Promoting Midwife‐Provided Gynecologic Care: With Women for a Lifetime

Abstract

This issue of the Journal of Midwifery & Women's Health is the second in a 2-part series on gynecology. This series has addressed mainstays of gynecologic care, such as sexually transmitted infections (STIs)1, 2 and contraception,3, 4 as well as more complex conditions, including polycystic ovary syndrome5 and breast cancer.6, 7 Two of the articles in this issue address topics that have been frequently requested in the Journal's reader surveys: hormone therapy8 and infertility.9 Overall, the series recognizes that midwives provide a broad scope of gynecologic care. Throughout my career, I have had a strong interest in gynecologic care. I taught women's health for several years at Frontier Nursing University, studied the gynecologic services provided by midwives for my doctoral dissertation, and am co-editor of a gynecology textbook. One of my greatest professional passions is contraception, and I believe that helping women to have intended pregnancies is one of the most important things any clinician can do. So I often found myself mystified when students told me they had no interest in gynecology or even didn't consider it part of midwifery care. Gynecologic care is well established in the American College of Nurse-Midwives (ACNM) Core Competencies,10 and it is an essential aspect of midwifery practice. The midwifery hallmarks that make midwives exceptional providers of maternity care, such as incorporation of scientific evidence into clinical practice and empowerment of women as partners in health care, are also qualities that make midwives ideal providers of gynecologic care. Gynecologic care gives midwives the opportunity to truly be with women for a lifetime. Pregnancy and birth are important and life-changing events, but they are short and fleeting opportunities for health care. Our ability to provide gynecologic care allows midwives to maintain continuity of care, another one of the midwifery hallmarks, with women from adolescence through old age. Most women spend only a couple of years of their lives needing maternity care services, but they need health care services that midwives can provide for many more years than that. And yet, most women have no idea midwives provide gynecologic care. I would rank the belief that “midwives only provide maternity care” as one of the great myths of our profession, right up there with “midwives only attend home births” or “midwives only take care of women who want unmedicated birth.” I have been asked by women, pharmaceutical representatives, and even physicians if midwives provide gynecologic care. I believe midwives bear some of the burden for this misconception about our scope of practice. Midwives often use language and images that focus on pregnancy, birth, mothers, and families, without promoting the gynecologic and primary care services we provide. I recently had the privilege of hearing Susan Reinhard, RN, PhD, FAAN, who is Senior Vice President for Public Policy at AARP and Chief Strategist for the Center to Champion Nursing in America at AARP, speak on the Future of Nursing Campaign for Action. Dr. Reinhard talked about using the terminology “barriers to care” rather than “barriers to practice” to put the focus on patient care instead of providers. There are many barriers to care caused by regulations that limit midwives’ ability to practice to the full extent of our education and training. However, midwives present a barrier to care when we do not make women aware of the broad range of services we provide, particularly those extending beyond pregnancy and birth. Each of us can begin to break down this barrier by making sure our language about midwifery accurately conveys our scope of practice. As midwifery practices choose their names, create logos, and develop advertising materials, they should think about whether they are communicating all the clinical responsibilities that midwifery practice encompasses or just focusing on pregnancy and birth. Midwifery practices need to publicize the gynecology services they provide. Midwives must ensure their pregnant patients know that midwifery care can continue long after they give birth. Midwives who don't provide gynecologic care should refer to other midwives for these services whenever possible. Promoting gynecologic care provided by midwives is particularly timely with new regulations of the Affordable Care Act that went into effect on August 1, 2012 and affect women's health care. Women can now receive annual well-woman visits, human papillomavirus testing, counseling for STIs, HIV screening, and contraceptive methods and counseling without a co-payment, co-insurance, or a deductible.11 As women's access to these services increases, midwives must be poised to provide them. Recently ACNM launched a public relations campaign, Our Moment of Truth,12 that promotes an understanding of women's health care choices, including the fact that midwifery practice is not limited to maternity care. One important truth midwives must convey to women is that we provide care beyond pregnancy, birth, and the postpartum period. The majority of midwives provide gynecologic care.13, 14 Now midwives must make sure women know we provide these services so that we can truly be with them for a lifetime.