For the first feature of our "Great in Fredericksburg" Series, the Owners of Doulas of Fredericksburg recently asked Amy Frederick, MSN, CNM of Advanced Care for Women to open up a bit with us. We were not surprised to find her knowledgeable, delightful, and passionate about quality health care for women at all stages of their lives. Please enjoy reading about one of our Great Fredericksburg Midwives, Amy Frederick.
What drew you to being a midwife?
Did you know in 1920’s and 30’s, there was a woman named Mary Breckenridge who brought the idea of Nurse-Midwifery to fruition? She did some work in Europe, after World War I, and saw the midwives in England caring for mothers during pregnancy and birth but they were not nurses. They focused on the power and strength of women and used their experience to keep families safe. She realized nurses in the United States were doing the same things for non-birthing women.
So, in the mid-1920s, she came back to Kentucky, and began practicing public health and maternity care with nurses who she then sent to Europe for midwifery training. She eventually began the first nurse-midwifery school (which later became Frontier Nursing University), where she trained nurses to be amazing midwives! She sent them out into the communities, and pretty soon, there were women who were trained in childbirth and in safe medical practices helping families throughout southeastern/rural Kentucky. Their rates of survival and health were many times higher than the national average of the times! This happened because she had this vision where women were educating each other, helping one another, and meeting each need as it arrived. How could I *not* want to be a part of that?
What was the process to become a midwife?
Since they are helping women delivery babies in hospitals, Certified Nurse Midwives (CNMs) have to be nurses first; I have been a nurse since 1998 and been here in Fredericksburg since 2004. I started working in Labor and Delivery in 1999. I worked as a labor nurse for 9 years before I went back to school (and continued working as an L&D nurse during my midwifery training). It took me three years but, in 2012, I graduated from Frontier Nursing University with my Master of Science in Nursing degree, and began my career as a CNM.
Right after graduating from Frontier, my husband and I moved our family to Pennsylvania to take care of some extended family. My first midwifery job was there, where I worked with a largely Mennonite/Amish population. It was great, because those women were so healthy and so hardworking. I used to have to talk them into staying at the hospital because they wanted to go home and go straight back to working on the farm. Like the day after they had a baby. It was crazy, but in that wonderful way where you get to focus on true midwifery care.
I was definitely spoiled a bit, because when we moved back to Fredericksburg, I had already had this great experience, caring for amazing women, and I wanted to be able to continue to practice the way I had there. I actually waited a bit, and continued to work as an L&D nurse until I found what I was looking for in a practice.
Is that how you came to work with Dr. Josephs?
Yes! I found that home in Advanced Care for Women. It was important to me that I belong to a small practice, where I could truly work as a midwife, and where the other providers would share my philosophy of care. I wanted my patients to know they would get the same personalized care focused on education and patience whether they saw me or the other provider. So I started working with Dr. Josephs in 2015, and we’ve been seeing patients together since then.
What is the difference in care with an OB/GYN physician vs. a midwife?
The fundamental difference is training. Doctors are, by their nature, trained that birth is a risk for mother and baby, and needs to be managed. Birth can be treated as an illness.
Midwives are trained that birth is a normal, physiological process until it deviates from normal. While it can certainly be risky, it is not necessarily a disease process which needs management. Further, our training heavily leans toward educating and addressing the whole person: spirituality, the family, holistic health. Also, one of my philosophies is: “when we take care of the mothers, we are taking care of the whole family” as women are often the caregivers and healthcare decision makers for the entire family.
What kinds of births do you attend?
I can basically attend any birth with exception to cesarean delivery, you need a surgeon for that--but I do often accompany my patients into the OR if they do end up needing to give birth surgically. I can happily assist women as they attempt Vaginal Birth After Cesarean (VBAC), yes, I can help a mother deliver her multiples, yes I can help if you choose pain medication… if you are relatively low-risk and delivering in the hospital, I can attend those births too. If a need arises for a higher level of intervention, I will consult and/or collaborate with Dr. Josephs for the patient’s best outcome.
What is your birth philosophy?
