Nurse-Midwife Model of Care

Nurse-Midwife Model of CareOur Certified Nurse-Midwives are advanced practice nurses educated in the two

disciplines of nursing and midwifery. They have earned a master’s degree from an

educational institute accredited by the American College of Nurse-Midwives and

have also passed a national certification examination.

Nurse-midwives are particularly suited to caring for healthy, low risk women across

their lifespan. They offer a full range of individualized health care services including:

• Prenatal care

• Labor & delivery care

• Care after birth

• Disease prevention

• Family planning assistance

• Gynecological exams

• Health maintenance counseling

• Menopausal management

• Preconception care

Nurse-midwifery focuses on wellness and the philosophy that pregnancy and

birth are normal processes and not an illness. Certified Nurse-Midwives are skilled

at using alternative birthing positions, birthing balls, hydrotherapy, and massage.

Their supportive presence during labor allows them to utilize and encourage these

alternatives with women. Nurse-midwifery care is both a safe and satisfying option

for women

Atrium nurse midwives have privileges at Aultman Hospital and Mercy Medical

Center. They work in close collaboration with our physicians who are readily

available should the need arise for physician services. The physician and certified

nurse-midwives are available 24 hours a day to attend to patients in labor and for

any and all emergencies.

Atrium OB/Gyn offers the

option of nurse-midwifery

care for our patients.

Possibly one of the best-known

features of nurse-midwifery is

the commitment to facilitating

uncomplicated pregnancy and

delivery.

Nurse/Midwife 2

Labor Support Provided by Nurse-Midwives The nurse-midwife is present during the active phase of labor to assist the patient in

remaining calm and focused while laboring. The nurse-midwife’s focus is on helping

the patient achieve the type of birth experience she wants, safely and peacefully.

Each mother is unique and her birthing experience is tailored to her family’s needs.

Some families welcome the baby into a quiet room with soft classical music playing,

while other babies come into a room erupting with shouts of joy and clapping to

be heard down the halls. There is so much more to a birth than the hospital room

and machines. Nurse-midwives are there to help the patient navigate the various

birthing options and to support her choices during labor and delivery.

The nurse-midwife is also skilled in providing non-medicated methods of pain relief

during labor support. Some natural pain control methods include:

• Counter pressure

• Applying hot or cold compresses

• Changing positions/ walking

• Pelvic Tilting

• Pelvic Squeezing

• Hypnobirthing

• Massage

• Music

• Birthing ball

• Showers/ Tubs

• Scents

In addition to these methods, the nurse-midwife can administer IV pain medications

or epidural. In these instances it is not uncommon for the nurse-midwife to step out

of the labor room once the patient is comfortable to allow her to rest, if she desires.

The nurse-midwife is still available for labor support.

Resources for Midwife PatientsThe resources listed on the next page are for information purposes only. Listing

does not imply endorsement by Atrium OB/Gyn, Inc. We do not endorse any

commercial products that may be advertised or available from these organizations

or on these web sites. The list is not meant to be comprehensive and exclusion of a

source or web site does not reflect the quality of that source or web site.

Nurse/Midwife 3

WebsitesCHILDBIRTH

www.midwife.org

www.lamaze.org

www.childbirthconnection.org

www.givingbirthnaturally.com

www.hypnobirthing.com

www.hypnobabies.com

www.optimalfetalpositioning.com

www.spinningbabies.com

PRENATAL YOGA

www.yogastrongstudio.com

www.theyogaplaceohio.com

www.yogaglo.com

BooksThe Yoga Birth Method by Dorothy Guerra

New Mother’s Guide to Breastfeeding, 2nd edition by American Academy of Ped., Joan Younger Meeker

The Nursing Mother’s Companion, 6th edition by Kathleen Huggins

The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solution Guide to Breastfeeding from the Foremost Expert in North America by Jack Newman & Teresa Pitman

Spiritual Midwifery by Ina May Gaskin

Birth Matters: A Midwife’s Manifesta

by Ina May Gaskin

This list is updated

periodically, however,

web sites and URLs

are subject to change

without notice.

Nurse/Midwife 4

Please print this worksheet and fill it out.

