Why would you want to see a midwife at menopause? Because they offer a uniquely personal and holistic perspective on the journey. Though historically their role has been to help women through childbirth, many modern midwives now focus on helping women to feel better and be healthier at the other end of the reproductive cycle.
It’s an intriguing concept, so I spoke with Angela Deneris, PhD, a certified nurse midwife and associate professor in the Nurse-Midwifery and Women’s Health Nurse Practitioner Programs at the University of Utah. According to Dr. Deneris, who has been in practice for nearly 30 years and whose clients range in age from teens to a woman in her 80s, Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are fully qualified to partner a woman through perimenopause, menopause and the postmenopausal years—and some actually specialize in caring for older women. All midwives are trained to provide the full spectrum of routine gynecological care—including pap smears and pelvic examinations and referrals for screening and diagnostic tests, such as mammograms and sonograms, as well as routine primary care, including annual physicals and screening for conditions such as diabetes, heart disease and declining bone health.
Midwives are trained in "whole woman care," emphasizing natural treatments and lifestyle adjustments over pharmaceutical drugs. For instance, said Dr. Deneris, for a woman complaining about hot flashes, a midwife will start by trying to ascertain whether specific situations trigger them and will also discuss dietary and lifestyle measures that might help reduce their severity or frequency. A midwife will coach patients in how to take more responsibility for the aspects of her health that she can control by eating right, exercising and keeping track of medical history and records. And for those women who really need something more, midwives are qualified to prescribe medication and hormone replacement therapy if appropriate.
Education for midwives varies from state to state, with some requiring a bachelor of science and others requiring a degree in nursing prior to midwifery training. Accreditation requirements (for both Certified Midwives and Certified Nurse-Midwives) are standardized by The American College of Nurse Midwives (ACNM). An accredited midwife is able to do just about all aspects of routine care (and childbirth, of course) up to but not including surgery.
For older women in particular, midwives work closely with doctors when trying to determine whether symptoms and discomfort a patient is experiencing are caused by aging or disease—especially if serious illness, such as cancer, is suspected. In that case, the doctor will take over the patient’s care, but the midwife often remains very involved.
For instance, Dr. Deneris told me she continues to provide gynecological and other care for her patients who have had breast cancer, including screening for heart disease, diabetes and depression as well as counseling for diet and exercise. "Staying involved while a woman is receiving care for a serious, chronic health issue enables us to continue to treat our patients as whole, complete women," she said.
As part of their holistic perspective, Dr. Deneris said women can also expect that a midwife will devote much more time to each patient. She told me she spends about an hour with women over 40 for their annual visits. "We discuss lifestyle, diet, exercise routines, and the particular stressors in their lives, and then put the pieces together," she said. "Rather than immediately prescribing something for mood swings or insomnia, we’ll look beyond such symptoms to examine the broader picture." Dr. Deneris said she routinely discusses sexuality with her patients…asks about quality of life…screens for depression…and makes it a point to explore whether there are possible issues around abuse or addiction. It’s all intended to provide context for understanding what is happening with a woman’s health.
Most insurers cover midwife services. To locate a qualified midwife, Dr. Deneris suggested visiting www.midwife.org, the Web site for the American College of Nurse Midwives, which offers a search option for locating a midwife by entering a Zip code or town.