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?


Anonymous said...

As a lifelong OB/family practice client, I switched to a midwife for baby # 7 because I wanted someone to actually BE THERE for the birth. She ended up running interference for me, keeping the nurses at the hospital so far back I don't know if they would have been nice or mean without her there. She also was kind and compassionate in appointments. She listened like no one else has to me and my wishes for birth. She never did anything without asking (except try to turn the OP baby head as I remember and I likely wouldn't have been able to do anything to give permission anyway...I was pushing as she did it, and if it worked it would have been wonderful). I have yet to decide if I want to use her for all care. I hadn't realized that she could be my primary care provider until late after the birth reading an article somewhere to that effect. She did say at my 6 week, "I'd like to see you for more than just this birth." I didn't get that she was saying primary care, and thought she just wanted to stay in touch and maybe do my pap etc. I now know she could be my provider and my child's provider. One thing that's good is my family doctor and my midwife communicate well, and so therefore, I feel care between the two is seamless.

Certified Nurse Midwife said...

Excellent compilation of information. I work as a certified nurse midwife at a local hospital and love helping women through the life cycle of pregnancy happily and successfully. It is a truly rewarding process. I would encourage all women to consider partnering with a midwife when they become pregnant. It is nice to form a strong female bond during that time of your life.