor run away if you were afraid or if you weren't safe or if your baby wasn't safe, you could run away. Maybe it's a hurricane coming. Well, that's a long time to put it off. But we've known in women if they have a big scary thing, their labor can stop and then you end up having to start it up with external hormones and things like that. Celeste: Absolutely. And sometimes even just going to the hospital, the smells of the hospital, the people talking to you, the bright lights, that can sometimes slow labor down. And we'll see that sometimes when a woman will get to the hospital and her contractions were two minutes apart at home, but now they're 10 minutes apart and kind of sluggish and not really picking up. So keeping the lights low, making sure she has the people around her that feel safe and comfortable to her. Keeping the questions to minimum, just whatever you need to know but not being excessive with that. Making sure that she has access to a doula which is a trained birth support person. Allowing her to move and eat as she needs to. These things are going to decrease those stress hormones and hopefully keep them in that optimal range. Dr. Jones: Well, so let's back up just a sec, because certainly I could be in clinic and one in five women in the last couple of weeks of pregnancy will say, "Can't you just induce my labor? I just don't want to be pregnant anymore." That's a common . . . now on the one hand some of them say, "No, no, no, I don't want an induction," meaning start the synthetic hormones. But many women assume that doctors want to induce their labor. And maybe they live far away and they're afraid they won't get there on time, or maybe their husband's leaving to be deployed. I mean, there are thousands of reasons, and we've tried to do fewer and fewer inductions. And I think we're really dropping the number of inductions that we're doing. But women ask for it. Celeste: Yeah, absolutely. I mean it's hard to say . . . Dr. Jones: I want to tape your comments and say, "Oh no, your baby's brain isn't ready." Celeste: Yeah. I mean, there are sometimes really good reasons to induce. We have to weigh the risks and benefits. But when we don't have a really good reason to do it, we need to talk with women about what the risks are. So maybe a baby's brain who isn't as primed to go without oxygen, maybe the baby's brain is not going to do us well in labor as the baby whose brain is primed. So it's something to talk about and really discuss with women, and let them know about the research that we have and the outcomes. They're better for spontaneous labor. Dr. Jones: Well also women are given this due date which, not necessarily your patients, but mine used to think it was their God-given right to deliver by their due date, and so I'd say, "Here's an approximation. Here's your due date, but it could be a couple weeks on either side. So don't start counting down until it's a week or two after this date that we've given you." Celeste: I almost feel that we kind of give women a disservice, by not giving them a range and just saying, "You could have your baby between this and this." Dr. Jones: Right. Celeste: And that would be totally normal, right? Dr. Jones: Right. Well, what are other good ways to support physiologic birth? Celeste: The other things that are really important have to do a lot with the postpartum period. So when babies come out, making sure that as little as possible there is as little disruption to the process of baby being on the mother's skin as possible. And this is really interesting too because there are things about that postpartum period that we kind of tend to rush in the hospital. And I'm saying this because I've seen it and I've done it too. Where it's like, that baby is on her chest and it's kind of bobbing around and you're just like, "Baby go to the breast. It's over there." But it takes baby a while to get there. Dr. Jones: But baby's got a headache. Celeste: And sometimes baby has a headache. But that, it's interesting in the studies looking at babies who bob and are kind of looking around and don't necessarily get the breast in their mouth yet. The mother's oxytocin goes much high than babies who are just latched on right away. So there seems to be some reason why these things are happening, so as much as possible to kind of watch for those danger signs of course and make sure mom's not bleeding too much or doing those things. But really allowing mom and baby in that little ecosystem, right? That's really important to a baby survival, allowing that to happen. And the really interesting thing about these things is that, let's say you end up with a C-section. Well guess what? There's physiologic things we can support even in a C-section. We can allow skin to skin. We've been doing that in the operating room, right? So you can do skin to skin. There's a lot of studies now going on with the vaginal microbes. Dr. Jones: Oh, we did a study. Listeners, you can actually tune in on that. Celeste: Yeah. So again, there's a lot of stuff we don't know, but there's a lot of things that we can see physiologically that happen in nature that we can try to really safeguard. Dr. Jones: Yeah. Well I always liked doing deliveries in the almost dark and especially after the baby was born, to turn off the lights so the mom and the baby aren't squinting. The poor baby, the lights are too bright. All I need is a spot at the other end so I can make sure the bleeding isn't happening and get the placenta delivered and let the mom and