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Archive: Nurse-Midwives, Physicians Collaborate for High-Quality Maternity Care
Focus on Interprofessional Education Leads to Improved Care, Increased Options for Mothers
On a sunny day in late October, a group of midwifery graduate students from UC San Francisco School of Nursing and residents in obstetrics and gynecology from School of Medicine sit in a windowless room in the Kanbar Center for Simulation, Clinical Skills and Telemedicine Education talking about an emergency scenario they have just completed.
Surprisingly, most of the discussion centers not on clinical skills or decisionmaking, but on communication: how physicians and midwives can engage in meaningful, respectful dialogue to improve patient care during the stressful, high-stakes events that are obstetrical emergencies.
Scenes like this one illustrate an increasing focus on interprofessional education that intersects with a collaborative model of maternity care between UCSF’s certified nurse-midwives (CNMs) and obstetricians that began at San Francisco General Hospital (SFGH) and has evolved over almost 40 years to allow each to learn from one another and practice to their unique strengths, to the benefit of patient and provider alike.
Birth of a New Kind of Maternity Care in San Francisco
In the early 1970s, a group of obstetricians at SFGH began discussions with CNMs in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences who also chairs the leadership council of the nurse-midwives of SFGH.
It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.
The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.
The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.
“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.
Continue reading on the Science of Caring website
On a sunny day in late October, a group of midwifery graduate students from UC San Francisco School of Nursing and residents in obstetrics and gynecology from UC San Francisco School of Medicine sit in a windowless room in the UC San Francisco Kanbar Center for Simulation, Clinical Skills and Telemedicine Education talking about an emergency scenario they have just completed (see slideshow). Surprisingly, most of the discussion centers not on clinical skills or decisionmaking, but on communication: how physicians and midwives can engage in meaningful, respectful dialogue to improve patient care during the stressful, high-stakes events that are obstetrical emergencies.
Scenes like this one illustrate an increasing focus on interprofessional education that intersects with a collaborative model of maternity care between UC San Francisco’s certified nurse-midwives (CNMs) and obstetricians that began at San Francisco General Hospital (SFGH) and has evolved over almost 40 years to allow each to learn from one another and practice to their unique strengths, to the benefit of patient and provider alike.
Birth of a New Kind of Maternity Care in San Francisco
Midwifery in the US
Laws regarding midwifery in the United States are a constantly changing hodgepodge of state regulations that stipulate everything from who can call herself a midwife to what limits, if any, are placed on practice. There are four general categories of midwife in the US.
Certified Nurse-Midwives
Certified nurse-midwives (CNMs) are registered nurses with advanced degrees in midwifery (since 2010, at master’s or doctoral level) from university-based programs accredited by the Accreditation Commission for Midwifery Education. They are certified by the American Midwifery Certification Board to provide a wide scope of women’s health care, including primary and gynecological care, family planning and care through pregnancy and childbirth, as well as care of the newborn. They are licensed in all 50 states and the US territories, practicing in hospitals, clinics and birth centers and at home births, and can prescribe a wide range of medications. They do not perform surgical births (cesarean section or vacuum- or forceps-assisted vaginal deliveries) but may assist obstetricians in such deliveries.
Certified Midwives
Certified midwives (CMs) have the same midwifery and women’s health training and scope of practice as certified nurse-midwives, but they are not registered nurses. They can practice in hospitals and birth centers and attend home births, but at this writing only New Jersey, New York, Rhode Island, Delaware and Missouri recognize the CM credential.
Certified Professional Midwives
Certified professional midwives (CPMs) have a high school diploma or equivalent (required for CPMs credentialed after September 2012) and are certified by the North American Registry of Midwives (NARM). They follow one of two educational paths: completion of a midwifery education program accredited by the Midwifery Education Accreditation Council, or completion of NARM’s Portfolio Evaluation Process (PEP), an apprenticeship-based pathway that requires no formal didactic educational component (currently, the majority of CPMs in the US are credentialed through PEP). CPMs care for women and babies during pregnancy, childbirth and the postpartum period. They may legally provide care in 28 states (only some of which require licensure) and primarily attend out-of-hospital births. Some states permit CPMs to obtain and administer a limited variety of medications.
Lay or “Traditional” Midwives
These midwives are not licensed or credentialed and may legally care for women in pregnancy and attend childbirth in only a handful of states that do not prohibit their practice.
In the early 1970s, a group of obstetricians at SFGH began discussions with CNMs in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UC San Francisco School of Medicine, who also chairs the leadership council of the nurse-midwives of SFGH.
It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.
The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.
Changing the Culture of Childbirth at SFGH
The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.
“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.
- See more at: http://scienceofcaring.ucsf.edu/future-nursing/ucsf%E2%80%99s-nurse-midwives-collaborate-physicians-high-quality-maternity-care#sthash.scG0LjDl.dpuf