Episode 9: Nurse Midwifery and Women's Health

Cara Lunsford (00:01.786)
Hi Jessica.

Jessica Brumley (00:04.536)
Hi Kara, how are you?

Cara Lunsford (00:06.992)
Good, I'm doing really well and you look beautiful. You look amazing and you sound great too.

Jessica Brumley (00:12.59)
Thank you. Perfect. Okay, great. It said headphones were preferred. I, yeah.

Cara Lunsford (00:23.63)
Yes, it's always super helpful to have headphones. one of the things I will tell you is that when I'm done, I'll say goodbye, but stay on just for like 30 seconds or so with me, like, I'll turn off the recording because Riverside has to upload it really quick. So even if I'm like,

See you later. Bye. Don't hang up. Yeah. So, so Jessica Brumley, how are you?

Jessica Brumley (00:57.442)
Yes. Got it. Yeah.

Jessica Brumley (01:05.806)
Great.

Cara Lunsford (01:08.578)
Yeah, you're doing well. Are you doing well?

Jessica Brumley (01:11.855)
Yeah, I'm doing well. Yeah.

Cara Lunsford (01:13.496)
Yeah, it's an interesting time in the world right now. And it's a hard time. It's really hard, and especially when we think about women's health. And I know we'll talk a little bit about that today for sure. But Jessica, would you introduce yourself really quickly to our audience, just who you are and.

Jessica Brumley (01:18.744)
Yeah.

Jessica Brumley (01:30.124)
Mm-hmm. Yeah.

Cara Lunsford (01:41.306)
how you got started in your profession and yeah, yeah, and you're here with us because you're part of the certified nurse midwives and certified midwives. I? Yes, okay. I wanna make sure that I get it right.

Jessica Brumley (01:43.424)
sure.

Jessica Brumley (01:57.89)
Yeah, yeah, yeah, Kara, you got it. Absolutely. Midwifery credentialing in the United States can be a little bit confusing for even those of us in the profession. So definitely I'm happy to talk about that. But I'll start with introducing myself. Thank you for having me. I am just really thrilled to talk with you today. I am

a certified nurse midwife.

and I am in clinical practice at the University of South Florida in Tampa, Florida, where tomorrow we will celebrate our 40th year anniversary. So really excited about what we've been able to build in our community for generations now. And I'm the director of the service and have been for a little over a decade. So that's my day job. You know, my home job is a wife,

mom to nearly two grown children, 17 and 22, and just love seeing them grow into adults. It's a really cool part of parenting, I think. And then my other job, my non-pay job, as I like to say, is that I serve as the president of the American College of Nurse Midwives, which is the professional organization for midwives.

that include a certified nurse midwife and the certified midwife credential.

Cara Lunsford (03:38.146)
Yeah, it's unfortunate that that's an unpaid position, isn't it? Because it's a lot of work. mean, so the more that I've been talking with presidents of associations and I've had several conversations, I'm always like, this is a lot of work.

Jessica Brumley (03:53.004)
Mm-hmm.

Jessica Brumley (03:59.936)
Mm-hmm. It is mission. Yeah, right. It's like mission-focused, passion-driven work. I can only believe that people who take on this role are doing it out of a desire to make the world better and do so through their profession that they believe in really strongly, right? So I...

Cara Lunsford (04:01.965)
You have to be passionate.

Cara Lunsford (04:24.793)
second.

Jessica Brumley (04:29.891)
I am just honored that my colleagues have trusted me with this work. Yeah.

Cara Lunsford (04:50.096)
rose.

Jessica Brumley (04:53.048)
What happened?

Cara Lunsford (05:02.073)
no. Well, she'll be back.

Jessica Brumley (06:14.446)
you

Jessica Brumley (06:28.949)
The power just went out in my house. Yeah, it's not even raining. I don't know what it's about, but I was just like, huh, why did that light go out?

Cara Lunsford (06:31.726)
my gosh, no way.

Cara Lunsford (06:39.564)
Is it, is it back? Is it like?

Jessica Brumley (06:42.783)
No, it's not back. No, I just, I just joined my hotspot. So, so yeah, I'm my batteries charged and hopefully it'll come back soon.

Cara Lunsford (06:57.402)
Yeah, I wanna make sure that it's a good enough.

Jessica Brumley (07:01.431)
connection. Yeah.

Cara Lunsford (07:03.162)
connection. It sounds okay right now, so let's see how it does. Am I coming through your headphones?

Jessica Brumley (07:09.546)
Okay, sounds good.

Yes.

Cara Lunsford (07:16.208)
don't know why I can hear myself.

Cara Lunsford (07:21.776)
If you turn the volume down a little bit.

Cara Lunsford (07:27.984)
Sometimes if it's coming through really loud in your headphone, it can actually pick it up through your mic.

Jessica Brumley (07:36.767)
Is that better?

Cara Lunsford (07:39.182)
Yeah, I think that's good. Okay, so what you were saying before the electricity went out in your house was that you were saying that you must have a passion.

Jessica Brumley (07:39.732)
Okay.

Jessica Brumley (07:44.691)
Mhmm.

