To many the title “midwife” brings with it an image of an older lady traveling to the expectant mother’s home, ordering a nervous father to boil a pot of water, while the baby is delivered behind closed doors. It may also bring to mind screaming due to lack of pain medication. Jordan Miles is changing the image of midwives and providing more options for expectant mothers in Marianna just in time for a baby boom.
Originally from Graceville, Jordan earned a Master’s degree from Frontier Nursing University. She is a Nurse Practitioner with an additional, intensive study in midwifery, or Certified Nurse-Midwife. After graduation Jordan worked for Tallahassee Memorial Hospital. She loved her work, but missed Jackson County. About a month ago, Jordan moved to Marianna and began working at Chipola Surgical and Medical Specialties, OB/GYN.
According to Jordan, there are other types of midwives. A Certified Midwife (CM) goes through graduate-level midwife training, but their undergraduate degree is in a field unrelated to nursing. A Certified Professional Midwife (CPM) often takes online classes to pass competency testing through the North American Registry of Midwives (NARM) to obtain a certificate. There are additional categories of midwives, such as Direct Entry Midwives (DEM), who have learned how to be a midwife from an apprenticeship or study other than nursing, and Doulas, who provide support for expectant moms throughout, pregnancy, labor and postpartum, but do not actually deliver the baby.
With so many options to choose from how can expectant parents make the right decisions, and why is a midwife needed? Midwives have become a more popular choice in recent years for many reasons. They are skilled in guiding mothers through healthy options during pregnancy. They assist women in learning ways to cope during their pregnancy, labor and delivery without medication. They often spend more time with the mother during visits while pregnant, and during labor and delivery. Finally, midwives take on a role of partner with the mom during the pregnancy, labor and delivery. Not only does Jordan have specialized training as a nurse and midwife, she explained that she only delivers babies at Jackson Hospital under a physician’s supervision. If surgery is needed, a physician is available.
In recent years some expectant mothers had begun traveling to larger cities to use a midwife. Now, women have an option locally. Jordan explained, “Probably all the hospitals around have been busy since Hurricane Michael.” “One of the labor and deliveries in Panama City is closed,” she added. Jackson Hospital brought Jordan to the area because she offers methods with less intervention. Jordan explained that epidurals are still available for her patients. “They can have all or as little intervention as possible,” she shared.
This year Jackson Hospital became a Baby-Friendly Facility. According to “Baby-Friendly USA – Upholding the Highest Standards of Infant Feeding Care,” about a year ago there were only 512 Baby-Friendly facilities in the United States. Nursing mothers are provided accommodations, other than restrooms, when they need to feed their infants. There will be a celebration of the award on Wednesday, Aug. 28, from 2 p.m. to 4 p.m. Everyone is welcome to attend.
Jackson Hospital also offers classes on pregnancy and childbirth a couple of times of month. Jordan shared, “Moms can get up and walk around during labor and in October Jackson Hospital is expecting to have portable monitors so that moms can move around with the monitor attached.” Jackson Hospital provides “birthing balls and is hoping to provide birthing tubs in the future,” she continued.
When asked about tips for expectant moms, Jordan encourages staying active. “Talk to your doctor or midwife and be educated when making decisions.” Some exercises to discuss with your physician are swimming, squats, walking, jogging and going to the gym. However, she pointed out “if it is uncomfortable don’t do it” and “pregnancies with complications may require modifications.” Activities like boxing or gymnastics that may hit your tummy or make you fall, should be avoided. She also encouraged eating a balanced diet. “Avoid a lot of juices and sugar and take good prenatal vitamins” she added. “You’re not eating for two.” Jordan explained that doctors usually approve Tylenol if needed, but Aspirin, Ibuprofen, Motrin and combination cold medications may cause blood pressure and other complications. Expectant mothers should avoid drug use, drinking alcohol and smoking. “Smoking can cause the baby not to grow as well” she continued. Drinking leads to a neurological condition known as Fetal Alcoholism (FAS), which results in birth defects, behavioral and learning problems. “Babies can be born addicted to drugs, which can be so severe that they die,” she added. “Usually this is seen with high doses of prescription medications.” Jordan encourages expectant moms to bring siblings to appointments. “Remember it will be an adjustment, so let them be involved with the baby.”
