Collaborative ObGyn Care – A Q&A Session

Did you see Women’s Care featured in the January Edition of Mini City – The Pregnancy and Baby Issue?  Well we loved answering Mini City’s questions so much we thought we would share with our blog readers too!

Your practice is a combination of midwives and physicians, tell us a little about this dynamic.
We are collaborative practice of 6 OBGYN physicians and 4 certified nurse midwives – that means we care for all of our patients together as a team. Patients get the both of best worlds with this approach. Midwives are trained to manage the prenatal care and labor process in a normal physiologic way, whereas physicians training focuses on both normal and high risk pregnancies. Physicians of course also train for surgical emergencies and complications. By melding both of these approaches in a private practice setting, the patient receives clinically appropriate care that prioritizes spontaneous vaginal deliveries and significant amount of personalized one-on-one care, while always having a physician available for any issues or emergencies.

What is a midwife, and how are they trained?
Licensed midwives in New York State include certified midwives and certified nurse-midwives. They each hold a master’s degree or higher, and are certified by the American Midwifery Certification Board. Their education is focused on wellness rather than illness, and they recognize birth as a normal process. While midwives are trained to use medical interventions, they do so only when necessary. Midwifery coursework includes the study of preconception, pregnancy, postpartum, and newborn care, as well as gynecologic care, primary care, and family planning. In addition, midwives study sciences such as biology, chemistry, anatomy and physiology, and embryology. Midwives also study pharmacology in order to prescribe birth control and other medications. In order to obtain a degree, each midwife must also complete training in the clinical setting where they gain hands-on experience. Some midwives also hold a degree in nursing.

Can midwives and physicians work together in higher risk pregnancies, or in just “normal” expected deliveries?
While many pregnancies are normal, some patients have at least one risk factor, whether it is maternal age, prior medical issue or surgery, or an acquired problem in the pregnancy such as anemia. Luckily, most pregnancies turn out very well with a healthy mother and baby. Midwives can and do care for most problems in pregnancy, but they may check in with one of our physicians to confirm a plan or get more detailed clinical input. Because we are a collaborative practice, these quick consultations are easy and routine in our practice – usually it’s just a walk down the hall or a phone call. There are a few rare patients who have risks that need to be managed exclusively by physicians, but this is the exception, not the rule.

What can a patient expect at her first prenatal visit at your office?
The first prenatal visit typically includes an ultrasound to confirm the dating and viability of the pregnancy, review of the patient’s medical, surgical and obstetrical history, discussion of optional genetic screening tests, and a physical exam. Questions are answered and advice given about routine restrictions in pregnancy.

What can a patient expect in the delivery room with the midwife/physician combination?
Midwives in our practice typically manage the intrapartum (or labor) process. Much of this management is determining progression of labor, and much of it is watchful waiting without intervention. However, if labor is not progressing normally, typically the midwife will work within standard clinical practice to safely achieve a vaginal delivery. Sometimes, however, that is not possible, and it is then that physician management typically begins. Sometimes the end result of that is still a vaginal delivery, but other times it means the patient undergoes a cesarean section. Each clinical situation is different. Other times there is shared care of a normal process, sometimes with both the physician and the midwife present for delivery. We love delivering babies, so sometimes both the midwife and the physician are there to experience the delivery with the patient and her family!

What can a patient expect for postpartum care with the midwife/physician combination?
It is typical within our practice to have the on-call midwife or physician perform postpartum care for patients still at the hospital. However, once the patient leaves the hospital, she will typically follow-up with the provider who delivered her baby. However, we are flexible in this regard to accommodate patient’s desires and wishes (and schedule!).

Your practice is the only local all female practice.  How does that set the practice apart?
We are very happy to offer an all female obstetrical team to our patients. Many patients feel most comfortable with a female provider, and given the way obstetrical care is practiced these days with a rotating group of on-call providers instead of a sole practitioner on 24/7, our practice ensures that no matter who delivers a patient’s baby, it will be by a female provider. This provides a lot of comfort and decrease in anxiety for many patients.

What does it mean to be an independently owned practice?
Women’s Care is the only private practice providing comprehensive obstetrical care in the Saratoga Springs/Glens Falls area. We make our own decisions about how to practice and care for patients, and we are not managed by any other entity such as a hospital. This enables us to make decisions that are best for our patients and to provide the kind of care we think is appropriate. We love our patients and love being able to care for them!