Dr. Mavis Schorn is a certified nurse-midwife and the program director of the Nurse-Midwifery Program at Vanderbilt University. At Vanderbilt since 2002, Dr. Schorn brings extensive clinical, teaching, and research experience to her role in the graduate program. LoveToKnow Pregnancy recently interviewed Dr. Schorn about midwifery and how it works for expectant mothers, as well as for women in many other stages of life, both in the United States and abroad.
Dr. Schorn and Midwifery
LoveToKnow (LTK): Can you please tell us about your experience with midwifery and what your position entails at Vanderbilt?
Dr. Mavis Schorn (DMS): At Vanderbilt University School of Nursing, I have several roles. I still have the privilege of providing care for women in clinic and during labor and birth. I do this on a part-time basis now because I also "midwife" students. I am the director of the nurse-midwifery academic program, which means that I teach and guide graduate students through our program to become a nurse-midwife. Now I often live vicariously through the student experiences. When they tell me a birth story including what they did, what they learned, and how it went, I have the opportunity to either just listen in support or add some guidance - just like I do when I provide care to women. When I see the "light go on" in excitement over learning or experiencing something new or special, it is exciting for me, too. These graduates will provide excellent care to women across the country or even internationally. Appreciating the great impact they will have motivates me to want to be that much better of a teacher for them.
LTK: Why did you choose to enter into midwifery?
DMS: I fell in love with the profession of midwifery during nursing school. One of my professors was a midwife and was a strong influence. After nursing school and a couple of years of experience, I returned to school to receive my midwifery education. After passing a national board exam, I was considered a CNM (certified nurse-midwife). Please note that I use CNM and midwifery interchangeably in this interview although there are several paths to midwifery.
The philosophy of helping women to make choices that are right for them, many of whom have very little control over the rest of their lives, is very rewarding. Some examples include the choice of what birth control is right for her, what dietary adjustment she could do to improve her health, or whether or not to do prenatal screening tests during her pregnancy. Sharing information in a way that she can understand and participate in choices about her own health empowers a woman no matter what age or socioeconomic group she belongs to. Witnessing the emotional growth and affirmation that a woman commonly experiences in a pregnancy and birth warms my heart. The joy of facilitating a woman and her family through the highs and lows of a labor and birth is an experience that is hard to explain.
Midwifery and Pregnancy
LTK: What is midwife care during pregnancy?
DMS: A midwife provides safe, comprehensive care throughout pregnancy. This includes common labwork, regular check-ups, and other tests as needed. A significant portion of midwifery care during pregnancy is guidance and teaching. Women must feel comfortable to ask questions of their midwife (or any care provider). Satisfying those questions, concerns, and emotions that occur during pregnancy takes care of her head as well as her body! For women, that is extremely important.
LTK: How does being in the care of a midwife differ from an obstetrician?
DMS: The most significant difference is the belief that pregnancy is a normal process of a woman's life. It is not a disease or a complication ready to happen. Obstetricians are extremely well trained to care for medically-complex obstetric cases and I am extremely grateful to have worked throughout my career with knowledgeable, experienced obstetricians for whom I have the utmost respect. When it comes to normal birth, midwives are the experts. One day I heard a physician happily exclaim: "I had a midwife birth today!" when he felt he had had a normal birth because it really is the exception for him and he knew it.
Women respond positively to the midwifery model of care, which is also sometimes referred to as the humanistic model of care. This type of care is more commonly given by midwives and refers to:
- Focusing on health, wellness, and prevention of disease
- Labor and birth as a normal event, not a disease
- Use of no or minimal intervention, unless medically necessary
- Allowing the mother to "give birth" (woman-centric rather than provider-centric)
- Individualized care
In contrast, the technocratic or medical model of care refers to:
- Focusing on managing medical problems and complications
- Labor and birth as dependent on the use of technology
- Higher rates of interventions
- Having the provider "deliver the baby"
- Routine care
LTK: What is the experience of giving birth like with a midwife?
