The holistic approach of the nurse midwife

Across the United States and at Vanderbilt University Medical Center, more pregnant women are opting for certified nurse midwife-assisted births, a consumer-driven trend that is expected to grow. Currently about 10 percent of all vaginal births in the country involve a nurse midwife. Industry sources project that by 2010, nearly 20 percent of deliveries will be nurse-midwife assisted.

Vanderbilt University Hospital has had a successful partnership with the Vanderbilt University School of Nursing integrating nurse midwifery into the hospital’s clinical practice, and positioning nurse midwives in key roles to train with residents during the delivery process. The result is that in fiscal year 2006/2007, more than 700 of the 3,000 deliveries at Vanderbilt were with certified nurse midwives.

“We think it’s very important that our patients have the option of choosing the kinds of relationship with their provider,” said Nancy Chescheir, M.D., chair of the Department of Obstetrics and Gynecology. “A vast majority of women have perfectly normal, healthy pregnancies and deliveries, and midwives have a very special, holistic approach.”

Tonia Moore-Davis, M.S.N., C.N.M., clinical practice manager for VUSN’s Nurse-Midwifery Faculty Practice, emphasizes that nurse midwifery of today is evidence-based as well as a popular model of care in other countries such as the United Kingdom.

According to the American College of Nurse-Midwives, 85 percent of all births are considered normal and do not require medical intervention. Midwife-assisted deliveries are a low medical intervention option that focuses on physical, emotional and social needs of the pregnant woman and her family. Moore-Davis and her colleagues are exploring additional options to enhance labor and delivery, such as cutting edge pain management options like hydrotherapy and nitrous oxide.

“The point is that it’s not simply your home-grown nurse midwife who is attending,” said Moore-Davis. “It is academic medicine. A lot of programs are incorporating nurse midwives into their faculty and using their expertise to train residents.”

At Vanderbilt, there’s no need to look further than the fourth floor of Vanderbilt Hospital to see nurse midwives and residents working together. Deborah Wage, C.N.M., assistant professor, moved from her clinical practice affiliated with VUSN to head the Division of Midwifery and Advanced Practice for the Vanderbilt University School

of Medicine in 2006. She and colleague Angela Wilson-Liveryman, C.N.M., assistant professor, are helping integrate the midwifery model of care into an academic school of medicine. This approach has proven successful at many of the top schools of medicine, and Vanderbilt’s program is well under way.

As a result of this integrated model, experienced nurse midwives can help provide a new perspective that will allow the students to develop strong clinical skills for the provision of obstetrical care and understand the family-centered approach to delivery.

“In cases of high-risk patients, they help provide clinical care in a co-management arena where midwives team up with perinatalogists and maternal-fetal medicine experts, but the nurse midwife is providing the collaboration,” said Wage.

Anecdotally, Wage knows of many residents who have gone on and purposefully chosen practice settings where certified nurse midwives are their colleagues. She believes each resident will leave the Vanderbilt program having seen the “other way” of doing things.

“We are not here to turn residents into nurse midwives,” said Wage. “We are here to respect both approaches and work together for the patient.”

Due in part to the number of patients requesting nurse midwifery services, the School of Nursing practice has expanded to Nashville General Hospital as well.
- KATHY RIVERS