Something Was Wrong
Episode: S23 E3: Standards of Midwifery Care with Dr. Amy Giles, DNP, CNM
Release Date: February 27, 2025
Host/Author: Broken Cycle Media | Wondery
Introduction
In this episode of Something Was Wrong, host Tiffany Reiss engages in an in-depth conversation with Dr. Amy Giles, a certified nurse-midwife (CNM) and owner of Allen Midwifery and Family Wellness in Allen, Texas. The discussion delves into the standards of midwifery care, the unique landscape of midwifery in Texas, and the critical aspects that ensure safe and compassionate birthing experiences.
Dr. Amy Giles' Journey into Midwifery
Dr. Giles shares her personal and professional journey, highlighting the pivotal moment that led her to midwifery.
“When we walked in, it was such a completely different experience... I want people to feel loved and taken care of, just like she made me feel today.” — Amy Giles [02:36]
Originally from Louisiana, Dr. Giles moved to Texas for her undergraduate studies at Baylor University. Her encounter with a nurse-midwife during her first pregnancy inspired her to switch from pursuing a family nurse practitioner path to becoming a nurse-midwife. This transition was driven by her desire to provide personalized and compassionate care, emphasizing the importance of building strong relationships with her clients.
Unique Aspects of Practicing Midwifery in Texas
Dr. Giles explains the distinct environment for midwives in Texas, where multiple types of midwives operate alongside varying scopes of practice.
“Texas is interesting because we have several different types of midwives.” — Amy Giles [06:20]
In Texas, there are:
- Certified Nurse Midwives (CNMs): Hold a bachelor's in nursing and advanced degrees in midwifery, capable of handling higher-risk pregnancies and prescribing medications.
- Licensed Midwives: Trained through apprenticeships, primarily delivering outside hospital settings without prescribing authority.
This diversity allows for a range of birthing options tailored to different client needs, contributing to the growing popularity of birthing centers in the region.
Importance of Birth Center Hospital Privileges
A significant advantage of Dr. Giles' birth center is its hospital privileges, allowing for seamless transitions in case of high-risk scenarios.
“If someone becomes high risk, then we continue to follow them and to deliver them in the hospital.” — Amy Giles [08:38]
This continuity ensures that clients receive consistent care without the abrupt shifts often experienced when transferring to a different facility, thereby enhancing both safety and client trust.
Proximity to Hospital: Standards and Recommendations
The location of a birth center relative to a hospital is crucial for ensuring timely access to emergency care.
“I think if you're somewhere between five and 10 minutes, that’s pretty safe.” — Amy Giles [09:42]
While Texas licensing mandates a 30-minute proximity, Dr. Giles advocates for a closer distance, ideally within 5 to 10 minutes, to ensure rapid access in emergencies. This standard minimizes delays in transferring clients who require higher-level medical interventions.
Reasons Clients Choose Midwifery
Clients are drawn to midwifery for various personalized reasons, emphasizing individualized care and a supportive birthing environment.
“People are looking for individual attention, individual plans of care... that’s a big deal.” — Amy Giles [12:03]
Common motivations include:
- Personalized Care Plans: Tailored to individual needs and preferences.
- Extended Appointment Times: Allowing for thorough discussions and emotional support.
- Family-Friendly Environment: Accommodations for existing children, creating a welcoming atmosphere.
- Holistic Experience: Focus on emotional and physical well-being throughout the birthing process.
Addressing Client Concerns and Negative Experiences
Dr. Giles addresses common grievances clients have based on previous negative birthing experiences, underscoring the importance of continuity and appropriate risk assessment.
“...if you feel like you're low risk and you're a good candidate for this particular type of care and then it doesn't come to fruition.” — Amy Giles [16:48]
Issues highlighted include:
- Lack of Continuity: Transferring to hospitals without consistent care.
- Inadequate Risk Management: Misjudging a client’s risk level leading to unexpected transfers.
- Community Reputation: Poor outcomes can tarnish the entire birthing center community, stressing the need for transparency and high standards.
Advice for Prospective Birth Center Clients
Dr. Giles offers essential advice for those considering a birth center, emphasizing informed decision-making and personal comfort.
“You should always know you have an option, but you should go with your gut and decide what's best for you and your family.” — Amy Giles [09:42]
Key recommendations include:
- Research Providers: Understand the staffing, client load, and available medical support.
- Assess Comfort Levels: Choose a setting where you feel safe and supported.
- Evaluate Services: Ensure the birth center can handle potential emergencies and has necessary resources.
Understanding Transfer Rates
Transfer rates from birth centers to hospitals are a critical metric of a facility’s safety and effectiveness.
“I would say 10% is probably a good number.” — Amy Giles [21:37]
Dr. Giles explains that:
- Low Transfer Rates (<10%): May indicate either overly restrictive criteria or potential underpreparedness.
- High Transfer Rates (>20%): Suggest possible overcautiousness or high-risk clientele.
- Ideal Range (10-12%): Balances the ability to handle most births while ensuring swift transfers when necessary.
Additionally, distinguishing between emergent and non-emergent transfers is essential for evaluating a birth center's preparedness.
Emergency Transfer Scenarios
Certain emergencies necessitate immediate transfers to hospitals to safeguard both mother and child.