Jessica Brumley (07:48.951)
You

Jessica Brumley (07:55.769)
Hmm. Yeah, this is, yeah, there's no way that you would, you know, volunteer to do this if it wasn't really in your heart, right, to serve your profession and your community. think, you know, any of us goes into this with a desire to make things better. And it's really, I think what I said was that it's really just an honor to have the privilege to do that and that.

Cara Lunsford (07:57.998)
for this in order to do it.

Jessica Brumley (08:25.529)
that other people have trusted me to do this work for this time.

Cara Lunsford (08:32.431)
How long have you been the president of the ACNM?

Jessica Brumley (08:37.018)
months. So it's a two-year term before taking on the role of president. I served as president-elect for a year and I was also vice president for three years before that. So I've been on the board a little over four years now.

Cara Lunsford (08:55.376)
So what is some of...

What mainly do you focus on as an association? What is your focus?

Jessica Brumley (09:04.217)
Hmm.

Mm-hmm.

Jessica Brumley (09:10.113)
We focus on creating a home for midwives in the United States, a professional home. So where midwives can come and develop relationships, be inspired to do great work, right? And be inspired by others that are doing amazing work, develop their skills, whether it's through continuing education, leadership development opportunities,

engaging with key stakeholders, right? And then also being a voice for midwifery in the United States. And so doing advocacy work, partnering with other organizations that are mission aligned organizations, right? So the kinds of tables that our partners we might have might include other professional organizations like nursing and physician colleagues, other midwife credentials.

But other national organizations that do work like the March of Dimes, right? So people who are interested in advocacy in this space will also be our partners. We're always thinking about how do we advance the profession of midwifery? So whether it's pay equity, and I might be showing up at a table of insurers to talk about why it's important to reimburse midwives fairly.

and the benefit of the midwifery model of care, right? Or hospital associations, talking about why it's important to privilege midwives, to allow them continuity of care when they're practicing in the community setting and need to bring their patients into hospitals. So those are some of the examples of the kinds of work that we do as an organization.

Cara Lunsford (10:58.254)
And I know that you all work also with JopiGo, which we're familiar with as well. And I had interviewed Pandora in a previous episode on NurseDOT.

Jessica Brumley (11:05.164)
Mm-hmm. Mm-hmm.

Yes, Pandora has a long career in international work and we're really lucky to have an international organization for midwifery in the United States, I mean in the world, the International Confederation of Midwives. And so a lot of the work that we do internationally is partnering with organizations such as those in order to

improve healthcare in other nations and to strengthen the profession of midwifery globally.

Cara Lunsford (11:48.708)
Yeah. I want to ask you a little bit about your personal journey because I think that people are always interested in why I think they're interested in like the biopics, right? Like why did this person choose nursing and then eventually, did you always know that you were going to become a certified nurse midwife or did you start out as a registered nurse?

Jessica Brumley (11:52.656)
Mm-hmm.

Cara Lunsford (12:18.217)
working in labor and delivery or what was your what was your journey like?

Jessica Brumley (12:19.581)
Yeah, that's a great question. So I didn't really have any nurses in my family. in high school, you're trying to figure out what you're going to do with your life and go to college and what you're going to major in. And my mom, very smart woman that she was, I think you'll be a great nurse.

know, 17. I was like, I don't want to be a nurse. They wear scrubs to work and that's not cute. The thing. Yes. It's not what I would say today. Right. So, but then I met somebody who was a nurse practitioner.

Cara Lunsford (12:55.504)
But they're comfy!

Jessica Brumley (13:08.332)
and she talked about her role as a pediatric nurse practitioner. And that was appealing to me. I enjoyed working with children and I had worked in lots of summer camps and babysat and that kind of thing. And so that was appealing to me and...

know, silly things. She wore dress clothes and a lab coat. And I was like, I can see myself doing that. Right. And so I said, I'll, I'll become a nurse. And I started my freshman year in undergrad with the intentions of going to nursing school. And, and I took a course in feminist perspectives in women's study in feminist perspectives in women's health. And

my eyes were sort of, you know, really opened to the profession of midwifery. I didn't really understand the different credentials of midwifery. Honestly, I didn't even fully understand the breadth of the work of midwifery. But when people spoke about midwifery, they spoke about the opportunity to make a great impact during a really, really vulnerable time in a person's life.

and the opportunity to change the health of entire families through working with someone during pregnancy, labor, and birth. And how the focus was really on empowering that individual and centering them in the work. And that really spoke to me. I don't think I'd ever heard anyone talk about that possible impact that you could have in that way.

And I made the decision in that class before even taking a single nursing course that I would become a midwife. I had not met a midwife. I had not attended a birth. I didn't know that it was more than birth. I just knew that that was what I wanted to do. And I did.

Jessica Brumley (15:08.354)
I was really privileged to have a lot of mentorship in my undergraduate education and went ahead and applied for graduate school while I was completing my nursing degree, which was at that time, and we're talking about the nineties, really unheard of. Not a lot of people went straight through. Most people had years of

RN experience before they went on to graduate school. It was really an expectation and many programs required it. You had to have at least a year of labor and delivery nursing experience before you could even apply to the programs. And so I sought out programs that didn't have that requirement.

Cara Lunsford (15:45.647)
Yeah.