Name: __________________________________________________________________________________________

My obstetrician/midwife: ___________________________________________________________________________

Tell us about yourself: _____________________________________________________________________________

________________________________________________________________________________________________

Support people: __________________________________________________________________________________

Concerns: _______________________________________________________________________________________

________________________________________________________________________________________________

Labor Options: Environment:

• Soft lighting• Music• Pictures • Other

Position Changes: • Move around for comfort• Walk• Squatting positions• Other _____________________________________

Comfort Techniques:• Shower or bath• Heat/cold• Breathing• Continuous support

Labor support:Helpful things to say and do for me: ___________________________________________________________________

________________________________________________________________________________________________

Classes attended: _________________________________________________________________________________

Medical interventions during labor: ___________________________________________________________________

Pain control wishes: _______________________________________________________________________________

After my baby is born

My pediatrician: _______________________________________________________________________________

Feeding method: ______________________________________________________________________________

I plan to record my birth process using: Camera___ Video camera ___ None___

Going HomeSpecial concerns or educational needs: ________________________________________________________________

Labor Preference Worksheet

Breastfeeding andSkin-to-Skin

Skin-to-Skin CareSkin-to-Skin Care makes your baby feel safe:

• Stabilizes baby’s temperature and vital signs.

• Causes baby to be comforted, feel calmer and cry less.

• Promotes feelings of closeness and protectiveness

• Allows your baby to adjust to the outside world from the safeness of his mother’s arms.

• In the upcoming days, when your baby is fussy, skin-to-skin care will help calm him. If baby is too sleepy to nurse, this will stimulate and arouse him to breastfeed.

• Babies are calmer and cry less when they are in skin-to-skin care. When babies are placed skin-to-skin, they warm up better and learn to stay warm faster.

• Skin-to-skin helps baby’s respirations, heart rate, and blood sugar stay normal and their oxygen levels are highest when held skin-to-skin.

• Stimulates milk production.

• Causes your uterus to contract and bleed less.

• Provides the best opportunity to get breastfeeding off to a good start

Skin-to-Skin Care benefits breastfeeding by:

• Baby has more opportunity to feed and gain weight better.

• Baby is more aroused to feed.

• Baby breastfeeds better and longer overall.

What is Skin-to-Skin Care?

Simply put, your unwrapped

baby will be placed tummy-

down on your chest under

a blanket. Holding your

baby for the first time is an

experience that no one can

prepare you for.

Breastfeeding and Skin-to-Skin 2

Skin-to-Skin Care benefits mothers by:

• The movement of your baby’s body on your body stimulates hormones that cause your uterus to contract and bleed less.

• Being skin-to-skin helps lower your stress, and makes you feel closer to your baby. This is a great time for both of you to get to know one another. The bonding that takes place during skin-to-skin time lasts long after birth.

Skin-to-Skin Care promotes bonding:

• Dad can do skin-to-skin too! Although Dad cannot breastfeed, the baby knows the sound of Dad’s voice.

• Even after the first few hours of skin-to-skin time, continue to place your baby skin-to-skin over the next several days. If baby is fussy, this will help calm him. If baby is too sleepy to nurse, this will stimulate and arouse him to breastfeed.

• Skin-to-skin time continues to help make baby warm and comforted. It also continues to help make breastfeeding a successful and enjoyable experience.

Benefits of Breastfeeding For Baby:

• Easily digested

• Perfectly matched nutrition

• May have protective effect against SIDS

• Less gastrointestinal disturbances, ear infections and allergies

• Stimulates senses of taste and smell

• Filled with antibodies that protect against infection

• Skin-to-skin, eye and voice contact

For Mother:

• Convenient

• Economical

• Helps the uterus return to its normal size faster

• Helpful with weight loss

• Reduces the risk of osteoporosis

• Less likely to develop uterine, endometrial or ovarian cancer

• Reduces the risk of breast cancer

For Both Baby and Mother

• Contributes to a very special and loving relationship

• A beautiful and intimate way for a mother to bond with her baby

More Information: www.ameda.com/breastfeeding/benefits

To Review:Skin-to-skin contact immediately after birth has these positive effects on a newborn:

• Stable and normal skin temperature

• Stable and normal heart rate and blood pressure.