Sometimes there are complications during pregnancy. Often expectant moms experience morning sickness. Jordan explained “usually nausea resolves after the first trimester”. She added that there are new medications available to treat the symptoms if needed. Similarly, expectant moms may be dizzy from the flow of blood when changing positions too quickly. However, this is something to discuss with your doctor or midwife. Jordan explained that some women experience bleeding. In those cases, contact your doctor. At 28 weeks expectant mothers are tested for Gestational Diabetes, a disease that occurs in pregnant women, where hormonal changes may work against their body’s insulin in breaking down glucose. “If diagnosed, this usually can be controlled with diet and exercise” she shared. Another condition that may be seen during pregnancy is Preeclampsia. Jordan explained that with Preeclampsia “blood pressure is high because the mother’s body treats the placenta like a foreign object”. Often in these cases delivery is recommended after 37 weeks. Still another condition is Toxoplasmosis. Caused by a parasite found in cat feces and undercooked meat, this condition is dangerous for unborn children. Although typically associated with outdoor cats, Jordan recommends avoiding cats and litter boxes while pregnant. Some moms have experienced Rh incompatibility. This takes place when the unborn baby is Rh-positive, which means the infant carries the Rh protein molecule or antigen in his red blood cells, and the mother does not carry the Rh protein. The mom’s blood mixes with the Rh-negative fetus’s Rh-positive blood. According to Jordan “this is dangerous for the next pregnancy because the mom’s blood will attack the baby.” Screening takes place a couple of times during pregnancy. Treatment is available and is usually provided at 28 weeks, after delivery and in some cases when there is bleeding. “In the cases of miscarriages,” Jordan added “I always recommend waiting one normal cycle because there is a higher percent of success.”
Technology has changed over time and so has the dispelling of old wives tales, such as how the mom carries the baby indicates the gender. A procedure that was used routinely in past years for older mothers-to-be, known as Amniocentesis, where during the second trimester amniotic fluid was checked for fetal defects, is now only used for high risk pregnancies. Genetic testing is available and is very accurate at letting parents know of genetic conditions in advance.
First time moms often wonder about how to prepare for the big day. Jordan recommends packing a hospital bag with nursing gowns, tank tops, maternity leggings or just comfortable clothing without tight waist bands. She also recommended baby gowns and special baby clothes for the newborn. Jordan points out that as the time draws near “semen is a prostaglandin and will help prepare the mother’s cervix for labor”. Jordan explained that when the mom’s water breaks, it could gradually leak. Contractions can be distinguished from Braxton Hicks Contractions by waiting to see if the contractions intensify. “During early labor take a warm bath and put your feet up, if it slows down then wait,” she explained. “If the contractions get to three to five minutes apart and are stronger and longer for two to three hours, it’s time,” added Jordan. “Usually it takes 12 to 24 hours on a first-time baby,” she shared. “If the contractions are super strong, go in.” To reduce pain during labor, Jordan recommends moving around and changing positions.
Jordan shared “after the birth, the baby hardly ever leaves the room.” “Skin to skin bonding with mom for at least an hour after delivery is encouraged,” she continued. However, if mom is tired, there is someone available to help. Typically, mothers and babies are discharged from the hospital two days after a vaginal delivery, and two to three days after a caesarean section delivery. According to Jordan, once home the mother needs to rest and abstain from intimacy for four to six weeks or until cleared by her physician. If she is not taking pain medications with narcotics, she can drive. However, it is important to move around to prevent blood clots. In the case of caesarean sections, the mother will have a checkup a couple of weeks after delivery.
Jordan offers family planning options. There are many different choices. Some are safe while breastfeeding and some are hormone free. According to Jordan the hormone-free, copper intrauterine devices (IUDs) are effective for about ten years and regular IUDs work for about five years. Patients can choose injections quarterly, implants, patches, diaphragms, condoms and rings. She added that it is possible to conceive while breastfeeding.
Although Jordan does not see many gynecological patients, she is available to her patients for annual health exams and other questions. One question she has been asked is about personal care products. She recommends women use whatever they are most comfortable with, but to change at least every 3 to 6 hours. “Diva Cups are popular among younger women and I think they are a new and good option,” Jordan explained. Young women should start their annual exams when they begin engaging in intimacy. Pap smears are not needed until age 21 and then, only once every three years.
Jordan is married to Justin Miles, a teacher and coach at Chipley High School. They have two children: Greyson and Ella Grace, aka “sister.” Jordan joins Orlando Muniz, MD, Anthony Dorbu, MD, Michele Baber, APRN, and Jackie Bard, APRN at Chipola Surgical and Medical Specialties located at 4250 Hospital Drive. For an appointment or more information, call 850-526-6711. What a great option for expecting moms! Visit the City of Marianna’s website at http://www.mariannafl.city/335/New-Businesses-and-Other-Community-News to learn more about businesses in Marianna.
Kay Dennis, MBA, MPA, A.I.C.P., is the director of Municipal Development for the City of Marianna.