Midwives at home in hospitals too

SPECIAL DELIVERY: Kathleen Tirrell, a certified nurse-midwife based at Obstetrical Associates Inc. in Newport, with a patient. Tirrell has 20 years of experience as a midwife. / PBN PHOTO/KATE WHITNEY LUCEY
SPECIAL DELIVERY: Kathleen Tirrell, a certified nurse-midwife based at Obstetrical Associates Inc. in Newport, with a patient. Tirrell has 20 years of experience as a midwife. / PBN PHOTO/KATE WHITNEY LUCEY

Though she doesn’t have the data to prove it, Linda Nanni, a certified nurse-midwife and member of the R.I. Department of Health Advisory Council on Midwifery, thinks the number of women who choose to have midwives deliver their babies may be on the increase in Rhode Island and nationally.
“I think it’s on the increase because there have been myths about midwives and people have discovered they’re myths,” said Nanni. “For example, midwives don’t just deliver babies at home. “Ninety-nine percent of the births across the country attended by midwives are done in a hospital.”
About 10-to-15 percent of babies born in Rhode Island are delivered by midwives, estimates Nanni.
In 2013, midwives were involved in more than 1,200 births at Women & Infants Hospital, said Nanni, who has been on the midwifery staff in the department of obstetrics and gynecology at the hospital for 30 years and is a past New England region representative for the American College of Nurse-Midwives.
At Women & Infants, midwives attend births in the traditional labor and delivery unit and in the Alternative Birthing Center.
In a recent analysis of Women’s Care and Ob-Gyn Associates, the two medical practices that have midwifery services at Women & Infants Hospital in Providence, midwives from those two groups attended 15 percent of the births at that hospital, said Nanni.
In light of the fact that midwives attend births at several hospitals in Rhode Island, the 10-to-15 percent estimate of the number of babies in the state delivered by midwives seems reasonable, said Nanni.
“Midwives are a very viable option in Rhode Island,” said Kathleen Tirrell, a certified nurse-midwife based at Obstetrical Associates Inc. in Newport, who has delivered babies of women she delivered a generation ago.
“It’s wonderful to be in the community and work with generations of women,” said Tirrell, a resident of Portsmouth who has a master’s degree in nursing from Yale University, 20 years of experience as a midwife and 41 years of medical experience overall, including work as a labor and delivery nurse at several hospitals.
Asked about the difference between prenatal care and delivery by a specialist in ob-gyn and a midwife, Tirrell said care by a midwife is often considered more personal. “We spend more time with patients and tend to sit with them during labor,” said Tirrell, who added care by a certified nurse-midwife is covered by insurance.
Tirrell said she is not in favor of home births. One medical group in Rhode Island, however, does have midwives who deliver babies at home, as well as attending births at Memorial Hospital in Pawtucket.
Kristina Shepherd, a certified nurse-midwife, works with that group, RI Home Birth and Hope Family Health, in Scituate, which also provides primary care across the age spectrum.
“We have four midwives in our practice and we always have two at a home birth. We want to maximize safety,” said Shepherd. “We work with low-risk, pregnant women and newborns up to 28 days old.”
RI Home Birth attends about 36 homes births a year, said Shepherd, who has a bachelor’s degree in nursing from Boston College and a master’s degree in nursing and nurse-midwifery from Frontier Nursing University in Kentucky, a school that specializes in educating nurse-midwives and nurse practitioners.
“Pregnancy is such a pivotal and dynamic time in the life of a woman and a family,” said Shepherd, who has experience as a labor and delivery nurse at New York Presbyterian Hospital in Manhattan and at Memorial Hospital in Pawtucket.
“I work with a lot of fantastic doctors and a good doctor can have the same camaraderie and relationship with a patient that a midwife has,” said Shepherd.
“I think one of the core differences is the philosophy of midwifery that pregnancy and delivery are a natural physiologic process that should be supported and encouraged and viewed as normal, versus something that’s fraught with potential risks,” said Shepherd.
“Midwives are constantly assessing for risks. We spend an hour at every prenatal visit with every patient, so we build a trusting relationship,” said Shepherd, whose two children, ages 1 and 4, were both born at home with a midwife.
Certified nurse-midwife Nicole Heig, who works at Ob-Gyn Associates in Providence, a part of Women’s Medicine Collaborative, a Lifespan partner, started as a doula, a person who supports a woman during labor, in an AmeriCorps program at the former Fox Point Health Center. She did her graduate training, with a specialty in midwifery, at Yale University School of Nursing. “We attend births at Women & Infants in the regular labor and delivery unit and the Alternative Birthing Center,” said Heig.
“I’ve worked with women one-on-one and I’ve seen how birth has the potential to be a very powerful and beautiful experience, or a traumatic experience if women don’t have agency over their own bodies and have decisions being made for them,” said Heig. “I want to help make birth a beautiful experience.”
Rhode Island has 119 active, licensed midwives, according to Twila McInnis, director of the Board of Nursing Registration and Nursing Education for the R.I. Department of Health.
Some revisions to update the state health department’s Rules and Regulations for Licensing of Midwives went into effect on Aug. 19. The revisions, however, are not expected to have much of an impact on midwives in the state, said Nanni.
Up until the new regulations, all midwives in Rhode Island had to be certified nurse-midwives in order to get a state license to practice midwifery, said Nanni.
The new rules acknowledge three categories of midwives.
“A certified midwife has the same education and training as a certified nurse-midwife,” said Nanni, who said the difference is the certified nurse-midwife was educated at a school of nursing. A certified midwife, while having the same training, may have gone through a school of public health or other educational system, but still has to pass the same national certifying exam, she said.
Those two categories of midwives hold a certification as a midwife from the American Midwifery Certification Board.
The new regulations also acknowledge a somewhat different certification, as it relates to the practice of midwifery in the Ocean State, which is the certified professional midwife.
The certified professional midwife is accredited by a different national board, the North American Registry of Midwives.
“One hundred percent of certified professional midwives do no work in hospitals,” said Nanni. They are allowed to do home births, or they could work in a free-standing birth center not associated with a hospital, but none of those exist in Rhode Island, said Nanni, who has a master’s degree from Georgetown University and is on the teaching staff at Yale University and Frontier School of Midwifery, which is based in Kentucky.

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