By Judith Spitzer, Spokane Journal of Business
Obstetricians and midwives both provide care to women during
childbirth, and both work together at Rockwood OB/GYN &
Midwifery Center, in a department that, by design, offers health
care by women for women.
An advertisement running in area magazines this month, sponsored
by the center, shows a photo of 12 women with a caption that reads
"Care for women, by women." The women in the photo, five medical
doctors and seven certified nurse midwives, are all proud of the
fact that the department is an all-women crew and in fact, some of
the women in the group were planning its structure for many years
before the all-women department became official.
Dr. Katie Lessman, department group leader, was instrumental in
the formation of the department two years ago. Lessman says
everything has changed since then, with the entire department being
regrouped. The women in the group have essentially been handpicked
to provide health care for women in a specialty where women caring
for women makes a difference, says Lessman.
"There have been changes on the obstetrics side in the last
couple of years," says Lessman, who worked with other department
heads to make the changes. "We completely rebuilt it," she
The Rockwood OB/GYN & Midwifery Center, which is located at
910 W. Fifth, next to Deaconess Hospital, employs about 18 nurses
and support staff in addition to the physicians and midwives who
A big part of the change, besides a focus on women caregivers,
is that patients are no longer assigned strictly to one physician.
All midwives and physicians have access to patient charts and the
group shares information and gives advice about patient care
As a rule, the five physicians tend to treat higher-risk
patients at the center. Midwives help birth about 25 babies there
every month, about the same number as the physicians.
Renata Gruber, a certified nurse midwife (CNM) and advanced
certified nurse practitioner (ARNP), says the center has been a
dream of the seven midwives who came from three different health
care providers to practice at Rockwood's center. Both she and
Lessman say the more people in sync with a woman giving birth …
"the better her labor will be."
When potential patients call the center, they are asked whether
they want to see a nurse or a midwife.
The women all knew one another so when the opportunity to work
together arose, all seven jumped at the chance, says Gruber.
All seven of the midwives in the group are licensed with CNM and
ARNP designations. Certified nurse-midwives (CNMs) are registered
nurses who have graduated from a nurse-midwifery education program
accredited by the Accreditation Commission for Midwifery Education
(ACME) and have passed a national certification examination to
receive the professional designation. An advanced registered nurse
practitioner is a nurse practitioner who has taken training and
passed a national examination in one of four areas, in this case
Nationally, in 2007, certified midwives and nurse-midwives
attended 318,00 births, or 7.3 percent of all births, according to
the National Institute for Health Statistics, a 240 percent
increase over the number in 1989.
Gruber says a significant difference at the center is the
feminist model of care-women are making decisions about their own
"We feel that we can give women more choices," she says. "It's
not the patriarchal model that prevails-women come in and the
doctor tells them what's wrong and then treats them. Women should
be given choices. Women should be in charge of themselves. We offer
options and they choose."
Gruber says the women dreamed of creating an all-women practice
for many years.
"It's a delicious, perfect model," she says, adding that the
combination of open communication and collaboration of patient care
is optimal. Women who have been to the center have probably been
seen by one or more of the other midwives and doctors, which means
they probably are acquainted with whomever is on call for the
"I can consult with them when needed, and the two groups are
very collaborative but separate," she adds. "Our patients get a
Gruber says midwives, more than obstetricians, have to deal with
public perceptions that aren't necessarily true.
"People think that midwives deliver babies out in tents,
squatting down over a brick," she says with a laugh. "Certified
nurse midwives deliver in hospitals or birthing centers. Not that
we look down on other types of providers. They all fit in a
different niche of the same system. Different women have lots of
different needs and desires."
While midwives can order and interpret diagnostic tests,
diagnose and treat common illnesses and injuries, as well as
prescribe and manage medications, only doctors can surgically
intervene if a cesarean section is indicated.
A cesarean section, or C-section, is the delivery of a baby
through a surgical incision in the mother's abdomen and uterus. In
certain circumstances, a C-section is scheduled in advance, and in
other cases, it's done in response to an unforeseen
The group of midwives at Rockwood, all talking at once during an
interview with a Journal reporter, offer up all the alternatives
they use for women who want to go through childbirth naturally
including hydrotherapy, the use of bean bags chairs, birthing
stools and more.
"We can help deliver babies with the woman standing up holding
onto a bar, squatting, sitting and any other position she wants,"
"And most women want to sit or stand up to deliver," she
Lessman says that while she would love to help women birth every
baby vaginally rather than by C-section, there are many reasons
women might need to have the surgery. "We deal with diabetes,
hypertension, advanced maternal age … and as physicians, we have
(different) tools in our arsenal," she says.
She says that while the rate of C-sections might look higher for
physicians than the rate for midwives, the reason is that 75
percent of the patients physicians at the Rockwood center see are
women with high-risk pregnancies.
As long as mom and baby are doing well, typically midwives are
more patient in waiting for labor to move forward, Gruber says.
They also can offer a woman the same pain medications a
physician can provide.
"Women instinctively know what they need to do. But they want to
be listened to," she adds.
Gruber says another misperception about midwives and OB/GYNs is
that they only see women during pregnancy and childbirth. Recent
studies show that a significant number of women in the U.S. see a
midwife or OB/GYN physician through their whole lives for health
care, she says.
She says her patients range in age from about 10 years old to
"We see lots of women throughout their life spans," Gruber says.
"And their daughters, and their daughters."
"I see women throughout their life span," she adds.
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