DMS: Birthing experiences with a midwife are as varied as people. If all is normal, the experience is dependent much more on what the woman and her family desires. If their particular needs or desires can be safely accommodated, midwives will facilitate to help them achieve the experience they request. Midwives are particularly well trained to support women in an unmedicated labor and birth; however, some women either know they need pain relief during labor or have a labor that is very challenging, resulting in the need for pain relief measures (like medication or an epidural anesthesia). Midwives provide choices and education about the pros and cons of those choices. Midwives also continue to influence hospitals to change policies to be supportive of family desires while staying safe. Not all facilities are there yet!
Birth is a sacred time for a woman and her family and an experience they will likely never forget. Ideally, it is wonderful at the end of it all if the woman can say "I did it!". It is, after all, all about her and her power to birth - mentally, emotionally, spiritually, and physically. When a baby slides out into her parent's receiving hands, is looked at wondrously, and the mother holds her baby for the first time against her skin, it is a special time to respect and honor. While the midwife is keeping an eye on medical things (for example, how is the baby transitioning to the outside world or how much is the mother bleeding), she is also a secret voyeur, having the opportunity to be a part of one of the most intimate times in a family's life. To intervene if needed while continuing to support a couple to revel in their accomplishment and wonder of their baby is a fine balance.
Midwife Training and Care
LTK: What kind of training do midwives receive? Can midwives offer care to all pregnant women?
DMS: Certified nurse-midwives receive education and training as both a nurse and as a midwife. The midwifery training is accredited by the Accreditation Commission for Midwifery Education and is at the graduate level with most of nurse-midwives having a Masters or Doctorate degree. Nurse-midwives take a national board exam at the end of their education program to become board certified. CNMs provide care to young women in puberty and throughout the rest of their lives. Their education includes preparation for maternity care (prenatal, labor, and birth), gynecologic care, family planning, and primary care. They may treat male partners for sexually transmitted diseases and newborns during the first month of life. They do not provide primary care for men or children nor do they perform surgery, so it is necessary for midwives to have a close working relationship with a physician who can respond when needed.
CNMs can provide care to most pregnant women, but it does depend on a woman's specific history and condition along with the particular midwife practice. CNMs collaborate with physicians or refer women to physician services when needed.
LTK: Does a midwife also offer post-natal care?
DMS: Nurse-midwives do provide early and later post-natal care. They will assist with breastfeeding and give guidance on birth control options if desired. Assisting with family transition through the addition of a new member is important. Post-natal care includes the mental as well as physical care. Depression during this time has received more attention the last several years, so women and families are more aware of that possibility. Educating, screening, and treating postpartum depression, if necessary, is part of the midwife role.
LTK: How does the amount of midwives, and their function, compare in the U.S. with that of other countries?
DMS: Midwives are credentialed in a variety of ways in the U.S., so the scope of practice of the midwife is dependent on the education she received. Midwives in other countries primarily care for women during the maternity cycle only, but it depends on the country. In countries that have the best outcomes in the world for mothers and babies, midwives provide the maternity care for the majority of women. Only those women who have conditions requiring the education and training of a physician receive care by them. Those who are healthy usually give birth with midwives.
LTK: What is the trend of midwifery in the U.S.?
DMS: Birth attended by midwives in the U.S. is increasing and is at about 8-9 percent of all births according to the Centers of Disease Control and Prevention. The number of births attended by midwives in 2003 as compared to 1990 has more than doubled, with most of these occurring in the hospital. The number of out-of-hospital, midwife-attended births (birth center or home birth) has not changed significantly. Unfortunately, the areas of the country that have the poorest outcomes for mothers and babies have the fewest midwives practicing due to political barriers making it difficult for midwives to practice to the full extent of their education and training. According to the Milbank Report, (an independent collaborative document), midwife-attended birth is identified as one of the most underused, effective interventions for maternity care in the U.S.
Choosing Midwife Care in Pregnancy
Women who are interested in finding out more about the possibility of midwife care during pregnancy should check locally first to find out what, if any, midwifery services are available on a local scale. While midwives are not certified to help all women through pregnancy, expectant mothers who have a "normal" pregnancy can consider this woman-centered type of maternity care. Choosing a midwife results in a different approach to childbirth than the mainstream pregnancy care provided by obstetricians across the United States.