Nurse-midwives Continue to Play Important Role in Ensuring Safe Deliveries

The Massachusetts General Hospital Midwifery Service, within the Department of Obstetrics and Gynecology, is one of the largest and most longstanding midwifery services in Boston. The practice began in 1994, and since that time, each year, nurse-midwives deliver about 1,000 babies at the hospital. At Mass General, nurse-midwives offer evidence-based care for women during the prenatal, labor and delivery and postpartum periods of their reproductive lives.

Since the outbreak of the COVID-19 pandemic, the nurse-midwives continue to play an important role in ensuring safe deliveries and maternal care at Mass General.

“Expectant mothers should be assured that we are engaged in incredible amounts of thought, attention and energy to ensure that their care upon arrival to labor and delivery at Mass General is not only safe, but excellent,” says Susan Hernandez, CNM, MSN, chief of the nurse-midwifery service.

“Our strong team-based approach to providing care to women has been vital to effective and safe practice,” she says. “We’ve had to reorganize many aspects of how we deliver obstetrical care. Having an integrated and cohesive team at the start has made for an agile response in creating safety measures to keep both patients and providers safe.”

The Nurse-midwifery Model During COVID-19

There are several core philosophies of the midwifery model of care that have been amplified in the COVID-19 frontline response for birthing women, including the promotion of women and family-centered care and the empowerment of women as partners in their care. Many families have had their lives upended and their hopes for their births changed in ways that no one could have imagined even just months ago.

“As always, our work continues to provide women with current information and guidance so that they can make informed decisions for themselves and their babies to stay as healthy and as safe as possible,” says Hernandez.

The Midwifery Service remains fully operational, seven days (and nights) a week, but has quickly pivoted to remote care in order to keep the continuity of the care model. The nurse-midwives provide care to patients through video and telephone visits in addition to those needed in-person visits.

Providing Equitable Care to Vulnerable Populations

Another hallmark of midwifery is the care of vulnerable populations. The nurse-midwives at Mass General have clinical practices in several of the Greater Boston communities that have been disproportionately impacted by COVID-19, like Chelsea and Revere. Access to virtual/remote care can sometimes be challenging for patients in these communities. Only a small percentage of Spanish-speaking patients, for example, have access to electronic portals like the Mass General Patient Gateway. As such, the Midwifery Service has added more provider sessions at the Mass General Chelsea HealthCare Center and Revere HealthCare Center

Additionally, many have volunteered to take on above-and-beyond normal clinical responsibilities to help these communities. For example, in the City of Chelsea, due to increased testing, there is an incredible volume of calls needed to deliver news of positive results to patients. Several nurse-midwives are helping with these calls. The team includes several certified and qualified bilingual members who can communicate with Spanish-speaking patients. And, as Harvard Medical School (HMS) faculty, the nurse-midwives have engaged the help of HMS students to increase outreach phone calls that assess for food, housing and other challenges to the social determinants of health.

“Midwives have been adaptive and responsive to the public health, and we continue to do so and use our voices to advocate for those communities who are now faced with incredible social and medical challenges. Keeping issues of equity and justice at the forefront of all our initiatives and policies is a core value of the midwifery service and OB/GYN department,” says Hernandez. Mass General nurse midwives participate on the Mass General Equity and Community Health COVID Task Force and in the COVID-19 Equity in OB/GYN Committee.

A Team Approach to Maternal Care

Since the start of the pandemic, the Department of OB/GYN has been working as a team to adjust best practices and face the uncertainties.

“The caliber of thought and clinical expertise that happens at a place like Mass General is never more evident than in times of challenge,” says Hernandez. “Our department values teamwork and interdisciplinary collaboration so that women can trust that when they come to have their babies, we are ready to keep them safe.”

“The opportunity to work and collaborate with a great team of midwives was one of the key reasons I chose to return to Mass General 23 ago,” says Jeffrey Ecker, MD, chief of Obstetrics and Gynecology. “That choice has been continually affirmed during the last two-plus decades. Our physicians and nurse-midwives work as a true team, allowing patients to enjoy the best of what each type of provider has to offer.”