With Sophie Mou, left, and Rachel Friedlander, right, MD candidate students, Class of 2021
This midwife’s perfect audience? Third - year MD candidate students! I was given the opportunity this past spring to introduce the midwifery model of care and birthing options to medical and physician assistant students at a large urban academic medical center. Course directors Rachel Friedlander and Sophie Mou, MD candidate students, Class of 2021, implemented a five-week elective series, “Diversity in Reproductive Choice and Human Sexuality.” These inspiring women sought out community members who were experts in their respective fields to lead each session. My topic, “Birthing Methods,” covered an array of subjects: birthing methods and perceptions in various cultures; the medicalization of childbirth; the role of various health care workers in the birthing process; patient autonomy in choosing a birthing method; liability; how to safely counsel patients on birthing methods; and helping patients understand how to facilitate their chosen birthing method.
I asked Sophie and Rachel why they implemented this five-week series. They responded, “We felt there was space to add material on sexual health to the current curriculum, since we wanted to explore topics in sexual and reproductive health through a wellness perspective rather than through pathophysiology. Literature suggests that a minority of medical students feel comfortable broaching sexual and reproductive health topics with patients, so we designed the course, under the mentorship of an adolescent medicine specialist, in order to expand student knowledge and comfort broaching these topics. We also incorporated activities to simulate interviewing and counseling patients. We hoped our five-part lecture series would address these student knowledge gaps by covering topics including birthing methods, options counseling, sexual problems in various populations, and sexuality/sex practices.”
I started off “Birthing Methods” with a powerpoint lecture. Then we viewed the Brazilian classic film Birth in the Squatting Position. For the second hour I gave the students a multiple choice quiz, focusing on case management spanning the reproductive years. This was followed by a lively interactive discussion about the answers.
Sophie and Rachel shared that prior to taking my elective, “We had limited knowledge, which is why we were so excited for your session! We learned a ton about the scope of nurse midwives' practices, in the context of both private practice and interdisciplinary obstetrical teams in hospitals. We also learned how midwives manage patients’ diets and exercise, general health, and medications. They said they were also more well informed about when nurse midwives should collaborate with physicians.
If physician candidates are informed early on in their medical educations about the scope of the midwifery profession, when they are practicing physicians, they can help their clients make informed choices about health care during and beyond their reproductive years. In taking medical histories, providers would ask their clients about their personal birth preferences, and philosophies about childbirth, to determine if they are appropriate midwife clients. Midwives refer high-risk women to obstetricians and to maternal fetal medicine specialists for high-risk pregnancies. Obstetricians should be able to recognize low-risk, healthy women who would do well with midwives, especially if they are without high-risk medical conditions. Such conditions include heart, kidney, and lung diseases, diabetes, or other known blood coagulation diseases, or medical or genetic issues for the fetus, all of which require an obstetrician.
At the conclusion of my session, participants stated in their feedback that they became more comfortable counseling patients about midwifery.
It was a true honor to be a part of an academic program that is changing the conversation to advance women’s reproductive well being, while increasing providers' knowledge. To further research the subject, Sophie and Rachel submitted their abstract, Diversity in Reproductive Choice and Human Sexuality, to the Sexual Medicine Society of North America’s annual conference in Nashville, and it was accepted. They gained further insight about the national and international research that is being conducted on sexual and reproductive health.
Academic institutions can benefit from integrating this type of elective series into their curricula. I believe it is essential for institutions to teach students about licensed midwives who collaborate, consult, and co manage low-risk patients with obstetricians. I look forward to teaching more medical students in the near future.
Do you believe medical school programs should integrate a midwifery elective?