Midwife

Certified Nurse-Midwife

April believes in women being active participants in their care. This means getting educated about your pregnancy and making decisions that are best for you and your baby. Child birth education is encouraged and referrals are given to many Las Vegas and Henderson classes including, Bradley method of natural child birth, Hypnobirthing, Lamaze classes, and Birthing from Within. Referrals are also offered for doula services, lactation consultants, La Leche League meetings, and much more to help you through pregnancy to parenting.

Another service , April, provides is helping parents create a “wish list” or birth plan for the big day. This is individualized and can include ways to avoiding tearing, desiring a water birth, or having dad catch the baby.

April started her career in maternity care as a labor and delivery nurse at Sunrise Hospital. She worked as a labor and delivery nurse for 5 years and helped bring over 1,500 babies into the world over those years. At the time, Sunrise was only one of two hospitals in Las Vegas that had a level III neonatal intensive care unit. This meant that there were a lot of high risk pregnancies and deliveries that April encountered in her time there. This experience has been invaluable in clearly knowing the difference between normal and abnormal.

April was a bit surprised at how medicalized birth was in the hospital. She questioned the necessity of many of the cesarean sections that happened during her years working as a labor and delivery nurse. April felt she could better serve families by training to become a midwife. April spent the next two years obtaining her masters degree in nurse-midwifery. Much of April’s student midwife years were spent in birth centers and home birth. After graduating from midwifery school April began a hospital based practice at St. Rose Hospital. Over a 3 year period April introduced water birth and many other natural child birth friendly options for mothers.

At the end of 2007 April fulfilled a long time dream and opened a home birth practice.

What are the different types of midwives (DEM, CPM, CM, CNM)?

April is the only Certified Nurse-Midwife attending births outside the hospital in Southern Nevada.

Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives

Certified Nurse-Midwife (CNM)

  • Licensed and trained as a Registered Nurse and in midwifery.
  • Experience as a registered nurse (generally labor and delivery, postpartum, or neonatal). April has experience working as a RN on all of these units.
  • In Nevada CNM’s are licensed through the Nevada state board of Nursing and required to maintain continuing education in their specialty.
  • Entry-level education: Master’s Degree
  • Can practice in all states
  • Can deliver in all settings (home, birth center or hospital)
  • Can provide care from “menarche through menopause” (menarche being the first menstrual cycle).
  • Does not require any physician oversight in the state of Nevada
  • Can write prescriptions and legally carry prescription medication to births
  • Many insurance companies require a midwife be a CNM for reimbursement. Teacher’s Health Trust, TriCare, and Culinary are a just a few of the insurances that only recognize the CNM license.

Certified Professional Midwives (CPM)

  • Licensed and trained in midwifery only.
  • You can become a CPM without going to a school. This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process).
  • If you go to school, you can go to an MEAC accredited school or one that isn’t accredited. Non-accredited schooling requires PEP as well.
  • Entry-level education: high school diploma
  • Can practice in most states, but some states will not license CPMs. Nevada does NOT license CPM’s
  • Can only attend deliveries Out of Hospital (OOH)
  • Cannot write prescriptions or legally carry any prescription medication in Nevada
  • Care is limited to pregnant or post-partum women in some states. Other states allow well-woman care as well

Are there laws regulating home birth midwives?

Nevada currently only regulates certified nurse-midwives. This means that any other type of midwife isn’t regulated in our state. This has both risks and benefits for consumers. It means that anyone can legally call themselves a midwife and practice in Nevada and they wouldn’t be breaking any state law in doing so. This puts a lot of responsibility for parents to choose a midwife wisely. It’s very important to interview a prospective midwife and ask for educational background, clinical experience, number of births attended, and references. Here is April’s resume:

Experience

Certified Nurse-Midwife & Certified Professional Midwife, Baby’s 1st Day, Las Vegas, NV — 2008-Present
Founder and president of Baby’s 1st Day, Midwifery Services. Attending sixty home births per year. Providing complete antepartum, intrapartum, postpartum, and newborn care.

Certified Nurse-Midwife, Deseret Women’s Health Care, Henderson, NV — 2005-2008
Managing practice partner with collaborating OB/GYN, and physician assistant. Attended 240 hospital births per year. Cesarean first assistant in the operating room. Complete GYN care in office including family planning, menopausal management, and well woman care.

Certified Nurse-Midwife, Fremont Women’s Health Care, Las Vegas, NV — 2004-2005
Worked with four collaborating physicians in a busy OB/GYN practice. Complete GYN care provided including family planning, birth control, annual exams, menopausal management, colposcopy, IUD placement, and fertility care.

Student Nurse-Midwife, Frontier University, Hyden, KY — 2002-2004
Attended births in birthing centers, at home, and in the hospital. Attended 87 births as the primary midwife under supervision.

Registered Nurse Labor and Delivery, Sunrise Hospital, Las Vegas, NV — 2000-2004
Provided care to high risk antepartum women, routine intrapartum care including circulating operating room nurse, neonatal intensive care experience, and postpartum couplet care. Electronic fetal monitor certified, advanced cardiovascular life support trained, and neonatal resuscitation certified.

Education

Masters in Nursing
Case Western Reserve University, Cleveland, OH – 2004

Masters in Midwifery
Frontier School of Nurse-Midwifery, Hyden, KY – 2004

Bachelors in Nursing
University of Nevada Las Vegas, Las Vegas, NV – 2000

Board Certifications

American College of Nurse Midwives
Board certified as a nurse-midwife since 2004 – certification # 24678

North American Registry of Midwives
Board certified as a certified professional midwife since 2008 – certification # 08030008

Licenses

Registered Nurse
Arizona license # RN160290
Nevada license # RN36201

Advanced Practice Nurse
Arizona license # AP3487
Nevada license # APN000807

How many births has April attended?