the baby be in the dark and quiet. And it gives me a chance for my blood pressure to come down as well, as the deliverer, so until the baby is out my blood pressure is up. So I like the dark. Celeste: Yeah. Absolutely, and I tend to do a kind of mindfulness exercise when I'm even in that second stage when she is pushing, so I really feel my feet on the ground, I want to stay really present, I don't want to get too anxious, want to kind of create that space for her. But also be vigilant, of course. Dr. Jones: The other thing is that I've often seen and I can't say I've participated because I'm not a yelling person. But when women are pushing and people want them to push firmly, although I don't think there's any evidence that they have to push hard. The body will make them push hard. But they start yelling at someone to push. And you see this on TV. "Push, push." And I'd rather be sweet talked. So talk about your own practice in this regard. Celeste: Well, think about it. I mean, in the physiology about birth, they actually call it the fetal ejection reflex. So in some ways it's like a reflex, in that when the baby's head reaches a certain point, you will push, and if you can feel it, you will push. So especially with a woman who doesn't have an epidural, you don't need to . . . Dr. Jones: It's uncontrollable. Celeste: Yeah, it's uncontrollable. If you have a woman with an epidural, they do some times need a little more guidance, but again, they'll get the hang of it. And really having to direct them in pushing, there's no evidence that that is beneficial. Dr. Jones: I just don't think it's beneficial at 60 decibels or 80 decibels. I think you could probably coach someone. But when you watch it on TV, they're kind of yelling at the mom to push, and can't you sweet talk that baby out? Celeste: Yeah, and it's a less like a sport and more like a bowel movement than anything else, right? I mean it's like there is a certain amount of . . . Dr. Jones: We'll hold that thought. Let's just hold that thought. Well as we put things together, I want to briefly talk about home births and the safety of home births and some studies from Europe and compare the European experience with the American experience. Celeste: Yeah. Absolutely. So there's been a number of studies on out of hospital birth, especially home birth in the Netherlands, in the United Kingdom for low risk women. And this is an option that's completely integrated into their health system, meaning these are midwives who work with the National Health Service. They have a set criteria of risk that they look at to see if someone is eligible for an out of hospital birth and they have set criteria for transferring when they need to. Dr. Jones: And the transfer time is short. They're not a hundred miles from the hospital. Celeste: Yeah. They actually have to be within about 15 minutes I think it is. So in that scenario, home birth can be a really safe option for low risk women. If you look here in the United States, we have a different health system. It's not comprehensive. It can be rather fractured. And so this ability to kind of transfer seamlessly into the hospital when you're having a home birth is not as smooth. And so there are some challenges that way. When you look at outcomes you can see that Cesarean rate for low risk women is lower when they are out of the hospital. And that's true regardless of if it's a birth center or if it's a home birth. The Cesarean rate is lower for low risk women than low risk women who are having their babies in the hospital. Dr. Jones: Right, and that the women who aren't transferred. And clearly when get transferred the story is over in terms of . . . Celeste: But you still need to follow those women, those transferred women, and that's something we're actually doing here in the state of Utah, is that we are now capturing the women who transferred in to see what are their outcomes like? And to be expected, the outcomes are not as good, right? If you transfer. Dr. Jones: Right. But once you've gone from low risk to high risk at home, then that ends up being a bigger problem than going from low risk to high risk in the hospital. Celeste: Absolutely. Dr. Jones: But birth is a physiologic phenomenon and there are many, many of us on the planet, so we must be doing it pretty well. Even though the stories from 150 years ago are heartbreaking with the number of moms and babies that we lost, I think that we really do very well in various settings with people who are informed and supported. The biggest issue is supported. And we all want the safest and most comfortable birthing experiences for mom and we offer options that let women make some choices in their birthing experience. And thanks for joining us on The Scope. Announcer: Want The Scope delivered straight to your inbox? Enter your e-mail address at thescoperadio.com and click "Sign me up" for updates on our latest episodes. The Scope Radio is a production of University of Utah Health Sciences. |
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The Role of a MidwifeMidwives play an important role in the birthing experience, should a pregnant woman choose to have a midwife. Dr. Kirtly Parker Jones speaks with certified nurse midwife Celeste Thomas about the…
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October 19, 2017
