Jennifer and Jessica have developed a Midwifery Service at Bend OB/GYN and work together as a team assisting their patients and their partners throughout their pregnancy and birth.  The Midwives will share their call coverage with one of them being on call for answering questions or attending births at all times.  The Midwifery Service is well supported by Bend OB/GYN's team of physicians.  If any complications arise a physician will be consulted or the patient's care can be transferred if there is a medical emergency.  Jennifer or Jessica can remain with the patient to give emotional support.  In the event a cesarean section becomes necessary, the midwife can assist the physician in the procedure if appropriate.  The Midwives have full admitting privileges for the Family Birth Center at St. Charles Medical Center - Bend and can place necessary orders including pain medication or epidurals if the patient desires. 

The Midwifery Service is for low risk women that want more personalized care.  If a woman has a particular issue and is unsure if she should see a midwife or a physician, she is welcome to call our office and speak to one of the Midwives.

PRENATAL:

Jessica and Jennifer will share their prenatal patients.  When making an appointment, either midwife can begin your prenatal care, however, if you have seen either Jessica or Jennifer for your annual exam in the past and you are now pregnant, you can start your pregnancy care with the midwife with whom you are familiar with.  Your prenatal visits will alternate between the two midwives throughout your pregnancy.  If you would like to meet any of the physicians during your pregnancy, you are welcome to do so.

FIRST OB VISIT:

Your first visit will be scheduled for one hour on a Friday or a Monday.  If that is not convenient, we can make other arrangements.  Patients can be seen at anytime in their pregnancy, from the first positive pregnancy test at 4 weeks up to late prenatal care. 

RETURN OB VISITS:

Please allow 20 minutes for these appointments.  This is a chance to check in with the emotional and physical states of pregnancy.  Please bring any questions to these appointments that you would like to discuss.  Toward the final trimester of pregnancy, the midwives will discuss birth desires or ideas.

PHONE CALLS:

The midwives try to respond to their own phone calls from patients.  The best way to reach them is through the office phone number (541) 385-8050.  After hours, there is an answering service that will relay calls to the midwife on call.  To reach the answering service, follow the prompts on the phone system.  Please return calls to the midwives through the office phone number unless otherwise directed by the midwife.

OB/GYN Midwifery Service Guidelines:

Antepartum Bend OB/GYN Midwifery Service Guidelines

Certified Nurse Midwives  (CNM) independently manage low risk pregnancy and birth.  Women who desire nurse-midwifery care and women who desire a female provider are appropriate candidates to begin prenatal care with a CNM.  Physician back up is always available if needed by the Bend OB/GYN on-call physician.

The CNM will assume responsibility for the antepartum management of the medically and obstetrically uncomplicated patient.  The CNM can identify known risk factors for a pregnancy, the appropriate level of case review and/or consultation.  Consultation is necessary with any significant deviations from normal findings.  There are many conditions that increase the risk of pregnancy, these include but are not limited to:

• Late entry to prenatal care (after first trimester)
• Drug or alcohol abuse
• Maternal, paternal, or family history of genetic disease
• Younger or older maternal age (less than 16 or more than 35 years old)
• BMI<18.5 or>25
• Diet controlled gestational diabetes
• Inadequate weight gain
• Recurrent pregnancy loss

The CNM will refer patients to the physician for the following conditions:

• Previous cesarean delivery
• Diabetes preceding the pregnancy
• Gestational diabetes requiring medicine to control blood glucose
• Chronic maternal disease such as chronic high blood pressure
• Malpresentation
• Other significant deviations from normal in which CNM recommends physician management

Intrapartum (During labor and birth)

CNM independently manages low risk pregnancy and birth.  Physician back up is available if needed by the on-call physician for the practice.

CNM will consult with on call physician for the practice for the following issues:

• Pitocin augmentation
• Induction of labor
• Suspected 9 pounds or greater infant
• Fetal heart rate abnormalities
• Arrest of labor for 3 hours with no response to appropriate intervention or if patient refusing intervention
• Maternal temp>100.4 F after 2 evaluations and if unresponsive to intervention
• Mild preeclampsia
• Amnioinfusion
• Preterm premature rupture of membranes or labor prior to 36 weeks
• Abnormal vaginal bleeding
• Meconium stained fluid
• Third or Fourth degree perineal laceration or cervical lacerations
• Chronic medical illness as needed
• Other significant deviation from normal
• Postdates > 42 weeks
• Prolonged 2nd stage
• Abnormal presentation

Co-manage:
Physician and CNM involved in patient care during labor and birth.

• Gestational hypertension needing medication to reduce blood pressure
• Gestational Diabetes
• Vacuum Assistance
• Preeclampsia requiring Magnesium Sulfate

Transfer Care to physician:

• Severe preeclamptic
• Birth prior to 36 weeks
• C/S indicated
• Other significant deviations from normal in which CNM recommends physician managment