Jessica Brumley (15:56.675)
And we were living in Florida, but I'm originally from New York. And so I considered, you know, those two locations as potential places. And I was really thankful that I found New York University, NYU, gladly admitted me without any nursing experience into their graduate program in midwifery. And I worked part time as a postpartum nurse while I was going through midwifery school.

girls gotta pay the bills. And that was good. That was a great opportunity for me to learn how to interact with people. But what they said that I didn't need to learn some of what they thought of as bad habits, right? That they wanted to really have the opportunity to teach us the midwifery model of care and not the medical model of care.

Cara Lunsford (16:28.147)
Ha!

Jessica Brumley (16:52.612)
And so I think that was a strength for me. And I know some people still feel strongly about having a lot of labor and delivery nursing experience before you become a midwife. But that wasn't my path. And I was grateful to have been given that opportunity really early on because that's meant a really long career in midwifery. And so I completed my midwifery training in 2001.

So there's not a lot of people that remain in clinical practice over decades because I had the chance to really start in midwifery really early on in my life. Yeah.

Cara Lunsford (17:34.042)
So I think it's really interesting that you say a couple of different things, right? That it was that...

Jessica Brumley (17:37.54)
No.

Cara Lunsford (17:41.818)
There was this...

I don't know, in a way they were saying, hey, you you don't have bad habits. It's kind of nice that you don't have bad habits. And look, as nurses, I've been a nurse for 17 years, of course you develop bad habits. you know, and we all do, and you hope that it's, there's a range of bad habits, right? Like there's things that are not gonna really affect.

the patient care or you've just learned how to adjust your practice to different settings and things like that. But I can understand because this is very similar to when there was a time where you couldn't go into a specialty unless you had done Med Search, right? That was so frowned upon. It was like, you're just going to come out of nursing school and go...

Jessica Brumley (18:21.036)
Mm-hmm. Right.

Cara Lunsford (18:43.4)
straight into a specialty, can, people can, nurses can be very opinionated.

Jessica Brumley (18:49.446)
I felt lucky to get a postpartum job straight out of nursing school because most of the only units that I would get interviews for was a med surge unit.

Cara Lunsford (19:01.284)
Yeah, yeah, and that was very common back then to just say, well, no, you have to start here and then you can move after a couple of years into a different specialty. I also went straight into a specialty. I went straight into pediatric hematology oncology. That was what I was passionate about. That's what I wanted to do. I think it's more important that you pay attention to what you're passionate about.

Jessica Brumley (19:22.266)
Right? Mm-hmm.

Jessica Brumley (19:28.87)
Mm-hmm.

Cara Lunsford (19:29.988)
because otherwise if you just go into an area that you don't really have an interest in, you will burn out. You're gonna burn out before you even get to your specialty.

Jessica Brumley (19:41.606)
I talk to people about this often because burnout is, well, we're in a post COVID era. Everybody's talking about burnout, but burnout's been an issue that we've been talking about in our profession for quite some time. And I believe strongly that a big reason why I have been able to continue to endure in my profession, one, I'm super passionate about it. So I'm mission driven.

And I'm very intentional about the work that I take on and that it aligns with my values in that way. And then two, I have been also intentional about developing my professional community and really thinking about who it is that I surround myself with. Where do I gain inspiration to be able to continue to do the work that is so critical? My community needs me to be present.

to be able to improve the systems of care that exist in my community. How do I do that? How do I do that if I'm one of maybe three midwives when I joined the practice? I didn't know what other people were doing. When I would go to a national meeting and I would hear about the amazing work that people are doing around the nation, I would say, light bulb, that's what I wanna do. And so many times throughout my career,

That's exactly what I've done. I've taken that inspiration and I've moved it into my community and implemented protocols for change so that now when people come to our hospital, they don't feel like they need a birth plan that spells out everything that they wanna do because those are our routines. Whether you get a midwife or not, you're getting skin-to-skin care and delayed cord clamping and freedom of movement and intermittent auscultation and the opportunity for hydrotherapy and all the things that we know are evidence-based.

and they would only think that they could get from a midwife or if they asked for it and if it was spelled out. Now, because we've created those changes locally, inspired by others who were doing that work, my community is better off for it. And the people who birth in our hospital have access to opportunities that they didn't have before.

Cara Lunsford (22:01.602)
So in the hospital where you are currently working, okay, let me go back really quick. So when I had my son 13 years ago, well, I watched the business of being born and it completely changed my outlook on birthing in America.

Jessica Brumley (22:04.391)
Mm-hmm.

Jessica Brumley (22:08.262)
Okay.

Jessica Brumley (22:18.075)
Mm-hmm.

Cara Lunsford (22:30.36)
I really think it's important that people educate themselves. I don't think there's one right way to have a baby, you know? I think that it has to be a comfort level for each person. And some people are like, no, I could never ever have a baby in my house. I want to go to the hospital. For me, I...

Jessica Brumley (22:39.238)
Yeah.

Cara Lunsford (22:58.872)
was like a hybrid. Like I wanted to have my OB. I saw an OB the whole time, my whole pregnancy. I also saw a certified nurse midwife my whole pregnancy. I had this, and probably because I am a nurse, I liked putting those two worlds together a little bit. I preregistered to

Jessica Brumley (23:22.405)
Mm-hmm. Mm-hmm.

