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Dr. Jacob Thomas on the Value of CNMs

Jacob Thomas, MD, of Durham Women's Clinic, part of UWH of the Carolinas, is passionate about connecting with his patients and providing an atmosphere where they feel respected, seen and heard. For him, partnering with CNMs is part of that.

“We have a very strong midwifery presence in our practice,” he says. “It’s something that we pride ourselves upon because our patients appreciate the opportunity to experience different approaches - for prenatal care and especially for labor and delivery."

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Dr. Thomas says the Durham Women's Clinic midwives function as additional providers. “We’re here as a liaison to provide insight or help with difficult patients or patients who the midwife may want a second opinion about,” he says.

“It’s a very much a collaborative care model.”

The practice employs four CNMs who each have a supervising physician listed under their state licensure, but that physician does not need to physically oversee the midwife’s work or loom behind them in the exam room.nd thealso

FULL SCOPE

Cindy Womble, who has served as the Durham Women’s Clinic practice administrator for 22 years, says their CNMs bring great value to the table.

“We love midwives,” she says. “They help out tremendously at our practice.

“They see patients for prenatal care, labor and delivery and postpartum care, and after all that is said and done, they can also provide gynecological care. They can do pap smears, STD screenings, and insert IUDs and NEXPLANON – all of our CNMs are certified in both. So, they’re able to offer the full scope.”

Dr. Thomas says midwives routinely perform deliveries if the labor process has been uncomplicated. “If the patient is moving along in an expected way, a CNM can perform the full delivery – including a perineal repair if within their scope.”

A midwife (along with an ObGyn from Durham Women Clinic’s sister practice) is also on call 24-7, and will handle most non-emergent overnight deliveries (including VBAC).

GROUP PRENATAL CARE

Durham Women’s Clinic was the first practice in the area to offer CenteringPregnancy, an evidence-based, community prenatal care model that supports groups of pregnant women going through the journey to motherhood together.

The practice’s very first midwife brought the idea to the office and founded the program. Now, all the clinic’s midwives complete facilitator trainings where they get familiar with the group setting, and learn to lead the 90-minute sessions and encourage members to interact with each other and participate.

“It’s a great model of care,” says Dr. Thomas. “It's associated with decreased risk for preterm delivery among high-risk patients, and the CNMs are exclusively providing that service in our clinic.”

Nationally, the program has been shown to nearly eliminate racial disparities in preterm birth. It also decreases the rate of low birthweight babies, increases breastfeeding rates and leads to better pregnancy spacing.

Learn more about CenteringPregnancy

ATTRACTING PATIENTS

“Midwives and APPs definitely attract new patients to our practice,“ says Dr. Thomas. “Women who desire a low-intervention or a more physiologic birth are attracted to midwifery care, therefore an expert CNM team is an important part of our care model.

“Midwives make sure the patient’s desires are well expressed. They serve as staunch patient advocates.”

Womble agrees that midwifery can also help empower women and contribute to continuity of care.

“Our midwives encourage patients to actively participate in their healthcare decisions and advocate for their own needs – during pregnancy, childbirth and beyond.”

HIGHER QUALITY CARE

Dr. Thomas says partnering with midwives makes a big difference for physicians when it comes to hospital call.

“From a call perspective, if your task burden is reduced, you're able to provide higher quality care in the interactions you're having with patients because you're not stretched so thin,” he says.

“In a sense, midwives open up physicians’ schedules and help make them more productive.

“Because CNMs are seeing low-risk patients and providing quality prenatal care – the physicians are able to direct their attention to surgical patients and those with more complex gynecologic needs.”

Womble says CNM care allows greater patient access and decreased labor costs - which presents an enhanced revenue opportunity. The practice is also able to ensure all their obstetric patients can get timely appointments, and increase its patient volume overall.

GROWING THE TEAM

Durham Women’s Clinic is in the process of hiring a fifth CNM, who will complete a six-week training period to get acclimated to the practice and processes before she starts seeing patients. The team will then promote their new clinician via their website and social media posts.

Dr. Thomas says recruiting midwives has become more competitive in recent years, because potential employers are more aware of the value they bring to a care team. And Womble notes that determining cultural fit is critical.

If your practice is interested in hiring a CNM, the Unified Provider Recruiting team can offer helpful resources and customized assistance.

At this point in his medical career, Dr. Thomas can’t imagine a model that didn’t include midwifery.

“Ultimately, including midwives in our practice – and allowing them to shine at what they do best – has alleviated burdens for the physicians and created opportunities to provide more specialized and focused patient care.”

Physician Perspectives is a new series featuring insights, opinions, resources and knowledge sharing from affiliated physicians across the Unified community. Have an idea for a featured physician or topic? Please email Rosemary Thompson.