"Have a Sense of Humor" — Advice from a Nurse Midwife

Bundles of Health: What is your role and where do you work? 

Allison Manko: I am a certified nurse midwife at Swedish Covenant Hospital in Chicago. I've been here for over five years, and have been practicing for seven years.

Bundles of Health: How do pregnant women hear about you? What kinds of services do they typically ask for? Do they know when they come in that they want to get a midwife? What other options are there?

Allison Manko: We’re a group of 10 midwives. A good number of our clientele are midwifery seeking, so they come in searching for midwives. Some people when they call to set up their first appointment, they’re offered by our front desk the option of OBs or midwives. Sometimes they’re learning about us for the first time. So they have their first appointment with us and kind of go from there, seeing if they would like to continue with midwifery care.

We also provide Centering Pregnancy, which is prenatal care aimed at creating a community for our mom-to-be patients. We (offer) prenatal care (for) women in groups with other women with similar due dates. This has really been a wonderful model. Over the last two years since instituting the program, we've seen lower rates of postpartum depression, lower rates of isolation in women who’ve gone through prenatal care in this group model versus the traditional model. A few other hospitals have reached out to learn more about what we do and how we do it, so we’re hoping it’s the way of the future for prenatal care. 

Bundles of Health: Do you offer any postpartum support for free?

Allison Manko: We’ve been grappling with how to come up with a better solution for new moms for decades. We see women come into our office who don’t feel like they’re supported, don’t have the resources – emotionally more than physical resources. It’s a very loaded issue because we as a society don’t have the infrastructure set up. Most healthcare plans don’t necessarily have great (mental) health coverage. People nowadays live far away from families and feel isolated from their closest communities. It’s a very complex issue, and anything that we do come up with – it all boils down to, can people afford these things?

Here at Swedish Covenant Hospital, we hold a free, weekly drop-in new moms support group every Wednesday. Anyone is welcome. You don’t have to have delivered with our group or even at this hospital. It’s been widely popular. We’re in our third year now.

The biggest piece of feedback from the new mom participants is that they very quickly learn that they’re often not alone in how they feel—whether it be about themselves, their postpartum body, their baby, their husband, their relationships. 

Bundles of Health: In the birthing process from pregnancy to birth to postpartum, what is typically called upon for your group of midwives to do?

Allison Manko: As certified nurse midwives, we are providers of women’s healthcare—from puberty to menopause. We focus on individualized healthcare, really focusing on women, families, and babies. and While we do focus on the natural, holistic approach to healthcare, we are also nurse-practitioners with full prescriptive rights and we follow evidence-based guidelines in medicine.

For our patients, we fully manage prenatal care. With the exception of dealing with certain high risk conditions, which are typically less common, we provide the same prenatal care as an OB would. The real difference you would encounter is in birth. During the birth process, we do something called labor sitting, where we really spend time with the woman during the whole time they’re pushing. We become part of their support system. We try to be much more reachable. Our goal is that women trust us, they trust the care, and they feel comfortable reaching out to us. That’s really the big difference. We follow all the same guidelines, offer the same testing, the same ultrasounds and everything that an OB would. But we support natural birth a little bit more. We allow women to eat and drink in labor, move around freely, deliver in any position they want, our flexibility is little greater when it comes to birth and trusting the process.

Bundles of Health: How many babies do you deliver annually, and what is your C-section rate?

Allison Manko: On average, we do 600 births a year. We’re a busy group. We’ve been a big group at this hospital. Our relationship with them is very well established. Of those 600 births, our C-section rate is actually about 10%, which is very impressive nowadays. We try to keep our rates of intervention low as well. That’s one of the other advantages of having a midwife—we tend to have lower C-section rates and lower rates of complication.

Bundles of Health: What causes an intervention typically?

Allison Manko: Babies in distress, bleeding, stalled labor, issues like that... Sometimes we do have to medically intervene, whether that be certain medications to get labor going or put in internal monitors. If there is a medical situation where intervention is necessary, of course, we will intervene. But if there’s no clinical indication, we don’t intervene as a precaution, which you do tend to see sometimes in some groups.

Bundles of Health: If you were to give any advice for new moms, what would your top 3 would be?

Allison Manko: That is hard because it’s a tough period in life—being a new mom with your first baby—or even second or third baby, really, because each time is such a big transition.  

  1. Don't put expectations on yourself. That's the most important thing. Comparing yourself to others leads to disappointment. Set yourself up for success for postpartum while you're pregnant. Set up your resources, set up your support systems, and let things come as they come. Don’t put that pressure on yourself because one of the number causes for postpartum / baby blues / stress in moms is looking around and saying “well, this person’s doing that, and that baby’s doing that, and I should be doing this… or, I saw this on Pinterest, it should look like this. Why doesn’t it look like this for me?” And that’s when you get that spiral of anxiety and stress. Women think that that the postpartum period is just going to be a beautiful picture but that's not the case for many people—it’s messy and you’re sleep deprived and you haven’t showered in 4 days. You don’t want your husband to touch you and everything’s falling apart and you feel so alone. Your experience is not going to look like a snapshot of someone else's perfect Facebook feed. Find those people who are willing to share the real story. That’s key.

  2. Know that "it's ok." In my profession, I speak to hundreds of women. There's a lot of mommy shaming out there. I know some women who say "I can't afford to feed my baby organic. What do I do?" And they're losing sleep over this, and you know what, it's ok. You can still be a great mom even if you're not feeding your baby organic or doing any one of the ten million other things other moms online are saying are "must do's." It's ok, really.
  1. Have a sense of humor. When you look at it through a light-hearted lens, you start to realize that it is often pretty funny. If you just let it go, it can be quite comical—when your baby has that blowout in the middle of the grocery store, you have to have that sense of humor because something embarrassing is bound to happen sometime. Keep in mind that "this too shall pass," and laugh on. 

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Allison Manko, CNM, MS is the Director of Midwifery Services at Swedish Covenant Hospital in Chicago. She decided to become a Nurse Midwife while getting her undergraduate degree at The University of California-Davis where she had been training to be a veterinarian before falling in love with Midwifery! She changed her major, got a graduate degree from Columbia University, and finally moved to Chicago where she has practiced midwifery at SCH for the last five years.


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