Why See A Nurse Midwife

Nurse-Midwives are an appealing option for women who want a more individualized, less routine approach to childbirth. At UNT Health, we focus on helping you learn about the physical and emotional changes you go through during pregnancy, teach you how to maintain good health habits, and consider you an active participant in all aspects of your care. Every pregnancy is a unique event and we encourage you to consider your options for labor and delivery and to personalize your own birth plan.

Whatever kind of birth you choose, UNT Health Nurse-Midwives will support you in your decision.  Our midwives will guide you through a non-medicated labor if that is what you choose, however, you still have the option of having an epidural during labor. Our obstetricians are available for consultation and backup if needed.

Centering

What is Centering?

 
Centering is an evidence-based redesign of health care delivery that helps to promote:
• safety
• efficiency
• effectiveness
• timeliness
• culturally appropriate patient-centered care
• more equitable care

Centering is a model of group healthcare, which incorporates three major components: assessment, education, and support.

Group participants meet with their care provider and other group participants according to a regular schedule for a much longer period of time (usually 90-120 minutes) than a usual check-up visit. Centering promotes individual health empowerment and community-building.
 
At the start of a typical session, patients have a brief individual assessment by the care provider, participate in self-care activities, complete a Self-Assessment Sheet on a particular topic, enjoy refreshments, and have informal conversation with the other participants. When the group “circles up” together, there is facilitated discussion about a heath topic and the exchange of corporate wisdom on shared health experiences. Groups are lively, interactive, and patient-centered.
 
Research has shown increased patient and provider satisfaction in Centering groups and improved patient outcomes.

Ask our midwives for more information!

Water Birth Questions and Answers

The UNTHealth Nurse-Midwives feel fortunate to offer hydrotherapy (laboring in water) and water birth to our clients at Harris Methodist Hospital in Fort Worth. Some women may be candidates to labor in the water and others may be good candidates to labor and deliver in the water. This handout is designed to answer some of your questions.

What are the benefits/risks of hydrotherapy or water birth?

Women who labor in water often report less painful contractions, easier labors, and increased satisfaction with their births. Water birth can be used as a method of pain control in labor and may help many women avoid using other forms of pain management (IV sedation, epidurals) during labor. Some other reported benefits include a shorter pushing phase, less lacerations, and less bleeding. Contrary to some beliefs, there is no increased risk of infection to the mother or infant who labor or deliver in the water.

The primary risk associated with delivering your baby in the tub is space limitation. For this reason, your Midwife may or may not feel that delivery in the tub is a safe option for you or your baby.

Hydrotherapy (laboring water without delivering in water):

• Women who do not need to be on continuous fetal monitoring,
• Women who have not recently received any pain medicine,
• Women who have had previous cesarean deliveries and are attempting a trial of labor (this requires consultation with your Midwife and is subject to
change during your labor)
• Women experiencing normal labor progress without the use of pitocin,
• Women with singletons (one baby) in a head down position,
• Women who do not have a history of a shoulder dystocia,
• Women who do not need continuous fetal monitoring

In cases of obesity, diabetes, hypertension and other medical complications consultation with your Nurse-Midwife is required

UNT Nurse-midwives Far Below National Cesarean Rate

The UNT Health Nurse-Midwives are proud to announce that our practices Cesarean Section rate for the year of 2009 was 11.7 %. This is a big deal for us and for you!

The World Health Organization (WHO) recommends that developed countries maintain a c-section rate less than 15% for optimal outcomes for mothers and babies. The United States national Cesarean section rate has risen dramatically over the last decade with reported rates for 2007 of over 30%.

In 2006 The Texas Health Care Information Collection analyzed data from Texas hospital inpatient discharge records and provided average hospital cesarean rates. In the DFW, in 2006, Cesarean Section rates ranged from 12-30% of each hospital’s deliveries. Harris Methodist’s Cesarean rate was reported at just under 19%.

Talk to your provider about what you can do to lower your risk.

With Doctors in Short Supply, Responsibilities for Nurses May Expand

This article is taken from the New York Times.

