Midwives once played a prominent role in American peripartum care, but receded into the background as hospital birth became the norm. In recent years, however, the midwife model has had a comeback in the United States, and many tout it as an integral piece in tackling soaring maternal mortality rates.
Wendi Cleckner was my own midwife in 2010. I was drawn to the nurturing and empowering philosophy of midwifery, and to the continuity of care afforded by having the same provider present for every prenatal and postpartum appointment as well as the actual birth. Now, as a future physician, I’m eager to share more about this ancillary field with my medical colleagues, and contacted Wendi for the following interview.
What is a midwife?
The role of the midwife is unique in the care and treatment of a mother and child, throughout the lifespan of a woman, and more specifically, the birth process; the role is comprehensive and involves education, treatment, and collaboration with a more skilled medical team. A community midwife, meaning a midwife who practices outside a hospital setting (birth center or home), is more often than not a Certified Professional Midwife (CPM). A CPM is a midwife who has completed didactic education, in addition to clinical hours with a preceptor. They are skilled in normal, community birth and work in collaboration with CNMs, NDs, DOs, and MDs to ensure the birthing person receives the care that is appropriate for her. A CPM’s scope covers all prenatal visits, including blood work, ultrasounds, and other diagnostic tests as needed. It includes the normal progression of labor, birth, and up to six weeks of postpartum care. CPMs are skilled in emergency protocol such as resuscitation and anti-hemorrhagic measures.
How did you get into midwifery?
I had a desire early in life to work globally in developing nations. I wanted a skill that would translate no matter where I ended up. Midwifery fit that to a tee.
What does your practice look like?
I own and operate a private practice as an independent provider in downtown Tempe. My office is bustling with pre and postnatal visits, classes on birth preparation, yoga, parenting, breastfeeding and general support groups. I work in a team with other midwives, students, doulas, and health care providers. We are always stronger together and it is the only way to make this profession sustainable. We believe in community at our core, so we are always giving an opportunity for families to come together.
What do you love about your job? How is it challenging?
I love walking with families in this journey of becoming parents. I love empowering pregnant people, women, and girls. The most challenging part is being on-call 24/7. I have missed birthdays and I have been called in the middle of Thanksgiving dinner, and I have had to leave the embrace of my partner because a client has needed me. When I have a strong team, it lessens that burden, but it is always there. The other greatest challenge is working within a system that does not understand or support your role in the community. I work with a lot of great providers who do understand and are supportive; however, they are few and far between. The vast amount of providers do not understand or support, and at times may even actively work against me and my clients.
What do you see as your role in the healthcare system?
Midwives, CPMs and CNMs are the answer to a very broken system. The World Health Organization published a recent article titled “The Case for Midwifery: The Potential of Midwives for Improving Quality of Care” that states it best [1]:
-83% of all maternal deaths, stillbirths and newborn deaths could be averted with the full package of midwifery care (including family planning);
-62% of effective practices within the scope of midwifery show the importance of optimising the normal processes of childbirth and early life, and empowering women to care for themselves and their families;
-82% reduction in maternal mortality possible with universal midwifery coverage;
-Midwifery is associated with more efficient use of resources and improved outcomes when provided by midwives who are educated, trained, licenced and regulated in international standards…
-Midwifery is associated with reduced maternal and neonatal morbidity, reduced interventions in labour, improved psycho-social outcomes and increased birth spacing and contraceptive use;
-Community-based midwives have been found to rank positively for economy, efficiency and effectiveness;
-Case loading midwifery care is safe and cost effective;
-Midwives have the potential to provide excellent quality of care but socio-cultural, economic and professional barriers must be overcome to allow them to practice to their full potential.
What should clinicians know about your role, and how should they collaborate with midwives?
Clinicians should know that we are certified by a national organization and licensed by the state of Arizona (each state is different). Though we do less than 1% of all births in Arizona, pregnant people are choosing to have their babies at home and in birth centers, and it is vital to have a skilled birth attendant who is educated and trained to attend those births. There are times when, in the course of prenatals, labor, or birth that things go outside of normal and then the safest place is in a hospital. We NEED collaborative respectful care to ensure the highest provision for our families. If we have to transfer care at any point in time, we are your allies, we come with a lot of information that can be helpful to your decision making.
- The case for midwifery: The potential of midwives for improving quality of care. World Health Organization. 2019. Retrieved from: https://www.who.int/maternal_child_adolescent/topics/quality-of-care/midwifery/case-for-midwifery/en/
Jessica Pirkle is a member of the Class of 2022 at the University of Arizona College of Medicine-Phoenix. She completed a BA in Spanish at ASU and worked for several years as a school teacher before switching gears and obtaining an MS in Health Care, also at ASU. When not studying the marvels of medicine, she enjoys making and eating delicious healthy food with her four children, and daydreaming about being a music festival groupie.