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Expansion already planned for Iowa Health’s midwife clinic


Iowa Health-Des Moines opened its midwife services clinic at 1416 Woodland Ave. less than a year ago, and is already making plans to move to a larger location and hire additional staff to meet the growing demand for midwife services in the community.

Nurse-midwifery practice, the independent management of women’s health care – focusing primarily on pregnancy, childbirth, the postpartum period and the family-planning and gynecological needs of women – is on the rise nationally, with 10 percent of all births during 2002 being attended by a certified nurse-midwife, compared with about 3 percent of all births in 1989 and fewer than 1 percent of births in 1975.

“Midwifery is very mainstream in other parts of the country,” said Sue Gehlsen, the executive director of women’s services for Iowa Health-Des Moines. “We’re just getting on board.”

Certified nurse-midwifes such as Pam Jach and Sea Fey who practice at Midwife Services of Iowa Health-Des Moines, are trained in master’s degree programs at universities across the country. Both Jach and Fey had worked for a physicians group within Iowa Health prior to getting assistance from the hospital system to set up a separate hospital-based clinic for midwifery services just south of Iowa Methodist Medical Center. Despite doing little advertising, the clinic has attracted more people than anticipated, Jach said.

“We started in January with five deliveries, and for this December, we have 26 patients due,” Jach said. “We knew that we would grow, but we didn’t know that it would be quite this fast.”

Jach said her patients come from all social strata, from low-income women to well-educated professionals. Midwifes are not “hippies,” and neither are their patients, she said.

“A lot of people come to us because they are trying to get through pregnancy and delivery naturally, and they’re hungry for more information on what they can do to make it easier,” Jach said. “Also, people come to us as good consumers who understand that they have more options available for their care.”

Gehlsen said insurance companies, have been receptive to midwife services.

“The insurance companies are open to reimbursement for midwife services because very often, they are less expensive,” she said. “The same services might cost more if you had a physician provider, and midwives typically don’t use as many interventions, such as epidurals or inductions that would be present in the physician experience.”

Defining what makes midwife services different from the traditional clinical experience is not easy, Jach said, because for the most part, the differences don’t lie in their procedures, but in their overall approaches. Though patients receive the same schedule of regular checkups in either situation, the experiences they have will differ.

“We look at pregnancy with a nursing or wellness model, which means we view it as a naturally occurring event in a woman’s life, as opposed to an illness that needs specific interventions,” Jach said. “One of the hallmarks is that with nurse-midwifes, we tend to sit down and take a little more time with our patients. We get to know then, and they get to know us. We’re not claiming to be better than physician-based care, but just a different option.”

For Michelle Oberholtz, who has delivered two babies with Jach in the last year and a half, she says she has no doubt that she made the right choice by choosing midwifery services for her pregnancy, childbirth and postpartum care.

“I don’t like hospitals or doctors, and I never had the feeling of being at ease in that setting,” she said. “A friend of mine suggested that I try a midwife, and when I met with Pam, I felt like it was a less clinical environment. She was more one-on-one with me and made the whole process a lot less stressful.”

Oberholtz said although she has only given birth through midwifery, and thus can’t compare it with traditional methods based on personal experience, she has traded notes with her sister-in-law, who had recently delivered.

“My sister-in-law had her monthly appointments with three doctors, whereas I always knew that I would see Pam and she would be the one in the delivery room with me,” Oberholtz said. “If a person meets with a same person regularly, there is a less of a chance of communication breakdown, and when you get to the delivery, you feel like you have friend in the room with you.”

Jach said she currently sees 13 to 20 patients a day, and she can’t imagine not being involved in the lives of those she serves.

“They just touch my heart,” she said. “Being a part of one of the most important parts of a woman’s life is an incredible thing to be a witness to, and you want it to be as special and memorable for them as it can be, which means taking that extra time with the patient.”

Gehlsen said the relationship that develops between women and midwives is unique, and that the patients at Midwife Services of Iowa Health-Des Moines like knowing that they are not only getting the benefits of the philosophy and care provided by midwives, but also access to the resources of the hospital.

“We have a team of several physicians who serve as consultants if there is crisis,” Gehlsen said, adding that “less than 1 percent of patients are transferred to physicians after becoming an established patient of Jach or Fey.” One reason for the low rate of physician assistance is that patients are screened early in the process, with those with high-risk pregnancies being referred to traditional care.

Jach said midwifery is for the “normal” pregnancy, and if her patients develop complications, she refers them to physicians whom she has worked with as consultants. Jach said she and Fey always deliver babies within a hospital, as do 80 percent of midwives nationwide.

“Everybody likes that assurance, just as I like to have that oxygen behind the wall, the suction equipment, but if you don’t need them, you keep that cupboard closed,” Jac said.

Gehlsen said she sees the growth of the midwifery clinic as a success story for everyone involved, and also for the broader issue of women’s health.

“I’m passionate about women’s health and trying to make sure that women have options for their care during their pregnancy and childbirth,” she said. “I think there’s a place for everybody’s preferences here at Iowa Health, and that’s important for everyone to have a choice in their care.”

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