Students perform a simulated baby delivery at UCSF’s Kanbar Center for Simulation, Clinical Skills and Telemedicine Education. Photo by Elisabeth Fall
On a sunny day in late October, a group of midwifery graduate students from UC San Francisco School of Nursing and residents in obstetrics and gynecology from School of Medicine sit in a windowless room in the Kanbar Center for Simulation, Clinical Skills and Telemedicine Education talking about an emergency scenario they have just completed.
Surprisingly, most of the discussion centers not on clinical skills or decisionmaking, but on communication: how physicians and midwives can engage in meaningful, respectful dialogue to improve patient care during the stressful, high-stakes events that are obstetrical emergencies.
Scenes like this one illustrate an increasing focus on interprofessional education that intersects with a collaborative model of maternity care between UCSF’s certified nurse-midwives (CNMs) and obstetricians that began at San Francisco General Hospital (SFGH) and has evolved over almost 40 years to allow each to learn from one another and practice to their unique strengths, to the benefit of patient and provider alike.
Birth of a New Kind of Maternity Care in San Francisco
In the early 1970s, a group of obstetricians at SFGH began discussions with CNMs in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences who also chairs the leadership council of the nurse-midwives of SFGH.
Read more about maternity care and other news from the School of Nursing in the latest edition of the Science of Caring.
It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.
The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.
The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.
“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.