Changing face of midwives
Profession gains new popularity
Three Valley midwives are affiliated with doctors and deliver babies in hospitals.
YOUNGSTOWN — It’s extremely gratifying to guide and support a woman through her pregnancy and the birth of her baby, said certified nurse-midwife Rachel Sieman.
Sieman, who used a certified nurse-midwife for the births of the last two of her four children, delivered Will Robert Johnson, the seventh child of Sarah and James Johnson of Youngstown, on Feb. 29 in a hospital.
“It’s more natural,” Sarah said of her decision to choose a midwife over a medical doctor for her primary pregnancy care.
“The doctor has a medical protocol, but with a midwife, it’s all about you,” Sarah said.
“Rachel was so calming and she was there all the time. This was my easiest birth,” said Sarah, who noted that her doctor had missed the births of two of her children.
Sieman and the other two certified nurse-midwives practicing in the area are affiliated with medical doctors and only deliver babies in hospitals. Their services are covered by health insurance, Sieman said.
While nurse-midwives treat pregnancy as a normal process in most cases, and not an illness, Sieman said it is essential to have medical back-up when things do go wrong.
“You get the constant attention and care of a midwife, and there is a medical team there if you need it. It is the best of both worlds,” said Sarah.
Nurse-midwife assisted pregnancies and childbirth are making a comeback nationally. According to the American College of Nurse-Midwives, in 2004, certified nurse-midwives attended 11 percent of all vaginal births in the United States and 7 percent of all births.
This trend has not yet arrived in the Mahoning Valley, said Sieman, of Boardman. She said less than 1 percent of women in Mahoning County use a nurse-midwife during pregnancy and childbirth.
Sieman, who recently opened her practice in association with Dr. Robert C. McClusky in Poland, said she and two other local CNMs, also affiliated with doctor’s offices, are hoping to increase the acceptance of nurse-midwives. Also practicing in the Mahoning Valley, are Gaye Sympson, whom Sieman calls her mentor; and Tammy Pangilinan, another of Sympson’s students.
“Gaye paved the way for all of us,” Sieman said.
Sympson is associated with the Center for Women in Canfield. Pangilinan’s collaborative physician is Dr. Nicholas Garritano in Poland.
Dr. McClusky said having a nurse-midwife affiliated with his practice gives patients the option of seeing a female if they want. Younger women, in particular, seem more comfortable with a nurse-midwife, he said.
He said he had worked with nurse-midwives in the 1970s when he was in the Air Force at Wright Patterson Air Force Base.
“At the time, that was pretty progressive,” he said.
Dr. McClusky said he had been looking for a nurse-midwife to join his practice for some time, and he approached Sieman, whom he previously knew when she was a delivery nurse at St. Elizabeth Health Center.
He said his patients seem to enjoy the “very, very personalized care” provided by nurse-midwives. Most times, they are less rushed than the physician. Also, she can answer a lot of questions when patients call in, and is available to handle problems as they arise.
Dr. McClusky said it is a collaborative working relationship.
“She is part of my practice, but also has her own practice within that setting. She has some of her own patients and I have my own. But, she also helps with my patients, if for example, I’m stuck at the hospital, and vice versa. We are very compatible,” he said.
From ancient times to the relatively recent past, midwives were widely used by women during childbirth. Women helping women during pregnancy and while giving birth is called “midwifery” (pronounced mid-wiff-ery). And, according to “Webster’s Dictionary,” midwife literally means “woman with, woman assisting.”
In 1915, 40 percent of all births in the U.S. were attended by midwives. By 1935, however, that number had decreased to 10.7 percent, of whom 54 percent were non-white, according to the Parkland School of Nurse-Midwifery at the University of Texas Southwestern Medical Center at Dallas, Texas.
The main reason, according to the Parkland Web site, is that in the late 1800s and early 1900s midwives did not have access to the advances in medical techniques and training, and so they fell out of favor.
But today, in Ohio at least, midwives are highly educated professionals who are often affiliated with a doctor, have hospital privileges, and can write prescriptions. To be licensed in Ohio, a midwife must be certified by an accredited school, be a registered nurse, and have a master’s degree in nursing. Sieman, for example, received a bachelor’s degree in 1994 from Youngstown State University and has a master’s degree in nursing from the Frontier School of Midwifery & Family Nursing in affiliation with Case Western Reserve University in Cleveland. Frontier is in Hyden, Ky. In addition, the 1988 graduate of Youngstown Christian High School worked for 13 years as a registered nurse, the last eight years at St. Elizabeth Health Center, where she was a nursing supervisor. During her clinical midwife training, she delivered 40 babies under the supervision of Sympson, who delivered Sieman’s last two children.
Sieman says there is more to midwifery than delivering babies. While specializing in pregnancy and childbirth, she says midwives offer all aspects of women’s health care from puberty through menopause.
Midwifery also adheres to a philosophy that differs from that of a medical doctor, she said.
“While no one would argue that you need a good physician if you are ill, nurse-midwives believe that pregnancy is a normal process in most cases, not an illness. Nurse-midwives tend to focus on prevention and education, and encourage a woman to participate in decision-making, Sieman said.
“One major difference between nurse-midwives and physicians is that midwives offer continuous labor support, which means they are present with a woman during her entire labor. A physician’s patient is typically cared for by a nurse who consults via the telephone with the physician, who arrives just in time to catch the baby,” Sieman said.
That being said, Sieman said while midwives are experts at normal pregnancies, they also are trained to recognize when something is not right, and call in a doctor when necessary. “When I deliver a baby, I’m in a hospital. I need to know I have physician backup. I won’t take chances with the mother’s life or the baby’s life,” she said.
Pangilinan graduated from YSU with an associate degree in nursing in 1982. She received a bachelor’s degree from Case Western Reserve University in 1994, and a master’s degree from Case in 1996 along with a certificate in nurse-midwifery. She has been a board certified nurse-midwife since 1996 and has had her own practice in Youngstown for 12 years.
She said she decided to be a nurse-midwife after 14 years of labor and delivery experience and wanting to make a difference for women and their families.
“Midwives offer a personal experience with our patients. Being there throughout labor and delivery affords the opportunity to allow for some changes in their care to promote a more family-centered experience,” said Pangilinan, who has assisted with 1,000 deliveries.
Sympson, who graduated in 1974 from Hubbard High School, was a registered nurse for many years at Northside Medical Center, when she decided she wanted to get out of critical care, what she calls the “death and dying mode,” and get into education and wellness.
“I wanted to give patients the power to make decisions by giving them information,” she said.
Sympson, of Poland, is a part-time nursing instructor at Kent State University and part-time midwifery instructor at Case Western Reserve. She received an associate degree in nursing in 1977, a bachelor of arts degree in psychology in 1982, and a master’s in business administration in 1987, all from YSU. She also has a master’s degree in nursing and a doctorate in nursing practice from Case Western Reserve.
“I’ve been doing this now for 15 years. It’s very rewarding when you see somebody making decisions because they are informed, and the outcome is what they want it to be,” she said.
“I would never knock what physicians know and their surgical skills ... after going through residency and internship. High risk obstetrics and gynecological surgery is truly a specialty all by itself,” Sympson said.
“But, I believe that when nurse-midwives and physicians work together, the patient get the best of both worlds: The education, wellness skills and personal attention of the nurse-midwife, and the skills of the doctors when they are needed.”
alcorn@vindy.com