Womens Health Dr. Jones: "I don't know nothin' about birthin' babies, Miss Scarlett." That is something no mother should ever hear, except on the big screen. Trained midwives have helped women and their babies safely through birth for a long time here in the West. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Utah Health. No, it's not "Gone With The Wind." Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope. Dr. Jones: Building on the rich tradition of midwifery in the intermountain west, the Certified Nurse Midwifery program at the University of Utah is one of the top 10 programs in the U.S. Certified nurse midwives at the University of Utah help women with their choices in their birthing experience. Today in the Scope studio we're talking with Celeste Thomas, a certified nurse midwife and Clinical Director of Birth Care Healthcare at the University of Utah College of Nursing. Welcome, Celeste. Celeste: Thank you so much. Dr. Jones: So are there other kinds of midwives who practice in Utah? Celeste: Yeah, so there are three types of midwives here in Utah. I am a certified nurse midwife, so I have gone through a master's or doctoral program after becoming a registered nurse to become a certified nurse midwife, and that's similar to a nurse practitioner. And there are also midwives who are licensed by the state of Utah that are called licensed direct entry midwives. These are midwives that primarily do out of hospital births, so that would be home and birth center births. And they are also licensed by the State of Utah, and they usually go through an educational program but can also do a portfolio-based apprentice program as well in order to sit for their board exams. And then there are midwives who are not licensed in the state of Utah, and Utah allows midwives to practice even if they are not licensed. It's one of the few states that does that. Dr. Jones: So your training, as you mentioned, was you had an undergraduate degree and then you got a nursing, an RN. Celeste: I got an RN. Dr. Jones: And then a special extra three or four or five or however many years it might be with a lot of hands-on training. I'd see the midwives in our program on labor and delivery at the U pretty frequently. Celeste: Yeah, and a lot of their training is hands on. About half, 50% of their training is hands on and the other 50% is didactic or in the classroom. Dr. Jones: Well, let's talk about that hands-on part. There are some aspects of the natural birth experience that women are kind of afraid of. Many women are worried about their bottoms. Getting a baby through there's no small task, and they might be choosing a midwife for many reasons, but one might be that they don't want an episiotomy, a cut that makes their vaginal opening a little larger. Now as we OBs don't commonly do episiotomy for a normal vaginal birth, but even we think that midwives might have a knack for getting the baby out without a tear. What is your magic? Celeste: Oh, well, it's not magic. It's research. Dr. Jones: Okay. Tell me about the research. You mean, you don't pass it down from midwife to midwife for the last 300 years? Celeste: Well, it is very interesting. Maybe 20 years ago a lot of OBs were still doing episiotomies, and as the research came around to show that that was really not helpful to keeping that perineum, which is that skin between the vagina and the anus intact, that really has fallen out of favor and it's pretty rare to find an OB nowadays who does an episiotomy. Now as midwives, we rarely did episitomies, so we just kept rarely doing them and that's worked for us. Dr. Jones: Oh. That was your knack? Celeste: But the other things that we know about keeping the perineum intact, there are some things that we know in the research do work. So one is perineal massage. So this sounds really lovely, like massage. Dr. Jones: Well, it sounds a little X-rated. Celeste: It might. It really is gentle stretching. And doing that before you go into labor in the studies has been shown to decrease the number of tears, especially for moms who are having a baby for the first time. Dr. Jones: So moms do it at home? Celeste: Moms do it at home and with their partner. This does not have to be done by a health provider. So starting at 35 weeks and they only have to do it about once or twice a week. It doesn't have to be all the time in order for it to have the benefit. Dr. Jones: Oh, well, that's good news. Celeste: Yeah, so that's something kind of easy they can do. Dr. Jones: Well, when you think about how much stretching actually, and often it happens over a period of just maybe 15 or 20 minutes. And for someone who hasn't had a baby to see where they are before and then see what has to happen, you're amazed that that tissue can stretch so easily and then come back to its almost before state. Celeste: It's pretty miraculous, but we like to help it out if you're a first-time mom. And the research is pretty strong on that one too. Dr. Jones: Okay, now let's talk about water birth. What is that? Celeste: Well, water birth, it has been getting more popular recently, and really women laboring in water is the thing that seems to be supported in the research. So we know from the research that women who labor in the water have shorter labors. They have less need for any medications or an epidural, and they have greater satisfaction and greater mobility to be able to move, because as you know when you have a baby inside you, it can be difficult to kind of get into certain positions, right? It's hard enough just tying your own shoe. So being able to move in the water is really lovely. And for a lot of women who don't want to use medication, being in the water during