Cara Lunsford (23:27.044)
go to the hospital in case I needed to be there. But I made all the arrangements to be able to have our son at home. It was, my mother came with me to the very first nurse midwife appointment because she of course was like, Kara, this seems so unsafe.

I don't understand. Why can't you, and this has been a theme throughout my life where I feel like people have said to me, why can't you just do what other people do? And I was like, yeah, I don't think that's my jam. So, you know, she went with me, she learned about it so that she could feel comfortable. But you know, there...

Jessica Brumley (24:00.519)
That would be so boring.

Cara Lunsford (24:20.622)
There's a lot of people and even at the hospital where I worked, some of my colleagues were like, Kara, why would you choose to do this? It's so unsafe. And I couldn't believe how many opinions people had about this. Very, like a lot of judgment. And so, but I ended up having a really healthy, beautiful...

Jessica Brumley (24:36.465)
Mm-hmm.

Yeah, yeah.

Cara Lunsford (24:49.626)
home birth, it was like an eight to five, like I, my water broke at like one in the morning, I really started going into labor like around eight in the morning. And I had my son at five eight p.m. like on a Friday. It was like, yeah, literally like, I put in a work day.

Jessica Brumley (25:04.921)
I love it.

Ehh-hoo!

Beautiful.

Cara Lunsford (25:12.662)
Yeah. And I had a certified midwife, or certified nurse midwife and a certified midwife. Marina Alzugari was my, and she was just so beautiful and just so like the listeners understand. There was a moment where I was kind of hanging kind of onto my wife and I was swaying back and forth and my son's dads were there because we co-parent with two men.

Jessica Brumley (25:18.545)
Mm-hmm. Mm-hmm.

Cara Lunsford (25:41.048)
And so they were there as well. And I was like kind of like swaying back and forth in the kitchen, just trying to like open my hips and my pelvis and everything. And that was what felt comfortable to me. And I but I was like tired at that point, pretty tired. And I remember looking over to my left and I see Marina standing there making tea and she's just so calm.

Jessica Brumley (25:56.315)
Mm-hmm.

Cara Lunsford (26:07.938)
She's just sitting there kind of dipping her tea bag in the tea and she looks over at me and without saying anything, she just kind of gives me like a reassuring smile and nods her head at me like, it's okay. Like this is the process. Like you're good. And I cannot tell you how that made me feel. can still, I feel it today when I look back on that moment.

Jessica Brumley (26:23.845)
Mm-hmm.

Cara Lunsford (26:36.468)
And so I love that this is something that even if you're in a hospital, like you can have these kinds of experiences having a nurse midwife or having a certified midwife in the hospital. How does someone go about asking about that? Like if they're like, I don't know, I could do it at home, but I want to learn more about this.

Jessica Brumley (26:46.279)
Mm-hmm.

Jessica Brumley (26:58.693)
Yeah. Well, you need to find a person in your community that, you know, is a CNM or a CM. There are many midwives that are part of practices that you might go to already, right? And so that might be easy for you to find in some communities and in others, not so much. You can go to our website.

know, midwife.com.org. I'm sorry. And there's a find a midwife function on there as well. You can look for your insurance and see if there are midwives that are credentialed providers on on your insurance. We practice in all of the settings, but not every midwife practices in all of the settings, right? So there are midwives that practice at home in birth centers.

and in hospitals. There are midwives that practice full scope gynecology and sexual reproductive health services and others that mainly focus their work in birth work. So you may choose to have a midwife to do your pap smear and prescribe your contraceptive management.

and have a midwife experience for that as well as, or instead of your birth provider. So think that's important to recognize as well and being in one place for so long. have people whose births I attended 18 years ago and whose PAPS I've been doing ever since.

And if I'm not in the office enough because I'm busy being the president of the American College of Nurse Midwives, they will send me an email and say, where are you? And why can't I get up app schedules with you? And I'll go, OK, OK. No.

Cara Lunsford (28:59.664)
You're like, hey, I'm busy. I'm busy changing the world for nurse midwives and certified midwives. Like, sorry, I have bigger fish to fry here.

Jessica Brumley (29:10.251)
I say have them double book you on so-and-so schedule and I'll come in and see you. That's what I say. Yeah, no, I'm gonna take care of them. You know, I mean you when you only see someone for so long you just want to see that person, right? I mean, I totally get it. Like it's only so many people you want between your legs. Like that's the truth.

Cara Lunsford (29:16.858)
I love that. I love that.

Cara Lunsford (29:27.407)
Yes.

Right? Ain't that the truth?

Jessica Brumley (29:33.741)
Yeah, and I mean, you you bring up a really good point about how you felt during your birth. It's really important for people to know that it's not only the kind of care that we're providing, but the way that it's provided that is equally important, right?

And so what you had was an established relationship and an established sense of trust with that individual that you felt, I imagine that you felt very centered in that experience. And, and, and so the way that made you feel physically, emotionally is interconnected. And so

What I think it's important for people to know is that that kind of care can be healing. That kind of care can be therapeutic. That kind of care actually improves outcomes.

