FARGO — Midwifery — an ancient health care practice dating back nearly four thousand years ago according to The Encyclopaedia Britannica —is experiencing a resurgence in the United States while the practice begins to slowly grow in the Midwest.

In fact, a 2018 study by PLOS, a San Francisco-based nonprofit, reported states that have done the most to integrate midwives into their health care systems (Washington, New Mexico and Oregon) have some of the best outcomes for mothers and babies.

However, North Dakota ranks low in this list with a score of 30 on the weighted Midwifery Integration Scoring System(MISS). This system with 50 items and a max score of 100 quantifies the potential impact on patient access to high-quality maternity care across birth settings. Minnesota sits in the middle of the list with a 50 MISS rating.

Levels of integration displayed by quartiles of MISS scores from PLOS' 2018 study. Deeper shades of purple represent higher integration and lighter shades represent lower integration of midwives. Figure courtesy of journals.plos.org.
Levels of integration displayed by quartiles of MISS scores from PLOS' 2018 study. Deeper shades of purple represent higher integration and lighter shades represent lower integration of midwives. Figure courtesy of journals.plos.org.

In the Red River Valley, midwives from established health care facilities and private practices say this holistic approach to a women's health can significantly impact the success of a person's major life cycles.

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"A midwife provides care for all women across their lifespan including teenage years and beyond menopause," said Women's Health Nurse Practitioner (WHNP) and Certified Nurse Midwife (CNM) Jennifer Janke at Essentia Health in Fargo. "I spend equal time during a clinic day providing preventative health evaluations, problem-focused visits, family planning, as well as pregnancy and postpartum care."

Despite being a practicing midwife for more than 16 years, Janke said many people still have misconceptions.

"From questions I get, I believe there are many myths out there," she said. "For example, people assume a midwife only provides care in pregnancy and labor. A midwife will not provide pain medication during labor, and is not as qualified as a physician for women's healthcare."

Janke says midwives can either provide primary medical care or collaborate with a woman's primary physician or specialty referrals as needed.

To combat misinformation, Janke highlights what midwives do and services they provide.

"Patients find that a midwife takes time to answer questions. A midwife will listen to your concerns and provide health information and resources," she said. "The rates of positive outcomes using a midwife are high, backed up by multiple studies done."

Jennifer Janke, women's health nurse practitioner and certified nurse midwife at Essentia Health, says her primary goal is to help women to achieve their own personal health goals. Submitted Photo / Special to On The Minds of Moms
Jennifer Janke, women's health nurse practitioner and certified nurse midwife at Essentia Health, says her primary goal is to help women to achieve their own personal health goals. Submitted Photo / Special to On The Minds of Moms

Midwives provide general check-ups, screenings, vaccinations, gynecological care services and diagnosis or treatment of sexually transmitted infections. They provide family planning, pregnancy care, labor and delivery as well as postpartum care and newborn care. They prescribe medications including all forms of birth control and can order tests and procedures as needed.

Christine Mehl, CPM and licensed midwife in Fargo, said most midwives follow "The Midwives Model of Care," a continuity of care practice that believes pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

  • Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;

  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support;

  • Minimizing technological interventions;

  • Identifying and referring women who require obstetrical attention.

Mehl serves about 24 clients a year in private practice.

"I am the sole midwife from the beginning of care through labor/birth and to six weeks' postpartum," Mehl said. "My prenatal appointments last about an hour, and I provide five postpartum and newborn visits during the six weeks following birth."

Christine Mehl, a  Certified Nurse Midwife (CNM) and Licensed Midwife (LM), has been practicing since 2017. Submitted Photo / Special to On The Minds of Moms
Christine Mehl, a Certified Nurse Midwife (CNM) and Licensed Midwife (LM), has been practicing since 2017. Submitted Photo / Special to On The Minds of Moms


'Empower women's health'

Janke and other certified midwives in the area agree their goal is to empower women with holistic approaches that fit their needs.

"It is encouraged for women to take charge of their health and we want to be there to support and guide a person as they achieve their own personal health goals. Each woman has their own unique pregnancy and labor experience," Janke said.

Before starting a conversation with any midwife, Janke instructs women to always ask and obtain proof of credentials. Christine Mehl, Certified Professional Midwife and Licensed Midwife in Minnesota, shares the most often, the first questions she receives are checking her educational background.

  • "What is your training and education?" I completed my midwifery degree from Midwives College of Utah, and completed a four-year midwifery clinical training where I served home birthing families in Fargo-Moorhead, and interned as a midwife at freestanding birth centers in Utah and Alaska.
  • "Are you trained in CPR and neonatal resuscitation?" Yes, I maintain certifications in CPR/Healthcare Provider BLS (Basic Life Support) and Neonatal Resuscitation.

Janke said other types of questions vary depending on a woman's needs and specific health condition throughout her life.

"Women partner with midwives as young as the teenage years, to years after menopause exploring each individual need of the patient," she said. "This may include discussing family planning or birth control options, screenings for infection or hormone replacement options."

Essentia Health in Fargo has offered midwife services for more than 30 years. Now, midwives and their staff host a causal event where local women can "meet the midwives" from 5:30 to 7:30 p.m., Jan. 30, at the Avalon Events Center. Hosted by Cori Jensen, this fun and informative event will feature midwives sharing about their professions, including time for questions from attendees.

While some women may still not want to partner with a midwife, Janke shares warm encouragement.

"A midwife will guide the woman through experiences and keep their wishes first," she said.

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If You Go

What: Essentia Health's "Meet the Midwives"

When: 5:30 to 7:30 p.m., Jan. 30

Where: Avalon Events Center, 2525 9th Ave. S., Fargo

More information: This event is free and open to the public. You can register to attend this event at Eventbrite.com. Learn more about our midwives and the services they provide at EssentiaHealth.org.