labor is really beneficial. The question is then when the baby comes out, is there a benefit to being under water? And from what we can see in the research there is no benefit. Dr. Jones: But there's no harm either? Celeste: For low-risk women, we don't have a lot of evidence, but from what we have there doesn't seem to be a lot of harm. We have a study ongoing here at the University of Utah about water births specifically to look at potential harms. But yes, it is a good option as far as we know for low-risk women, and a lot of women just don't want to get out in that really intense moment when the baby's head is kind of maximally stretching things. Dr. Jones: How deep is the tub? Celeste: So the tub in order for it to have its benefit needs to be at least 27 inches deep. Dr. Jones: I would think it'd have to be deeper if you really want to have some buoyancy. Celeste: You have to at least be immersed usually up to your chest in order to have those benefits. Dr. Jones: Okay. Now the next question is, do you have to come as the midwife in your bathing togs, or do you have to just get your scrubs right in there or you just bend over and get back pain? How do you get in there? Celeste: This is a good question. So body mechanics is important. The thing to remember is that you don't have to support the baby's body in the same way as you do when baby's born with gravity. So when you have a woman who's delivering, it's important to be able to get to the baby if you need to, but you're watching for that baby and you really are not doing a lot of hands-on in that moment when the baby's coming out. You just need to be able to reach the baby and bring the baby up above the water when the baby comes out. Dr. Jones: Well, I was thinking again, if we go back to the episiotomy question when we are delivering a woman in a bed, this is OBs, we're careful to kind of support the head and make sure it doesn't come out too fast and gentle the head out. But that's kind of a low position to be in in the tub. Celeste: Which is why we don't get into that position in the tub. It's pretty hard to get there, and depending on the mom's position. We do try to coach her through that crowning process so that she does it nice and slowly. Dr. Jones: Crowning, when the baby's head is just about to be born but isn't it quite born yet. Celeste: Yes. But in general she is letting the baby out, and then we are bringing the baby up to the surface when baby comes out. Dr. Jones: Okay. But you don't get to have an epidural in the tub? Celeste: No epidurals in the tub, no. Dr. Jones: Okay. No narcotics in the tub? Celeste: No narcotics in the tub because of the risk of dizziness. And currently at the University of Utah we also don't allow people to have nitrous gas also in the tub because of that risk of dizziness. Dr. Jones: Right, right. Well, we have tubs at the U. Celeste: We do. We have four rooms with tubs, but only one of them is technically deep enough to push your baby out under water. But you can absolutely use them . . . Dr. Jones: For laboring. Celeste: . . . and sit in the tub for labor, and that really is where the benefits come from. Dr. Jones: Right. So getting back briefly to certified nurse-midwives, you primarily practice inside the hospital but create an environment which we'll talk about a little bit more that you think is as homey as you can be, given that you're close to all the other things that a hospital can offer. Celeste: Yeah, so the majority of certified nurse-midwives give birth in hospitals, but there are certified nurse-midwives who do home birth and birth center births as well. We can catch a baby anywhere. Dr. Jones: Oh, you can catch a baby anywhere. I'm glad to hear that. Well, so whether you choose a physician, a certified nurse midwife, or a team of both, because sometimes people have complications, they need the entire team to be with them. For your OB care and delivery, our goal is to provide the safest and most comfortable passage for moms and their babies through pregnancy and birth. And thanks for joining us on The Scope. Thanks, Celeste. Celeste: Thank you. Announcer: Want the scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences. |
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No Laughing Matter: Using Nitrous Oxide for Labor PainNitrous oxide—or laughing gas—is used widely around the world for labor pain relief. But the United States only has approximately 100 hospitals that make it available to women in labor.…
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July 22, 2015
Family Health and Wellness
Womens Health Debra: If you've been to the dentist you may have heard of laughing gas. Did you also know that it's used for labor pains? Today we'll be talking about nitrous oxide on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Debra: I'm Debra Penney and I'm talking today with Michelle Collins, PhD. She's also a certified nurse midwife and the director at Vanderbilt University of the Nurse-Midwifery Program. First of all Michelle, what is nitrous oxide? Michelle: A lot of people think of nitrous oxide as laughing gas because that's what they know it from the dentist. It is similar to what they use at the dentist, but it's a different concentration. A lower concentration when we use it in labor. Debra: And tell me, how is it given to women in labor? Michelle: They inhale it either through a mask or a mouthpiece. The mask goes over their mouth and nose, where the mouthpiece they purse their lips around. Debra: And can she