The mission of the nurse midwifery program is to support the educational goals of Brown University medical students and obstetric residents at Women & Infants Hospital regarding basic knowledge and skill acquisition in both obstetric triage and low-risk intrapartum care (including educational workshops). The Nurse Midwifery Program at Women & Infants does not accept private patients.
The program further augments the clinical services provided by obstetric residents within the Department of Ob/Gyn by providing timely and expert care within the obstetric service – i.e. labor and delivery, operating room, maternal-fetal medicine gestational diabetic clinic and obstetric triage.
The nurse midwifery program advances the academic mission of the Department of Ob/Gyn by participating in national and international presentations, publications and research projects advancing the scope of nurse midwifery.
Inpatient Service – Labor and Delivery
Nurse midwifery faculty provide clinical management, consultation and teaching in labor and delivery Monday through Friday. Consultation and supervision are provided for medical students and obstetric residents in the clinical management of labor and delivery on the low-risk obstetric service. Nurse midwifery faculty provide direct clinical services to women on the low-risk obstetric service by sharing in the care of all women presenting in labor in that service. Nurse midwifery faculty are currently orienting the first assist at primary c-sections, as well.
Ambulatory Service – Obstetric Triage
Nurse midwifery faculty staff the obstetric triage unit, along with attending physicians, caring for women who present with obstetric complaints. Midwifery faculty provide direct clinical care to patients and provide clinical teaching to obstetric interns and Rhode Island Hospital emergency room residents. Nurse midwives assist PGY-1 residents in the acquisition of various skills, including:
- Use of the microscope.
- Sterile speculum and vaginal exams.
- Fetal assessment.
- Limited sonography (including amniotic fluid index, biophysical profile, biometry).
- Leopold's maneuvers.
- Evaluation of women with:
- Preterm labor.
- Post-term pregnancy bleeding.
- Intrauterine growth restriction.
- Other obstetric complaints.
Gestational Diabetic (GDM) Clinic
One afternoon per week, GDM clinic is staffed by one nurse midwifery faculty member with MFM consultation available. This clinic is a referral for all antepartum GDM patients at Women & Infants Hospital and at the Providence Health Centers. Nurse midwives work collaboratively with MFM in this setting.
The midwifery faculty assist in core clinical education for third year medical students from The Warren Alpert Medical School of Brown University. These students perform history and physical exams and participate in labor and birth experiences under the guidance of the midwifery faculty. Simulations for episiotomy and laceration repair, mechanisms of labor and hand maneuvers for delivery to enhance skill acquisition are practiced while on the labor unit. This is in preparation for actual experiences with patients as well as to prepare for the OSCE skill stations at the end of the rotation, in which the midwives participate as proctors. Six hours of lecture time are provided by the CNMs during the six-week rotation.
During the eight weeks of the PGY-1 residents are on the low-risk OB service, nurse midwifery faculty assist them with:
- Labor management.
- Birth experiences.
- Procedural skills.
- Insertion of IUPCs, FSEs.
- Use of local and pudendal anesthesia.
- Episiotomy and laceration repair.
- Verify the accuracy of vaginal examinations.
At the completion of approximately 30 births, each PGY-1 resident is assessed for competency with hand maneuvers for delivery, episiotomy/laceration repair, and accuracy of vaginal examinations. They are also assessed for competency with basic ultrasound skills, including amniotic fluid index, biophysical profile and biometry, as well as with selected clinical scenarios in the triage setting. Numerous educational workshops are held annually for residents by the midwifery faculty.
The PGY-1 Resident Orientation is a full-day program given to all ob/gyn interns at the beginning of their residency. The content consists of intrapartum seminars and skill sessions addressing clinical dexterity and beginning level clinical management of pregnant women in labor and delivery. The skill sessions include:
- Abdominal assessment.
- Vaginal exams.
- Rupture of membranes.
- Prolapsed cord.
- Use of fetal scalp electrode.
- Intrauterine pressure catheter.
- Electronic fetal monitoring.
- Local anesthesia.
- Cutting and repair of episiotomy/lacerations.
- Hand maneuvers for birth (including management of nuchal cord, meconium and shoulder dystocia).
- Third stage management.
- Postpartum hemorrhage.
PGY-2 Advanced Skills Workshop
An advanced clinical skills workshop for the PGY-2 residents is conducted each year. This advanced skills workshop covers a case-based approach to fetal heart rate (FHR) monitoring and advanced interpretation of FHR strips, as well as clinical management of non-reassuring FHR tracings. The workshop also covers:
- Shoulder dystocia.
- Postpartum hemorrhage.
- Alternative birthing positions.
- Principles of effective clinical teaching in the birth setting.
Clinically, the midwives are available on labor and delivery to review labor management and clinical decision-making with PGY-2 residents.
This advanced skills workshop is a collaborative effort between midwifery and the Division of Urogynecology and Reconstructive Pelvic Surgery. A clinical simulation lab is set up to demonstrate and return demo repair of 3rd and 4th degree lacerations and to cover didactic material on episiotomy and perineal anatomy and physiology.
PGY-4 Leadership Workshop
This is a 2-1/2 hour workshop focusing on leadership skills for chief residents. This workshop is guided by the SynecticsTM process of using creative problem solving techniques. Leadership scenarios are included in the workshop to role play leadership issues commonly encountered by chief residents.
The Women & Infants' Nurse Midwives provide periodic educational workshops, simulation experience and practice review of a variety of Ob/Gyn topics.
PGY-1 Resident Mentoring Program
Each June, the midwifery faculty assume the role of mentors for the incoming PGY-1 residents. Each resident is assigned to a midwife faculty during the first year. The midwifery faculty meets with him/her on a regular basis, tracking clinical experiences and adjustments to the resident role, especially while rotating on the low-risk obstetric service. Obstetric noon conferences for interns are coordinated through the midwifery faculty preceptor who assumes responsibility for assisting interns with conference planning and presentation skills.