• Stable blood sugar.

In addition, the baby will:

• Cry less.

• Latch-on the breast better.

• Exclusively breastfeed longer.

Breastfeeding and Skin-to-Skin 3

Baby’s Stomach Size A newborn baby’s stomach is small (about the size of a marble) and holds 5-7 ml for

the first few days of life. The mother’s colostrum is exactly what the baby needs for

nutrition. At 7 days, the baby’s stomach increases to the size of a ping pong ball and

gradually increases to the size of an egg by 2 weeks of life. The mother’s body will

produce milk on supply and demand. As the baby experiences growth spurts, the

mother’s milk will increase to keep up with the needs of the infant.

Engorgement may occur three to four days postpartum. Your breast may become

heavy or swollen due to engorgement. This usually decreases in 24 to 48 hours.

Some effective treatments for engorgement:

• Breastfeed frequently.

• Apply warm compresses 5 minutes prior to breastfeeding.

• Manually express or pump out milk to soften the areola and nipple. The baby may not be able to latch on if the breast is too hard.

• Apply cold compresses to breasts for 20 minutes after nursing to relieve the swelling.

• Wear a sleep bra even at night but make sure it is not too tight.

Breastfeeding Positions information: www.babycenter.com/breastfeeding

How to Know Your Baby is Getting Enough Breast Milk• The first or second day after birth your baby may have one or two wet diapers.

Around the seventh day, your baby should have at least six to eight wet diapers daily.

• Your baby should pass meconium, the greenish-black tarry first stools, the first few days. About the third day your baby should have two to five or more daily yellow, unformed bowel movements.

• Your baby may lose up to 10% of his/her birth weight during the first three or four days of life. Once your milk supply increases, expect your baby to gain at least four to seven ounces per week or at least a pound a month. Count weight gain from the lowest weight on the third or fourth day of life, not from birth weight.

• Your baby will nurse about every one and one-half to three hours, averaging about 8 to 12 times in 24 hours.

• Once your mature milk has come in, your breasts will feel fuller before you feed and softer after you feed.

• Your baby will appear healthy, alert and active. His/her color will be good, skin will be firm, and he/she will be filling out and growing in length and head circumference.

Breastfeeding at NightBabies were designed to wake up often at night to feed and cuddle. Most babies do NOT sleep through the night and should NOT sleep through the night without feeding.

A newborn’s stomach is very small and breastmilk is easily digested in approximately 90 minutes. Infants consume about one-third of their daily calories at night.

One research study showed that babies nurse more frequently around 3 to 6 a.m. when prolactin levels are highest. Frequent nursing at night does not indicate the baby is not getting adequate milk supply. Babies like to suck for reasons other than hunger, since sucking is a stress-relieving reflex.

Breastfed babies experience more frequent arousals during sleep, decreasing the risk of SIDS.

Nursing a baby through the night will help a mother increase and maintain her milk supply and increase the likelihood of successful breastfeeding.

Breastfeeding and Skin-to-Skin 4

Signs of Hunger

• Rooting: Baby uses his mouth to search for food

• Sucking motions, licking hands, smacking lips

• Baby starts moving his arms and legs more

• Tense and tight fists, often putting them to the mouth

• Crying is the last sign. If a baby waits too long he becomes frantic and cries

Signs that baby is getting enough milk while breastfeeding

• Mom hears the baby swallowing

• Baby shifting gears, changing from short, firm sucks to slow rhythmic sucks

• Hunger cues are gone

• Poster/affect, drowsy. Baby is relaxed and in a state of bliss

• Sleeping with nipple left in the mouth. Often babies fall asleep at feeding and a sleeping baby is a contented baby

Breastfeeding ResourcesThe Breastfeeding Center 330-837-0220 www.thebreastfeedingcenter.com

Stark County Women Infants & Children www.cantonhealth.org

La Leche League of Ohio – Canton lllohio.org/groups/akroncanton.html

Mercy Maternity Services – Lactation Consultants www.cantonmercy.org/maternity-services

Aultman Lactation Consultants www.aultman.org/ourservices/centersofexcellence/aultmanbirthcenter/bclactationservices.aspx