Midwifery care now available at UNC Rex

Over the past three decades, more and more expecting moms have elected to deliver their babies with the help of a certified nurse-midwife, professionals who are registered nurses and have additional advanced training.

Elder has more than 20 years of labor and delivery nursing experience caring for women with both low and high risk pregnancies. In her late 30s, the mom of three decided to head back to school and graduated from East Carolina University's midwifery education program. The nurse-midwives at her previous job at the Duke Birthing Center at Duke University inspired here.

"There was a wonderful group of nurse-midwives there," she said. "I found them to be amazing. They were all brilliant. They had a passion for their patients. ... Nurse-midwifery is an extension of nursing. To see that model of care and how it can be integrated into the broader medical model and seeing the benefits over time, I was sort of enamored with them."

Now, she's thrilled to be helping new moms in Raleigh deliver on their own terms with backup from doctors when needed.

"There are medical conditions that need to be managed with a doctor, but when it comes to labor, they can have normal labor that ends in a safe vaginal delivery," she said. "Wherever midwifery is integrated fully, the patients have better outcomes."

A new OB visit usually lasts no more than 30 minutes, but Elder spends an hour with patients who are coming in for the first time.

Elder does a physical exam, but she also goes into teaching mode - talking to them about what's next and answering their questions.

"In that first visit, I start talking to them about a healthy pregnancy and making some recommendations to them for non-traditional things like extra supplements or going out and doing pre-natal yoga and classes," she said. "We tackle all of those things early on in the first visit."

Even after the first visit, Elder spends twice as much time with patients during each visit. Patients get 20 minutes with Elder compared to 10 minutes with the doctor.

"Not that every visit takes 20 minutes, but it really does give extra time to talk through things with patients," she said. "For the first-time moms, they are very surprised at the aches and pains. We talk about the normal discomforts of pregnancy."

During the second trimester, Elder said she likes to provide patients with strategies to help them determine if those twinges and cramps that they're feeling are actually normal.

"It builds that confidence in them for that third trimester and what's to come," she said.

The extra time also lets her incorporate spouses, partners and other family members, who may tag along on visits, into the conversation. Once she's answered all of mom's questions, she'll often turn to the her support people.

"I'll ask, "Do you have any questions, are you worried?'" she said. "Particularly the dads will say, "Actually, yes.' I can talk them down."

At about 28 weeks, Elder will encourage expecting moms to start working on their birth plan.

"It creates a dialogue for me to find out what is important to them," she said. "You may have one mom who has this vision of what she wants her birth to be. For her, it could be, 'I want to be up and mobile and no medications.' Your classic natural labor. I have other women who want an epidural pretty quick. I will talk to both groups about whatever they are wanting."

Elder said she encourages women to come up with a plan A, plan B and plan C.

"In the event that there is an emergency, I want the patients to at least be familiar with what could happen," she said.

Elder is with her patients throughout labor and delivery, providing support and care.

"I tell patients, 'These are your decisions and you're choosing your path,'" she said. "If you have a question about something, ... I will give them the options. I will give them my recommendations. And I will tell them the data behind it."

Elder also will follow up with the moms for a check up six weeks after delivery.

Throughout the experience, Elder's goal is to support each mom and help her have a meaningful experience as she grows her family.

"I'm there for a moment," she said. "They will carry those memories for the rest of their life."