Thursday, December 23, 2010

Midwife Connection Goes on Vacation

Midwife Connection is taking a holiday break. We will return to our regularly scheduled postings on January 4, 2011. Season’s Greetings and best wishes for a happy, healthy, and prosperous New Year from your friends at the American College of Nurse-Midwives.

Wednesday, December 15, 2010

Midwifery Care from the Client’s Perspective

by Melissa Garvey, ACNM Writer and Editor

Our friends at Science and Sensibility have an interesting post that should be generating more discussion. The post explores certified nurse-midwife Mary Ellen Doherty’s study in the Journal of Perinatal Education called “Midwifery Care: Reflections of Midwifery Clients.”

Doherty conducted her study to describe the experiences of women who chose midwives as their health care providers throughout the lifespan. She and her team interviewed 12 women who had received prenatal, birth, postnatal, well-woman gynecologic, contraceptive, and primary health care services from midwives.

Five themes emerged from the data. As a member of the ACNM communications team, I’m particularly interested in two of them: 1) decision to seek midwifery care and 2) midwives as primary health care providers throughout the lifespan.

What Makes Women Choose Midwives?

That’s the million-dollar question here at ACNM. We exist to support and promote certified nurse-midwives and certified midwives. We know midwifery patients are extremely satisfied with their care. But how do we get a woman who has never considered a midwife to realize what she’s missing?

The women in Doherty’s study said they chose a midwife because of:
  • a brochure from a midwifery practice along with one from ACNM that exuded “competence, confidence, compassion, and kindness.” (Go, ACNM Communications Department!)
  • the recommendation of friends who had already given birth and had a positive experience with midwifery.
  • an obstetrician’s recommendation.
  • an insurance company’s recommendation.
Midwives as Primary Health Care Providers

All 12 of the women in this study discovered that midwives provide services beyond prenatal, birth, and postnatal care. Just among this sample of 12 women, midwifery services included:
  • Contraceptive care
  • Treatment for vaginal infections
  • Flu shot administration
  • Throat culture
  • Annual exam
  • Pap smear
  • Treatment referral and support for postpartum depression
  • Other health care referrals and recommendations for both patient and family members
Because this study was a phenomenological study, small sample size is not considered a limitation. However, Doherty notes that because her study focused on a “self-selective and purposive sample,” its results are not representative of all women. The majority of women were Caucasian, highly educated, married to their child’s father, and self-identified as “middle class.” Still, there’s a lot to learn from their answers…

…and a lot to add! Here’s where you chime in. What made you decide to choose a midwife? And what health care services do you receive from your midwife?

Thursday, December 9, 2010

Hit the Holiday Sales at

by Melissa Garvey, ACNM Writer and Editor

Looking for the perfect gift for that special student, midwife, or parent in your life? Visit for unique gifts that promote and support midwives.

Now through December 15, all ACNM logo wear and ACNM and midwife branded products are marked down 15% for ACNM members. Log in with your ID and password; then enter promotional code HOL1 at checkout to receive your discount.

Not a member? Join now, or support ACNM with your regularly priced purchase.

Tuesday, December 7, 2010

Do You Really Know Kegels?

by Alyce Adams, RN, BSN, "the Kegel Queen"

Midwives are experts at applying low-tech, low-cost health care strategies that promote self-care and help women avoid the dangers of unnecessary interventions. Every midwife is familiar with the cesarean epidemic and with the safe, simple approaches that can keep birthing women out of the operating room.

But many health care providers and consumers don't know enough about another surgical epidemic affecting women. Each year, 200,000 US women have surgery to treat urinary incontinence or pelvic organ prolapse (POP). Eleven percent of women in this country will have this type of surgery by the time they're 80 years old — that's a lifetime risk of one in nine. Of those who have surgery to treat prolapse, one third will end up back in the operating room at least once.

Millions more will suffer without any treatment at all: 50% of women will experience urinary incontinence at some point in life, and 50% of mothers will have some form of POP.

Kegel exercises — when performed correctly — are a highly effective treatment for urinary incontinence and POP. The exercises are simple, promote self-care, and they're completely safe. The only side effect is better sex! But most people don't realize how effective kegels can be to solve these health problems without surgery, because they don't have the facts about correct kegel technique.

Check out these popular kegel myths. Do you have the facts?

Myth: Kegels are intentional contractions of the pubococcygeus (PC) muscle.
Fact: Correct kegel technique involves the entire pelvic floor, not just the PC.

Myth: Women should do kegels whenever they think of them — at a boring meeting, at a red light, or waiting in line.
Fact: There are three reasons this approach to kegels doesn't work. First, effective kegels are sustained, high-intensity muscle contractions. Real kegels require your full attention. If you're trying to drive and do kegels, you'll either do weak, useless kegels or crash the car. Second, you must relax the pelvic floor fully after each kegel contraction. This complete relaxation requires your full attention as well. Finally, research shows that women who do kegels "whenever" simply don't end up doing them. Doing kegels on a regular schedule and connecting kegels with preexisting daily routines is the way to succeed.

Myth: Women should do 200 kegels a day, or more.
Fact: Too many kegels can lead to hypertonic pelvic floor muscles and pain with intercourse. A few dozen kegels a day is all you need — then far less for maintenance over time. Correct kegel technique takes just a few minutes a day.

Myth: Truly effective kegels require a kegel device.
Fact: Devices make kegels complicated, messy, and inconvenient. Study after study shows excellent kegel results with no devices at all.

When done correctly, kegels can eliminate prolapse symptoms, stop incontinence, and transform women's sexual health. Get the facts!

Wednesday, December 1, 2010

When it Comes to HIV, Every Woman is at Risk

by Jan Kriebs, CNM, MSN, FACNM, Assistant Professor and Director of Midwifery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine

Today is World AIDS Day – a reminder that HIV and AIDS are part of life for 33.3 million people around the world. Women are 15.9 million of those infected.

I have worked with woman who are pregnant and HIV-positive for almost two decades. You cannot tell who they are by looking at our waiting room. Some are poor, inner-city women without jobs. Some are women with homes and careers. Some come alone to their visits, afraid of anyone finding out they have HIV. Some come with their husbands, sisters, or best friends. Since we have had access to highly active antiretroviral medications, none of the women who knew they were positive for HIV in early pregnancy and who took medication throughout their pregnancies, have transmitted HIV to their child at birth.

Our pediatricians report that the young children they see in the pediatric HIV clinic have mothers who were not diagnosed, did not seek care, or were unable to manage their medications.

In the United States, where recommendations for universal HIV testing have been in place for years and where a full range of medications are widely available, babies are still born who will carry the virus for their entire lives. Part of the problem is a woman’s fear. What will I do if I am positive? Who will want to be with me? Part of the problem is our collective unwillingness to believe that ANY woman might be infected as well as our failure to decrease the barriers to testing.

The most common cause of HIV in women is sexual activity; it is responsible for more than 80% of new infections. As midwives we must recognize that pregnant women are an at-risk population. It is easy to think that “our” patients are safe, but it isn’t true. We may also think that women who are privately insured, who live in safe communities, and who are married cannot be at risk. But risk is a tricky topic. These women may not be at high risk, but that is not the same as no risk.

The theme chosen for World AIDS Day this year is Universal Access and Human Rights. For the families, women, and children seen by midwives, access begins with testing. If you do not know your status, you cannot seek care.