‘Growing by the day’: Midwifery health care is expanding across Pittsburgh area

By MEGAN SWIFT
TribLive

Allegheny Health Network is expanding its Nurse Midwife Services with a newly opened office in Penn Hills.

As the practice grows, providers are working to educate patients about what modern-day midwives do. A “midwife” doesn’t have one specific definition, which is why there are misconceptions about what they do.

At AHN, all certified nurse midwives can provide care to low- to moderate-risk patients. CNMs also provide routine gynecological care and resources, such as birth control options, and can take patients from puberty to post-menopause.

Amy Gramz is the midwifery supervisor at AHN, based at Jefferson Hospital. She was a labor and delivery nurse for about 16 years and has been working as a midwife since 2020.

“We take more time in understanding the why behind it — that gives me the ability to provide care throughout the entire process, developing that trust and building it with them,” she said. “I was only seeing (patients) in the birth process. I wanted to get to know them a little more to help their birth experience better.”

The Rodi Road office joins AHN’s other midwifery care locations in Peters, Uniontown, Brentwood and AHN Jefferson Hospital.

Patients at the new midwives’ practice will deliver babies out of Forbes Hospital, AHN said.

If someone chooses midwifery care rather than traditional OB-GYN in the birthing process, Gramz said she and the midwife team get to know them, including their family background, potential anxiety surrounding the process and any history with trauma, to help put them at ease and help them navigate the process.

Midwife misconceptions

At AHN, the midwifery team provides Pap smears, contraceptive counseling and treatment for routine gynecological issues. CNMs are trained in primary care as well.

“The way I view it is just a more tailored approach,” Gramz said. “We can’t do anything without physician support — we collaborate with our physicians when we need to; we can take care of women with maybe a little bit more moderate risk because we have support with the physicians within the network.

“I think the benefit is you get the safety of medical intervention with the comfort and convenience.”

She said this is one of the main drivers for more local people seeking out midwives.

“We follow the same guidelines as physician care … we take time in our visits, a little bit more than the physicians do,” Gramz said, which allows for more tailored patient care. “It’s allowing them to take the time to ask the questions and seek out trauma-informed care. That’s a lot more conversation-based to develop that trust. We do respect their right to choose, which the physicians do as well.”

Often, this means that she and the midwifery team might see one patient for five or six years — from the time they get their first pap smear to when they’re having a baby.

Diana Shane became a midwife in 2011 and began working at AHN Jefferson in 2017. Now, she’s part of the new midwifery team on Rodi Road.

Midwifery care is different depending on the person, according to Shane.

“A lot of people seek it for an unmedicated birth,” said Shane, 45, of Gibsonia. “Midwives specialize more in supporting unmedicated birth.”

In Pennsylvania, midwives have to be board-certified, so the team at AHN all started as registered nurses who went back to graduate school for midwifery care, she said.

“The term ‘midwife’ can get a little confusing,” she said. “Pennsylvania is one of the stricter states; you have to be a nurse midwife to practice within the state and receive approval through the [state] Board of Medicine, the ability to prescribe and take care of women in hospitals.”

One of the main misconceptions, Gramz said, is that people think midwives are against medical intervention overall and would prefer holistic care.

“There are extremes on both ends,” she said. “We want to give someone that ability to have a say in their care, take the time in office visits to find fears, tailor and give a more personal approach.”

If someone wants a more holistic birth, Gramz said she will help the patient seek out those resources and develop a birth plan throughout pregnancy.

“We can take care of pregnancy, as long as it’s normal and not highrisk,” Gramz said. “The only thing we cannot do is a C-section or surgery. Then we would involve (physicians).”

The midwifery team at AHN offers certified in-hospital births. However, if a patient wants a homebased birth or freestanding birth, she said the team will recommend other options.

‘Growing by the day’

Word-of-mouth recommendations are integral to obtaining patients, according to Gramz, at least at Jefferson.

“When they call in, what we’re working on right now is what kind of care you’re looking for. Break down those barriers of understanding what a midwife is, what they do, what they can’t do. We’re hoping to get more of a presence by fall,” Gramz said of the midwives employed there, so that patients have more availability for appointments.

Shane agreed that word-of-mouth recommendations are integral to obtaining patients at the new Penn Hills location.

“It’s been really neat to watch it grow, watch it flourish and have that service available to the community,” Shane said.