By Sara McCloskey and Debbie Schumacher

Pregnancy and childbirth bring huge changes physically, socially and emotionally for people. There are many options for families expecting a newborn when it comes to pregnancy care, one of which is having a midwife. A midwife is a healthcare provider who is trained to provide obstetrics and gynecology (OB-GYN) care, including uncomplicated, natural pregnancies.

The midwifery care model has been practiced for centuries and evolved over time. This patient-centered approach is based on the fact that pregnancy and birth are normal life events.

“Midwives were the initial advocates for many of the things we take for granted now, such as laboring people wearing their own clothes or continuing to eat and drink during labor,” said Leslie Fehan, CNM, a midwife at VCU Health’s Department of Obstetrics and Gynecology. “VCU Health has always been a very supportive place both for midwifery and patients. Our whole labor and delivery team works with patients to have the experience they were seeking.”

With 25 years of experience, Fehan is part of VCU Health’s team of certified nurse-midwives. In recognition of International Day of the Midwife on May 5, VCU Health News asked Fehan about midwifery care and changes she has seen in the field. 

What makes midwifery different than services provided by other clinicians, like an OB/GYN?

Midwives help individuals and families navigate these changes in the best way for them. It is an individualized, holistic approach to care that involves a lot of listening, often referred to as “high touch, low tech.” Though technology is certainly used, it is used judiciously as each patient has different needs.

There are different types of midwives, depending on their training and certifications. At VCU Health, our certified nurse-midwives have the most advanced level of training, having completed nursing school, a graduate degree in midwifery and passed the certified nurse-midwife exam.

An OB-GYN has completed medical school and specializes in obstetrics and gynecology, complex problems and are surgeons. Our certified nurse-midwives have the most advanced level of training and have a collaborative relationship with our physicians and care team.

How do midwives support pregnant people in their care before, during and after childbirth?

Midwives can serve as the primary health care providers for pregnant people going through one of the biggest transitions of their lives. We tailor fit services and care to support each individual patient.

We see pregnant people through their prenatal course, manage their labor and delivery experience, and care for them postpartum. In addition to in-person appointments, we also do virtual visits for people that may need more follow-up after giving birth.    

Can I see a midwife for other healthcare needs?

Yes, midwives see patients for most gynecologic needs including annual exams, menstrual cycles issues, infection treatment, management of contraception and management of menopause symptoms.

If complications happen during a pregnancy or birth, what happens if a midwife is overseeing the process?

For low-risk patients, there is a very low percentage of complications occurring. If something does arise, our physicians staff the labor and delivery department 24 hours a day, seven days a week. We seamlessly involve them in the person’s care when needed. Midwives don’t do cesarean sections or assisted vaginal births. If a baby needs help getting into the world with one of these methods, our physicians will get involved. Prenatally, if complications arise, we arrange for our patient to see one of our OB-GYN’s for management. 

What makes VCU Health’s midwifery program unique?

Our midwifery service is an independent group approach to care. A patient does not have a lead midwife or a primary midwife, but instead, we collectively take care of that person. We communicate daily about patients due to have a baby in the next month and have team meetings to update each other on any high-risk patients or those that have special circumstances. Our team of nurse-midwives is the only Richmond area practice to achieve the American College of Nurse-Midwives Triple Aim Best Practice designation, based on improving the patient experience, reducing the cost of care and improving the health of populations.

Our midwifery team is committed to training students, having served as a launching point for many new midwives in Richmond and beyond. We also work closely with doulas and community advocates to promote best practices in natural pregnancy and patient care.

As someone who has been a midwife for over 25 years, what are some changes you have seen in the field?

VCU Health continues to lead the way for midwifery care in Richmond. In 1996, there were no hospital-based or group midwifery practices in the area. Now there are several.

Midwifery services have grown tremendously at VCU Health over the past 25 years. The increase in midwives is due to more demand for our services and our desire to increase access to care. We currently have six, diverse midwives, working in three clinic sites. One of our midwives is available 24/7 in the labor and delivery unit.

Our team strives to make labor and delivery a soothing and beautiful experience. VCU Health had the first labor tub in Richmond, and we have continued to use tubs and showers as non-pharmacologic pain relief options. We have a range of natural pain management options such as using a transcutaneous electrical nerve stimulation (TENS) unit, which provides small electrical impulses to part of the body, and natural birthing tools, such as medicine balls and acupressure.

Additionally, our midwives advocate for best practices for mother-baby bonding, such as skin-to-skin contact after birth, breastfeeding practices and “rooming-in,” the hospital practice of having an infant stay in the same room as their mom after delivery. As a result, VCU Medical Center is the only Richmond area hospital to be designated Baby-Friendly by the World Health Organization and United Nations Children’s Fund.