Midwives can provide care before pregnancy and throughout pregnancy. Ellington explains that visits may begin with preconception counseling or early pregnancy appointments, followed by ultrasounds, lab work and routine prenatal visits that help monitor health and prepare for delivery.

What kind of postpartum care do midwives provide?

Postpartum care continues after delivery and includes follow-up visits and check-ins based on each patient's needs. Ellington says this may include monitoring physical recovery, discussing emotional well-being, addressing concerns such as anxiety or depression and talking through contraception and future family planning goals.

Do midwives only care for pregnant patients?

No. Midwives can provide care for women across many stages of life. In addition to pregnancy and postpartum care, Ellington says midwives may provide annual gynecologic care, birth control counseling, preconception visits and menopause care, often building long-term relationships with patients over time.

Episode chapters

00:00 Introductions
00:38 Switching providers during pregnancy
00:58 Collaboration between OB-GYNs and midwives in pregnancy care
01:03 Team-based approach to pregnancy care
03:07 Advantages of the team approach in pregnancy care
05:09 Epidurals and pain relief with midwifery care
07:44 Pain relief options and changing plans during labor
09:15 Eligibility for midwifery care for high-risk pregnancies
10:14 VBAC with midwives: planning vaginal delivery after cesarean
11:27 Benefits of midwifery in reducing C-section rates
13:20 Prenatal care at Novant Health: what to expect
14:29 Postpartum care: what does it look like?
15:51 Midwifery care across the lifespan (pregnancy through menopause)
17:57 Final thoughts on midwifery care at Novant Health
19:32 Closing remarks and resources

Episode transcript

Melanie Cole, MS (Host): Welcome back to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Melanie Cole and in our last episode, we spoke with Emily Ellington, a certified nurse midwife with Novant Health, on common myths and misconceptions about midwifery. Now, it's time for part two of our conversation. We hope you'll enjoy it.

Host: Emily, can a patient switch between providers during pregnancy if needed? If someone starts with their ob-gyn and they want that more time, they can switch to you. But then, if they feel like they have questions for their ob-gyn, they can see them as well. Can you work together?

Emily Ellington: Absolutely and we actually do that, I think, I would say, in our practice pretty well. All of us practice very similarly, whether we're a doctor or whether we're a midwife, we kind of handle pregnancy the same way. There are certain guidelines you should be following in pregnancy. There are certain testing and things that need to be done around a certain time.

So, we already have that rote kind of schedule for when we should be seeing patients. Obviously, if you want to see a midwife only, you can totally do that. If you want to see a doctor only, you can totally do that. You can plan to see me, and then you can see a doctor, and then you can see me, and then you can see a doctor, and then you can see another midwife here.

All of us should be moving through the pregnancy with the same goals and the same kind of status updates that need to happen periodically through the pregnancy. Also, if someone needs to be seen same day, you know, if they're pregnant, we're seeing them, we're seeing them that day and so if you only see midwives, you may need to see a doctor when you come in.

Also, it may be that you've only ever seen a doctor, and then you have a visit with the midwife, and then you decide that care is more where your gut, like where your where your goals are aligned and we all share patients. None of us ever having like our feelings hurt because a patient decided that they liked seeing Dr. So and So instead of me or vice versa. We just, want the best for our patients, and the best is where they feel heard. The best is where they're getting what they need and they're getting good care and I know for a fact all of our providers in my clinic provide great care, so I'm happy for them to see anybody.

Host: What a lovely way to say that and such a comprehensive approach. Now, with all of that, and I'm so glad that you pointed out that none of you get hurt feelings, because a lot of times, especially when we're in that phase of labor and delivery or throughout pregnancy, we know hormones can mess around, we get nervous, we get a little fearful. It's an exciting time, but it can also be a little scary. But then, we don't want to worry about that. So, thank you for pointing that out. I think that's so important for new mothers to hear and tell us about the advantages that you have seen with that team approach. You have other team members, you have the physicians, you have the nurses. Tell us the advantage for the new family-to-be with that team approach.

