When asked how long she’s been a midwife, Robyn McHugh lets others do the math.
“From time to time, I’m taking care of the children of the babies I’ve delivered,” she says with a laugh.
McHugh is a certified nurse midwife, with Missouri Midwifery Service. A midwife works in partnership with women to conduct births and give support and care during pregnancy and labor predominantly outside of hospital systems.
Missouri Midwifery Service is a women’s health clinic that provides culturally sensitive maternity care to Amish and Mennonite families, McHugh says.
“It started with 500 horse-and-buggy families in the Versailles community that were remote from hospitals,” she says.
This group of families formed a board of directors under 501(c)(3) organization Parochial Health. They launched Missouri Mennonite Clinic and later purchased the former BirthCentered office in April 2017 to found Missouri Midwifery Service. McHugh joined as the midwife and administrator alongside Columbia-based collaborative physician Dr. Mark Grant. The center has added two CNMs, seven nurses, two birth assistants and additional support staff.
Missouri Midwifery Service is in the process of becoming a licensed birth center, McHugh says. The clinic’s only lay midwife does not perform deliveries but assists in births and serves as a Pennsylvania Dutch translator.
“There are lots of different flavors of midwifery in Missouri,” McHugh says. “Our goal here is to be a collaborative model that works alongside hospital-based systems.”
Missouri Midwifery Service mostly serves Amish and Mennonite families with low-risk pregnancies. High-risk pregnancies are funnelled to hospitals.
“Knowing who you’re serving and what matters to them makes a huge difference,” McHugh says. “We’re breaking down a lot of barriers in the Mennonite and Amish community over time.”
That includes screening for genetic issues, which McHugh says are in higher frequency in Amish and Mennonite communities.
“Before we were on the block, there were about 0% of patients who would opt into genetic and carrier testing because I think they thought it meant they might be interested in termination,” she says. “Our goal is to determine the setting that best meets their needs. You want to convey the information in a way that would not be morally offensive to them.”
In the United States, 9.4% of all births are attended by a CNM, according to 2018 Centers for Disease Control and Prevention data. Sarah Jones, a CNM, works with Mercy Clinic Midwifery, a program founded in 2017 to provide midwifery services and low-intervention birthing within a hospital setting.
“Our program has grown exponentially over the last three years,” Jones says.
Jones and McHugh cite the importance of guiding patients to the safest personalized care for their needs as one of the appeals of midwifery.
“In midwifery care, the midwives are the lighthouse, and the patient is the captain of the boat,” Jones says. “We guide them where to go based on research, medical knowledge and experience.”
Interest in personalized care is on the rise outside the Amish and Mennonite communities. The National Center for Biotechnology Information notes that birth center births more than doubled from 2004 to 2017, making up 0.52% of all births nationally. Currently, Missouri Midwifery Service schedules eight to 10 patients per month.
“In the Mennonite and Amish community, they have lots of children, so they keep us busy,” McHugh says.
Missouri’s Amish population numbers about 14,500, according to the Young Center’s Amish Studies. McHugh notes in the past three years, the percentage of non-Amish and non-Mennonite patients has increased to 25% from about 10%.
Delivery in a pandemic
The New York Times and Washington Post reported increased interest in non-hospital births during the coronavirus pandemic.
“There have been some patients who have chosen to do home births because of COVID-19,” Jones says.
“We offered telehealth and phone visits, but you can’t really do that in the Mennonite community, so it turned out to be home visits most of the time,” McHugh says, noting that no unnecessary home visits were scheduled during the pandemic, and her team wore N95 masks and full personal protective equipment.
“I think it was difficult for those few patients who had to deal with COVID-19 and the disappointment that it wasn’t going to be the delivery that they planned, but I think COVID has done that for all of us.”
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