If I'm not stressed, I don't get high blood pressure, right? My cortisol levels don't spike. I'm less likely to have complications. Even if I have diabetes, right? It's easier to control. We all know how stress can impact our health. That's really clear. The way the system is designed can either make us more stressed or mediate that stress. And that's our

goal, right, in providing care. Support the normal physiology. How do we make you feel good and feel safe and feel protected and nurtured?

Cara Lunsford (31:15.118)
Yeah, I, it's, it's kind of, I think like what you're describing is it's that holding space. And I've talked about this before in other episodes. Usually for me, it's always been around end of life, but that's still a transition, right? Like that is a, it's, it's a transitioning out as opposed to a transitioning in. and.

Jessica Brumley (31:33.285)
Mm-hmm.

Cara Lunsford (31:46.008)
There is so much.

Cara Lunsford (31:51.288)
energetically that we can do as practitioners about creating this really safe space. And it's not, it's not about what you do. I don't know how to exactly explain this, but there's this, this common centeredness that if you can bring that in,

Jessica Brumley (31:52.229)
Mm-hmm.

Cara Lunsford (32:19.35)
It, it kind of ripples out, right? It just ripples out to everyone in that space. That's kind of what I felt like my midwives were bringing was this very centered, strong, like, look, I know that you don't feel like you've got this, but we've got this. And so, because...

Jessica Brumley (32:21.67)
Mm-hmm.

Jessica Brumley (32:40.391)
Mm-hmm. And we got you.

Cara Lunsford (32:49.646)
Because they have that confidence. They have that strength that...

Jessica Brumley (32:53.454)
Mm-hmm.

Cara Lunsford (32:59.532)
It's kind of this amazing gift that you can give. And I think as nurses, a lot of times we think about nursing as this very task driven, I'm gonna know how to check your dilation. I'm gonna know how to do these very, I'm gonna check, use the fetal heart monitor.

I'm going, I know how to check for late decels. I'm know how to, and, and yes, all of that is important.

But the energy to me is equal, if not more important than all of those other things.

Jessica Brumley (33:54.861)
I often tell students that when I'm attending a birth, I feel like all of my Spidey senses are tingling. And I'm using every single sense that I have. And I might just be sitting there, quiet as can be on a stool. But I'm observing, I am listening to the heart tones on the monitor and the beeping of the monitors.

Cara Lunsford (34:04.974)
Yes.

Jessica Brumley (34:24.963)
and the way that the birthing person is breathing a little heavier, right? The couple beads of sweat on their upper brow. I notice the dad who's got an anxious, right? Little sort of energy in the corner and backs away and sits in a chair because he's getting a little nervous, right? Everything that's happening. I am feeling and sensing in that moment.

and just subtly a little nod, a little whisper in the ear, right? Just it's the subtlest things that you can do to help shift the energy. But it really takes me being present and aware and conscious, right? And birth is probably when it's the most heightened, right? I mean, in that moment, When you're preparing to birth your baby. But the whole labor course, every interaction that we have,

Right? When we use those kinds of senses to notice, hmm, something's a little off today. Yeah, how do I just sit back and listen a little more, engage in a little more conversation, really, really get a feel for this person, you know, in in this moment, maybe this thing doesn't have to happen right now. Maybe we just need to talk. Yeah.

Cara Lunsford (35:47.194)
Mm-hmm.

Yeah, and some of that, yes, I agree, comes with years and years of experience, right? Like, it's not lost on me that some people are like, my gosh, I go into a birth and I'm still terrified. You know, I can barely pay attention to it. I think in a way, it is kind of a luxury of time, right? Like time spent doing this profession.

Jessica Brumley (36:05.255)
you

Jessica Brumley (36:17.784)
Mm-hmm.

Cara Lunsford (36:18.968)
I'm sure the first death that I was.

witness to was very different than the 20th or the 30th, know, like death that I was, you know, so.

It is a learning. It's something you do learn. But what I do think is that we all have...

We have an innate sense, right? Like I think that all of us, no matter whether this is your first year as a nurse or a nurse midwife, we all have gut instincts. It's about quieting yourself long enough that you can hear those instincts, that you can feel those instincts. And I think that that is a practice. It's almost like Brene Brown has this...

series that I love listening to called Rising Strong as a Spiritual Practice. I love that so much. keep, I say her name all the time thinking I'm going to manifest her onto this podcast with me. But I think that there's a, there's like nursing as a spiritual practice. And this doesn't have anything to do with religion. It's about tapping in and being present, like you said, and quieting yourself.

Jessica Brumley (37:22.118)
Mm-hmm.

Jessica Brumley (37:36.647)
Mm-hmm. Mm-hmm.

Cara Lunsford (37:48.792)
so that you can move that energy.

Jessica Brumley (37:51.843)
And as you said, it's a skill to be practiced. We have to give ourselves the opportunity to practice that skill. it's okay to understand that there are technical skills that you're still learning. But there are ways that you can work on developing those kinds of skills as well. And part of that is really being present in your

with your patient as much as possible. And sometimes with the technology that we have available to us, it can feel a little odd maybe just sitting in your patient's room. But that's something that one needs to learn to do is really just be present and not at the nurse's station, right, too much. How do I just sit there and be present with someone?

because that's an opportunity for you to practice that skill.

