Call the Midwife


By Rosa Nanasi Haas

It was noon and midwife Jessica Schwarz was caught with her head between a 42-year-old woman’s legs at the Children’s Hospital of Philadelphia one Friday in November. The patient’s water broke the night before, but when Schwarz checked her patient’s cervix and it was completely closed.

Schwarz gave her patient Pitocin, a drug that induces contractions and it started to do its job. The patient’s cervix began dilating.

The woman’s contractions grew longer, stronger and closer together. Her cervix started thinning out. The patient pushed harder and harder, until a little head started crowning.

Schwarz looked at the monitor and saw the baby’s heart rate dip. The dips continued.

The baby had to come out. Schwarz did a maneuver to help the baby deliver faster.

Schwarz delivered a shocked, eight pounds, 10-ounce baby boy at the Children’s Hospital of Pennsylvania.

Another delivery successfully completed, one of thousands Schwarz has assisted in.

Schwarz is currently the Team Lead for the midwives and nurse practitioners at CHOP who assist women during and after pregnancy. Over the course of her 11 years as a midwife, she has been present for thousands of births and has risen in her field to become a skilled midwife.

“I learn stuff here everyday,” Schwarz said of her job at CHOP. “It’s like the weirdest, strangest place to work.”

Schwarz, 37, received her degree in Midwifery from the University of Pennsylvania in 2003.

When asked why she is a midwife, Schwarz replied, “It was all the natural, earthy-birthystuff was what I really fell-in-love with.”

Newborn Baby

Schwarz began her career as a midwife in 2005 when she went to work at Lawrence OBGYN, a small private practice in Lawrenceville, New Jersey.

Schwarz explains how she hopes women feel after giving birth. “I hope they can come through feeling like they have a voice and they have decision- making capacity.”

* * *

Schwarz had recently started working at the Children’s Hospital of Pennsylvania. A mother was admitted to CHOP.

When she arrived at the hospital, she was nine centimeters dilated. The woman was nervous and jittery.

Schwarz comforted the patient.

“Take a breath. It’s going to be fine. You’re almost there. We’re going to push the baby out. We’re going to be done. We’re going to be done before you know it.”

After a beautiful healthy baby arrived the doctor that was assisting Schwarz with the birth said, “I would have gotten her pain medication.”

Schwarz responded firmly, “She didn’t need pain medication. She just needed support.”

In 2006, Schwarz started working at Midwifery Care Associates, a small, private practice in New Jersey, because she was impressed with the care the midwives had given her when she delivered her children.

Schwarz delivered babies at Midwifery Care Associates at home and in the hospital, but soon began to dislike being stuck at a patient’s home until the mother delivered, along with the unpredictable hours.

That same year, Schwarz left the Midwifery Associates to deliver babies primarily in a hospital setting.

She began at Chestnut Hill Hospital, a community hospital where she assisted with C-sections, and worked with midwives who did the OB Triage for the hospital. Schwarz worked three nights a week where she did vaginal deliveries. Her unit delivered about 100 births per month.

Schwarz appreciated the experience and knowledge she gained from relying mostly on herself. “We didn’t have anesthesia in house. We didn’t have a doctor in house, so you were the one to make the decisions.”

While at Chestnut Hill, Schwarz had many successful deliveries, but she recalls one birth that did not end up the way she hoped.

“It was a horrible experience for me. Obviously a hundred times more horrible for the family. It was a really amazing learning experience.”

When she was fairly new to practice, she delivered a baby that ended up severely brain-damaged and the case went to court, settling on-behalf of the family.

Schwarz recalls this horrible experience. “I look back now and I think there were many things that I didn’t do optimally, but also as a team that we didn’t do really well. It really taught me a lot about communication and documentation.”

This was Schwarz’s first bad outcome.

“That will be with me forever. I will never forget them. I still think of it,” Schwarz recalls.

After being at-home for a year with a new baby, Schwarz started at the Children’s Hospital of Philadelphia (CHOP), where she currently works.

“You’ll find the whole theme of my career was that I was always seeking a sense of mastery,” she explained. “I never felt like I knew as much as I should know. I still don’t feel competent.”

* * *

Schwarz is the Team Lead for the midwives and a couple of nurse practitioners at CHOP. She works with women whose babies have been pre-diagnosed with a birth defect.

Schwarz, along with a couple other midwives recently set-up a group pre-natal care program at CHOP.

“It’s a very evidence-based model. It has been shown to improve pre-natal outcomes,” Schwarz says.

The group is made up of three to six mothers. The women start the program in their first trimester and meet four times throughout their pregnancy. The women receive two-hour pre-natal visits in a group setting. These overwhelmed mothers appreciate the support they receive from people who have a common experience and tend to feel isolated from mothers whose babies are not sick.

