Midwifery is an ancient profession and midwives today still help women through their pregnancy, labor, and delivery every day. Ob Hospitalist Group has nearly 40 midwives working in our hospitalist programs across the United States and the number is growing. May 5 marks International Day of the Midwife, a celebration of the important and dedicated work of midwives across the globe.
The International Confederation of Midwives established the idea of the International Day of the Midwife in the late 1980s and formally launched the initiative in 1992.
“Midwives leading the way with quality care is significant in highlighting the vital role that midwives play not only in ensuring women and their newborns navigate pregnancy and childbirth safely, but also receive respectful and well-resourced maternity care that can create a lifetime of good health and wellbeing beyond the childbirth continuum,” writes the International Confederation of Midwives.
Sallie Hill, CNM, works in the OBHG program at Alta Bates Summit Medical Center, a bustling location in northern California. She talked with us about her journey to becoming a midwife and why the profession is beneficial to mothers, physicians, and hospitals.
First, the training
Hill became interested in midwifery following the difficult birth of her son, and her physician said he wished the hospital had midwives because she would have been a perfect candidate. “I thought, ‘They still have midwives?’ and decided that’s what I wanted to do,” said Hill.
She attended nursing school and later worked in labor & delivery nursing for several years before entering the midwifery program at University of California at San Francisco.
Hill began her career with the Indian Health Service, working at the Pine Ridge Indian Reservation in South Dakota. “It was a really wonderful place to work. We rarely had an obstetrician, so the midwives ran Obstetrics and Gynecology along with Primary Care. We learned skills like ultrasound, colposcopy, and vacuum-assisted delivery because we were so remote,” said Hill.
Next came solo practice in South Dakota followed by a practice in Boulder, Colorado. When she returned to California, Hill worked at a free-standing birth center and later joined what became the Alta Bates Summit Perinatal Center. She’s worked there for 15 years. The pace was ultra-fast in the beginning, said Hill, “When I initially started, we did 7,000 to 8,000 births a year, sometimes 10 births in an hour, but now it is about 4,000 per year. It’s busy, but very rewarding.”
‘Birth is normal, but they’re all different’
Using midwives on labor & delivery reaps multiple benefits. When Hill is on shift at Alta Bates, a midwife and two physicians are on the L&D unit. She oversees the entire birth (and the rare repair) on her own and only calls for physician consultation or backup if something goes wrong or she is out of her comfort zone, said Hill.
A benefit for the mother is that midwives are trained to treat birth as normal while still keeping an eye out for something that deviates from normal so if there is an emergency, they can react and take care of it, said Hill. “We can be with the mother as much as possible and provide reassurance for them,” she added.
Hill recounts a story of when she had a backup physician covering for her and the physician said when confronted with a situation with one of Hill’s patients, she thought about what Sallie would do. “And I just sat on my hands,” reported the physician.
Working on an OB hospitalist team versus solo practice offers a different perspective, said Hill. “You’re more focused on working with a team and you’re more dependent on your colleagues for a team approach to everybody’s care. This is because you don’t know the background of the women you’re caring for as well as you would in full-scope clinical practice. It’s nice to have that camaraderie and team support,” she said.
Sallie Hill shared some of the lessons learned in her decades of practice. Establishing a rapport or common ground when the patient first arrives is paramount, she said. “I’ve learned to listen and get patients to tell me their story. By doing that and listening to the women, it’s easier to establish a connection. I want to get that story first,” she said.
“I’ve also learned that it’s really important that you not insert your ego or your expectations into somebody else’s labor and birth experience. That can be a hard lesson to learn for some people. You have to learn as a midwife to be able to not have your expectations forefront,” she added.
And when the birth is not going the way the patient expected, a midwife must be a support and guide. “You may have to respectfully tell them that an intervention is needed. We have to really learn to listen and discuss rather than dictating how something will be done,” she said.
“Some women want complete control and you can control nothing about labor. You may have to work around that [expectation] and keep the safety of the mom and baby at the forefront,” said Hill.
What’s on the horizon
Obstetrics trends evolve and Hill said one distressing trend is hospitals closing their labor & delivery units, so women in rural areas may have to travel hours to a hospital that offers Labor & Delivery.
This trend could drive up the number of midwives. “I think midwives are going to be even more prevalent, not only in hospital settings, but in rural clinics and even in city clinics as we run into a shortage of doctors. There is going to be more of the type of practice where consultations are done by phone or video because a physician is 100 miles away,” she said.
The pendulum in Obstetrics swings back and forth, said Hill, but the process of pregnancy and labor hasn’t changed for thousands of years. “I hope to see more midwives in practice and an examination of what interventions are really needed,” she added.
An optimal model
Midwives and obstetricians working together is beneficial for all, said Hill. “I think the collegial and collaborative midwife/obstetrician approach is really best. I think that midwives and obstetricians can learn quite a bit from each other.”
“It’s very important that an open dialogue is maintained between those positions and that’s what’s going to benefit women and their families. There are so many strengths that both professions have. I need to be able to learn from the obstetricians, but they also need to be able to learn from me,” she added.
When residents are paired with midwives during rotations, this is an excellent model and helpful for both parties, she added. “It gives exposure to midwives and normal birth, which may not happen for an obstetrician in training,” said Hill.
Sallie Hill said working as a midwife in a hospitalist program truly suits her. “It’s always challenging, it’s always interesting, and then you get to go home. What’s nice about being a hospitalist is that you get a wide variety of clinical situations, but you don’t have to take those home with you.”