By MICHELLE ANDREWS

Marilyn K. Yee/The New York Times In many states, nurse practitioners perform medical services once provided only by primary care doctors.

If the health care system is overhauled, patients and practitioners are likely to face a primary care bottleneck, experts say. An estimated 30 million newly insured people will begin making appointments for check-ups and other routine care with physicians who are already stretched thin caring for existing patients.

The increase in demand may well put an end to a simmering policy dispute over the circumscribed role of nurse practitioners in medical care. If tens of millions of new patients enter the health care system, it seems clear that nurse practitioners will be needed to perform many of the tasks now performed by physicians.

Nurse practitioners are registered nurses who typically have a master’s degree in nursing. Numbering roughly 125,000 nationwide, more than three-quarters of them train in primary care, making them the largest group of non-physician primary care providers, according to a study by the American College of Physicians. (Physician assistants, another type of non-physician provider, generally work for specialists rather than in primary care.)

As this blog has noted, the American Academy of Family Physicians projects a shortfall of 40,000 physician generalists — family practitioners, pediatricians, general internists and geriatricians — by 2020, even without significant changes to the current health care system. No one expects that nurse practitioners can fill that gap. The nursing profession faces its own supply challenges, with shortages of all types of nurses estimated at 260,000 over the next 15 years.

But the health care bills moving through Congress contain provisions that would increase funding for nurse training programs, including one aimed specifically at raising the number of advanced practice nurses, which include nurse practitioners.

State laws that define nurse practitioners’ “scope of practice” vary, but in general they perform many of the tasks that primary care doctors do: they diagnose and treat illnesses, order tests, prescribe drugs and make referrals to specialists. Twenty-two states allow nurse practitioners to practice independently, without physician involvement. In other states, they work with varying degrees of oversight and input from physicians.

Nearly a quarter of primary-care physician practices have nurse practitioners on staff. Although doctors and nurse practitioners work amicably together in clinics and medical offices around the country, skirmishes over how much independence nurse practitioners should have periodically erupt among policy makers. Physician organizations, sensitive to encroachment on their turf, argue that nurse practitioners, who have less clinical training, may miss a diagnosis, especially with patients who have multiple chronic conditions. “We think that collaborative work and use of the team approach is preferable,” said Dr. Lori Heim, president of the American Academy of Family Physicians.

There are financial considerations in addition to clinical ones. Nurse practitioners earn significantly less than primary care physicians and can provide comparable care at a lower cost. A RAND Corporation study that examined ways to control health care spending in Massachusetts found that increasing the use of nurse practitioners and physician assistants for certain types of office visits could save up to $8.4 billion by 2020.

Federal funding for nurse education has always been a sore spot among nurses. Unlike doctors in training, whose residencies are almost entirely funded by Medicare, most nursing education is self-financed. Nurse education received a little over $300 million in federal funding in 2006. Half of that amount was restricted to hospital diploma programs, which graduate only about 5 percent of nurses today.

The Senate Finance Committee bill would provide $50 million annually from 2012 through 2015 to fund a Medicare demonstration program for graduate nurse education. Participating hospitals would receive Medicare reimbursement for their education and clinical instruction costs. Meanwhile, the House health reform bill that was unveiled last week would authorize an additional $638 million to support nurse training from 2011 to 2015, including training for advanced practice nurses.

“This bill recognizes that we need more resources for graduate nursing education,” said Brenda Cleary, director of the Center to Champion Nursing in America , a program of the AARP Public Policy Institute.

Physicians, too, recognize that looming primary care shortages are too big for them to address single-handedly. “There is more than enough medical care required for both nurse practitioners and primary care physicians to do,” said Ms. Heim.

As for patients, “There’s never been a problem with consumers thinking they’re getting second-rate care with nurse practitioners,” said Linda Aiken, a professor of nursing and sociology who directs the Center for Health Outcomes and Policy Research at the University of Pennsylvania . Quite the opposite. Patients who were cared for by nurse practitioners were more satisfied, some studies have found, and they believed nurse practitioners did a better job at patient education and communication.

· Copyright 2009 The New York Times Company