Expansion of USF Health midwifery program gives women more options for delivering their babies [video]

There was no question for Alayna Vernon that she would partner with a midwife to help deliver her babies. After all, her great grandmother was a midwife and would joke that she had helped deliver half of the population of Grand Rapids, Michigan.

So when Alayna and her husband were planning their second child, they contacted midwives at USF Health to help her deliver their baby boy. That connection gave her advanced care from certified nurse midwives, but also gave her – standing at the ready throughout her pregnancy and delivery – a team of USF Health maternal fetal specialists and a state-of-the-art neonatal intensive care unit at Tampa General just in case her pregnancy or delivery turned from typical to high-risk.

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Alayna Vernon (left) and USF Health’s Dr. Jessica Brumley. Photo courtesy of Alayna Vernon.

“I knew I wanted a midwife and that I wanted to deliver at Tampa General so the USF Health midwife team was a perfect fit,” said Alayna, who had her baby boy April 10. “The experience was absolutely wonderful; the best care I could hope for.”

USF Health’s Division of Midwifery Services is based in the Department of Obstetrics and Gynecology of the USF Health Morsani College of Medicine. The team includes eight certified nurse midwives who see patients at four prenatal care sites and deliver at Tampa General Hospital.

And that may be what sets this midwifery program apart from others: it is part of this region’s only academic health center, a connection that gives women throughout the Tampa Bay area not only access to coordinated care across multiple specialties, but also the expert care they want with their low-risk pregnancies backed up by a team of highly skilled specialists if problems arise.

“The best academic health centers have full-scope midwifery services,” said Jessica Brumley, CNM, PhD, who directs the USF Health Division of Midwifery Services.

Besides the obvious – helping mothers deliver babies – those services can include providing well-woman care to women across their lives, from their teens to their senior years.

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A certified nurse midwife is an expert in low-risk pregnancies. They perform vaginal deliveries independently, as well as focus on holistic care of the woman throughout her lifespan. They are nurses with advanced training in a variety of fields, such as primary care and pediatrics, and have earned at least a master’s degree.

“The focus of this advanced training is care of the normal pregnant woman,” Dr. Brumley said. “But we also provide well woman gynecology, we manage birth control options for our patients, and because our program is part of a larger academic medical center with so many resources for our higher risk patients, USF Health midwives may co-manage patients that many midwives in the community wouldn’t.”

The USF Health team of midwives is also an active component of medical school’s resident physician education program, offering new doctors valuable experience in normal pregnancies.

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Dr. Jessica Brumley, center bottom, with some of the eight USF Health certified nurse midwives.

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While midwifery services have been offered by USF Health for decades, it only recently became the department’s newest division. The new designation fits the vision and mission of Jerome Yankowitz, MD, chair of the USF Department of Obstetrics and Gynecology, for offering a full-scope midwife service to area patients.

“My goal is to create is an environment where a woman who wants the highest touch, lowest intervention kind of delivery has that option,” Dr. Yankowitz said. “Childbirth is a normal process and most pregnancies and deliveries will be fine. The less intervention you do, the less you’re interfering with that normal process and the more likely you’ll have a healthy outcome. There are a lot of women with healthy pregnancies who want choice in how they will be taken care of and our midwife service will give them that choice.”

COPH sound-icon-png   Listen to Dr. Yankowitz talk about the impact of the USF Health midwifery program.

This approach became obvious early in his career, Dr. Yankowitz said.

“Where I spent a large part of my career, the midwives worked side-by-side with the doctors,” he said. “They had their own patients who preferred midwives. Doctors and residents and the midwives all worked very collaboratively. In fact the midwives’ presence taught the residents a lot about normal delivery and different ways of approaching the delivery for greater success. So what I’m doing in our department here at USF Health is have a truly full-scope midwife service where the midwives have their own patients and those patients and their families know the midwives are going to be there throughout the entire process.”

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Another unique feature of a midwife program associated with an academic health center is the ability to help a woman have a vaginal birth after having had a Caesarean section. Called V-BAC (vaginal birth after Caesarean), the option isn’t a service commonly offered by independent midwives because of an associated risk for complications.

“Our USF Health midwife program has had great success with V-BACs because we’re able to offer women in-house 24/7 coverage from a physician, a midwife, anesthesia service, and basically anyone and anything we would need if there’s a complication,” Dr. Brumley said.

“The USF Health nurse midwives and physicians really strive to implement evidence-based practice and the evidence supports that the majority of women who have had a prior C-section may deliver vaginally safely in an environment that supports them and allows for emergency backup as needed. Our numbers last year for the USF midwifery service saw an 80 percent V-BAC success rate. That is really phenomenal and illustrates our strong work in supporting women to have a vaginal birth after having prior C-section.”

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Most pregnancies are low-risk, and do not require many of the interventions so frequently implemented in hospital, Dr. Brumley said.

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Dr. Brumley reacts to good news with her patient.

“Evidence suggests that midwifery care improves a woman’s chances of having a successful vaginal birth,” Dr. Brumley said. “We encourage women to remain mobile during labor and to not be restricted to the bed or to delivering in any particular position. They are not restricted on their oral intake, they are not tied to a monitor the entire time, unless there’s a complication. We encourage intermittent monitoring of the baby, which further supports the woman’s ability to move and to be in different positions. We encourage hydrotherapy, so getting the shower or tub during labor can really help them feel safe, feel relaxed and allow normal labor to progress the way it should.”

Midwives do this by offering a model of supportive care, realizing that there are many times when labor can be long and will progress on its own time. Dr. Brumley said evidence shows that labor takes longer than previously thought and that health care professionals should be more patient in their expectations of how a woman progresses in labor.

“A first-time mom can be in labor for 18 to 24 hours,” she said. “We encourage women to stay home in the early part of labor. If they come in and they’re not in active labor, we encourage them to go back home, to take showers, and to eat and snack and come back. When women are in the hospital too soon, there’s often an increase in interventions that are not necessarily indicated because things are just taking a long time. Well, that’s what happens when you’re not in active labor – things just take longer. So we educate women on what to expect and how labor will change so they come in when they’re in active labor.”

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It’s not uncommon for a midwifery program to be a part of an academic health center, but there are many in the community (both patients and fellow midwives) who might not know the extent of care they can have by partnering with midwives who are part of a medical school.

But Alayna Vernon knew – about the range of services, about the high touch/low tech approach to care, and about the extensive training and experience. Even more, she said, she knew she would connect with USF Health midwives as a woman about to give birth, and as the great granddaughter of a midwife.

Multimedia by Sandra C. Roa, USF Health Office of Communications.