When should prenatal care begin?

Wendler recommends establishing prenatal care during the first trimester. Early care allows healthcare providers to identify and manage risk factors sooner and tailor care based on a patient's individual health needs during a period of rapid fetal development.

What should I do when there isn't one clear answer to a pregnancy decision?

Learn about the pros and cons of each option and consider how they fit your personal goals and circumstances. Wendler explains that midwifery care focuses on empowering patients with information so they can make informed decisions, even when multiple reasonable options are available.

Episode chapters

00:00 Introductions

00:43 Distinguishing evidence-based information from misinformation in pregnancy

02:23 Common pregnancy myths and the evidence

02:30 Is natural always better in pregnancy?

02:51 Marijuana in pregnancy: what the research shows

03:37 How evidence-based care has changed midwifery practice

04:49 Evidence-backed habits for a healthier pregnancy

05:00 Prenatal vitamins and folic acid: preconception benefits

06:11 Helping patients make informed decisions when there isn't a clear-cut answer

06:44 The CNM's role in explaining risks and benefits

07:43 One piece of evidence-based advice for a healthier pregnancy

09:17 Returning to the basics: nutrition, sleep, and movement

10:01 Closing and thanks

Episode transcript

Gina Kaye (Host): Meaningful Medicine is 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 for navigating medical decisions and building a healthier future. I'm Gina Kaye. And with me is Autumn Wendler, a certified nurse midwife. And today, we are discussing midwifery. Welcome, Autumn. It's great to have you with us today.

Autumn Wendler, CNM: Thank you so much, Gina. I'm so glad to be here and be able to share whatever knowledge I can impart for everybody.

Host: Great. We're excited to hear what you have to say. So, let's start off. There's a lot of pregnancy and women's health advice on social media. How can patients tell the difference between evidence-based information and misinformation?

Autumn Wendler, CNM: Yeah. Well, that's a great question, because we are inundated with information all the time, especially with social media platforms and TikTok. And it's hard to navigate. I mean, folks who are MDs, nurse practitioners, people in scientific research, they spend entire courses being able to discern, what's quality scientific research and what's not.

So, it can be even harder for folks who have not spent that time studying that information. The things I like to tell folks to navigate towards would be to look at your professional organization. So, is it coming from a professional organization? So in our instance, when it comes to pregnancy care, that would be ACOG, the American College of Obstetrics and Gynecologists, ACNM, the American College of Nurse-Midwifery, Women's Health Nurse Practitioner Organization, the American Pregnancy Association. Is it a government site? Because government, they have to go through rigorous studies as well in order to be published and endorsed. So, something that's being published by the CDC, for instance, would also be a reliable resource. And then when it comes down to it, if sifting through it is really difficult then talking to your care provider and having them kind of break it down for you and explain.

And I also like to tell people, a lot of times if it sounds too good to be true or too novel, it probably is. So, making sure, if that research or that evidence has not been duplicated somewhere else, there usually is a reason for that, and sometimes we have to look at that with a more critical eye.

Host: Great. What is one common pregnancy myth you hear regularly? And then, what does the evidence actually tell us?

Autumn Wendler, CNM: Yeah. So, one of the things we hear a lot, especially in the midwifery world, because we do tend and trend towards more natural and holistic practices, is that natural equals better. And that's not always the case. There are many things found in nature that are toxic. Toxic to humans, toxic in pregnancy, for instance.

One of the things that comes up a lot, for instance, would be THC or marijuana, for instance. We'll see folks that use that in order to help manage early pregnancy nausea or appetite, for instance. And for them, some feel that it is superior because it is what they consider to be natural and not an artificial pharmacologic, such as medications that we prefer to use, like Phenergan, Diclegis, Zofran.

But what the research actually shows us is that we have actually shown harm to the baby whenever marijuana has been used, whereas these medications, these prescriptions have been rigorously studied to determine that they are safe to use. But we are seeing research studies that show that there are neurodevelopmental outcomes to babies that are born to mothers who utilize marijuana in pregnancy.

Host: Let's talk a little bit about evidence-based care. How has that changed the way midwives support patients during pregnancy, labor, and delivery over the years?

Autumn Wendler, CNM: I feel like evidence-based care and practice has really expanded the care that midwives can provide. Meaning that it used to be that we could really only manage low-risk patients because that is our specialty. But we know people and their health statuses are getting more complicated, but does that mean that those more complicated folks don't deserve access to midwifery care?

And the answer is no. I think that anybody who wants access to that care model deserves it. But what evidence practice provides is it provides protocols, it provides algorithms so that we can rely on those things, kind of help us check those boxes to make sure that we are managing them medically in collaboration with our MD, DO partners, of course.

