Georgia Certified-Nurse Midwives (CNMs) work in diverse practice environments across our state and continually exhibit excellence in their work. The Georgia Affiliate of the American College of Nurse-Midwives is proud to share here a little of what our members do every day to make our state a healthier place for mothers and families.
For this member spotlight we interviewed Tanya Guldenschuh & Roxanne Jones, two of the CNMs at Gwinnett Physicians Group OB/GYN at Gwinnett Medical Center.
GA ACNM: When did the midwifery practice at Gwinnett Physicians Group OB/GYN begin?
Our practice began as a hospital-based OB/GYN Clinic at Gwinnett Medical Center in 1996. Prior to that, prenatal care was provided by Emory attending physicians in the clinic, while CNMs from the Emory Midwifery service provided care in labor and delivery. The original OB/GYN Clinic provided care to self-pay patients as well as those insured by Medicaid. Shortly thereafter, our practice expanded to the Johns Creek area providing care to private insured patients. That practice eventually moved to the Duluth campus of Gwinnett Medical Center (GMC). In 2011, the two practices merged and evolved into the Gwinnett Physicians Group OB/GYN, providing care to insured as well as the uninsured at the Lawrenceville office. We also assist in training the Family Practice residents at GMC.
Our practice currently provides services to our established clients as well as women in the community who present to GMC without a designated OB/GYN provider. We are proud to provide care to clients in one of the most ethnically diverse counties in Georgia. Approximately 20% of Gwinnett county residents speak a primary language other than English.
CNMs have been a vital part of our group since its inception. Joan Durdin and Tanya Guldenschuh were the first CNMs in our group and remain with us today. We take pride in the longevity of the providers in our group; it is a sign of our commitment to the community and the quality of our working environment.
GA ACNM: How many midwives are in the practice?
Our group currently has seven CNMs. Five of our CNMs are full-time and two are currently part-time. We work in collaboration with six OB/GYNs.
CNMs in our practice attend Vaginal Birth After Cesarean (VBAC), twin deliveries, and first assist at C-sections providing continuity of care for our patients. We also provide annual exams and contraceptive counseling including prescriptions for oral contraceptives, Nuvaring, Depo-Provera, Intrauterine devices (IUDs) like Mirena and Paragard, and Nexplanon placement.
GA ACNM: How many births do the midwives at Gwinnett Physicians Group OB/GYN attend?
GMC provides delivery services for approximately 4,800 births per year. Births in Gwinnett County alone average almost 9% of total deliveries in our state each year. Our group attends approximately 1,000 births per year. 70% of our deliveries are attended by CNMs at GMC.
Our practice has a great relationship with GMC, which strives to provide a supportive, baby-friendly environment in caring for patients. One example is GMC’s role in the Georgia 5-STAR Hospital Incentive Program.
Hospitals participating in the 5-STAR initiative are charged with promoting and supporting breastfeeding by implementing the Ten Steps to Successful Breastfeeding by creating supportive policies, staff education, and post-discharge community referrals to support mothers. Nursing staff in Women’s Services at Gwinnett Medical Center receive a two-hour lactation course with incentives for lactation counseling training. Emphasis is also placed on uninterrupted skin-to-skin contact between mothers and their infants for at least an hour after birth. Skin to skin contact between mothers and infants has been shown to decrease distress in infants, increase breastfeeding initiation/duration, and promote bonding. In addition to the science behind skin-to-skin, many mothers also feel great joy and security when holding their infant for the first time. The CNMs at Gwinnett Physicians Group OB/GYN take great pride in supporting these moments.
GA ACNM: Do you keep quality improvement statistics in your practice? What are some recent statistics you would like to share?
Our group’s statistics are fairly similar to other practices that manage high-risk populations. However, our primary C-section rate averages 15%, which is better than some lower risk practices in the area and nationwide. The latest statistics for CNM-attended VBAC births with our practice showed an 86% success rate. We have relatively low incidence of 3rd and 4th degree lacerations at around 5%, the rate of preterm deliveries for our clients is around 5% as well. NICU admissions and vacuum extractions are both around 3%. We keep track of these statistics and other areas as well to not only compare ourselves to other practices, but also to look for trends or areas where we can do even better, improving patient care and the experiences that patients have.
GA ACNM: How is the practice at Gwinnett Physicians Group OB/GYN coordinated?
Our group practice is based on collaborative guidelines. Our entire team of CNMs and OB/GYNs reviews guidelines biennially. We strive to provide consistent evidence-based care. We feel that this process improves provider communication and patient outcomes. All of our OB/GYNs are very supportive of us and the CNM model of care, which we feel plays a big part in our success.
GA ACNM: Share with our readers the components/accomplishments of this practice of which you are most proud.
Our group is focused on providing quality and innovation in midwifery care. The CNMs of the Gwinnett Physicians Group OB/GYN are currently working on creating prenatal education videos for clients and the groundwork is being laid to provide alternative options to prenatal care other than the traditional model. We want to meet patients where they are and provide information in a variety of ways so that it is most accessible and understandable.
Starting in 2015, patients will have the option to participate in group prenatal care. In this model, mothers will have traditional prenatal visits with a midwife and also 4 visits where the traditional prenatal checkup is combined with group discussion about important topics like staying healthy during pregnancy, labor preparation, breast feeding, and preparing for parenting. As our website is further developed, we plan to have more resources available to patients to become more proactive in their care and improve their outcome and have the most satisfying and fulfilling birth experience possible.