Cara Lunsford (38:51.13)
Yeah, learn how to crochet. You know, I think if you can learn how to crochet, I spoke to a nurse a long time ago who said that she used to sit, she was an artist. And so she used to sit in the room and she would just sketch. And it was just a way that she quieted herself. It was a way for her to be there, be present.

Jessica Brumley (38:52.494)
Hehehehehe

Jessica Brumley (39:14.919)
Hmm.

Cara Lunsford (39:20.548)
but it was also relaxing for herself and for the other people in the room. It was kind of like, look, I'm here. I'm listening. I'm listening to your breath. I'm listening to that monitor over there. I'm breaking my gaze from what I'm doing and I'm looking up at you to what you said earlier. And I'm checking for that bead of sweat to see how labored your breathing is.

Jessica Brumley (39:22.768)
Mm-hmm.

Cara Lunsford (39:49.624)
Are you grimaced? you, you know, and, and knowing like, look, I'm, I'm here, even if it looks like I'm, drawing or I'm crocheting or I'm doing something. I am here. And that gives so much comfort, so much incredible comfort.

Jessica Brumley (40:00.101)
Mm-hmm.

Cara Lunsford (40:16.525)
did I break up? yeah, just saying like that that provides so much comfort. So I think some. Yeah.

Jessica Brumley (40:17.418)
Just for a moment there. Yeah.

Yeah. Yeah.

I agree. It's like, it's kind of cliche, right? A midwife sitting in the corner like crocheting. Like, I feel like, you know, that's, that's a thing we always talked about in school. But there's a reason, right? There's there's a reason why it's an it's an effective strategy. For sure. Yeah. And, and I think there's a lot to be learned across all specialties, right? Or, you know, about that about developing that skill. I think the other thing that is

Cara Lunsford (40:42.618)
Mm-hmm.

Jessica Brumley (40:55.85)
happening right now in the industry that is very beneficial to everyone is the focus on things like trauma informed care and respectful care and that approach to care and how these are now concepts that are being discussed at higher levels and by entire institutions and there's training and resources being put into that. And so I think people are starting to really think about

the way care is provided in our institutions and how do we start to make that shift. Yeah, I think that's really important.

Cara Lunsford (41:37.826)
How would you? Sorry, that didn't come out at all like I thought it was going to.

Jessica Brumley (41:41.399)
You

Cara Lunsford (41:47.312)
How do you recommend that someone think about when they're trying to make a decision about, do I go the certified nurse midwife route or do I go the certified midwife route? What are some of the advantages to one versus the other? Are there areas where you're kind of open to more things if you do one route versus a different route? Like, what's your, what are your thoughts?

Jessica Brumley (42:16.016)
great. do you mean as a nurse considering advancing their profession or looking for a provider of care?

Cara Lunsford (42:26.722)
So, so well, we could, we could say both, but let's start with maybe there's people listening. There's probably, I know there's people listening, obviously that are already nurses. So in that situation, they would likely go the certified nurse midwife route because that would make the most sense for them. Right. but let's say you're not a nurse. Let's say you're, you're, you know, part of the just public and

Jessica Brumley (42:29.747)
Okay.

Jessica Brumley (42:42.492)
Exactly. Yeah. Yeah.

Jessica Brumley (42:54.004)
Mm-hmm.

Cara Lunsford (42:54.818)
you're listening and you say, you know what? I'd love to go into this, but do I go the certified nurse midwife or do I go certified midwife? Like which route do I go? What would you say to them?

Jessica Brumley (43:04.16)
Right.

So I think that it's important to understand how both are trained and where they can practice. so certified nurse midwives and certified midwives are trained in graduate level degree programs, so masters or doctoral programs. And they're trained usually right alongside each other. They have the same scope of practice and basically the same skill set that they acquire in school.

they take the same certification exam. And so one comes to midwifery through nursing, and the other one comes to midwifery not through nursing, right, through any other degree. And so that might be one thing to consider, right? Do you want to be a nurse? Are you a nurse already? And so then it would likely make the most sense to become a certified nurse midwife. The other thing to consider is

what state that you're living in and and where do you plan on practicing because certified midwives are currently able to practice in I believe it's 13 states so they're not yet licensed in in all 50 states and they're really only a few education programs although that's growing because we recognize the need to grow the midwifery workforce and

And so states are taking that on on a state by state level. Unfortunately, that's how it works in this country is if you want to get the ability to practice in a state, can't be done at the federal level. It really has to be done at the state level. So it's a lot of work to get that done. But we have been as an organization have really been pushing for that and providing resources to all of our midwives in the states to encourage them to.

Jessica Brumley (44:59.338)
grow that credential in their state. So I think those are things to consider. The other thing to recognize is that there are other credentials of midwifery that are not CNM and CM credentials in the United States that our organization doesn't represent, but there is the Certified Professional Midwife and that their organization is the National Association of Certified Professional Midwives.

