The Role of Midwives in Addressing America’s Maternal Health Crisis: Insights from OBHG’s Amanda Shafton

Welcome back to another episode of MedCity FemFwd, a podcast dedicated to exploring the breakthroughs and challenges in women’s health. In this episode, we are joined by Amanda Shafton, a practicing Certified Nurse Midwife (CNM) and National Director of Midwifery at Ob Hospitalist Group.

We discuss the benefits of physician and midwifery collaboration and explore how midwives can improve maternal health outcomes.

Here is an AI-generated transcript of the episode:

Marissa Plescia: Welcome back to MedCity FemFwd. I’m Marissa Plescia, reporter for MedCity News. In this episode, we are joined by Dr. Amanda Shafton, a practicing CNM and National Director of Midwifery at OB Hospitalist Group. We discuss the role that midwives can play in improving maternal health outcomes.

Hi, Dr. Shafton. Thanks so much for joining MedCity FemFwd.

Dr. Amanda Shafton: Hi, Marissa. It’s so nice to see you. Thanks for having me. Please call me Amanda.

Marissa Plescia: Of course. Well, Amanda, can you tell me a little bit about yourself and your work?

Dr. Amanda Shafton: I would be happy to. My name is Amanda Shafton, and I am a certified nurse midwife. I practice as a midwife hospitalist in Austin, Texas, and I have the honor and privilege of working with OBHG, which is the largest employer in the country for obstetricians and midwives, adding services to different hospitals and communities across the nation.

I work to add midwife hospitalists in existing programs or in new programs, and also to examine how to integrate midwives into clinic spaces. I always think the answer is more midwives. More midwives all the time.

Marissa Plescia: That’s great. And going off of that, what we are talking about today is collaboration between physicians and midwives. Can you tell us a little bit about what this care looks like for patients?

Dr. Amanda Shafton: Absolutely. We are really passionate at OBHG about collaborative team-based care. The idea is to make sure that all patients are seen as OBHG patients. It is our job as the hospitalist team to be the safety net for the hospital.

We like to ensure that we are the backup for any of the private physicians or private midwives caring for patients in those hospitals or communities. And, of course, we usually take care of anybody who maybe does not have a private practitioner, whether they have not had prenatal care during their pregnancy, or maybe they are on vacation.

I see a lot of people in Austin who are here for a visit and then end up needing some type of care, and so our team takes care of them. I say team because that team-based care is so important. It is not a midwife-only patient or a doctor-only patient. All the patients are cared for collaboratively by the team.

That usually includes a physician and a midwife. We find that when we look at our data at OBHG, our teams that have a doctor and a midwife outperform all other versions of our teams because there is something really magical about that collaborative care, bringing obstetrics and midwifery together to care for people.

Marissa Plescia: In this team-based model, is there ever any inclusion of doulas as well?

Dr. Amanda Shafton: Absolutely. Usually doulas are hired by the pregnant people. That is somebody that they will pick throughout their pregnancy journey who they have a bond with. That person is there to support them physically and emotionally, helping to advocate for them and ask questions.

Then we, as their team taking care of them (the obstetrician, the midwife, and the nurse), work with the doula as part of this idea of surrounding that person with a community that all shares the same desire for a great outcome for that patient and their family.

Marissa Plescia: Thank you. So what are some of the benefits to this kind of physician-midwife collaboration for the patient?

Dr. Amanda Shafton: Absolutely. Midwifery is based in the fundamental knowledge that pregnancy and birth is often a normal part of a reproductive journey for a pregnant person. We really see the opportunity to provide education, support, and care for pregnant people throughout that process. It is a little bit more of a wellness model than what obstetricians are typically taught in, which is a more medically minded model.

I always say that we are experts in normal. Midwives typically have higher rates of successful vaginal births, including higher rates of successful vaginal births after cesarean sections, or VBACs. We usually have fewer interventions in our care because we try to harness that natural process the best that we can, and of course, use medical interventions as needed.

Most of us who are hospitalist midwives are caring for higher risk individuals, medically more complicated people, throughout their pregnancy, birth, and postpartum course. Those medical interventions are super important, whether we need to use Pitocin to help labor progress or if a patient wants an epidural for their pain management.

But it is just being smart about the use of those interventions. What I am super passionate about, and midwives in general, is making sure our patients have had the time to ask all the questions and feel really well informed so that they are the decision makers in their process.

Because at the end of the day, it is not my baby and it is not my birth. I want that person who is having the baby and that family to really make those decisions about what feels right for them.

Marissa Plescia: Well said. And how extensively is this kind of model and care really offered once?

Dr. Amanda Shafton: We are really proud at OBHG to employ a very large number of midwives. We have over three hundred and fifty full-time midwives across the country working with us in a variety of different settings. When I add our folks who are not full-time, who are maybe PRN or part-time, that number gets closer to five hundred, which is super exciting. Like I said, I think midwifery is always the answer.

More midwives improve culture, they improve outcomes for patients, they improve satisfaction for nursing staff, and they also improve the work-life balance for our physician collaborators. We know, and I am sure you have talked about on your podcast, that there is this looming maternal healthcare crisis that is already happening, but is only going to get worse as we have fewer people choosing to become OBGYNs, as more rural hospitals are closing and forcing people to travel farther and farther for their prenatal care and birth care.

