Midwifery Today

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Midwifery Today

• Karen Armstrong, CNM
• (BSN, MSN, FNP/CNM)

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• BSN from California State University, San Diego
• U.S. Navy
• MSN from University of Kentucky, Lexington
• FNP/CNM Certificate from Frontier Nursing
  Service in Appalachia

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• L.A. County/USC Medical Center
• Women's Health Care Professionals in Klamath
  Falls, Oregon (private practice)?
• FHP in Guam (HMO)?
• Salem Nurse-Midwives, Salem, Oregon (private
  practice - midwifery-owned)?

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• What is a CNM?
• Completed an accredited Midwifery Educational
  program (associated with a college of nursing)?
• Certified by the American College of
  Nurse-Midwives must pass a national certifying
  exam
• Licensed by the State in which she/(he) practices

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• Settings of Midwifery (CNM) Practice
• Hospital (95 of us)?
• Out of Hospital Birth Center
• Homebirth

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Difference between Physician and Midwifery Care
Philosophy Birth is normal Women should direct
their own care Midwife means with
woman Midwifery care often includes labor
support Cesarean is just another route of
delivery Preventive care is essential to caring
for the whole person
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• Barriers to CNM Practice
• State licensure restrictions
• Definition of Supervision vs. Collaboration with
  physicians
• Finding supportive back-up physicians
• Malpractice
• Insurance reimbursement
• Hospital Privileges
• Lack of public awareness of Midwifery advantages

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Issues in Maternity Care Today

• Childbirth Preparation
• Hospital-based classes vs newer philosophies -
• LaMaze
• Bradley
• Birthing from Within
• Hypnobirthing
• Centering Pregnancy

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• The Rising C/Section Rate
• Fear of Litigation
• Lack of patience when labor is not progressing
  normally
• Convenience of provider/patient
• Inability to identify correctible problems and
  taking measures to intervene earlier (ie.
  unfavorable position, ineffective labor
  contractions, maternal exhaustion)?
• Inadequate labor support when needed (ie.
  effective coaching in 2nd stage)?

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• Rising Epidural Rate
• Epidurals are neither evil nor always ideal
• Interventions when the epidural interferes with
  normal labor fever, slowing of labor, inability
  to push effectively, hypotension and decels
• Lack of support from Significant Other once
  epidural working
• Fear of patient changing positions

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• Changes in Nursing Skills and Roles in LD
• Effect of Central Fetal Monitoring
• High epidural rate with changes in labor support
  and management
• Effect of philosophy/expectations of care givers
• Loss of skills to impact patient progress in
  labor (promoting ambulation, position changes,
  coping techniques)?
• The pendulum swings - will you be able to adapt?

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• Challenges in Breastfeeding and Maternal
• Attachment
• Skin to skin bonding
• Early start in breastfeeding
• Use of Lactation Specialists and support
• Rooming In
• Education of families about normal newborn
  behaviors