Schwarz has gained a lot of confidence over the years, but she was not always this way.

“For many, many years, I felt like, ‘I’ll just hold a leg. I’ll just be here and hold her hand and if someone else comes in and makes the decisions I’m perfectly happy with that.’ I feel more confident now. I still don’t love that and it feels terrible if you feel like you didn’t do a great job, but it took me a long time to feel any ability to win that moment.”

Schwarz also works at Woman Wise Midwifery, a midwifery-owned private practice with two offices in East Norriton and Wyndmoor, where she sees healthy women for 20-minute long pre-natal visits. Schwarz spends two weekends a month on-call waiting for women to go into labor on their own and then meeting them at the hospital to deliver their babies.

“What I always say to patients in both my practices, every where I work is I hope the day your baby is born is a day you can look back on and say that was a good day.”

Schwarz returns the next day to discharge the women from the hospital. When she is not delivering, she works in the office two and a half days a month.

* * *

Schwarz arrived at Chestnut Hill Hospital at night. There were no doctors in house and no available anesthesia. Schwarz had just begun her career in midwifery.

When the patient arrived, she was hooked up to the monitor and her baby sounded great. Schwarz told the nurse that the mother could get off the monitor and walk around. The experienced obstetrics and gynecology (OB) nurse was nervous about taking the baby off the monitor.

“She kept the monitor on for another minute and all of a sudden the baby’s heart rate was down in the 60’s. Terribly low. Emergency. Emergency C-section.” Jesse recalls.

There was no one at the hospital to perform an emergency C-section.

Medical personnel ran in the room.

The OB nurse looked at Jesse and said, “Jesse. What are we doing?”

Jesse responded, “I don’t know.” Jesse thought, ‘You’re asking me? I don’t know what to do.'”

Schwarz thinks back to that night.

“That was the moment when you know, that’s what you take on when you become a midwife. You get all the loveliness of all the nice births, but you also take on those moments where whatever decision you make could mean the difference between life and not life. That was a reckoning for me.”

The mother left the hospital several days later with a new baby in her arms.

* * *

Schwarz founded Philly Metro Midwives, a formal Philadelphia Chapter of the national organization, in January 2013. Schwarz strongly believes that midwifery should be an option for everyone.

“Now, what I feel really passionate about on behalf of midwifery is that we need to be mainstream. Midwifery needs to be an option for all low-risk women in this country and probably a lot of moderate, and even some high-risk women. That midwifery care has value to offer and should be integrated into the healthcare system so that we’re not outsiders.”

Schwarz created the state affiliate to give another midwifery option and create connections between women after Delaware County Midwives shut down.

Schwarz explains her concern with midwifery still not being mainstream. “It’s over. We’re a profession, not a social movement, and that’s where we need to be.”

Philadelphia Metro Midwives is a group of working midwives. During their informal, monthly meetings, Schwarz and other midwives created a simplified benchmarking system to demonstrate for themselves, their employees, regulators, and the women in the community the outcomes of the care these midwives provide. Benchmarking is a way to compare one’s practices to midwifery best practices. Schwarz’s system measures time, quality, and the cost of the healthcare the Philly Metro Midwives provide.

Dana Perlman, the legislative Co-chair of the state affiliate of Philly Metro Midwives, and the Education Director for Midwifery Institute of Philadelphia University, speaks about her experience with the organization.

“In addition to the state level, which is one part of local, it is really important for us to have a really specific, local group of midwives to advocate for choices for women in childbirth. Philly Metro Midwives includes midwives who are practicing in home birth, smaller hospitals, hospital referral centers, highly specialized practices and academic practices, midwives who own their own practices and midwives employed by physicians and hospitals. It’s got a really nice, strong diversity-based membership.”

Through the work of Philadelphia Metro Midwives, Pennsylvania has the highest participation in benchmarking in the country.

* * *

It was the morning of December 4, 2014, and the patient had been admitted to be induced the night before. She was three centimeters dilated and her cervix was 50 percent thinned out.

The fetus had been diagnosed with hypoplastic left heart syndrome disorder, a rare congenital heart defect where the baby only has half of a functional heart.

The woman was receiving medicine to help her contract.

After a little while, she was administered an epidural.

Schwarz struggled to reach the baby’s head, when a doctor came in and assisted her, breaking the patient’s water.

Four hours later, the patient was completely dilated.

The patient began pushing.

Fifteen minutes later, a beautiful, healthy, baby girl, Mia was born.

As she handed the baby to her mother, Schwarz said, “You gave her the best start she could have had in life.”