Cara Lunsford (45:16.664)
Jessica Brumley (45:27.102)
And that is a direct entry midwifery certification. The sort of the maybe more like vocational program. So may or may not happen at a university. I think there's like one or two programs that are in university at the baccalaureate level, but most are separate education programs or apprenticeship style programs.

Cara Lunsford (45:39.61)
Mm-hmm.

Jessica Brumley (45:55.948)
and these midwives practice in home and birth centers and they take a different test, they take a different test and they have a different scope of practice. So we have a more advanced scope of practice. They're not going to do your gynecologic care and prescribe you birth control. I don't believe in any states that that's part of their scope of practice.

Cara Lunsford (46:02.586)
Do they still have to take the test like the same?

Jessica Brumley (46:22.496)
And so they're more focused on pregnancy and birth of low risk, healthy individuals. And licensure looks different in all 50 states as well. So they may or may not be legally practicing in your state. But that organization would be the place to go if someone was interested in understanding the different credentials of midwifery in the United States.

Cara Lunsford (46:31.994)
Would you say?

Cara Lunsford (46:50.136)
If I was to make like an analogy, would this statement be true? So a CNA is almost like a doula. let's say, okay, that we're gonna go these different routes, right? So it's like CNA, LVN, RN, NP. And if we were to take like a similar trajectory, almost like a doula.

Jessica Brumley (46:52.17)
Mm-hmm. Mm-hmm.

Jessica Brumley (47:05.588)
Mm-hmm.

Uh-huh.

Jessica Brumley (47:14.866)
It's hard.

Cara Lunsford (47:18.416)
and then like a certified professional midwife, like is that almost similar to like LVN LPN type of, like if you were to take like one step up?

Jessica Brumley (47:26.982)
if we had to apply that kind of hierarchy, sort of like the level of training that they get is different. It's also differently focused. And so most CNMs and CMs, the vast majority of their training is going to be in a hospital. And so that's the vast majority of their birth experience. And a CPM, their experience is going to be in home and birth centers. And so I've seen

Cara Lunsford (47:55.364)
Interesting.

Jessica Brumley (47:56.866)
I've seen certified nurse midwives train for home birth with certified professional midwives because they didn't get much experience in that area. So it's really interesting and very dynamic, know, state to state. You know, we're super thankful to have a very good working relationship, you know, with our CPM colleagues in the U.S. Unfortunately, it's just confusing.

Cara Lunsford (48:07.642)
Got it. So interesting.

Jessica Brumley (48:24.096)
Globally, it's actually a little more clear. If you went to Canada, it's really clear what education and training looks like for all midwives in Canada.

Cara Lunsford (48:25.53)
Yeah.

Cara Lunsford (48:31.449)
Yeah.

Cara Lunsford (48:40.557)
Now, what about insurance coverage? So, I mean, so my insurance paid a percentage.

Jessica Brumley (48:43.488)
Hmm.

Jessica Brumley (48:50.048)
Mm-hmm.

Cara Lunsford (48:52.406)
of my midwife's services.

Jessica Brumley (48:56.917)
Mm-hmm.

Cara Lunsford (49:01.57)
It was actually amazing. was so much cheaper for the insurance company to cover my midwifery services than if I had gone to the hospital and had a hospital birth.

Jessica Brumley (49:14.656)
Yep. So you would think that it would be so much easier and that insurance companies would be advocating for this model of care, but that is not always the case and not in every community. And I think we all know just how challenging, you know,

insurance is in, you know, in the United States. Even someone comes in and asks me, will this be a covered service? And I cannot answer that question for them, because every plan is so nuanced, and so different. And I can speak only in generalizations, and I have to ask them to reach out to their insurance company. And because of that, some home birth midwives are going to be cash pay only, right? Because they wouldn't be able to sustain their practice with insurance reimbursement.

and the way that it takes. And oftentimes it's at a percentage of what they would pay a physician. And so it really can be quite challenging for many midwives. And that's one of the things that we're, you know, we feel really passionate about advocating for is for equitable payment for our services.

You may find a midwife on your insurance panel and they are covered and without a problem. You may not. It's really variable. Some states Medicaid is paying for home birth and in other states it doesn't happen.

And in some states you're getting a doula paid for by Medicaid and in other states, know, that's not available. So there's a lot of variation state by state and by the individual payers.

Cara Lunsford (51:04.366)
Yeah, it's like you said, it's really challenging because there is so many variables and every plan is not the same. Every state is not the same. And what is reimbursed in some states is not the same as in other states and by other plans. And so it can be very challenging. But can you again remind people who are interested in finding

Jessica Brumley (51:23.582)
Mm-hmm.

Cara Lunsford (51:33.52)
either a certified nurse midwife or a certified midwife who can do some of their women's health, again, where they can find those people.

Jessica Brumley (51:40.957)
Mm-hmm.

Jessica Brumley (51:45.236)
Sure, right. So you can go to midwife.org and we have a find a midwife function on our website. That's also where you could go if you wanted just more information about how to become a midwife or the different kinds of midwife credentials. You can go to your insurance company and see if there are midwives listed on your panel of providers. You can ask your insurance company.

right, to help you find a midwife in your community. And I think that those are usually the two easiest ways to find a midwife to provide your care.