Emily Ellington: Yeah. I mean, I'm sure you've heard the expression it takes a village, and that's serious. Like, that means so much to us in lots of things. It means a lot in the raising of your children. It means a lot in just your healthcare alone. I don't know everything.

I actually taught one of our physicians something the other day, and it made me so happy. I used a medical term he had never heard before, and I was like, "It's a..." I don't even remember the situation. He was like, "What is that?" And I was like, "Oh, I know something you don't know." And I loved that I knew something he didn't know. So, we don't know everything. None of us think we know everything and it's great that we're continuing to learn.

You know, we bring different life experience to the table. I feel like one of my big strengths is helping moms with breastfeeding and helping with postpartum anxiety. Those are some of my bigger strengths, but those are some of the things I struggled with the most myself as a mother and so, those are things I'm passionate about. I'm also really passionate about antenatal care and making sure that my patients are recognizing when something seems off. I have another partner that's amazing at what they do. I have another partner that's a boss at ultrasound and then, we do have people that are newer to ultrasound.

And so, what I care about is that my patient is getting what they need, whether it's with me or not with me and back to what you were saying before, speaking to that anxiety and those hormones and the feelings you have when you're pregnant, we all know that we're seeing women in some of the most vulnerable moments of their life and the last thing that they need to be thinking about is whether or not they're hurting my feelings by seeing the provider that they feel most comfortable with.

Host: That is just great to hear. Now, biggest myth that I've heard in all of my years doing all of these kinds of things is that you can't have an epidural if you're going to use a midwife. I mean, that's a big one, right? So, is that true? Can patients receive pain management? Can they have an epidural? And how do you help women make that decision about pain relief? It's not true, right, that midwives try and push you to have a natural birth with no pain relief.

Emily Ellington: No, our goal is to support a woman's desire for her birth experience, but an epidural is a great tool. There has absolutely never been a time in my practice that I've ever tried to push somebody away from using an epidural or ever thought about withholding it. I would say probably midwives are better than a lot of providers at helping with pain management and all the different options that are available before you get to an epidural, because we start as nurses, you know.

A lot of midwives start as a labor and delivery nurse, and we've been with the patients that are struggling to make those decisions and, you know, there are lots of options between your first contraction, when you're in transitional labor, and when it's time to deliver your baby. Some of those options are nitrous oxide. We have IV pain medication. Certain movements are really helpful. We're super fortunate, and we have jetted tubs here, and they're wonderful for someone that's experiencing back pain in labor. So, there are lots of options before an epidural, but I'm a hundred percent pro-epidural if my patient wants an epidural.

If my patient doesn't want an epidural, then I'm going to be there to support them and give them suggestions for how they're going to manage what they're feeling during labor. I think a lot of the education that we do ahead of time can help women make those decisions for themselves. I think a lot of moms are curious to say, you know, "What would it be like if I didn't have an epidural?"

There's also a huge difference between is it your first baby or your sixth baby, you know. We know the timing of labor determines a lot. We know if you tell a mom, "Hey, you're moving quick. You might only have to do this for an hour," she might be able to go without an epidural, and if that's her goal, we'll help her get there.

But if she tells me at some point, "No, I don't care. I don't care that was what I said I wanted. I want an epidural," absolutely, we're moving towards an epidural, and I'm going to help you get there fast, you know. So, our job is to support what our patients want as long as we're keeping them safe and keeping their baby safe.

Host: And is it possible then to combine natural labor techniques, like you mentioned the jetted tubs, and medical pain management? Can a woman, like you just said, can they change their mind mid-birth?

Emily Ellington: Absolutely. They all do, right? We plan for what we think we want, but we know there's other tools in the toolbox. So if we get there, we pull those tools out. If we don't, then we didn't. I think knowing what the options are, making sure that we're kind of giving anticipatory guidance, "Hey, you're five centimeters now. Things seem to be moving a little bit quicker. It's totally possible you could be ready to push your baby out in an hour. If you want an epidural, now's the time to get it, if that's your goal. If it's not, let's start getting some movement. Let's get you in the tub." We can help by being able to do a clinical assessment and see the progress a patient's making.