be up and mobile while she's taking this gas or does she have to be in bed? How does that work? Michelle: It does allow for a woman to maintain her mobility. So she can be on her birth ball, on her hands and knees on her bed, doing slow dance with her partner, in the rocking chair, any position really. Debra: What kind of affect does it have on her and does it have any side effects? Michelle: Probably the largest side effect is about 10% of women will feel nauseous or need to vomit. But that's only 1 out of 10 women. That's probably the most prevalent. Some women get a little bit dizzy when they use it as well. Debra: What about the baby? How much of this gets to the baby? Michelle: So there has not been a great deal of research done on nitrous oxide, although we have a large body of what we call anecdotal evidence, meaning it's been used for almost a century in other countries. So we have lots of babies born over lots of years in lots of countries to look at and we've not seen it affect the baby at all after birth. In other words, we don't see sleepy babies or drug affected babies from mom using the Nitrous. Debra: Well it sounds like a pretty good thing then. If it's that good why aren't we using more of it here in the US? I understand there are only about 100 hospitals that have it available to laboring women. Michelle: It was actually used in the '50s, and then with the advent of the epidural anesthetic it kind of went out of favor as epidurals rose in popularity. Now in other countries the epidural rate is not what it is, not as high as it is in the United States, so they continue to use nitrous oxide widely. For instance some countries, like Great Britain, 60% of all women in labor use it. Some countries like Norway 80% of women use it in labor. Debra: So does this nitrous oxide work for every woman? Michelle: Not every woman is going to take the nitrous oxide just like not every woman likes an epidural or not every woman likes a narcotic. Some women will try it and not like it at all, feel it's not helpful, and move on to something else. Debra: When hospitals use it, do they have some kind of guideline in place for how it's given, or who gives it? Michelle: In most places in the US the midwife or obstetrician or family practitioner, or whoever is taking care of the mother, gives an order to the nurse, and the nurse initiates the nitrous oxide. In some hospitals only an anesthesia person initiates it. So it's dependent on the hospital. In birth centers there are only midwives and nurses so they would be the ones doing it at a birth center. Debra: So it sounds like a pretty good option. What other kinds of affects, other than taking the pain away, does it have any other affects on the mom? Michelle: It is really good for anxiolytic properties. What that means is it decreases one's anxiety. So for some women it's not the pain of labor that is intolerable, but the anxiety. They're so afraid of the birth process. So it can decrease their anxiety and help their labor along. Debra: So apart from labor pain, say she's waiting for an epidural that's really her drug of choice, can she still use this nitrous oxide while she's waiting? Michelle: Yes, that's a good use of it, is for the woman to inhale it while we're having her epidural placed. Helps with the pain, helps with her anxiety and generally gets her through that transition period until the epidural is working well. Debra: Have you ever seen it abused in the hospital? Or heard of stories with it abused? Michelle: That's a common misconception and it doesn't appear in the literature as any problem in the European hospitals and we've been using it at Vanderbilt for four years and have not had one instance of that happening. Debra: So what if a woman tries it and finds out she doesn't really like it? Michelle: If she inhales a few breaths, part of the advantage of using nitrous oxide is it's a very quick onset. Within about 30 seconds she'll feel an affect, and it also has a rapid offset. Meaning if she doesn't like it, she stops breathing it, takes a couple breaths, and the effect is gone. And that is really one of the advantages of using nitrous oxide. Debra: What are some of the other advantages? Michelle: Besides not affecting the baby at all, that we have seen in use, women can also control it themselves, so it's not strapped to their face where somebody else is controlling it. They are empowered to breathe it when they want and not breathe it when they don't want. This makes it a really attractive advantage, and hopefully it will be widely available to women in the US soon. Announcer: The ScopeRadio.com is the University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
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Why Choose A Midwife?Certified Nurse Midwife Dr. Debra Penney asks: “Why not choose a midwife?” Most people think having a physician deliver their baby is the only way to go, but Debra explains how midwives…
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May 26, 2015
Family Health and Wellness
