Heather Ramsey: Certified Nurse Midwife

Her Magazine
By Maureen O’Halloran Clark
April/May 2007

Heather Ramsey has delivered over 1000 babies while working as a certified nurse midwife (CNM) for the past ten years. She and four other CNMs work with collaborating obstetricians at the OB/Gyn Clinic at the Nebraska Medical Center. She delivers her clients’ babies at the hospital there.

Myia Swoboda has been a client of Ramsey’s almost from the beginning. She scheduled her annual gynecological exams with her for two years before she became pregnant and then continued to see her during her three pregnancies. Ramsey then delivered her three sons, ages six years, three years and two months.

Near the completion of her first son’s delivery, Myia’s blood pressure went up and the baby’s heart rate went down. Unbeknownst to Myia, Ramsey had the nurse place a call. Almost immediately, a Neonatal Intensive Care Unit team assembled in the back of the room, ready to help if necessary. Ramsey told Myia, “You need to push the baby harder than you think possible. This baby needs to come out now.” She did, and the baby was born. It turned out he was fine. The extra help was not needed but had been available just in case.

Megan Beard, R.N. is another repeat client. Ramsey also delivered her three children ages five years, three years and six months. She sees her for annual gynecological exams as well. She says of the midwifery care, “I like the care they provide overall.” She added, “Heather is there for you emotionally and takes care of what you need medically.”

In Nebraska, CNMs can attend cases of “normal childbirth” within a licensed health care facility; they can not participate in home births. They also work with collaborating physicians. Ramsey explained, “We have a relationship with a physician so that if we run into complications there is a physician who can help us out with caesarean deliveries or with vacuum or forcep deliveries in the event that would be needed.” This relationship is also important if problems arise at other times during the pregnancy or afterwards. “There are particular things that the midwives at the Nebraska Medical Center have worked out with our physicians that we feel are outside of our scope of practice.” Some of those situations include the mother developing diabetes, severe high blood pressure, or having multiple births. In these situations or others, the midwives consult or refer to one of their collaborating physicians.

The midwives at the clinic take turns being on call for 24-hour periods. Whoever is on call when a mother goes into labor stays with her throughout her labor and delivery. The group also tries to schedule a patient to see each of the five midwives at some time for her prenatal exams. During the exams they routinely check for diabetes and for high blood pressure. They also educate their clients about prenatal tests that are available and the purpose of the tests. The client can then choose whether they want the tests done. However, if there are indications which warrant a specific test, she will be referred for it. For example, a woman who has vaginal bleeding or whose abdomen is not growing normally would be referred for an ultrasound.

A CNM must be a registered nurse which usually requires four years of training. Then she must complete two more years, earning a Master of Science in Nursing with a specialty in nurse-midwifery. In addition, she must pass national boards given by the American College of Nurse-Midwives.

Stacey Damme, R.N. has worked side by side with the Nebraska Medical Center midwives as a labor and delivery nurse for three and half years. Her patients have included mothers who used the midwives and those who did not. When she became pregnant, she decided to use the midwives. Damme had been scheduled to work the morning of February 3rd, but called to say she would be coming in as a patient instead. That morning, Ramsey helped her give birth to her first child, a little girl.

Damme appreciates the midwives’ emphasis on comfort measures and their cooperation with a mother’s individual preferences. She liked the freedom to move around or to go into the whirlpool tub. She also mentioned that her insurance covers nurse-midwifery care, but her husband’s insurance with another company does not cover it.

Ramsey says that sometimes labor goes fairly fast. Other times it can take 24 hours or more. She is no stranger to going for the long haul though. Last year she finished two half-ironman triathlons, which each included swimming 1.2 miles, biking 56 miles, and running 13 miles. On top of that, she has given birth to five children of her own. If anyone has the stamina and empathy to attend a labor and delivery, Heather does!

Article text © copyright 2007 Maureen O'Halloran Clark. All rights reserved.