This is one of the things that set April apart from other midwives practicing home birth in Southern Nevada. Due to April’s hospital experience and the difference in volume that a hospital based midwife attends and a home birth midwife attends April has attended more births than any other home birth midwife in Nevada. This is valuable as most obstetrical emergencies happen in less than 1% of pregnancies and births, this is further decreased by only selecting low risk women. For a midwife to see complications she has to attended hundreds of births as most of the time birth happens without a hitch. April’s experience gives her confidence in managing complications.

2000-2002: April worked 4 twelve hour shifts a week. At that time UMC Hospital and Sunrise Hospital had the only neonatal intensive care units (NICU) in town. This meant that Sunrise (where April worked as a L&D nurse) was very busy. During that time Sunrise Hospital averaged 400-450 births a month. This meant that in a typical 12 hour shift a RN would attend anywhere from 1-4 births. April went to part time at Sunrise Hospital when she started graduate school in 2002. From 2002-2004 April worked 2 twelve hour shifts a week as a labor and delivery nurse. April did not document number of births she attended as a labor and delivery nurse, but a conservative estimate during this time is 1,500 births.

2002-2004: April attended 87 births as a student nurse-midwife. These were at home births, birth center births, and hospital births.

2004-2008: April practiced as CNM out of St. Rose Hospital. She attended 962 as the primary midwife over these years. This does not include cesarean births that she first assisted with, or births when she shared call with her OB/GYN partners.

2008-Present: April practiced as a CNM/CPM with Baby’s 1st Day. As of January 2017 April has attended 588 home births.

That makes for 3,136 babies!!

 

Why a Midwife?

Midwifery is based on a strong belief in partnership with childbearing women and respect for birth as a normal life event. April strives to empower parents with knowledge and support their right to create the birth experience which is best for them. April respects intimacy, privacy, and family integrity, and draws on her own patience and understanding to provide care during pregnancy and birth.

You can choose April to care for you during your pregnancy as long as you’re in good health (meaning you have no serious chronic medical condition, such as high blood pressure, epilepsy, heart disease, or diabetes). Midwives are an appealing option for women who want a more individualized, less routine approach to childbirth than most traditional obstetricians provide. They focus on helping you learn about the physical and emotional changes you go through during pregnancy, teach you how to maintain good health habits, and consider you to be an active participant in all aspects of your care. April sees every pregnancy as a unique event and encourages you to consider your options for labor and delivery and to personalize your own birth plan. Whatever kind of birth you choose, April will support you in your decision.

Are Midwives Safe?

Several studies in the United States have shown that healthy women with normal pregnancies who choose midwives are just as likely as those who choose ob-gyns to have excellent outcomes. What’s more, women who choose midwives tend to endure fewer medical interventions (including continuous electronic fetal monitoring, epidurals, and episiotomies) and have a lower rate of cesarean section.

April is able to recognize when problems develop during pregnancy, labor, and birth and is trained to manage emergencies. All Southern Nevada hospitals that have a labor and delivery unit have an OB/Gyn that is on-call. If the need arose to transport to a hospital, care would be available. Even if transport becomes necessary, she’ll most likely continue to be involved and provide support and care throughout the birth and postpartum.

“The quality of midwifery care is equivalent to physicians’ care within their area of competence, according to a 1986 study by the office of technology assessment. further, they are better than physicians at providing services which depend on communication with patients and preventive action.”

The Medical University of South Carolina Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birthweight infants, neonatal intensive care admissions, and perinatal mortality in a midwife directed clinic where midwifery care is given when compared to a MD directed team where MD care is given. This demonstrated that the contribution of midwives to high-risk prenatal care can be considerable.

There are approximately 10,000 midwives currently practicing. Midwifery practice is legal in every state and in the District of Columbia. Births attended by midwives have risen steadily since 1975; midwives presently attend over 9% of births nationwide and almost 25% of births in some states, including Florida, New Mexico, and Oregon.

How are midwives educated?

There are many paths of education for home birth midwives. Most home birth midwives are apprentice trained. April’s formal education are one of the things that set her apart. April has a bachelor’s degree in nursing and a master’s degree in the art of midwifery. In addition to this formal education April has practiced as labor and delivery nurse for several years. April has also had to pass rigorous state nursing board exams and national midwifery board exams to be licensed to practice.

Philosophy

April affirms the power and strength of women and the importance of their health in the well-being of families, communities, and nations. April honors and promotes the normalcy of women’s lifecycle events.

Midwives believe every person has a right to:

Equitable, ethical, accessible quality health care that promotes healing and health

Health care that respects human dignity, individuality and diversity among groups

Complete and accurate information to make informed health care decisions

Self-determination and active participation in health care decisions

Involvement of a woman’s designated family members, to the extent desired, in all health care experiences

Midwives believe the best model of health care for a woman and her family:

  • Promotes a continuous and compassionate partnership
  • Acknowledges a person’s life experiences and knowledge
  • Includes individualized methods of care and healing guided by the best evidence available
  • Involves therapeutic use of human presence and skillful communication

Midwives believe in:

  • Watchful waiting and non-intervention in normal processes
  • Appropriate use of interventions and technology for current or potential health problems
  • Consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care

Midwives affirm that midwifery care incorporates these qualities and that women’s health care needs are well-served through midwifery care.