My goal for each woman is for them to have the pregnancy and birth they have envisioned. Women dream about and plan for their births as much as they do for weddings, and we should honor their intelligence and wishes. I want to educate them, share my knowledge and help them to make the best decisions they can in regards to their care. If circumstances don’t allow for the birth they wanted, it’s important to also support them and help them to process that.
What’s your favorite part of being a nurse-midwife?
I loved being an L&D nurse. I could really help advocate for my patients, tend to their care and make sure they got the care they needed and deserved. As a CNM, I get to be with them through the entire process! We ideally meet early in pregnancy, I get to help them plan and implement their plan for birth (or create one if they are not sure what to do), counsel them on the decision making and support them through it all. Then, I get to be there when they have a baby! When their world changes and they’ve done it! That relationship is so special to me! I actually go through a withdrawal after they have their baby. Like, “Hey, I was seeing you every week, and then you go home and I don’t see you for 6-8 weeks!” I miss them a lot!
What is one thing you wish your patients knew during pregnancy?
You can literally ask me anything! I’m all about education, so there isn’t anything too small or silly. I want you to be comfortable and to trust your body to carry and deliver your baby.
What is one issue for newly postpartum parents you’d like to tackle?
I’d say 90% of my clients say they want to breastfeed, but between birth and 6 weeks nearly half of them stop. Which is ok, if that’s what they want or need for their babies. Really, I have no judgement about that.
But…I can’t help but feel like many people stop because they don’t know what to do. They don’t know what is normal or that it can be difficult sometimes. I think people are told “it’s natural” but don’t know where to turn when natural is difficult. I think if there were more support, if I could follow up with them in some way, if they knew where to turn, then perhaps they wouldn’t have to bag breastfeeding if they didn’t want to. KellyMom.com is a great online resource and so is the Lactation Office at the hospital.
I have always seen this need and this is why I teamed up with another L&D nurse who is a Lactation Consultant, and we started our own in-home lactation and childbirth education business, BellyGoRound. We have found that people who want to continue breastfeeding just need a little extra support. My partner will come to your home and do a breastfeeding assessment with you. Insurance usually reimburses the clients too (we provide coded billing to submit to insurance). I love being able to serve clients in both capacities, as a midwife at Advanced Care for Women, and then as co-owner at BellyGoRound.
We’ve seen the great care you provide for your patients. Is the old saying true, “I don’t need a doula because I’ve got a midwife?”
In an ideal world, I would get to stay with every patient, helping them through their entire labor. The reality is…I often have to see 20 patients a day, even while I have a patient in labor at the hospital. As much as I’d like to give individualized, holistic care to each patient for the entirety of her labor, unfortunately, my time is so limited and there is definitely space during pregnancy and birth for having a doula on your team to provide continuous support that I cannot realistically provide.
And then afterwards-- I’ve already mentioned how much of a freak I am because I miss my patients so much, right? After they leave the hospital, I don’t see them again for 6 weeks. I’d *love* to be able to call them, check-in on their aftercare, help them process the birth, do some follow-ups. But that’s not a role I can currently fill. That’s where doulas come in. They get to do all of the non-medical stuff I wish there was time for me to do. They are certainly a great idea before and after birth, and I am happy to work with them as part of the birth team, because it means I know my patients are getting great support throughout their whole pregnancy, labor and after the baby arrives.
You love your maternity clients so much! Do you also do well-women visits and see them for other common gynecological issues so you can keep in touch with them?
Yes! Many folks do not know this…CNMs can care for women throughout the lifespan (from teens who need birth control to post-menopausal woman and everything in between)! We can do well-woman exams (Pap smears/mammograms), provide primary care for basic illness/health prevention, diagnose and treat basic gynecological problems, as well as care for you during your pregnancy and birth. It is my desire for all women to know they need a midwife, no matter their stage in life!
We would like to thank Amy for her generosity of time and spirit in sitting down for our interview. Amy Frederick sees patients at Advanced Care for Women, helps them deliver at Spotyslvania Regional Medical Center and would love to see you there too!