The relationships that develop with patients are the most rewarding part of her job, says Jess Vaughan, a midwife in Madison.
“We have longer appointment times and we really get to know them on an individual level,” Vaughan explained. “They know that I am there and available for any concerns.”
The “midwife philosophy,” centered around shared decision making along with her interest in women’s health, is what drove Vaughan to become a midwife. She has been a certified nurse-midwife, or CNM, with SSM Health for two years, practicing “full scope midwifery”.
Meaning, Vaughan sees pregnant and non-pregnant individuals who seek well-woman care including birth control, gynecology problems and deliveries in the hospital.
“The whole midwife philosophy really appealed to me,” Vaughan said. “Meeting people where they’re at and providing evidence-based information and then trusting that women will make the best decisions for themselves and their families.”
Unlike labor and delivery nurses, CNMs are able to prescribe medications and diagnose without doctor or physician oversight.
Vaughan and other SSM Health CNMs’ futures as midwives were in jeopardy when SSM Health announced that they would discontinue their Midwifery Program at the end of 2021. “Shock” was all Vaughan felt when she learned the program was set to discontinue.
“We didn't know that was even on the table. We were all very shocked,” Vaughan said.
Persistent outcry from the community and CNM providers challenged the discontinuation, resulting in SSM Health deciding to reverse their decision and continue providing midwifery services.
Included in this community reaction was another group of Madison midwives who specialize in home-birth midwifery care and often work with the SSM Health midwives.
Ingrid Andersson, a home birth nurse-midwife in Madison for 21 years, stated that midwives like her rely on the program. When complications occur and a mother needs to be hospitalized, the SSM Health midwives are available at the hospitals to take care of them.
Andersson said when she had to transfer mothers to the hospital before the SSM Health Midwifery program was established, there was uncertainty in who would be on call for non-assigned patients and how much they knew about or supported midwifery care. Having midwives in the hospitals made the transition more seamless for Andersson’s families because they are familiar with the midwifery model and know what care the mothers have already received.
“They know exactly who we are. They know exactly how we work. They know all the scope of midwives in Wisconsin,” Andersson remarked.
“The grief of my families,” Andersson said, was her first concern when she heard that she might not have the SSM Health midwives to rely on in the future. Andersson views midwifery care as a different relationship model than doctors have with their patients. She doesn’t consider herself to have any patients, but rather families and partnerships.
“My families that I work with are not my patients. I don't ever call them my patients. I don't ever call myself a provider. It's not a provider-patient model, in my mind, and in the way I midwife — it's a partnership model,” Andersson said.
While she wrote letters and advocated for the program, Andersson said that the leaders of the movement were the families that would be affected by a loss in midwifery care and who organized events and contacted the press themselves.
Margaux Riewe, a woman who was pregnant at the time of SSM Health’s uncertain future, reached out to NBC15, stating that the discontinuation would put her and other pregnant women at a loss.
“Women who are pregnant around this time have the most to lose. I don’t have the luxury of being able to switch insurance providers,” Riewe said.
Vaughan described this community activism and outcry as “heartening.”
SSM Health said the unsustainability of the midwifery program was the reason for its discontinuation. However, Andersson felt this initial decision reflects greater systematic biases.
“Let's not hide the fact that [the SSM Health midwives are] all women. Let's not hide the fact that the CEO and the people who made these decisions are white men in extremely powerful, profitable institutions,” Andersson said. “That needs to be called out because we are working within sexist, racist institutions.”
Andersson and other nurse-midwives in the community were eventually able to discuss their concerns with SSM Health. Andersson believes the SSM Health decision-makers were understanding and cooperative, giving hope to wider midwifery care options in the future.
“It was just incredibly gratifying to see how that institution opened up,” Andersson said. “We felt really heard and validated.”
Vaughan, who had a similar experience with SSM Health, said that while they were unclear on their reasons for discontinuing the program, they’ve been willing to work with the CNMs to create a more sustainable program.
“They were not transparent with any data or numbers that influenced their decision to get rid of the program, but I think they have been willing to work with us to keep us and make it a better program,” Vaughan said.
The US has high birth mortality rates compared to other developed countries. Vaughan and Andersson agreed that the midwifery model is one of the solutions to this problem.
Both in the hospital and at home, midwives are able to look into ecological factors like nutrition and stress levels. Andersson is able to take that further by seeing environmental barriers such as chemical exposure, transportation limitations and food deserts that may impact the health of the mother and child.
In order for midwifery services to reach their full potential in combating birth mortality, the profession needs to become more accessible to people of color and those that are low-income to close regional, racial and income-level gaps, making it easier for women who seek midwifery partnerships, Andersson says.
SSM Health and their CNMs are collaborating to improve their midwifery program and integrate the practice into the OBGYN department as a whole, according to Vaughan. The hospital will give their recommendations on how to maintain a sustainable midwifery program in June.
Andersson hopes the midwifery model becomes a more prominent option for women. She has already seen a rise in demand for midwifery care, as people seek alternative options during the pandemic that offer greater support.
“That's why folks are seeking that out, (midwifery care),” Andersson concluded. “It tends to be a more empowering partnership, particularly through your pregnancy, labor and birth.