By Denise A. Salisbury

As a Certified Nurse Midwife, I wish to “sound off” in response to your recent articles, and to the Aug. 27 column written by Dr. Sizemore regarding obstetric and midwifery services on Whidbey Island.

In seeking a solution to our current dilemma of losing Dr. Sizemore, I do not believe your articles suggested or promoted the idea that midwives replace obstetricians and that we return to delivering all babies at home. I do not believe your intention was to provide free advertising for midwives, as Dr. Sizemore suggests, nor did I infer that midwives are superior in providing compassion and support to laboring women. The major goals of your articles have been to inform the public of the situation, educate your readers as to alternative solutions, and invite discussion. I feel that your articles have not gone far enough in these regards.

I am concerned that your articles, as well as Dr. Sizemore, have tended to lump Licensed Midwives (LM) and Certified Nurse Midwives (CMN) together in one pot. You seemed to stress that the major difference between LMs and CNMs is that CNMs can give pain medication to laboring women. There are a great many differences. I can only fully address my own practice as a Nurse Midwife.

CNMs are Advanced Registered Nurse Practitioners (ARNP) who specialize in the care of healthy women. Our primary emphasis of practice is on health promotion, health maintenance, education and counseling. We believe in promoting healthy life-styles, informing women of health care choices, and supporting women in the choices they make.

We care for women of all ages, from adolescence through menopause. We provide routine gynecologic care, including, but not limited to, annual health screening and breast and pelvic exams, screening and treatment for various gynecologic infections, and full contraceptive services except, of course, tubal ligations. We treat a variety of common gynecologic problems such as irregular or painful menstrual periods, Premenstrual Syndrome, and symptoms of menopause. We care for women throughout pregnancy and childbirth. We deliver babies in homes, in birth centers, and in hospitals. We sometimes function in the capacity of a Primary Care Provider, much like an Adult Nurse Practitioner or Family Nurse Practitioner. There are also Women’s Health Practitioners, who have a similar scope of practice as CNMs except that they do not provide care during labor and childbirth. Nurse Practitioners prescribe medications and we practice independently from physicians.

Does this mean that physicians do not provide these services, or that nurse practitioners are superior to physicians in these aspects of care? Of course not. The difference is that these are our primary areas of expertise. I hesitate to speak for my physician colleagues, but I will venture to say that many physician practices have health restoration, the treatment of illness and disease, and the management of complex health issues as their primary areas of expertise. Nurse practitioners have sometimes been referred to as “Physician Extenders,” and although many of my ARNP colleagues have found this term to be offensive, I do not. Nurse practitioners, in many ways, extend the capabilities of physicians.

CNMs practice in many different settings. Some are hired directly by hospitals and work exclusively on Labor and Delivery. Some are a partner in a medical group, or are hired by a group, and practice collaboratively with other CNMs and/or MDs. Some have limited their practices to obstetrics only, and do not practice any gynecology. Some no longer deliver babies, but have limited their practices solely to outpatient clinics. CNMs who practice independently must contract with a physician in some manner for consultation and referral services.

Nurse midwives also care for women with complex obstetric and gynecologic problems – but only in consultation with an ob-gyn physician. It is not unusual for a woman’s care to be so high-risk or complex that her care is transferred entirely to a physician. I have frequently had women continue to come see me throughout their pregnancy, even though I had transferred their care to a physician.

Having options and being able to make choices is what it’s all about. Currently, approximately one out of every eight pregnant women on Whidbey chooses Greenbank Women’s Clinic to deliver their baby. The remaining 7 of 8 women deliver with an obstetrician at either Naval Hospital Oak Harbor or at Whidbey General. Many women will continue to choose a physician to provide their care. Some women would prefer a nurse practitioner. I would like to see women have the choice.

Physicians and nurse practitioners are not mutually exclusive, but rather mutually supportive and mutually beneficial. Our goal is the same – we all seek to provide superlative health care. Of course I am a strong proponent of nurse midwifery, and I hope to be able to practice my profession here on Whidbey Island. I hope to see nurse midwifery play a role in the solution to our community problem because I believe nurse midwives offer valuable services and a type of care that is currently not available to women on Whidbey. Let’s give all women better access to more health care choices. Let’s seek an all around win-win solution for our community.

Denise A. Salisbury, ARNP, CNM, live in Oak Harbor.