Hartford HealthCare Podcast
The Hartford HealthCare podcast covers a wider range of topics on health, wellbeing and career opportunities within the healthcare industry.
Hartford HealthCare Podcast
Midwifery: Back to the basics of birthing
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Sarah Najamy is a certified nurse midwife with Circle of Life Midwifery in Shelton, Connecticut, and helped to design the one-of-a-kind midwifery birthing program at Hartford HealthCare’s St. Vincent’s Medical Center in Bridgeport, Connecticut.
Related links:
Read or listen! Protect Breastfeeding: A Shared Responsibility
Watch! Meet Sarah Najamy and tour the midwifery suites at St. Vincent's Medical Center
The birth of midwifery, I think we could go back to ancient times because all the pictures you see, the majority of them are women with women. The word midwife means with women. So this has all been evolving over hundreds of years, but women have always attended women in birth. I mean, this is what we do.
SPEAKER_03Welcome to More Life. Our guest today is Sarah Nadamy. Sarah is a certified nurse midwife with Circle of Life Midwifery in Shelton, Connecticut, and helped to design the one-of-a-kind midwifery birthing center at Hartford Healthcare's St. Vincent's Medical Center in Bridgeport, Connecticut. Welcome, Sarah, and thanks for joining us. Thank you for having me. Now, first, can you tell us a bit about yourself?
SPEAKER_02I have been a certified nurse midwife, certified by the American College of Nurse Midwifery since 1987. I entered OB as an LPN and then went on to become an RN, which uh you do have to be in the United States to be a midwife and graduated as an RN, went to work in several area hospitals and labor and delivery, and gained the experience I needed to then go on to midwifery school and have been in private practice ever since.
SPEAKER_03Great, and that's how our paths crossed. I work at St. Vincent's Medical Center and uh yeah, and we have a wonderful midwifery program there, which I'm so anxious to tell people about and let you describe. But first I want to get into a little bit more about you and your training. There are different certifications for midwives, which, if any, have received medical training.
SPEAKER_02The certified nurse midwives that are certified by the American College of Nurse Midwives have all been certified. Now, and again, that started, midwifery began a slow rebirth in the United States in the form of nurse midwifery when the Frontier School of Midwifery started in a rural county in Kentucky in 1925. Before that, there have always been midwives for hundreds of years, but they weren't really organized or certified. The American College of Nurse Midwives have been certifying us for many, many years. Now there are other types of midwives. There are CPMs and they're called certified professional midwives. I'm not 100% clear on where they get their training. They don't go to medical school like we do, they don't have to BRNs like we do, but midwifery itself has been around for hundreds of years.
SPEAKER_03That's right. And and it's really evolved over the centuries. Do you know the birth of midwifery?
SPEAKER_02Well, the birth of midwifery, I I think we could go back to ancient times because all the pictures you see, the majority of them are women with women. The word midwife means with women. So women have always assisted women in birthing their babies. Docs weren't always involved. The midwives knew what to do. This is a very interesting turn of events because at some point in our history, uh, midwives took quite a beating and got pushed under by the medical profession, and then now we're back and we're certified, so we're part of the medical profession.
SPEAKER_03Yeah, and so midwifery kind of started to fall out of favor, you know, with the growth of births in the clinical setting. Would that be right?
SPEAKER_02I I guess so. It was in the 30s and 40s that that men started to um take over obstetrics and kind of push the midwife to the side. So it's a hard one to call, and it depends on what part of the world you're looking at, because in parts of Europe, midwives are still the main providers and docs are only there for emergencies. So this this has all been evolving over hundreds of years, but women have always attended women in birth. I mean, this is what we do. You know, women know how to have babies, and other women being with women is a pretty natural thing to do.
SPEAKER_03Certainly makes sense. And it's just so exciting to see its growth and popularity, and like you said, the evolution of midwifery where there are even more options today than ever before.
SPEAKER_02I believe there is in Connecticut. We have probably somewhere in the vicinity of 110 certified nurse midwives. I may be off on that number in a few, but around there, and we're in all types of settings. Some women, uh some midwives, I shouldn't say just women because there are male midwives, do just the clinical settings, and then there's some of us that are in private practice that are strictly midwifery only. Our practice is midwifery only. We only call the docs in when there's a problem, and then others are part of a larger group that include midwives and doctors. So you have quite the varied setting here in Connecticut.