“Postpartum hemorrhage is another... it's very rare, but it can happen at any time.” — Amy Giles [23:41]
Common scenarios include:
- Cord Prolapse: When the umbilical cord descends before the baby, risking oxygen deprivation.
- Postpartum Hemorrhage: Excessive bleeding after birth requiring urgent medical intervention.
- Severe Hypertension: Risk of seizures due to dangerously high blood pressure.
- Fetal Distress: Indicators from the baby's heart rate suggesting it's not receiving adequate oxygen.
Dr. Giles emphasizes the necessity of being prepared to act swiftly to transfer clients in these situations to prevent adverse outcomes.
Policy on Vaginal Birth After Cesarean (VBAC)
VBACs are a debated topic within midwifery, with differing practices across birthing centers.
“At our birth center, we just don't feel comfortable with it because of the risk that is involved.” — Amy Giles [26:25]
Dr. Giles explains that her facility opts out of facilitating VBACs due to associated risks. Instead, while prenatal care may be provided at the birth center, actual delivery for VBAC candidates is planned at hospitals to ensure safety.
Duty of Care: Providing Adequate Materials
Ensuring that all necessary supplies are available is fundamental to maintaining safety and comfort in birthing centers.
“You need to think about when they get there from the very beginning to when they leave six hours after they have their baby.” — Amy Giles [27:30]
Dr. Giles expresses her concerns over reports of inadequate supplies, such as insufficient towels or basic sanitary needs. She advocates for standardized minimum requirements to ensure every client receives safe and hygienic care.
Staffing Standards and Student Supervision
Proper staffing is crucial for maintaining high standards of care and ensuring that clients are never left unsupervised by adequately trained personnel.
“They should not be practicing solo.” — Host/Tiffany Reiss [31:04]
Dr. Giles strongly opposes the practice of allowing students to handle clients without the supervision of a qualified midwife. She insists that:
- Transparency: Clients must be informed if a student is present.
- Supervision: Students should always work under the guidance of an experienced midwife.
- Safety Protocols: Adequate staffing ensures that emergencies can be managed effectively.
Challenges in Opening and Running a Birth Center
Establishing a midwifery practice outside of hospital settings presents several challenges, particularly in staffing and financial sustainability.
“It's hard to find certified nurse midwives who want to work outside the hospital.” — Amy Giles [35:19]
Key challenges discussed include:
- Recruiting Qualified Staff: Finding midwives who align with the birth center’s philosophy and are willing to accept lower salaries compared to hospital positions.
- Financial Management: Balancing the costs of running a birth center with the passion-driven commitment of the staff.
- Growth Management: Scaling operations while maintaining quality care and a family-like atmosphere.
Despite these hurdles, Dr. Giles highlights the rewarding aspects of running a successful and nurturing birth center.
Desired State and National Implementations for Safer Birth Centers
Dr. Giles advocates for systemic changes to enhance the safety and transparency of birth centers.
“I wish that every midwife outside of the hospital would have to turn in their statistics every six months or every year to the state.” — Amy Giles [37:27]
Her recommendations include:
- Comprehensive Data Collection: Mandating the submission of detailed birthing statistics to state authorities to monitor performance and outcomes.
- Standardized Education and Licensing: Unifying the training and certification processes for midwives to ensure consistent quality of care.
- Transparency in Outcomes: Providing public access to performance data, similar to hospital C-section rates, to help clients make informed choices.
Implementing these measures would create accountability and foster continuous improvement within the midwifery community.
Conclusion
Dr. Amy Giles emphasizes the importance of informed choice, high standards of care, and the necessity of a supportive and transparent birthing environment. Her insights highlight the critical role that midwifery plays in improving maternal and infant health outcomes, especially when integrated with robust safety protocols and continuous professional development.
Notable Quotes
- Dr. Amy Giles [02:36]: “I want people to feel loved and taken care of, just like she made me feel today.”
- Dr. Amy Giles [06:20]: “Texas is interesting because we have several different types of midwives.”
- Dr. Amy Giles [08:38]: “If someone becomes high risk, then we continue to follow them and to deliver them in the hospital.”
- Dr. Amy Giles [09:42]: “I think if you're somewhere between five and 10 minutes, that’s pretty safe.”
- Dr. Amy Giles [12:03]: “People are looking for individual attention, individual plans of care... that’s a big deal.”
- Dr. Amy Giles [21:37]: “I would say 10% is probably a good number.”
- Dr. Amy Giles [26:25]: “At our birth center, we just don't feel comfortable with it because of the risk that is involved.”
- Dr. Amy Giles [27:30]: “You need to think about when they get there from the very beginning to when they leave six hours after they have their baby.”
- Dr. Amy Giles [35:19]: “It's hard to find certified nurse midwives who want to work outside the hospital.”
- Dr. Amy Giles [37:27]: “I wish that every midwife outside of the hospital would have to turn in their statistics every six months or every year to the state.”
This episode provides a comprehensive exploration of midwifery standards, illuminating both the rewards and challenges faced by midwives like Dr. Amy Giles. It underscores the necessity for informed choices, stringent safety measures, and the benefits of personalized care in birthing environments.