[Music] midwives are often linked to the birthing process providing prenatal and postpartum support to patients and while that's certainly true of the profession in this episode of being well I'll sit down with caral health Midwife Zoe do to learn even more about her role in Women's Healthcare when Sara Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with health Lions is always at the Forefront to help you thrive [Music] thank you for joining us for this episode of being well I'm your host Lacy Spence and today we are talking about all things Midwifery and for that we've got a fabulous guest with us today we have Zoe do joining us here from Carl Zoe welcome to being well thanks for having me of course thanks for coming and uh we love to let our viewers get to know our guests before we launch into the topic so can you give us a little bit of background how did you end up doing what you're doing uh so my background is of course in nursing that's how midwives get their started I got my interest and my passion for this by watching a documentary called The Business of Being Born which came out when I was in college pursuing something totally different I learned about maternity care in the United States and how even though we live in this country where we have access to technology and quality care we're not always taking good care of our patients especially when it comes to women's health so I took my interest and my passion for that and I went to nursing school and then got my Master's Degree and now I'm doing this and so how long have you been in this field I've been in women's health since 2015 when I graduated from nursing school and I've been a midwife for a little over 2 years and so if somebody is unfamiliar with what a midwife is what they do can you give us kind of lay the groundwork what what do you do yeah so a midwife is essentially a nurse practitioner who specializes in women's health and can attend births so we have Advanced Training a master's degree some of my colleagues actually have a doctorate um and we provide Women's Healthcare so definitely a lot of prenatal care and attending births but we also do well woman visits contraception things like that okay so you have a wide variety of things that you do um in the birthing space there's also a term called a doua is that different from what you do yeah it's different but really important uh support role so adulla provides emotional and physical support to the birthing person and their family they often build a connection well before they come to labor and delivery and often provide postpartum care um support for lactation if the person is breastfeeding um but they're not a clinical or medical role my role is to you know order lab tests make sure that monitoring is appropriate help the patient navigate medical decision- making and then catch the baby catch the baby that sounds like um it could be a very Joy profession yeah there are a lot of really joyful moments and there are hard days too but we um having the opportunity to be present at of birth is amazing every single time it never gets boring yes so I was looking in your bi a little bit um talking about the area that you serve um and communities that you serve and one of them came up that um you also serve the Amish community can you talk about that yeah a couple of Our Midwives go down and serve the Amish community specifically in Arthur we have a location that's just for those folks um who tend to want to be a little less like more low intervention um and meet them where they are because Transportation can be an issue as well but it's important that all of the women in our community have access to high quality Care absolutely so if I'm somebody who is having my first interaction with a midwife or I'm I don't even know where to begin as far as how do I seek your care at what point would I need a midwife do I have to have a midwife so the choice to pick a midwife is always optional I think it's a great choice I think everyone should consider a midwife um if you are not pregnant and whether or not you hope to become pregnant you can enter our care for all of your Women's Health needs so like I said we do pops birth control we do gender affirming care and menopause care so really anything to do with the uterus breast hormones we're happy to help and all you have to do is call our office um you don't need a referral your insurance won't require that you can make contact whenever you want if you are pregnant and want prenatal care you can also seek us out by just calling our office self-referral usually we have you call about the time you find out that you're pregnant so we can start taking care of you and make an appointment for that first prenatal visit that usually happens around the 10 to 12 weeks of pregnancy and so so if I'm somebody who already has um an OBGYN do you work with them or are you instead of um yes and no and a little bit of both the great thing about Carl is we have lots of layers of care we are a tertiary facility we have a high-risk Nikki we have a high-risk uh OB team in addition to kind of traditional OB team and then the midwives midwives are experts in normal birth and normal care there is a pretty broad range of complications we can take care of gational diabetes a little bit of high blood pressure but we don't do things like take care of twins Etc so if you come to our office and you have a few complications we consult or collaborate with the OB or with the highrisk doctors called Maternal Fetal Medicine if you are low risk we can keep you all to ourselves and if you're really high risk sometimes we have to pass off your care completely if you're established with an OBGYN and you really like that provider stay with that provider that's awesome we have some really excellent physicians at Carl if you maybe want to try a different model and see what the midwif free office is all about you just have to call and so if you all are handling everything um before you get pregnant once you're pregnant um I believe you talked about a little bit of postpartum care what kind of services what does that look like so we have recently increased the number of visits postpartum it used to be we have all these visits building up to the birth this intense moment of birth and then we'll see you in six weeks which is not great so we've started seeing people at one to two weeks and doing some follow up there just to make sure mental health is going well if they're choosing to breastfeed that's going well and we're addressing complications early support is really important to new patients um new parents excuse me um especially if a baby just came out of them so we'd like to do that we also do provide a little bit of lactation support although Carl has