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Midwives: Changing Health Care for the
Better
Tuesday, November 5, 13
Midwifery:An Ancient Commitment,A Modern Success Story
Tuesday, November 5, 13
Mary Breckinridge
Frontier Nursing Service
1925
Tuesday, November 5, 13
The Growth of Midwifery
Published research that shows CNMS:
• Provide high-quality care• Have comparable or better outcomes• Have high levels of patient satisfaction• Lower costs due to fewer interventions.
Tuesday, November 5, 13
Increased CNM-Attended Births
Tuesday, November 5, 13
• Pregnancy, birth, and newborn care
• Women’s primary health care
• Family planning
• Advanced clinical practice (first assistants, circumcision, colposcopy, ultrasonography)
• Education and Public Health
We Do More than Deliver Babies:
Scope of Midwifery Practice
Tuesday, November 5, 13
Philosophy of Care• Focus on prevention and individualized
education
• View pregnancy as a normal process
• Provide compassionate and family-centered care
• Encourage women’s participation in decision-making
• Use technology appropriately...minimize interventions
• Consultation, collaboration and referral with members of the health care team.
Tuesday, November 5, 13
Emphasis on Primary Care
Primary Care During Pregnancy
Labor & BirthPrimary CareNon-Maternity
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0
1
2
3
4
Infant Mortality
Low Birthweight
CNMs MDs
Neonatal Mortality
CNMs Have Excellent Outcomes
Tuesday, November 5, 13
0 15 30 45 60
Forceps/Vacuum
Cont. Fetal Mon.
Epidural
Induction
Cesareans
CNMs MDs
Midwives Use Birth Interventions Appropriately
Tuesday, November 5, 13
Midwives Provide Effective Labor
Support• Twice as much freedom to move in labor• Twice as much intermittent monitoring• Twice as many non-medicated births• Half as many episiotomies• Supportive care during labor • Collaborates with patient’s doula
“High Touch, Low Tech”
Tuesday, November 5, 13
Midwifery Prenatal Care
Listen to WomenProvide Emotional
SupportPregnancy and Birth
EducationCollaborate with
Physicians
Midwifery Prenatal Care = Excellent Outcomes
Tuesday, November 5, 13
70
77.5
85
92.5
100
Satisfied Use Again
CNMs No CNMs
Higher Satisfaction Rates with CNMs
Tuesday, November 5, 13
MD
• Consultation
• Collaboration
• Referral
Collaborative Practice
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32%
32%
9%
9%
8%
11%
Hospital MD Owned Gov./MilitaryMidwife Owned Education Non-profit/Health Ctr.
Hospital
MD Owned
Gov./Military
Midwife Owned
Education
Non-Profit/Health Ctr.
Where are midwives employed?
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0
25
50
75
100
Hospital Birth CenterHome
98%
1%1%
Where do midwives attend births?
Tuesday, November 5, 13
• Nationally accredited education program
• National certification exam
• State licensure
• Professional liability insurance
• Continuing competency assessment
Midwives meet the following criteria:
Credentialing Nurse Midwives
Tuesday, November 5, 13
• A modern success story built on an ancient commitment
• Maternity, gynecological, well-woman care
• Emphasis on primary care and health promotion
• The midwifery model: high-touch, low-tech
• Excellent outcomes, satisfied patients, and value-added service
• Quality, professional care.
Midwives: Changing Health Care for the Better
Tuesday, November 5, 13
Find A Midwife
•www.midwife.org to find a midwife in your community.
•Triangle Midwives is the only private practice in Wake County with midwives.
TriangleMidwives.com
Tuesday, November 5, 13
Delivery Statistics:~ 2009 - delivered 700 babies~ Midwives managed, consulted or collaborated with 80% of those patients~ Midwives delivered 70% of the 700 babies
Cesarean Section Rates:~ Nationally - 31 - 34%~ Triangle Midwives: Primary - 17%; Repeat - 26 - 29%~ Low risk midwifery patients: 12 - 14 %~ High risk midwifery patients: 16 - 20%
Vaginal Birth After Cesarean Section (VBAC) Rates:~ 75% success rate
Tuesday, November 5, 13
• Triangle Midwives has 6 Certified Nurse Midwives
• All deliveries are at WakeMed Cary Hospital
• For patients, www.TriangleMidwives.com,www.myMidwife.org.
• www.GotMom.org, ACNM’s online breastfeeding resource.
Learn more...
Tuesday, November 5, 13
With Women…
…For a Lifetime
Tuesday, November 5, 13