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Military nurse midwives ride rollercoaster of emotions with their patients

Army Maj. Lena Fabian (left), staff midwife, William Beaumont Army Medical Center in Fort Bliss, Texas, places a wireless monitoring system on Capt. Merry Fontenot, a staff midwife 36 weeks into her pregnancy. (Photo by Marcy Sanchez, William Beaumont Army Medical Center Public Affairs Office) Army Maj. Lena Fabian (left), staff midwife, William Beaumont Army Medical Center in Fort Bliss, Texas, places a wireless monitoring system on Capt. Merry Fontenot, a staff midwife 36 weeks into her pregnancy. (Photo by Marcy Sanchez, William Beaumont Army Medical Center Public Affairs Office)

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Air Force Lt. Col. Sarah Martin knows the joy and heartbreak of pregnancy. As a certified nurse midwife (and a mother herself), she gets to experience firsthand the highs and lows experienced by moms and moms-to-be. On one occasion, it struck particularly close to home for the certified nurse midwife consultant to the Air Force Surgeon General and now assigned to Brooke Army Medical Center in San Antonio, Texas.

Martin saw a young couple for their first pregnancy and did an initial routine trimester ultrasound. They were people Martin knew socially – they all lived on the same base.

“But unfortunately, it was not a viable pregnancy,” said Martin. “It was very upsetting, and it’s hard, not only as a provider but as their neighbor, having to break this news.”

Martin said the couple didn’t give up, though. Within a year, the woman came back pregnant, and Martin was able to help them through the pregnancy to a healthy and happy delivery. “Their little boy is three now. So that was very special for me: seeing them through that saddest time in their lives to a successful delivery. Nature finds a way,” she said with a smile.

Martin is one of a small group of providers in the Military Health System – less than 100 in all services worldwide – who are midwives. They specialize in low-risk pregnancy care and delivery, as well as obstetrics/gynecological care. Most patients come in for routine well-woman exams, as well as PAP smears, fertility and contraceptive education, lactation advice and help, and treatments for menopause. If the care women require elevates, midwives work with doctors to transfer that care without gaps. Martin pointed to her own irony that despite being a midwife, she had both of her children by C-section, demonstrating how midwives work with doctors to make sure that patient experience is the priority. She said her midwife was still part of the birthing process.

“We don’t just hand over patients; usually, we’re the first to assist on C-sections,” said Martin, adding her own experience helps her be empathetic to other moms. “I can counsel my patients that if they can’t have their babies naturally, there’s nothing wrong with that. Sometimes, things are beyond our control. But you’ll get through it, you’ll have a healthy baby, and you’ll be healthy. And that’s really the outcome we want.”

TRICARE also covers certified nurse midwife services, provided the midwife is certified by the American Midwifery Certification Board and licensed in the state where they practice, if required by that state. Certified nurse midwifes are independent practitioners who do not require supervision by a physician. However, midwife services by a registered nurse who is not a certified nurse midwife may be covered with a physician's referral and supervision.

Midwife services in the Military Health System have been recognized recently for several achievements. Army Maj. Elizabeth Nutter, a consultant to the Army Surgeon General for the Nurse Midwife Program, was the recipient of the 2016 Kitty Ernst Award from the American College of Nurse-Midwives. The award honors an exceptional, relatively new certified nurse midwife (certified for less than 10 years) who has demonstrated innovative, creative endeavors in midwifery and/or women's health clinical practice, education, administration, or research. Beaumont Army Medical Center at Fort Bliss, Texas, received the International Board of Lactation Consultant Examiners and the International Lactation Consultant Association Care Award, which recognizes maternity and community-based facilities worldwide that hire currently certified breastfeeding consultants.

“It can be very trying, but it also can be very rewarding,” said Martin. “Families rely on you, even when it’s not the outcome they expected or wanted.”

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