a special lactation Clinic that people can see that is full of experts who are lactation Consultants that help with a bulk of that care so let's uh scoop back a little bit so talking about those 6 weeks postart that often times you know it just feels kind of like a desert of care it's just like you know you're a new mom you've got this thing you're just trying to keep alive you're sleep deprived your your moods are everywhere um what type of encouragement or instruction are you helping to bridge in that Gap that's such a great question and I think you nailed it it's such an intense emotional beautiful stressful time the first thing I always tell the parents is charge admission to see the baby not necessarily a ticket price but your family and friends are going to ask how can I help what can I do tell them tell them you can come mow my lawn you can walk my dog you can bring me a meal you can come speak to me like an adult about something other than dirty diapers um that's really helpful I think it's also important to identify those sources of support before the baby gets here we spend a lot of time building our Amazon registry and decorating our nursery and picking up baby names which are important and joyful parts of having a baby but having someone fill your freezer and figuring out who's going to take care of you when baby gets here is also really important and it's a critical part of your care postpartum yes before you and I started the official interview we were just kind of chatting just about um all of the logistics of Parenthood and it's a lot for someone to try and Tackle alone absolutely um identifying your sort of building your village before your baby gets here is really important so sometimes that's friends and family who can help you out it's other people who have similar gational ages to you um it's tapping into the resources that we can give you in terms of like Mental Health Etc from the midwife's office and so I have a stat here that you caught 44 babies in 2023 I did and you're you're already like over the 25ish mark yeah I'm creeping up on 30 um and it's been an exciting enjoyful year yeah busy so what does a a typical shift look like for you as uh somebody who's you know maybe that the water's broke and you know things are happening yeah the best part about my job is that there is no typical shift okay some days I am busy start to finish some days it's a little more relaxed um but typically when a patient comes in they're in labor I say yep it's time to stay and have a baby so we talk about what that looks like maybe getting IV access if they need medication for pain or some people need antibiotics we talk about what that looks like for our low-risk patients we talk about the option for intermittent monitoring which means not always being connected to monitors um we talk about moving around positions that will help facilitate maybe not an easy but an easier birth um pain management whatever they want want to do whether it's epidural nitrous tub or shower moving around all those sorts of things so do you help if uh somebody is trying to come up with like a birth plan we can be a resource for that for sure I think a lot of the benefit of building a birth plan is doing that research behind the scenes and learning about the things that will be offered and then coming to The Midwives with questions and we can talk to you about what your options are what's available what's safe what's appropriate what the evidence says and we can build a plan that works for you and I know things don't always go to plan you know that's life um but if there's somebody who's in the delivery room and uh they have made certain decisions about their birth plan and sometimes maybe communication falls through the cracks are you able to help um advocate for them absolutely the labor and delivery nurses at Carl are excellent and they are our number one Patient Advocates first because sometimes I have more than one laboring patient but the nurses are one to one okay but absolutely if something is going a little bit sideways and maybe we need to call the OB for backup we're talking about an unplanned cerian or another kind of birth intervention that maybe wasn't in their plan the first thing I'm going to do is talk to them about it early I'm going to explain it I'm going to give them as much time as I can to make an informed decision and then I'm going to help them navigate that process even if I'm not the person who ends up delivering the baby okay so if I'm somebody who um may be sitting at home and they're interested into in going into the medical profession um you talked a little bit about your schooling but what does it look like once you uh specialize I guess yeah so becoming an a certified nurse Midwife is at least a master's program so you have to have a bachelor's andb anrn to begin and it's a two to three year sometimes longer depending on how you do it program and there'll be a lot of Hands-On training in addition to the didactic sort of book learning piece um it takes a while but it's worth it and then the first couple of years of practice you're really getting your feet underneath you fair enough so you will uh definitely get to see a lot yes um you've talked a little bit about the program at Carl what you all do is there anything new with that anything down the works or down the pipe coming down the pike yeah there's a couple of things I'm really excited about okay one thing is the midwives are working on becoming size friendly providers we try to be that way anyway but the idea of this designation is that we acknowledge that pregnancy can happen in all kinds of bodies in all kinds of sizes and instead of making people feel guilty or ashamed or uncomfortable we provide respectful evidence-based care with accurate information about risks and um making sure that we're still providing holistic care to people in all bodies who walk into our office so we're really excited about that another thing that we've recently resumed at Carl which we started before covid and have brought back is a program called centering pregnancy this is a different model of prenatal care instead of coming to your 20 minute visit with me you come in a group setting with a group of four to six other pregnant people and their Partners at a set visit schedule and instead of 20 minutes you get closer to two hours the patient really takes ownership of their care they're taking their own weight they're taking their own blood pressure they're writing down all of the measurements of baby and heart rate things like that and then instead of a little snippit of Education you get this big broad expanse of education and the opportunity to build that Village and find people who are going through the same experiences