Midwifery Week is October 4-10! To celebrate, we spoke with Cecilia T Girard, CNM, a midwife at BMC and clinical assistant professor of obstetrics and gynecology at BUSM, who has been at BMC for 24 years.
Read on to learn more about the Midwifery Program at BMC and how they help care for our patients, while addressing health disparities.
What do you do at BMC?
Each week, I do two days of clinic at the East Boston Community Health Center. My role there involves a lot of education to patients and advice about topics such as nutrition, sexuality, the discomforts of pregnancy, contraception, labor, and other pregnancy-related issues. I see both prenatal and postpartum patients.
I’m also on call at BMC, where I take care of prenatal patients and women who are in labor. I work with doctors from Family Medicine, and Obstetrics, and other areas to ensure that pregnant women get the care they need. For example, I can care for most women with uncomplicated pregnancies, but if a woman has high blood pressure, she might need to see an obstetrician.
I have several patients assigned to me, but can take care of any patients in labor. If a woman in labor isn’t having any complications, they often receive care from a midwife, even if they haven’t previously seen one before. And the midwife on call will take care of any patient assigned to midwives.
While I take care of women in labor, I try to maintain the normalcy of labor and birth. But that also means taking action if there’s an issue, or bringing in a doctor for consultation if necessary.
How is care from a midwife different than other care pregnant women receive?
Midwifes are trained in the normal care of pregnant women and normal delivery. We learn how to listen to patients, educate them on risks and benefits of certain actions, and support their decisions. Our goal is to give women ownership of how they want to receive their care.
A lot of times, doctors have been trained to look for the abnormal. But pregnancy is a normal stage of a woman’s life. Midwives are trained to look at discomforts and help fix those, without necessarily treating them as pathologies. Our care is geared towards the normal parts of a woman’s pregnancy, but we also learn what might be abnormal and when to refer to a doctor for more specialized care.
Health disparities and lack of equity among pregnant and post-partum women has been in the news recently. How can care from a midwife help address some of those disparities?
Our midwifery group at BMC has been very active in connecting women with services that they need, especially during the COVID-19 pandemic. For example, we’ve been able to bring food to patients who need it, as well as provide mobile prenatal care to pregnant women who can’t come into BMC.
Outside of COVID-specific activities like this, we connect patients with mental health services, social services, and other supports. While doctors at BMC also connect women to services and support, they tend to see higher-risk patients and therefore have a stronger focus on medical issues. Midwives are generally able to take more time to learn what supports patients need and figure out how to provide those.
We’re also always trying to find ways to decrease disparities for women of color or low economic status. Midwives are focused on treating the whole person, and we really want people to have a better experience with the health care system than they may have had before. We also really focus on education, which can help address disparities. And programs like Centering Pregnancy and other models of group care help improve outcomes.
What’s something most people don’t know about being a midwife or getting care from a midwife?
A lot of people think that midwives only do home births. Some midwives do focus on home births, but there are midwives in hospital and other clinical settings as well.
Many people also think that midwives will refuse to give women medications for birth, which isn’t true. The goal of the care we provide is to listen to the woman we’re caring for, explain the risks and benefits of their different options, and respect their decisions. We feel that having the consent of the woman for treatments is the most important thing.
Finally, midwifery is an art and a science. We are experts in healthy pregnancies, labor and birth, and work collaboratively with other medical professionals in health centers and hospitals. Women who receive care from a midwife receive the same kind of are as people who see other types of doctors, but the care is a little more hands-on. There are many techniques, such as ways to turn a baby in the womb when necessary, that midwives have been doing for a long time and that doctors are just starting to incorporate into their practice.
What do you like most about working at BMC?
I love that BMC is committed to helping and improving the lives of all people, no matter where they come from or what their socioeconomic status is.
I also love the group I work with – midwives, physicians, nurses, and others – and being a part of educating residents, interns, and medical students. There’s no greater affirmation of what you’re doing than when one of your previous residents texts you and tells you they did a “midwifery birth” – that they supported the woman in labor without any unnecessary interventions.
