Midwife Mecca: Reflections of a Physician Leader

“I don’t know what to DO with you, so I’m just going to treat you like a resident,” I hear the OB doc say to our newly minted midwife.

My toes curl and I am searching the white walls of the hospital for a rock to crawl under. The midwife is trying to hold onto her best poker face and fight back the tears from coming out. She knows that shedding a tear would admit defeat. I suddenly feel a bit sad for the fact that we had placed her in a facility that was devoid of midwifery for the past 15 years.

“I can do it,” she said proudly during her interview. “I know it will take time and we will have to move slow, but I am up to the challenge.”

She wanted to pioneer. She saw the potential.

To be completely honest, we had already made huge amounts of progress at this little hospital down South. The first time I had gone down to the hospital to discuss the possibility of introducing midwifery had been six months prior. I literally left that meeting with tomato juice stains all over my dress. Good thing I have an excellent dry cleaner.

I went down to that place eight separate times – yes, EIGHT – before I had enough buy-in to introduce the group to our Midwife Director. She has such a nice touch and she really knows how to talk to the docs and put them at ease.

We finally had the green-light, we could bring one midwife into the group.

So you may ask… Why would we do that? Why would we “force” this model of care?

The answer is simple: our patients. They were screaming for it from the tops of the mountains demanding this model of care. Our Midwife Mecca at our flagship hospital was overflowing with so much volume that patients were delivering in the hallways and on the beds of our provider lounges. The patients were (and still are) driving in from far off places to deliver in our hospital. We needed to find a way to decompress our unit and expansion of midwifery into other markets was just one of many tactics.

But, we realized very quickly that expansion of the midwifery models of care required much more than just embedding a midwife provider in a new region. Yes. She was ready to pioneer. But, she couldn’t do it alone and she needed tools and influence along the way. Culture change takes years.

My Midwife Director’s favorite tools are the Pearls of Midwifery. She opens the chest and brings one out – “Skin-to-skin” – let’s start here. So, we did. Nursing education. Provider education. Stroking. Humming. Talking. Chatting. Reviewing. We can happily say that the “skin-to-skin” movement is well on it’s way. We’re even doing it in the operating room at some of the facilities.

If my Midwife Director is all the screws to help the midwife movement stick together, I’m the hammer that sinks those screws in deeper. The self-proclaimed Midwife Champion. Why? Because I believe in it. Yes, OB docs, this is not going to go away. The train has left the station and we are laying tracks as quickly as we can put them down. Hop on the caboose and get shimmying, otherwise no train is going to stop in your station.

So back to our OB doc calling the midwife a resident. Hospitals don’t usually have rocks in the hallways, so I really had no place to hide. I had to confront this one head-on. See, the OB doc doesn’t even realize that he said something offensive. In his mind, it is a complement. He’s basically equating the midwife to a junior doctor, or “mini-doc”.

But see, here in lies the disconnect.

They are not junior doctors. They are midwives. They are advance practice clinicians. Their training is different. Their focus is different. Their scope is different. They are a complement to us OB providers. They are our partners in care. They didn’t become doctors for a reason, because they wanted to be midwives. So, let’s show them the respect where respect is due. Let’s maximize the patient experience in a team-based approach to care. Let’s focus on the things we are good at.

*****

 Ring-Ring

 “Midwife Champion here,” I said answering my cell phone.

“Hi, Midwife Champion, this is the medical director from the hospital down South,” she said. “So, things are going well with Pioneer Midwife. We would like to request two more midwives for our group.”

Priceless.

Disclaimer: All medical leadership stories are fictionalized.