and the patients who have done it universally love it they think it's a wonderful model that sounds so exciting so you could find somebody who's like oh you know I'm only a neighborhood away like We Could meal share we could you know have the same young man come ow our lawn or whatever it precisely and building those connections and just being heard and being seen in your pregnancy makes such a huge difference so if we could kind of dive into that class I know it's kind of patient run but um what types of questions are they asking like what kind of knowledge are they gleaning from each other so if you get a few pregnant people in the same room they're going to have similar complaints about back pain and heartburn and things like that and so if you don't bring it up in your visit I can't help you with it but you get some people talking and it's like oh you know what really made me feel better was when I got in the pool last week boy that made my back feel better and then someone will say I thought you weren't allowed to swim when you were pregnant and then the Midwife can address sort of mythbusting kinds of things and the patients can build collaborative solutions to the common complaints they're having they can also help each other tap into those resources like you mentioned oh I've got a neighborhood kid who mows my lawn I'm sure he'd be happy to mow yours really reliable so that's kind of the care that we're getting we also have guest speakers come in so someone from anesthesia will come talk to you about what to expect if you get an epidural people from lactation come to kind of support that information and education piece so it's just a really wonderful opportunity to get a lot of knowledge well what a relief that um it seems that Co is in the rearview mirror just to be able to bring back such a wealth of knowledge that's a great resource uh since we have you here on on the hot seat you know um are there any other myths that you could help kind of debunk um well one thing that even my family does not understand is that I do not deliver babies at home there are midwives who do that but the certified nurse midwives at Carl operate in the clinic and hospital setting okay you can get an epidural if you choose a midwife you can choose to be unmedicated if that works for you um so we do a wide range of things it doesn't have to be low intervention and we like to use the word crunchy doesn't have to be crunchy if you don't want it to be um that's a big one that I get I'm not a you know I'm not a witch doctor I'm a medical professional no absolutely um you hear the name mid wife are there men in this profession oh yes one of the very best midwives um I've ever known was Ray sponer he passed away several years ago but he was sort of an institution at Carl and one of um just a really excellent certified nurse Midwife the classic version of the Midwife um Midwife comes from the old English with woman so it is about being with and together and I think that's the most important part of the job is not just me ordering your tests and interpreting them for you it's about me being with you on this journey the Journey of pregnancy the Journey of birth the Journey of no thank you I don't want to have a baby I can go on that Journey with you too so the it's the being with is the important part and I'm sure you see just a variety of again walks of life um preferences is what is maybe some of the more difficult cases that have come your way it's always difficult when a patient has a loss especially for a really desired pregnancy and walking through someone through that process like delivering the bad news and then telling them about what options look like what the next steps are is difficult but it's gratifying because I can be someone who's there and when I say call us anytime I mean it our nurses and my colleagues will respond to your questions at all hours whenever you need us so it's difficult but it's part of the process occasionally a patient comes to us and they haven't been treated well maybe at a different facility somewhere farther away and they haven't had this experience and they're ready to fight for everything that they want which is great self- advocacy but I want to take that like down like yes I'm ready to say yes to your reasonable requests and I'm ready to explain why I'm recommending something so bringing a patient out of that um intense anxiety place and down to like you're safe and comfortable here I'm going to take care of you and you're in charge um that's difficult but again also really gratifying you seem like you would AB absolutely be just a super calming presence sometimes I try um but I have to ask is there ever a time where someone you know you when you have to do kind of talk them off the ledge like the option was a little little too much what what's kind of something that maybe people should avoid I don't think there's any one thing that you should never ever because everything is very patient specific but if a patient has a request like um they want to decline certain recommended medications um in labor we have a long nuanced conversation what's important to me is that the person in front of me understands the risks of accepting or declining any intervention that I'm offering it's not my job to convince someone to do something they don't want to do yeah it's my job to bring them information and if they feel very adamant like I understand everything you're saying to me and I'm just not comfortable then I say okay and that's it because the care is respectful and again it's not my job to coer anyone it's my job to provide information and support fair enough so if we pivot back to prenatal care um maybe you're not even considering being a parent um kind of walk through what some of those conversations might be about like avoiding pregnancy or planning a pregnancy I would say both we're just trying to pick your brain on on everything Midwifery sure so I think a lot of my colleagues and I love love to talk about contraception and people think birth control maybe they think the pill but there is a wide range of options available and something for everybody there are non- hormonal methods barrier methods which protect against sexually transmitted infections there are a ton of what we call Long active reversible contraceptives so if you want to go a long time without having a baby or you're just not in a place to make that decision I can hook you up and set you up for three five eight years if you want to there are lots of options and I love to have those conversations and bring out my little demonstrations and my little you know tools to show people here's all the things we've got and you pick from my menu here if uh if somebody has complications with