SPEAKER_03So, Sarah, let's say I'm a prospective patient. When might I come to you? It's not just for childbirth. Can you give us a scope and an overview of what a midwife can provide for a woman throughout the course of her life?
SPEAKER_02Starting from the time they're early teens, midwives can provide gynecologic and obstetrical care right up through women in their 80s. I have patients that are in their 80s that I've seen most of their lives. We can see practically anyone. If they're too complicated for us or they have some medical issues, we'll of course we'll call in our docs, but for the most part, midwives can see anyone for any part of their transition from teenagers through menopause and beyond.
SPEAKER_03And do you find that most of your patients do seek you out in the teenage years, or do they typically come to discover midwifery for the purpose of birthing?
SPEAKER_02I think that we have a good cross. I've been in the area for a very long time. I went into private practice in 1987, fresh out of midwifery school. So I have a very good following. So a lot of the it depends on what we're talking about, but a lot of the kids that I've taken care of or that I birthed are now my patients.
SPEAKER_03Wow.
SPEAKER_02So they've known me most of their lives. For instance, I birthed a woman on Friday night who's been a patient of mine since she was born. I birthed her mother. I birthed her. I didn't birth her, her mother did, but I was there as the midwife. Yes. And that's happened to me, unfortunately. I'm pretty old. So that's happened to me quite a bit in the last few years. I would say that in the past uh four or five years, I've probably birthed a minimum of 20 to 30 babies that I actually helped birth.
SPEAKER_03Yeah. Sarah, do you have an overall count on how many babies you've helped to birth?
SPEAKER_02Yes, somewhere in the vicinity of about 5,000.
SPEAKER_03Um that's impressive. So um I've I've interviewed you before, and I remember um one thing that stood out to me when I was first learning about midwifery was that you really stressed it's uh midwife birth. We're talking about birthing now. It's not for everybody, not everyone is a good candidate. So tell us about it.
SPEAKER_02Yeah, so we you know, there are limitations of what we can do. You know, we're not in a position to be taking care of high-risk patients that, for instance, someone who's already a diabetic, that's not a good fit. If you become diabetic while you're pregnant and we can keep you diet controlled and keep you pretty healthy, yes, we have a big accent in our practice on good health. So that that part's not going to go anywhere. But if you have chronic hypertension and you're hypertensive before birth, you're probably not a mid-working candidate. Okay. You know, so you really have to look at is there any underlying conditions. And if there are, you know, you may not be a candidate. We do what we call free meet and greets in our office, and we do them quite regularly, where people have, you know, they come to us at any point in pregnancy, up to about halfway through, and they want to know if they're a candidate for midwifery care. And we'll sit down and go over all of their wishes and desires and some things we can handle, and there's other things that we don't. And we are tell our patients honestly, we have a perfectly honest conversation about their individual risk factors, and we go from there.
SPEAKER_03Okay. Now, for those who are good candidates, can you give us in a nutshell what a midwife delivery is like? Are the majority of yours done at home or in the hospital setting?
SPEAKER_02We're in a hospital setting, all of them. We don't do any home birth anymore. Our malpractice insurance carrier doesn't allow us to do that. Okay. So we're strictly out of St. Vincent's and we have started 11, it'll be 12 years this December, a birth center inside of St. Vincent's Hospital. We're the only in-house birthing center in Connecticut.
SPEAKER_03Okay. Can I just say this? Uh everybody just needs to go to the website. I will um post links in the notes to this episode. Sarah, it's just such a beautiful setting. And you have that home, it it provides for that home birth experience, very natural, very, you know, beautifully decorated suites and rooms that can accommodate a whole family. But right through the doors is that hospital setting, should you need intervention. Yeah.
SPEAKER_02And the reason I again I did that, call a Kate, who is since retired, and I designed the suite.
SPEAKER_03It's beautiful.
SPEAKER_02And we did that in with the help of our midwifery director, Dan Gotchall.
SPEAKER_03Yes, Dr. Dan Gotchall, who is our vice president of medical affairs and is an obstetrician by trade as well.
SPEAKER_02That's right, OBGYN, correct?
SPEAKER_03Right.
