Julie Blumenfeld, CNM, is the current president of the New Jersey Affiliate of the American College of Nurse Midwives and a midwife at Capital Health, a member of the Quality Institute’s Provider Council.
How can the involvement of a midwife impact a person’s overall pregnancy experience?
Midwives see pregnancy and birth as a normal, healthy part of the life cycle. And they place the pregnant person at the center of the experience. The pregnant person is seen as the primary decision maker, and she engages in a collaborative relationship with her midwife, who then provides ongoing health promotion, assessment, evidence-based care, education and support that’s individualized to every person.
A lot of the new strategies that are being implemented in maternity care now are things that midwives have been invested in as part of the general care that they always give. That’s collaborating with community partners, including doulas, group prenatal care like centering, and shared decision making with their patients. Midwives are experts in physiologic birth, typically with healthy low-risk people, but midwives take care of all kinds of people, even those with health issues, and work in collaborative practice with physicians. Midwives are primary care providers and we take care of women across the lifespan.
How does Capital Health use midwives in its maternity care service?
Midwives have been here for many years. The midwives work collaboratively with a terrific group of physicians. Patients get the benefit of midwifery care and support for physiologic birth … but we also can take care of a medically high-risk population. It’s a very diverse group of patients and practitioners, and there is a great sense of community involvement. We exceed benchmarks for key metrics in many areas.
Every patient who comes here has a nurse case manager. Additionally, there is a social worker, a nutritionist, a lactation consultant and an ultrasonographer onsite. There are pediatricians in the same building on the same floor. There is a Spanish language liaison. We also collaborate with two different community doula services.
What do you see as the greatest barriers to patients receiving high quality reproductive health care in New Jersey?
Many of the existing barriers to health care in New Jersey have their roots in structural racism. One of the greatest impediments to high quality care is access. Challenges in accessing care manifest in many ways, including financial, geographical, and logistical. Funding, in terms of both a family’s income and their access to insurance, is a barrier. Additionally, many people have to travel quite a distance to get to their providers; even those who do not need to travel a great distance may rely on public transportation that makes their journey more difficult or more costly.
One specific financial barrier is insufficient Medicaid coverage for the year following childbirth. Additionally, the people of New Jersey need expansion of coverage for contraception to a full year rather than the current coverage of only six months. The Reproductive Freedom Act will resolve many of these issues. It will both protect and expand access to birth control and pregnancy related care. It is thoughtful legislation that considers income level, immigration status and gender identity.
I couldn’t be prouder to work as a midwife in New Jersey under the current administration. It is striving to eliminate financial barriers, is closing gaps in care, and reducing disparities.
As a member of the Quality Institute Perinatal Care During COVID Work Group, how are you preparing patients for what to expect during a pandemic, both in maternity care and in reproductive health care?
We’ve set guidelines and protocols, and we’re reassuring patients that it’s okay to come in for care…in the inpatient setting, in the hospital, and in the outpatient setting. I feel very fortunate to work at an institution that has robust testing in place. And as practitioners, we’re setting the example: cleaning, wearing masks, setting up the waiting room for social distancing, and offering telehealth as an option. We’re talking about precautions and about signs and symptoms of COVID, so they know what to look for.
In the hospital, women can have their partner with them and now thanks to our terrific administration they can have their doula there as well. Limiting visitors has really re-centered the birthing experience on the birthing person. They become the focus, which sometimes in the past has gotten lost when there are so many people around.
How do you want to see midwifery change in New Jersey?
Nationally in the United States, midwives do anywhere between about eight or nine percent of births. And if you look at other countries across the world — with better outcomes — they have a greater percentage of midwives caring for their birthing people and babies. And I think the United States could take that example and run with it. Managing healthy women well with all of the ways that I talked about in terms of those seemingly simple interventions that have really good outcomes would improve overall maternal health outcomes.
And I think that some of the barriers that are preventing that from happening are reimbursement rates for midwives, which remain low, and access to educational opportunities for midwifery students. And I think just general public awareness about the role of the midwives and the really good work that we do.
We like to ask people about their lives outside of work. So what would you be doing on a day where you’re not working?
I asked my close friends and my kids what they thought I should say with regards to this question and they laughed. I am in the midst of finishing up a doctorate degree. So, my days in the sun, between my doctorate and COVID, have been very limited of late. But I just turned in my very last assignment and presented my final project. And so, I’m very much looking forward to having free days ahead. I’ll give a plug for our favorite local bakery, which is The Gingered Peach, here in central New Jersey. I love going there and sitting and having a latte with my three kids, talking about policy or their travels or their work and what they’re doing.