some of those longer term contraception options is that something that you can help remove an office or absolutely yeah we place um nexplanon which is the one that goes in the arm and iuds in our office we can do that we can also do that before you leave the hospital after your baby is born if you really don't want to have another baby right away um great option we do all of that stuff and if we do hit a snag like I said we have excellent colleagues just a couple flights upstairs from us that can back us up if we um hit anything unusual So speaking of the unusual what is maybe the most memorable case that you've had do any stick out um well not too long ago I got to be the Midwife when my niece was born so that was really wonderful and exciting and I've never been so nervous as a provider because I just wanted to do a really good job um everything went really beautifully and I had a colleague to support me through the whole thing and it was wonderful so that was my favorite midwif free memory for sure and I think you kind of hit on it earlier but your services are covered by Insurance correct absolutely yeah just like a nurse practitioner has covered the same way a doctor is if you have especially if you have Health Alliance but you have any of the local plans you should be fully covered at Carl you can always call your insurer and ask and if you are out of network we can usually tell you that when you call to get signed up and kind of avoid some of those surprise bills later and if I'm somebody who is looking to get in contact with your office what's the best way to do so you can give us a phone call 217383 6434 is the midwives Department you will talk to one of our excellent psrs Patient Service representatives and they will tell you everything you need to know now we've still got a couple of minutes left and um just to kind of circle back is there anything that we didn't quite talk about that is important that our viewers should know oh goodness um I want pregnant people to drink more water um and I also want people who are considering a pregnancy it's great to do some preconception care so if you're thinking about it when you come to your annual well woman's visit let's talk about it let's talk about medications you're taking let's talk about your mental health and getting you in a good place before you add some extra stress to that let's make sure that we've talked about your family history and risk that might arise so nothing is a surprise with the pregnancy other than whatever curve balls the pregnancy throws you and when you talk about mental health um I know you said you guys are just a call away but uh do you have any sort of relationship or referral to mental health professionals if it's needed yes we can make referrals within and without of the Carl system a few of The Midwives myself included have special training called um postpartum support International uh perinatal mental health so we have special training in prescribing and managing mental health in the pregnant population which is really wonderful years back we weren't prescribing any medications now we know that that is not best practice there are many things that are safe and effective during pregnancy and the mental health of mom is just as important as the physical well-being of the baby and we did talk about postpartum depression um in our last season but I do think it's a topic that is always worth shining a light on uh can you kind of talk about just this is normal it's okay to have these feelings yes you know one in four people who has a baby will experience some amount of postpartum depression or anxiety and the first thing I want you to do is tell me or tell your OBGYN that you're going through this I cannot help you with something that you don't tell me about there are lots of things we can do even if you don't feel comfortable starting a medication we can recommend therapy we can talk about lifestyle modifications and I can also tell you this is normal what what you're doing is hard and if it feels hard it's because it is hard you're probably doing way better than you think you are and let's come up with them strategies that will make you feel better so you can be the best parent to your baby and strategies like that what does that kind of look like in a practical sense um protected sleep is number one so finding a way to increase the amount of sleep that you're getting making sure theep sleep you're getting is high quality sometimes people are so worried they can't rest and we need to address that sometimes they don't have good partner support and we need to address that as well um time outdoors and exercise it doesn't have to be crazy you have a newborn your body just went through something but a brisk walk a little bit of yoga some time in the pool all of those things can make a huge difference in your mental health they're not expensive you can find a way to do them with your newborn with your other kids and they can really help get you on the mend and do you advise differently uh for patients who maybe went through a C-section versus vaginal birth um in terms of mental health not necessarily but in general sorry sorry for um on the physical side of things yeah so if a patient has a C-section I don't perform a C-section so they'll do their initial followup with the doctor who did that um and then we take it easy you've been through a major abdominal surgery and somebody handed you a newborn to take care of so giving yourself a little Grace is step one gradually returning to activity with the knowledge that your body has been through something is really important but there's no reason to think that you cannot eventually return to your normal level of activity and regain normal function and if you're finding that you're not you need to let us know so we can put you in touch with people who can get you back to where you want to be very great advice we're under 30 seconds here final thoughts final words for someone at home who's maybe wanting to seek a midwife yeah I think everyone should consider a midwife we have a wide scope of practice we um are going to do Shar decision- making really put you in the driver's seat of your care and very few people come in our doors and decide not to come back you'll like it here all right well Zoe do thank you so much for coming on being well I sure appreciate it yeah thanks for having me of course and we thank our viewers for joining us for this episode we hope you learned so much I know I sure did and we hope to see you next time Carl is redefining healthc care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the everchanging needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's Health Care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]