Emalie Gibbons Baker, CNM, arrives at St Mary’s Hospital at 7 a.m. Half an hour later she is scrubbed in, first assisting a community OB/GYN who performs a repeat cesarean delivery. By 9 a.m., the baby is safely delivered and resting with his mom, and the physician is seeing patients in her private practice a few miles from the hospital.
Now Baker cares for a nervous first-time mother in labor, sitting close to her bed and softly encouraging her through each contraction, praising her efforts when each pain subsides. She steps out to monitor an outpatient who has arrived for a labor check, performs a sterile speculum exam, and confirms the well-being of the fetus. Then reviews the signs of labor with the expectant mother, gives her a pep talk and a hug, and discharges her.
This is a typical start to a busy day for Baker, a certified nurse-midwife (CNM) laborist at St. Mary’s Hospital in Leonardtown, Md. CNM laborists like Baker work cooperatively with their collaborating physicians and midwife colleagues in the ambulatory setting and in the hospital, leaving their colleagues with time to care for high-risk women in the hospital and to hold office hours in their private practices.
Like most CNM laborists, Baker provides care during labor and the post-partum period for pregnant women and new mothers in the hospital setting. She oversees labor induction, augmentation, and pain management, including epidurals, for patients on the ward, works with the nursing staff, provides hands-on care for patients, provides first assists in cesarean deliveries, and evaluates pregnant patients who present to the emergency department (ED). When a new need arises, Baker can often provide the necessary service, and the list continues to grow as she adds circumcisions and interpretation of fetal fibronectin results to her responsibilities.
Skilled Laborers
Certified nurse-midwives are a valuable addition to the field of hospital-based healthcare. The approximately 7,000 practicing certified nurse-midwives in the United States delivered more than 310,000 babies in 2003, representing more than 10% of the vaginal deliveries in this country.
Many people are unaware that 98% of CNM-attended deliveries in the United States occur in a hospital. Certified nurse-midwives are qualified professionals who have graduated from an accredited university-based program and passed a national certification exam. Baker, like all CNMs, is a registered nurse. She earned her master’s degree in midwifery in 1994 at State University of New York Downstate University, one of 40 midwifery education programs in the United States.
Certified nurse-midwives practice in a variety of settings, including hospital and office-based practices, community health centers, and public health facilities. CNMs are licensed in all 50 states. They are reimbursed by Medicare, are Medicaid-mandated service providers, and are widely included in managed care provider listings. CNMs are experts in the management of normal birth. Studies have demonstrated that the outcomes of nurse-midwifery care are at least equivalent to those of patients managed by physicians for normal maternity care, and patients repeatedly indicate high levels of satisfaction with the care provided by nurse-midwives.
“Having [Baker] at the hospital has been a big selling point for patients. She helps by massaging the patients who are anxious or need things explained to them. I think this provides the patients with a sense of security, and they also appreciate that this is a unique and different service we provide here,” says Valinda Nwadike, MD, an OB/GYN at St. Mary’s County who previously worked with nurse-midwives in a large urban hospital in Washington, D.C. “All in all, having [Baker] on board as a CNM laborist means better patient interaction and increased quality and continuity of care. It is a very useful tool, one that improves both patient care and our quality of life as community physicians. It’s a win-win situation.”