SPEAKER_02So Dan and I started this birth center because we saw the demand. We put the rooms together with the family room. We just did it right. We did it right. It's a beautiful place. It's designed for low-risk, healthy women. We don't use monitors back there. We listen to the baby's heartbeat with a Doppler. So patients have to be comfortable with that. They sign consents, understanding what's expected of them and us during their prenatal course. And it is designed for active labor. So the woman does some of her labor at home, and then we meet them in the front of the hospital when they're ready to come in. And we bring them up to the birth center, and then we take care of them for the rest of the labor in the birth. The birth center is comprised of suites that are almost 400 square feet each. They're pretty big with their own private showers and tubs, clean-sized beds, regular linen. Women can wear their own clothes, bring whatever they need to feel comfortable, and we labor there until the baby's born. And then we have several different programs for afterwards. They can stay as little as 12 hours up to 48 hours. And if they decide they're going to stay in the hospital, we will transfer them to a postpartum room, which are private rooms at St. Vincent's with their partners, of course, and then they can stay in um the hospital for 24 hours, 36 hours, 48 hours. With our early discharge program, if the mom wants to go home before the 12-hour mark, we up until COVID, we're doing home visits so that we can do the rest of the baby's testing at the parents' house. COVID has sort of messed us all up a little bit, and eventually we'll get there and get back to it. But yes.
SPEAKER_03But that's an interesting point. And again, pre-COVID, but the midwife cares for the mother and baby.
SPEAKER_02We can. We have privileges at St. Vincent's for both the mother and baby.
SPEAKER_03That's wonderful. That's wonderful.
SPEAKER_02We are trained to take care of babies up until they're a year old. In certain parts of the United States, midwives are the only option for obstetrical care. So they have to know both sides, where obstetricians don't get that.
SPEAKER_03So, Sarah, um, during a delivery, hopefully everything just goes swimmingly and as planned, but occasionally you might need to transfer from the midwifery suites right through again, like you said, those double doors into a more clinical setting. What might trigger that?
SPEAKER_02It could be a variety of things for the baby or for the mother. So let's talk about the mother, for instance. All of a sudden her temperature goes up. Uh, that would be a cause for uh transfer because we'd have to do bloods, find out why her temp is up. It could be her blood pressure. If her blood pressure goes sky high, you're not a candidate for birthing in a birthing center. So those are some of the mama issues. The other issues would be we're listening to the heartbeat with a Doppler, we hear a deceleration after a contraction or during a contraction. That may not be normal in this case. That may need further monitoring, we may need to walk over. If the mom water breaks and there's meconium, which means the baby literally pooped inside of her, uh, we need to be in a setting where a pediatrician can see the baby, so we would transfer and walk over to the other side. So there's a variety of reasons why we might have to go to the other side to get that stuff taken care of. Okay.
SPEAKER_03It's just such a wonderful option. And the patients I've had the privilege of interviewing as well, and their experiences and some who have traveled far and wide to come back and have a second and third. Yeah.
SPEAKER_02Yep. Yeah. We do, um, as a matter of fact, we've had patients as far as New York City, Hoboken, New Jersey, that have come to us because they couldn't get the care that they needed on other places. Yes, that's correct.
SPEAKER_03That's right. And what greater testament is there that you'd want to come back and and have that experience again? Is this correct? That I don't know with COVID now, but it can be a family experience if they want to.
SPEAKER_02We had many families that brought the siblings and the grandparents and all that. But you know, COVID has changed us in the respect that now unfortunately we can't let children in at first because right now children are the ones that we're most concerned about.
SPEAKER_03Right.
SPEAKER_02Um, you know, they're allowed to bring their doulas if they have a doula and the doula's been COVID-tested every week, like the mom is COVID tested every week in our office. Um, we're trying to be as flexible as possible given the the mandates. Of course. We have to work inside of those.
SPEAKER_03Of course you do. So what about postpartum care? Then the mom and baby go home and your care continues with that new mom and baby.
SPEAKER_02Yeah, let's use a mom that's dated only 24 hours. So mom stays 24 hours with us. She goes home. We see them every day that they're in the hospital. We see our own patients, we take care of our own families. She goes home the next day, she'll get a phone call from us. The first week that she's home, she'll get anywhere from three to four phone calls from us, depending on what's going on inside that home. So that's like super terrific. And then if there's any issues, we one of us, uh Mary Jane Greenwood, is a certified laxation consultant. If there's any issues with breastfeeding or whatever, we have them come back to our office.