Also, with the experience level I would say we have a good kind of idea of what's happening with our patients to help guide them into making those decisions. But 1,000%, they can change their mind. They can change their mind to the moment their baby's coming out, and that's not up to me. My job is to help them to get where they need to get to have their baby.

Host: Well, we all know that we are allowed to change our minds whenever we want. So thank you for reassuring and reiterating that because Lord knows we definitely sometimes want to change our minds. But now another myth that I've heard over the years, and we've talked a little bit about high risk, and you yourself told us your story that midwives can't really attend to a high-risk patient.

Tell us about patient selection for midwifery care. Is everybody a candidate? And if someone is high risk, Emily, are there parts that you can take care of and then maybe their physician specialist helps with some of the other parts?

Emily Ellington: I would say anyone can see a midwife. You know, even the most high-risk patient would be able to get midwifery care during their pregnancy. People aren't having to address high-risk issues at every part of their pregnancy. They may be only really addressing those issues at the very beginning or even maybe the very end of their pregnancy.

I deliver high-risk patients every week. The delivery itself is not necessarily what makes somebody high risk. Someone that needs a C-section should see a physician. I can't do that for them. I can be there to help their physician, but that's the one thing I can't do. I think if you're planning to do a VBAC, like let's say you've had a cesarean section in the past, and your goal is to have a vaginal

delivery after the C-section, I think it's wise to meet with a physician at least one time during the pregnancy and go over your previous op note to look and see what your incision looked like, what your C-section complications may or may not have been, and see whether that person's a really good candidate for VBAC.

But beyond that, the midwives take care of those patients. I delivered a VBAC patient three days ago and she had a great outcome. But I have the safety net built in for myself that I know I have a surgeon all the time. So, I kind of feel like my job, I get the best of both worlds. I have a safety net, but I also get to practice at the top of my license and really affect my patients' outcomes.

Midwifery care has been proven to decrease C-section rates in all markets where they're used. Doula care has been proven to help with vaginal delivery rate as well, so that's something to really consider if you are wanting to be a low intervention birth, and if your goal is to avoid an epidural, that's something that you could consider.

I think those are all conversations that are great to have around the beginning of the third trimester in a pregnancy. But as far as who can and can't see a midwife, there's not a clear-cut answer on that. I would say you should be probably using the guidance of your care team. For instance—sorry I'm, like, going a long way about this answer.

If I had a patient that was like, "I've had two C-sections, and I really want to have a vaginal delivery for this next delivery," I would say to them, "I think we, should have a conversation with the physician. Either we can do that together, or you can plan to see them for your next visit." And then, I would go to that physician and say, "Hey, just so you know, I'm sending this patient to you. This is what they're planning on talking about."

Similar things can happen with GYN care as well. I saw a patient this morning for fertility. I've been seeing her for a few months now, and she's at the point where she's wanting to go to next steps. She needs a procedure, and I don't do surgery and so, I have scheduled her for a visit with one of my physician colleagues, and I've let him know that this is why she's coming to see him and I know he's going to take great care of her, and he'll do the procedure she needs, and then she'll come back to me.

Host: That's really reassuring to know that everybody's involved and it's really about the whole person, this mother-to-be and that exciting time.

Tell us a little bit, Emily, about prenatal care. What do you provide? How does someone work with you in those prenatal times?

Emily Ellington: So, we will see women from the very beginning of their pregnancy—well, actually, we can see you planning for a pregnancy before you ever become pregnant. A lot of people now are doing preconception visits, and that's where we may talk about what risk factors you may have, what medications you may be on that maybe wouldn't be safe for the beginning of a pregnancy and we can talk about optimizing nutrition and kind of lifestyle modifications that might be wise when you're planning to try for conception and then, we'll see you when you have a positive pregnancy test. Usually, our clinic starts with around eight weeks. Sometimes people will see us sooner just because they want some reassurance, and that's absolutely fine. We're happy to provide that. But people will come in and see us at eight weeks for an ultrasound. We'll get their dating to make sure that we're all on board, that we have exactly the due date that we're expecting based on the ultrasound and based on her last menstrual cycle and then, we set up visits there out. We'll plan for a nurse visit at some point to do lab work, and then we start seeing them every four weeks.

