Selasa, 07 Desember 2010

Midwives move in from the margins New women's clinic to be city's first free-standing health facility staffed solely by nurse-midwives


Midwives move in from the margins
New women's clinic to be city's first free-standing health facility staffed solely by nurse-midwives


By Ann Keeton, Special to the Tribune

December 1, 2010

Part of the Aviva Women's Health and Midwifery Care program at the University of Illinois at Chicago, a new women's clinic will be the first freestanding clinic in the city to be solely staffed by nurse-midwives.

Evelyn Rodriguez has avoided getting regular medical checkups for several years. The Logan Square resident uses a wheelchair and says she knows many women who won't make appointments for a variety of reasons.

"A lot of us are afraid to go to the doctor," she said. "There are women with physical disabilities who are embarrassed about being different, women who don't speak English or who have trouble paying for medical care."

A new women's clinic, set to open early next year, aims to address these issues. Part of the Aviva Women's Health and Midwifery Care program at the University of Illinois at Chicago, this will be the first free-standing clinic in the city to be solely staffed by nurse-midwives and serve both disabled and able-bodied women.

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While the medical establishment has been critical of lay midwives in the past, holding that it's dangerous for women to give birth without the support of a doctor and hospital, those staffing the new clinic will be certified by the American Midwifery Certification Board, which is recognized by the American College of Obstetricians and Gynecologists. The midwives in the Aviva program, registered nurses with postgraduate degrees, already assist with births at Sts. Mary and Elizabeth Medical Center. At the new facility they will also provide prenatal care, gynecological exams, menopausal counseling and other services in a clinical setting, where female patients can also join groups for networking and follow-up care.

A $1.9 million federal grant is providing startup costs for the clinic, said Judith Storfjell, professor of health systems science and head of academic practice at the UIC College of Nursing. But she is still negotiating a lease for a space close to transportation and convenient for underserved women in Logan Square, West Town and Humboldt Park — areas that have high rates of infant mortality and premature birth rates.

In the Aviva program, specially trained nurses already provide primary health care. In partnership with Sts. Mary and Elizabeth, UIC provides service at two clinics: one run by the Infant Welfare Society of Chicago in Logan Square and the Chicago Public Health Department's West Town Neighborhood Health Center Humboldt Park.

Patients who see midwives at the clinics can deliver their babies at Sts. Mary and Elizabeth, where a backup doctor can be called in if needed. Pregnant women who need more care are referred to specialists at UIC Medical Center. The new clinic will follow the same model.

More than 100 graduate students are enrolled this year in the UIC program for nurse-midwives, Storfjell said. Students can start the program after they have earned a bachelor's degree and have become registered nurses, or they can get those credentials while they are training as midwives.

"We have many graduates working as midwives, but this will be the first clinic of our own. This will fill a huge need out there,'' she said.

The new clinic will be accessible for people with disabilities, said Carol Gill, a professor in disability studies at the university. Plans for the Aviva clinic have been '"energized by a collaboration between the College of Nursing and the department of disability studies,'' she said.

Students are learning that physical disability is a cultural and economic phenomenon, not just a medical issue. While patients with disabilities may not require different treatment, they may need more time.

"On average, we allow about 45 minutes for each patient visit, compared with the standard 15 minutes to 20 minutes,'' Gill said.

Evelyn Rodriguez, the Logan Square resident, said she likes the inclusive plan to serve both disabled and able-bodied women. "My last doctor's office made me feel like a thing, not a person; no one wants to be treated like that.''

Mary Bauer, the director of the Aviva program, will head the new clinic, which will have four full-time nurse-midwives and three part-time midwives. Bauer, who has been a midwife for two years, went through the UIC graduate program for nurse-midwives. She's now delivered more than 125 babies. She recently helped Fani Castro, a teenage mom who doesn't speak English, bring a healthy baby into the world.

"I didn't speak Spanish before I got my midwife training. Now I can communicate just fine. You sort of pick things up.''

Castro had a very natural birth experience, Bauer said. "She had the freedom to move around a lot, even standing and squatting on the bed. That helped the baby get in the right position to be born.''

Bauer said midwives, along with trained volunteers called doulas, can help women experience childbirth without pain medicine.

"You have to understand that pain in childbirth is OK, but suffering isn't,'' said Bauer. But there is still a misconception that midwives frown on painkillers. "We offer a full range of pain medicine. About half of our patients use epidurals'' — injections that numb the body below the waist.

Lindsay Prior was a patient of Bauer's at the West Town clinic. "I have medical insurance, so I could have gone anywhere, but I stayed with Mary. I would follow her anywhere," Prior said, ''She answered every question about my pregnancy, no matter how dumb it was. I had some trouble with my blood pressure, and they monitored it very carefully."

Prior had planned for natural childbirth, but, 36 hours into her labor, "Mary made the call that we needed the doctor," said Prior. She ended up having a cesarean section at Sts. Mary and Elizabeth to deliver her son Logan, who weighed 8 pounds, 8 ounces. He's 6 months old now, and doing fine.

A few years ago, Bauer was a dental hygienist with five kids at home. "I wanted another child, but my husband said why not go back to school instead?" Bauer, 53, loves her new career.

"Most of our patients are prenatal," she said of the Aviva program's clients. "But if it comes up, we are trained to treat a cold or flu. If they have a broken arm, they need to go to the ER."
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