SPEAKER_01Good.
SPEAKER_02Uh we have a really beautiful quiet room uh that's really safe for the mother and the baby, and Mary Jane can assess them and see what's going on with um their breastfeeding issues.
SPEAKER_03It's so important. I found one of the hardest parts of having a baby was breastfeeding and the struggles that come with that. It's so important to have that support. We're always available.
SPEAKER_02Yeah. We're always available to talk to, and that's the beauty of us. That's wonderful. So we stay in very close touch, and then we see them at two weeks and at six weeks postpartum. And anytime they call our office, you know, we work, we call them back well within the hour if they need any issues. And then we have, you know, there's a lot of postpartum doulas out there. So if they are in a place where they really need support, we can get that too.
SPEAKER_03So, Sarah, prior to the birth, what kind of education is available to this new mom to be?
SPEAKER_02So if it's a first-time mother, it is required if you're going to birth in our birth center that you have to go to a childbirth education class that we're familiar with. So we have a list of people that we work very close with in the area all over Fairfield County, no matter where she lives, they are on Zoom now. So it's not really hard to get these classes. And we talk a lot about, like in every visit, about relaxation and what are they doing to learn how to relax in order to give birth? Because a lot of it is about letting go. So there's a lot of preparation ahead of time. We talk a lot about breastfeeding. There are free Zoom classes. We encourage them to do that. Your pediatrician has to be picked out. So, you know, they're not going into this without any education. They have to, in order to birth in a birth center, um, and you're wanting not to have any medication, you have to be totally unequivocally prepared.
SPEAKER_03So getting back to the natural birth experience, Sarah, um, someone who chooses this route is choosing to give birth without, basically without an epidural, which is the standard procedure.
SPEAKER_02Not everybody gets an epidural, not everybody wants an epidural, but if you want an epidural, you've got to go to labor and delivery for your epidural.
SPEAKER_03Okay, so a midwife birth is is you're going in expecting it to be completely natural without an epidural.
SPEAKER_02Right. We have showers, we have tubs, we have nitrous oxide, we have relaxation techniques, which the mom should have been practicing through her whole pregnancy, so she's prepared for it, and most of them are. Um, but if a mom decides that she doesn't want to do this, it was more than she thought was possible, then we can walk over to the other side and get enough girl. Okay. And that's we would never deny anyone pain med, but we don't use pain medication other than nitrous in the birth center.
SPEAKER_03That's good. So if for whatever reason the pain gets intolerable and somebody has a a change of of mind on what they can handle, that option is there for them. That's right. So if that's the case, then are you handing them off to labor and delivery or do you stay with that patient?
SPEAKER_02We stay with the patient and follow it through to the end. Absolutely. Oh, that's great. You know, we're we're all about wherever she ends up is fine with us as long as she's comfortable. And everybody is safe.
SPEAKER_03So whether you're interested in exploring um some midwifery options for childbirth or as we discussed earlier, your overall care from adolescence throughout your life. That's right. How does someone go about contacting you, Sarah?
SPEAKER_02They can call Circle for Life Midwifery 203-944-0264. We're at two Trap Falls Roads, Shelkin, Connecticut. We return all of our calls very quickly. And we can start the conversation on the phone or they can come in for a free meet and greet, which is 30 minutes free with a midwife, to discuss what is a good plan for them.
SPEAKER_03And again, we'll post all the links and the phone number and all the relevant information that you're gonna need in the show notes for this episode. And Sarah, I just can't say enough about what you've done at St. Vincent's, what you've helped to create there, and what a what a beautiful setting it is to start life and and have that just an amazing experience. Yeah.
SPEAKER_02It is, it's an amazing experience all the way around. I agree. And I'm very appreciative of St. Vincent's and all the support we have had over the years for the midwifery program. So this is this is Ben's firm.
SPEAKER_03Well, we're very proud of you and and grateful for all that you do. Thank you so much. You're welcome. Learn more about St. Vincent's Midwifery services at St. Vincent's dot org. And you can learn more about Sarah and Jamie and her team at circle of life midwifery.com. Be sure to check the links in this episode's notes, including a must-listen episode of More Life All About Breastfeeding. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_00I'm ready for my go to the house.