But it really also helps us to continue to focus on the holistic and the whole person aspect of the care versus getting kind of caught in the weeds of the medical aspects as well, because we know that's important. But what makes midwifery care so special is really being able to connect on that more holistic interpersonal level.

Host: Many patients want to make the healthiest choices for themselves and their babies. What are the most important evidence-backed habits that you recommend during pregnancy?

Autumn Wendler, CNM: So, I think this goes back to the roots of ensuring that, I believe that all women of reproductive age—this is not just me, but I definitely endorse this, that all women of reproductive age should be on a prenatal vitamin. There's really very low risks to it, but what research is showing us more and more is that having that folic acid in your system three months before you ever conceive is really beneficial to helping reduce the risk of neural tube defects.

What we see in the research is that about 50% of pregnancies are unplanned. If we're already on a prenatal vitamin, that already sets us up for more success with an early pregnancy, because a lot of times folks may not even find out they're pregnant until they're already four, six, eight weeks along, where a lot of those developmental milestones have already occurred.

In addition to that, I think that getting established with prenatal care in that first trimester is also very pivotal because that really helps us to be able to monitor and manage risk factors very early on, again, because there's so much development that happens in that first trimester and we can really kind of curate and cater your prenatal plan to you based on what you're coming into the pregnancy with.

Host: Some expectant parents are overwhelmed by conflicting recommendations. How do you help patients make informed decisions when there isn't a clear-cut answer?

Autumn Wendler, CNM: Yeah. So, my big platform and the platform of midwifery in general is empowering patients, right? Empowering them with knowledge. So really, we are going to discuss the pros and cons of each option and then kind of talk about what their goals are. Because sometimes what their goals are or what their background is can also inform maybe what might be helpful in choosing them if we're at equal levels of options.

Host: Let's talk a little bit about your role specifically. What role does a certified nurse midwife play in helping patients understand the risks and benefits of different care options during both pregnancy and childbirth?

Autumn Wendler, CNM: Yeah. So again, I think that really goes back to making sure we lay out the facts in an unbiased manner for each option available. And making sure that, again, we bring in the person's goals, their backgrounds to help them to make a decision that aligns with those, and ultimately supporting what their decision is.

So, sometimes patients may make a decision that you may not feel like is the right one. But again, still elevating them and supporting them and knowing that you provided them with the knowledge and now you're going to provide them the best care and support in the safest manner that you can. And knowing that you gave them the information, and ultimately what they chose to do with it was up to them.

Host: And finally, if you could give every pregnant patient one piece of evidence-based advice to help them have a healthier pregnancy and birth experience, what would it be and why?

Autumn Wendler, CNM: So, I think my answer to that is probably boring, because I think we all really want there to be that special, secret trick or secret supplement or things that we, as healthcare professionals, are gatekeeping. But what I truly, really feel like it goes down to is our roots of health and, when we lean into, nutrition and physical activity.

And we think if we are putting the best things in our body and taking care of our body in the best way possible and moving our body and physically active, that sets up the best building blocks so that we ourselves, as the pregnant patient and our babies, can have the best start. We already know that a lot of the pregnancy complications that occur. Some of the root causes can be related to poor diet, not enough exercise.

Now, we cannot blame that entirely, so I don't want anybody to ever think that because they developed, for instance, gestational diabetes or preeclampsia, that was their fault. Because by all means, those do happen spontaneously, and I've seen very healthy patients that are healthier than anybody, myself, anybody that I've seen, not that I'm the standard of health by any means.

But I do think that if we can really set ourselves up for the most success if we really get back to the basics of being very mindful of what we're putting into our body, monitoring the weight gain. Because, again, lots of pregnancy complications can kind of go back to that.

Host: It's funny, it seems like we all just want that magic pill, but sometimes it's just going back to the basics and doing the right things for the right reasons, right?

Autumn Wendler, CNM: Exactly. And I think we all have to be mindful of that. Even us in healthcare, we sometimes have to take a step back and reel it in and realize, okay, yes, we know that we want to be able to think that vitamin D or magnesium is going to cure all ills, but like maybe I need to work on my sleep hygiene and get better rest, and maybe I'll feel better and more productive throughout the day, right? So, it's something that I think we all can work on, but it's not sexy and it's not exciting, but it is very helpful and very important.

Host: Fantastic advice. Autumn, thank you very much for sharing your knowledge and your time. It is very much appreciated.

Autumn Wendler, CNM: Thanks again for having me. I appreciate it.

Host: Thank you for listening to the Novant Health Meaningful Medicine podcast. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. Thanks for listening.