The idea of making sure that we have a workforce that includes midwives and physicians enables them to have ideally a longer time in full scope practice. I think it is the right answer for every single person. I would love to have a midwife at every hospital where babies are being born, at least one, if not more.

It has been a challenge in the United States. Midwifery in general is a challenge, getting accepted into knowing that this is a normal part of a practitioner that cares for women during their lifespan and during pregnancy, and getting buy-in from our physician colleagues and our hospital administrators and everybody else who works within that big system to take care of people.

Marissa Plescia: Absolutely. And going off of that, can you talk a little bit more about how this kind of care can support rural and underserved populations, but also some of the barriers to accessing this kind of care?

Dr. Amanda Shafton: Absolutely. I think midwives are uniquely positioned to provide that type of healthcare in rural settings. Often most hospitalist midwives are nurses first and have practiced as nurses, although plenty of midwives become CNMs because they want to be a midwife and have not necessarily worked as a nurse or a labor and delivery nurse. But often the folks that I work with have felt this was sort of a calling where they were a nurse, they have been working in a hospital in their community, and they see a need for providers, and so they choose to go back for a master’s degree or a doctorate in midwifery to focus on caring for pregnant people.

So the idea of educating people who already live in those communities and already have that connection is really exciting and important. The pathway to educating a certified nurse midwife is a shorter pathway than a physician who goes through medical school and residency and potentially fellowship.

Midwifery is uniquely positioned to fill those gaps. It also expands the pool of practitioners. If we think of this collaborative model of recognizing that we need the right healthcare provider for the right patient at the right time, we can recognize that sometimes that is an obstetrician, sometimes that is a high-risk obstetrician or maternal fetal medicine specialist, and sometimes that is a midwife. Often throughout a person’s pregnancy and throughout their labor and delivery, all of those people are important and can flow with the patient to provide that best care.

Recognizing that by looking at not just OBGYNs, but also midwives, nurse practitioners, and other advanced practice providers, can help us really fill that need and fill those gaps in those communities.

Marissa Plescia: Absolutely. And what does insurance coverage really look like for midwife support right now?

Dr. Amanda Shafton: Insurance has, for the most part, caught up to supporting midwifery care. If you are pregnant and you are coming into the hospital, labor and delivery, to be seen in our triage department or obstetrical emergency department, you often will be cared for by a midwife automatically or a physician, and the insurance does not care what type of provider is taking care of you as long as you are getting that good care.

That reimbursement from an insurance standpoint, whether somebody has private insurance or public insurance, is covered. The times where that is more of a challenge for people is when people are choosing to do community-based birth, either in birth centers or in their own homes. That is not something we do at OBHG.

We are a hospitalist-based organization, but that can be a little more challenging for individuals. Speaking of community birth, it is something that we feel really passionate about at OBHG. We want to make sure that we are supporting those individuals who are choosing to birth outside of the hospital for the times where they need that escalated care.

When somebody needs a higher level of care and they need to transfer to a hospital for a variety of different reasons, we want to be a safe place for them to land, especially when there is a midwife-to-midwife transfer. That can be really nice for patients to know when their plan changes and all of a sudden they are in an environment and having interventions that they were not planning on, to know that there is a midwife as part of their team is usually a really nice thing to offer to people.

Marissa Plescia: Absolutely. Well, Amanda, I just have one last question for you. What can be done to further expand access to midwifery support?

Dr. Amanda Shafton: That is my favorite question. Number one, we really have to continue to get the word out about what a midwife is and why midwifery care is so important. At OBHG, we are really proud to continually access data from all of our healthcare providers to be able to prove that not only is midwifery care safe, but this team-based care is even better.

Our programs that have a midwife and a doctor actually outperform our programs that have two physicians because there really is something magical about this care that is collaborative and respectful, recognizing that midwifery and obstetrics are both really important for pregnant people.

Number one is getting the word out so that patients know that this is something they can advocate for, that they can ask their hospitals, that they can ask their OBGYN providers, “Do you work with midwives? Are midwives part of your care team?” And also, do you have a hospitalist program? That is important when somebody is choosing a provider and choosing a hospital to give birth at.

You should know who the people are that might take care of you. Is your doctor going to be there twenty-four/seven? That is not usually possible for people. So then who is going to help fill that time if your provider needs to be in two places at once, or gets to go on a vacation, or something like that.

Educating the public about midwifery and the fact that there are really excellently trained midwives who are hospitalists who want to provide that care for them is kind of a first piece. Another piece in the puzzle is definitely continuing to have organizations like OBHG that are doing some of the legwork to have that partnership and that collaboration between midwives and physicians to ensure best outcomes.

We help the hospitals. If they have never had midwives before, what does that look like to have privileges as a midwife? That is where I get to come in and answer some of those nitty-gritty questions. So just more advocacy, more outreach, I think is the answer.

Marissa Plescia: So well said. Amanda, this has been such a great conversation. Thank you so much for joining MedCity FemFwd.

Dr. Amanda Shafton: I am so excited to be here and really appreciate all the work that you are doing, so thanks for having me.

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