Host: Now, what about postpartum? What does that look like?

Emily Ellington: For postpartum in our clinic, we see you following your delivery at least the day after and sometimes two days after your delivery. We usually have a phone call with you sometime in the first week or two just to check in. If you're someone that's been dealing with some anxiety or depression later in your pregnancy or it's something you've dealt with really any time in your later adolescence, adult life, we'll plan to see you two or three weeks out after your delivery just to get a good kind of feel for how you're coping emotionally, and then we plan to see you six weeks out from your delivery as well. We'll do an exam if you had any kind of laceration or if you had any kind of complications with your pregnancy to make sure physically you're healing well and then, we usually talk about contraception at that visit as well.

Host: One last myth, Emily, and you've mentioned a few times that you can even see someone as they start going into puberty and women through post-menopause. You know, that would certainly be someone like me. But one of the biggest myths about midwives is that you are really only involved in that pregnancy time and that birth time, and now even we're learning that the postnatal time. But that's not really true, right? You can see women from start to finish, right? Tell us little bit about the midwifery model.

Emily Ellington: Yes, we can see women of all ages. I would say most people probably do start care with a midwife because they're pregnant or planning to become pregnant, and that's the kind of care that they think they want and then, we build great relationships with our patients, and so we will see them through their pregnancy. We'll see them postpartum. We'll usually see them for their annual exam. Maybe they're thinking about having another baby by that time, and we'll see them back for another pregnancy.

I have patients now, I've been practicing long enough, where I've done maybe three of their deliveries, and I've seen them in between for annual visits as well. I love when they bring the babies and getting to see them and seeing how big they are and getting a Christmas card to put on the bulletin board. Really, I love the relationships that I have with my patients. But, I mean, I've seen some people through when they were getting birth control in high school, and now they're thinking about having families, and I'm seeing them for preconception visits because they just got married, and they're thinking about next steps.

Oh, another story. I have a bunch of sisters so I have a group of three sisters I've been seeing. I've done all their deliveries thus far, and I just saw their mom for menopause care a couple weeks ago. I know. I love it and they're so cute, and they're sweet, and they're, like, super supportive of each other and I met their mom at one of their deliveries. I think that's neat. So, I get to see her for menopause care.

Host: That really is awesome and I love the babies too. Oh my, so cute. Now, Emily, gosh, you've given us so much great information. You have busted up a bunch of myths that people have always kind of thought about midwives, but not really ever understood this very ancient practice to help women.

So gosh, it's so important what you do, and I can hear the passion in your voice and the compassion. Your patients are lucky to have you. I can see that. I can feel it from everything you're saying. I'd love you to give us some final thoughts. What would you like the women and the people that love them listening to know about midwifery care at Novant Health?

Emily Ellington: Well, first of all, it's okay to ask these questions. I have patients that will bring their moms with them to their first visit because they want to make sure that their child or their baby is being taken care of as well as they can. So, it's absolutely fine to bring family members to your visits if they want to see what kind of care you're getting.

So first and foremost, don't ever feel weird about that. You can absolutely do that. Midwives are a great tool. We're a great kind of go-between. You're going to have personalized care with the midwife. It may not be that you see just one midwife. You may choose to see all the midwives in one practice.

I'm fortunate right now to have a great partner, and then we're about to hire another one at some point, so thrilled to have a third. I think if you're looking for patient-centered, educationally heavy, all-around kind of women's health encompassing, you know, GYN care, pregnancy, lactation, annual visits, and even into menopause care, I think that a midwife is a really great place to start knowing that you're going to get good care, but there's also a safety net at the end of the day. There is a doc at the end of the line in case we need something that a midwife's, you know, not in scope to handle.

Host: Thank you so much, Emily. You are lovely and thank you for joining us and sharing your incredible expertise for us today. That was just really such an informative episode. Thank you so much and to find a physician, you can always visit novanthealth.org and for more health and wellness information from our experts, you can visit healthyheadlines.org. That concludes this episode of Meaningful Medicine, a podcast from the specialists at Novant Health.