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It’s Only Natural

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LOUISVILLE Women First of Louisville has been providing obstetric and gynecological care since 1988. Their motto is “Women First … in all we do.” It was with that mindset that they added a new member to their family of physicians, nurse practitioners, and physician assistants – a certified nurse midwife.

“Our practice likes to meet women where they are, to add convenience, to add diversity, to recognize that everyone has individual needs and desires,” says Kelli Miller, MD, FACOG. “We’ve had more women asking about all-natural kinds of experiences, meaning unmedicated deliveries and having options with their childbirth. For some reason, Louisville has been slow to have midwifery care, so it’s not new, but it’s new to Louisville.” In fact, when Emily duBois Hollander, APRN, CNM, joined Women First in November 2015, she became the first certified nurse midwife to practice at Baptist Health Louisville, where Women First exclusively delivers.

DuBois Hollander grew up in Connecticut as part of a medical family. With a father who was a primary care physician and a mother who was a nurse, a medical career was only natural. But her journey started as a Peace Corps volunteer in 2009, serving in Rwanda for over three years. When she returned, she went through the nursing program at Vanderbilt University with specialties in nurse midwifery and family practice. Upon graduating in 2015, she returned to Rwanda on a fellowship, working at a maternity hospital.

While her path to Women First might not have been the conventional route, duBois Hollander is quick to point out that she and her colleagues have more in common than not. “I don’t think there’s too much of a difference between the way I practice and the way my colleagues practice,” she says. “I believe in the physiologic process of natural childbirth, and I think you’d be hard pressed to find a physician who would really feel differently. The kind of care that I provide fits really well into the practice philosophy here at Women First.”

Common misconceptions often paint the picture that the differing approaches of midwives and physicians can be at odds or that midwives only practice home births. There are different types of midwives, but as a certified nurse midwife, duBois Hollander underwent rigorous training as a nurse and midwife and only delivers in the hospital setting. For Women First, the physician-midwife relationship has been quite complementary.

“We work intimately and collaboratively with Emily, our midwife,” Miller says, noting that the model was patterned after that at Vanderbilt. “Our patients have the best of both worlds with midwifery care along with knowing they have a group of great doctors working with her and backing her up in a great hospital system. We wanted a collaborative model rather than us-versus-them.”

Miller explains that the crux of the difference between midwives and physicians comes from the mindset of each. Midwives view pregnancy and childbirth as a normal life event. While physicians acknowledge that they are trained to look for and treat the medical issues that arise. Midwives tend to focus more on patient advocacy, support, and how to naturally manage pain. “As physicians, we don’t focus exclusively on obstetrics,” Miller says. “We’re seeing gynecological patients, surgery patients, and we’re in the operating room. Our midwife can spend more time with the patients, and she’s able to provide a great deal of education on the front side, before the actual childbirth.”

The staff at Women First includes 10 physicians, a dozen nurse practitioners and physician assistants, as well as a midwife. Even though the nurse midwife position is relatively new at Women First, duBois Hollander says that she has been welcomed with open arms and has been quickly blended into the work environment. She sees patients both in the office setting as well as during delivery. She is part of the call rotation along with the physicians.

“We can never guarantee who will be on call, so that’s why it’s nice for our patients to get to meet everyone at some point,” duBois Hollander says. “The wonderful thing about Women First is that it’s an incredibly collaborative practice. People who are seeking primarily midwifery care can see me as much as they need to. I don’t think people understand that I am an independent healthcare provider. I can write prescriptions and I work right within the team of all the practitioners here.”

“Midwives are trained for the low risk, uncomplicated pregnant patient,” Miller adds. “They are well prepared to take care of that patient and do that delivery with a physician backup.”

Hollander also runs Women First’s postpartum support series. The free group is offered to moms for about 90 minutes every Monday with an obstetrician and duBois Hollander providing support and answering questions. Frequently, a guest speaker will provide information on such topics as infant milestones or postpartum depression.

The postpartum program is another example of the physicians and nurse midwife working together to provide optimal care to the patients.

“We have the opportunity to work with families in some of the most joyous and saddest moments,” duBois Hollander says. “That really is an honor.”

That opportunity unifies the staff at Women First to use their respective skill sets for the well-being of the patients.

“I love that we’ve been able to offer this to patients,” Miller says. “We see it as a cohesive model and relationship.”