Womens Health Interviewer: Why should a mother to be choose care from a midwife? We'll be discussing this next, on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: I'm talking today with Debra Penney. She is a certified nurse midwife from the College of Nursing. Debra, first of all, we want to establish that you are a midwife. Debra: Yes. Interviewer: A certified midwife. That is actually a real thing that mothers-to-be actually choose for care. Tell me some reasons why mothers, or mothers-to-be, should be choosing midwives for care. Debra: Well, actually, there are several reasons and I can name the top few. One is we see women prenatally, just as a physician would, and we do some of the same tests, but we actually have longer visits. So, we spend that time communicating, getting to know the woman and really understanding what this birth means for her and her family. Interviewer: So, it's a kind of a customized care. Debra: Yes, we center in on the woman and her choices. And, we can't guarantee that she'll have all her choices. But we really want to honor those choices, respect the woman, communicate clearly with her and develop a relationship so that we know what she needs in labor and during her postpartum period. And, we try to address all those needs. Interviewer: So, what are some of the personal choices, then, that you are talking about that she may not be able to get from a normal doctor? Debra: Well, I think that she can get most of them, but what she may not get is the lack of unneeded intervention. Interviewer: Got you. Okay. Debra: We try to really manage labor according to the evidence, and try to not intervene with routine things that are known not to really help labor, to facilitate normal labor. And, also, we want to help her understand her body and what's happening physiologically through the pregnancy and birth and postpartum process. So, we do a lot of education. And, as nurses, we really like to focus in on her cultural differences, as well, and how those play in to her birth plan and her birth choices. Interviewer: So, with that said, do you guys have the different knowledge of each culture and how they birth their babies? Debra: Well, actually, culture is very variable, but we like to get to know the woman personally first, and then we can modify what she needs. For example, we had a lady from, I think it was southern Sudan, and it was her first time ever in a birthing hospital, here in the United States. So we took off the monitors because she was having a normal birth and used an intermittent monitor, let her move around the room freely. Interviewer: Kind of natural? Debra: Yes, and she could also choose her own birth position. So, I think as midwives, we can adapt more and we also, as nurses, just really key in to what this lady needs culturally as much as she can express that to us. Interviewer: So, with doctors, I've noticed that when a woman gives birth, they kind of come in, check up on you a little bit, and then they walk out. Then they come in about, like, a half an hour later, and then, it's another, like, 30 second, "Hey, how are you doing?" I'm assuming that's different with midwives? Debra: Yes, and since we're nurses too, our scope of practice does overlap nurses a bit. That, we're in the room, helping this lady find the best position to help her baby come down and come out. And, also we can offer a lot of different choices as far as comfort measures, acupressure, massage. We're with her the whole time in labor. Now, if she wanted an epidural, that's fine. Interviewer: Oh, so she can get an epidural if she wants to? Debra: Yeah, there's a common misconception that women with midwives, birthing with midwives, cannot have... Interviewer: It's all-natural? Debra: Yeah, and it's really not all-natural. We try to keep it as much as she's willing to keep it natural, but it's her choice to have an epidural. Interviewer: Got you. Okay. I know that you said that you stay with the mom-to-be before she gives birth, the months leading up to it. You're kind of there holding her hand, being her best friend, and then you're there with her during labor. What's your role after labor? Debra: So, after labor, we see them a little more frequently, perhaps, than a physician would. We like to see them at two weeks and at six weeks, and we really love if they call us. So, we're really available to them all the time that they need. And, we also do, as part of their postpartum care, we offer contraception. And, I think we have one of the highest levels of contraception with our patients. Interviewer: Why isn't midwifery a more common thing? Debra: I'm not really sure. I think a lot of people just naturally think that a physician is the way to go, when they don't realize they have the choice for a midwife. Interviewer: So, the people interested in finding a midwife for their pregnancy, where can they find you? Debra: Our practice is located here at The University of Utah, and they can find us, if their insurance covers us here. But, actually, there are midwives in every major hospital here in Salt Lake Valley. Interviewer: See, I did not know that. That's, just, like a myth. Debra: So, that's a really good thing. Choosing a midwife should be a more common thing, because they really save on medical dollars because of lack of interventions and they have a better outcome for a lot of the women that they serve, so less c-sections. Our c-section rate here is only 8% where it's 30% in the U.S. So, that's another good reason to have a midwife. So, midwives deliver about 10% of the births in the U.S. and that really needs to increase. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |
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Do I Need a Midwife?There are a lot of misconceptions about midwives and their role in childbirth and postnatal care. Debra Penney is a certified nurse and midwife. She clears the air about the role of midwives in…
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May 13, 2015