Cara Lunsford (52:28.878)
And are there any other resources? I know I mentioned the business of being born. That was something that I really enjoyed watching. Are there any other types of documentaries or resources or books or anything that you really recommend in terms of like if you're trying to make that decision about, is midwifery for me or do I want to have a midwife who is providing my care?

Jessica Brumley (52:33.748)
Mm-hmm.

Jessica Brumley (52:45.119)
Mm-hmm.

Jessica Brumley (52:57.405)
Mm-hmm.

Cara Lunsford (52:57.732)
you know, different things like that.

Jessica Brumley (53:01.416)
Well,

One of my favorite resources for helping people become really informed about the kind of care that they provide is called evidence-based birth. And I'm not sure if you're familiar with Rebecca Decker. She's in PhD prepared RN and evidence-based birth provides a summary of the evidence on different interventions around birth. she's written a book and she blogs and has

Cara Lunsford (53:16.271)
No.

Jessica Brumley (53:32.67)
a podcast. And, and so in there she talks about the evidence. She talks about the evidence for midwifery. She talks about the evidence around induction and spontaneous labor and C-section and episiotomies and vitamin K injections for the newborn, like the kinds of things that people have questions about and are just kind of taking our word for it.

And so you can take childbirth education classes that review the evidence as well. And so I think that that's a really great resource for people to understand about midwifery and other factors that can impact pregnancy and birth care.

Cara Lunsford (54:20.622)
I love that. I'm definitely going to check it out myself. I'm not having any more babies, but I still want to go and learn more about it because I think it's so important as women and that we inform ourselves and we get access to evidence-based information and that we don't just

Jessica Brumley (54:25.6)
So it's a great resource.

Jessica Brumley (54:34.751)
Mm-hmm.

Jessica Brumley (54:45.279)
Mm-hmm.

Cara Lunsford (54:50.66)
We don't just follow. We don't just, you know, believe because one person says this or one practitioner says that. Everybody has a lot of opinions. And so just getting the data and making informed decisions based off of data is so, important. And how other countries do things. It's like sometimes we get so focused on how we do it and we don't...

Really, mean, our mortality rates are not fantastic. you know, maternal mortality is not great here, and you would think it would be better, right? Because we have so much access.

Jessica Brumley (55:28.544)
Yeah.

I do often, because midwifery is a global profession, and I do often refer to what's happening internationally and how things are practiced, regulated, and how midwives are educated in other countries. And I think that it's important for us to understand that there are different systems of care that have been set up.

that really provide better outcomes than the systems of care that we provide. one of the things that I often advocate for is a safe system of care. And you mentioned before that you had a community-based birth and that people had some really strong opinions about the fact that you were birthing at home. Sometimes people who are birthing at home,

need a higher level of care during their pregnancy or during their birth. And so they might transfer to the hospital. And I promise you those really strong opinions are sensed by the person who is coming from home into the hospital and they're feeling judged and those kinds of things happen. And so very recently there was a toolkit that was published on community based birth transfers. And how do we improve that? How do we improve the system?

of care because that's one thing that other countries really have is that they have midwives that can take their patient from the home or birth center into the hospital and they will be respected. The midwife and the patient will be respected for the decisions they made and they'll receive that next level of care that that person needs right now.

Jessica Brumley (57:12.368)
And so that's the kind of work that I think is really important moving forward for our profession and for anyone working in the pregnancy and birth space. If you don't have a safe system of care for people to be able to transfer from the community to the hospital, then you don't have a safe community to birth in.

Cara Lunsford (57:35.268)
That's a mic drop, my friend. That's so true. And it's absolutely true. And I completely agree with you. People have to feel safe that if I make the decision that I can no longer birth here at home and that I need to move, that I am not going to get somewhere where someone is going to then judge me.

Jessica Brumley (57:36.288)
That's so cool.

Cara Lunsford (58:01.302)
or be like, well, you you put yourself in this situation or you endangered your child's life. And that energy is not helpful for the birthing person or for the accompanying, anyone who's accompanying that person. You know, just put that stuff to the side and just be there and be supportive, you know, of

Jessica Brumley (58:15.935)
Yeah.

Cara Lunsford (58:30.48)
of the person who's now made the made the decision made the healthy decision to say, you know what, I don't I don't think that this is this is a safe place for me anymore. So I have to move. So I I love I love everything that you shared today, Jessica. I have enjoyed. I have enjoyed this conversation so much. I've enjoyed.

Jessica Brumley (58:41.374)
Yeah.

Cara Lunsford (58:59.564)
hearing your perspective. We're so lucky as women to have someone like you who is leading the charge for this professional association. And I'm also just really excited that nurse.com has started this relationship with the ACNM.

Jessica Brumley (59:07.259)
Cara Lunsford (59:21.392)
And I'm looking forward to so many more conversations, webinars, whatever it is that we decide to do to continue to share this information.

Jessica Brumley (59:32.286)
Thank you so much for having me. This has just been a pleasure. I can literally talk about these things all day long. So I agree. I can't wait for the next one.

Cara Lunsford (59:43.78)
Me too, me as well, I'm super passionate about it. have a wonderful rest of your week. Thank you again for joining me and until next time.

Jessica Brumley (59:56.01)
Thank you.