Cleveland Clinic Midwives Are Integrated With Ob/Gyn and Birthing Services

Since 1995, Cleveland Clinic midwives have been providing care for pregnant and laboring mothers. The program began with three nurse midwives developing a program that would grow to meet the needs of the greater Cleveland area. Twenty-five years later, 22 full-scope midwives and many advanced practice providers offer care for women in pregnancy and childbirth and throughout their lives.

“I think recognizing the value nurse midwives bring in caring for families helped grow the advanced practice nursing (APN) department at Cleveland Clinic,” says Niki Pearce, CNM, the coordinator for Cleveland Clinic’s eastside midwife service. “We are equals with a strong voice in patient care.”

Today, the Midwife Program, under the direction of Sue Hudson, CNM, oversees the births of about 15% of all deliveries at Cleveland Clinic. She says women seek out midwives when they are interested in a natural, unmedicated birth, or because they like the midwife philosophy that pregnancy and childbirth are life events that need nurturing.

Cleveland Clinic’s certified nurse midwives (CNMs) are registered nurses with a master’s degree in nursing and a minimum of two years advanced education in caring for women throughout the lifespan, including antepartum, peripartum and postpartum. Today, nurse midwives are an integral part of its Ob/Gyn & Women’s Health Institute. They have privileges to deliver babies at Cleveland Clinic’s three birthing hospitals, they can provide first- and second-degree repairs for tearing during births, and they can write prescriptions. And when new female patients are scheduling their annual Pap checkup, often the nurse midwives become their Ob/Gyn providers.

“I find there is still a lot of uncertainty about nurse midwives,” says Jenny Ceccardi, CNM, from Cleveland Clinic Hillcrest Hospital. “When I meet women for the first time to do an annual checkup and they learn I am a certified nurse midwife, this leads to a lot of questions about our services.”

Ceccardi explains that midwives are nurses first — that is, APNs who offer holistic care. “Birth is a life-changing and emotional event, and we are there to support moms,” she says. “We want to make the birthing experience the best it can be. Some mothers find it harder than expected, and we do our best to keep it from being traumatic. We are very interactive with moms as they give birth.”

Several years ago, Cleveland Clinic moved its birthing sites off of its main campus in downtown Cleveland and into two of its regional hospitals – one to the east of the city, Hillcrest Hospital, and the other to the west of the city, Fairview Hospital. This allows parents to have their babies closer to home in a suburban hospital. Since then, facilities have been renovated and upgraded. Expectant mothers with any compromising health concerns for mom or baby continue to have their deliveries scheduled at the high-risk birthing unit at Cleveland Clinic’s main campus.

Staffing and hospital amenities

For incoming moms, Cleveland Clinic’s Labor and Delivery teams are always staffed with two or three hospitalists, one laborist, one midwife, two resident physicians, and an anesthesiologist or nurse anesthetist. The midwives navigate care for their patients just like the obstetricians, by triaging patients, evaluating them, placing orders, admitting and discharging mom and baby. Safety rounds are performed, and the midwives and obstetricians discuss the progress of their mothers-to-be so the whole team is aware of which patients are onsite and where they are in the birthing process. At any time that delivery becomes compromised, for example, when the mother needs a C-section or when a problem with the baby or mother, one of the obstetricians is available for the delivery.

“The teamwork between our physicians and midwives is paramount to the health of moms and babies,” says Hudson. “We pride ourselves on that collaboration, and we work continuously to ensure that it is as robust as possible.”

The spacious and high-tech birthing rooms at Fairview and Hillcrest are equipped with seated showers, birthing tubs, birthing balls (both round and peanut shaped) and more. Ceccardi says when an expectant mother arrives at the hospital, the baby is monitored for 20 minutes to ensure everything is progressing normally. After that, the nurse midwives do intermittent monitoring of their patients, which allows expectant mothers to move around freely and to use the amenities as they wish. Midwives also encourage birthing mothers to have their babies in the position that is most natural for them. After the birth, babies stay in the room with moms to help mothers get used to their child and learn to breastfeed.

Ceccardi notes that some parents also hire a doula to be present throughout the birthing process, which adds another level of support for mothers. The mom’s partner is also part of the process, and the midwives help to educate them too. At Hillcrest, Ceccardi notes that the Labor and Delivery area sees a fair number of special situations such as those involving surrogate moms, older fathers and in vitro babies. “We meet moms and their partners where they are and customize our care to meet their needs,” she says. “Midwife means ‘with women,’” adds Pearce, “and to fill that role, we support women in their care decisions, making sure they are educated about the choices available to them.”

To prepare expectant mothers/couples for childbirth, breastfeeding and baby care, midwives promote classes offered by Childbirth Education, which is part of the Nursing Institute. Joyce Poplar, a perinatal educator/holistic practitioner in Labor and Delivery, offers hypno-birthing, Reiki, and mind/body/baby classes for moms who want to be more prepared and those planning a natural childbirth. “I see how much passion and empathy our midwives provide to moms. They create such a loving environment, starting at the prenatal visits,” Poplar says. Outpatient breastfeeding and postpartum support groups are also offered.

Cleveland Clinic midwives are on call in 24 hours shifts, just as the obstetricians are. “Being a midwife is such a rewarding career, as we are there helping families,” says Ceccardi. “We really get to know and bond with patients through this wonderful experience.”

According to Midwives Alliance of North America, there are around 15,000 midwives in the U.S. practicing in private homes, clinics, birth centers and hospitals, with about 10% of births attended by midwives.

2019 Midwifery STATS at Cleveland Clinic:

86.2% of births were vaginal births after a cesarean.

Cesarean birth rate was 10.6%.

47.5% of patients had an intact perineum and needed no repairs.

42.5% of patients went natural childbirth (i.e., no epidural).

The induction rate was 29%.

25% of patients were also attended by students.

The midwifery team helped birth 1,364 babies.