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Womens Health Interviewer: We've all heard of midwives, but what do they do and what services do they actually provide? We'll find out, coming up next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use, for a happier and healthier life. You're listening to The Scope. Interviewer: We're here in the studio today with Debra Penney, she's a certified nurse-midwife from the College of Nursing, and she's actually going to tell us a little bit about the types of midwives and what services they provide. I feel like there are some misconceptions going on. I've heard that there are two types of midwives; the direct entry midwife and then the certified, nurse-midwife, correct? Debra: Correct. So, here in Utah we have certified nurse midwives, and they're nurses that have an advanced degree. And we also have the direct entry midwife, and she is apprenticed or she can have a formal education, but she has a little bit less of a scope of practice. Interviewer: How does she differ from somebody who would be a certified nurse-midwife, like you are? Debra: Her background is going to dictate her scope of practice; and her scope of practice mainly is around childbirth and postpartum care. She does about 1% of the births and she usually does the home births. She doesn't usually come into the hospital, doesn't have hospital privileges. So, the certified nurse-midwife does most of the births in the hospital and she has hospital privileges here in Utah. She also is educated to do home births, or birth center births as well, but majority of them are in the hospital. Interviewer: So that is actually the large misconception because I've always figured the midwife helped deliver, or helped birth the baby at home, and doesn't really come to the hospital, doesn't really interact or mingle with the doctors and nurses in the hospital. But, from what you're telling me, that's actually not true. Debra: Right, that's correct. So most of the midwifery births here are done by certified nurse-midwives, and we actually collaborate with the doctors in the hospital because, of course, we don't do C-Sections. But we do work as an integrated team within the hospital that we're working with, and most of us have a plan of care for backup in case the lady does need a C-Section. So, we try to work along with nurses, doctors, pediatricians. And our scope of practice also includes not just birth, but prenatal care and well-women care, treating infections, common illnesses, doing some primary care, and then also menopause. So the whole lifespan basically. Also, a little care of the newborn in the first weeks of life. Interviewer: Okay, so let's clear the air here, first of all because I'm still a bit confused as to... your telling me what midwives do, it sounds very similar to what a regular doctor here would do in the hospital for a pregnant mother. So, what is the difference? Debra: So, basically. It boils down to our philosophy of care and how we look at pregnancy. We see pregnancy as a normal process, and it basically is for about 90% of the women who are pregnant. So we encourage the physiological processes that contribute to normal birth, like letting labor start on its own, and trying not to interfere with labor and not trying to push it to be faster than it needs to be. So we have a little more patience in the labor process. The other thing I always tell patients is that, we're with them in labor. So actually the word, "midwife," means "with woman." So, we are with women throughout their labor, which makes a huge difference and we get to see the big picture of how things are progressing. We also have a toolset of little things that we can do to help the baby come down and be positioned correctly, and so changing position, and helping the mom in certain ways. We do less interventions, as well, as the doctors because we only will do those if it's necessary. Interviewer: If there is a mother who's interested in having a midwife, walk her through her nine months of pregnancy, how does she get one, where can she find one? Debra: Well, we are on the website, she would also want to check with her insurance and we are covered by insurance. So, she would want to check both of those, to see where there is a midwife in her community. Interviewer: And does it vary? Because, I know that in Utah, we have specific names for our entry level and our certified midwives, but does it vary between states or countries? Debra: So, across the US, certified nurse-midwife is recognized. There is also a midwife that is called a certified-midwife that we don't recognize here in Utah but she's everything that a certified nurse-midwife is, without being a nurse. She essentially passes the same board exams and these are national boards. In other states, the direct entry midwife might be called a certified professional midwife, and she may be required to go through special training to have her license. Interviewer: So, to sum it up, midwifery is an actual process or a method or option, that pregnant woman can actually choose. Debra: Right. Here in the US certified nurse midwives had prescriptive authority and have been marketed since the '70s with the women's movement, and we've kind of reemerged. But we have a history here since the 1920s, or even earlier. But as certified nurse midwives, we have been around for quite a while in the US. Announcer: TheScopeRadio.com is University of Utah's Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |