Amanda Ruff, CNM at Southcentral Foundation

What exactly is a midwife?

A midwife serves women in various settings from hospitals to birth centers or homes. The heart of a midwife is in the method of practice. Midwives work with women and their families as a whole. Midwifery is based on relationship building and trust.  

How long have you been practicing and how many births have you attended?

I was a nurse at Geneva Woods Birth Center for five years before becoming a Certified Nurse Midwife (CNM). Previous to that, I worked at Geneva Woods Birth Center as a birth assistant. I currently work at the Alaska Native Medical Center (ANMC) and Southcentral Foundation (SCF). I have been practicing as a CNM for just over a year now. I have attended just over 400 births as a birth attendant and CNM. 

What is the role of a midwife during labor?

A midwife is the protector of normal physiological birth. During labor, it is our role to serve the mother and step in only when necessary. We believe in the power of these women yet midwives are trained to recognize when something is outside of normal. 

I really enjoy providing labor support and it is one of my favorite parts of labor. It’s very important to understand that the power a woman has during labor is her power. Birth is a journey that no one else can walk for her and it is the door she has to walk through.

ANMC is a unique clinical setting to practice as a CNM. Midwives at SCF/ANMCE see a wide range of women including women with a high-risk pregnancy, such as those with gestational diabetes or preeclampsia. In most settings, these higher-risk women would only be seen by a physician, but at SCF/ANMC these patients are seen by both a midwife and physician. The midwives and physicians at ANMC work as a team. The CNM’s role is to oversee the birth process while the OBGYN oversees the complex disease process. The women get the benefits of midwifery but also the care of a physician receiving the best of both models of care.

What led you to become a midwife?

When I had my first daughter, I was receiving care from a physician. Very late in my pregnancy I transferred care to a CNM and was introduced to the midwifery model of care. I realized that I had found my calling. I became a midwife to be in service to other women. I don’t think there is anything more rewarding than this profession. I am the mother of three daughters; so women are my business. 

What advice would you give to an expecting mother on how to find or choose a midwife?

There is a midwife for everyone. Just like any relationship, you might have to try a few before you find the right fit. There are so many types of midwives that practice in different settings and environments, which might play a huge role in your choice. I would say that my biggest piece of advice is to find someone that you connect with. The experience of birth is such an intimate moment in a woman’s life and every labor and birth is unique. It’s funny, women forget many details from life events such as graduations or weddings, but they often remember the details from their births so clearly. 

What are the benefits of having a midwife?

Statically speaking midwives are associated with a lower cesarean delivery rate. Midwives practice evidence-based care with a personalized approach. We dive into areas that many other providers don’t have the time to attend to such at nutrition and mental health. At ANMC and SCF, we practice the Nuka model of care in which our customer owners receive wrap-around services. At SCF, a pregnant woman can see a midwife, dietitian, behavioral health specialist, dental care, and any other necessary services. As a team, we can help connect families with community services they might need. 

How does prenatal care differ with a midwife?

We are able to provide women with longer visits giving us a chance to genuinely get to know what is going on in the mother’s life and how it is affecting the health of the mother and baby.

Midwives have a focus on prenatal care and assist women in preparing for birth. We discuss the birth process and collaborate on a birth plan, we discuss postpartum care and care of a newborn and the changes that will occur in life with having a new baby. We talk about the expectations of life with a new baby and especially discuss the challenge of the postpartum period. We really work to prepare and support women during the postpartum period. 

What are some common misconceptions about midwifery and how would you address those?

CNM’s provide care to women throughout the lifespan. We can provide care to women from puberty through menopause. Some common misconceptions are that midwives only do home births and are not trained, both of which are completely false. There are different types of midwives and different midwives’ practice in different locations and settings.  

What is the best part of what you do?

I love being with women during this beautiful process and witnessing the moment when the woman has her baby on her chest. After the birth when everyone is all tucked into bed, I thank the woman for allowing me to be there because after all, I am just a witness to their strength and work. 

Where do your births take place?

I attend births at ANMC. I am very proud of ANMC’s low cesarean delivery rate. Our prenatal care model with the collaborative care of CNM’s and OBGYN’s contributes to this success. At ANMC, I primarily serve Alaska Native and American Indians and their families. 


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