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Ask the Expert: Mary Washington Healthcare

Oct 19, 2022 05:00AM ● By Emily Freehling

Midwives make a difference


Certified Nurse Midwives (CNM’s) are highly qualified and educated health professionals who aim to honor a woman’s birth wishes. According to the American College of Nurse Midwives (ACNM) and the American College of Obstetrics and Gynecology (ACOG), CNMs are qualified also to provide primary care for women throughout their lives.

The World Health Organization (WHO) advocates for early prenatal care and recognizes nurse midwives being central to primary health care and often the first and sometimes the only health professional that women see. Here at Mary Washington Health Care, we are proud to offer the same philosophy and clinical approach to prenatal, intrapartum and post-natal care. That is why Mary Washington Obstetrics and Gynecology is committed to making midwives available in its practice. Now accepting new patients, Mary Washington Obstetrics and Gynecology has four certified nurse midwives on staff who can help women navigate their pregnancies, labor, delivery and any stage of their reproductive lives, including pre-conception counseling and care.

As our October Experts, two members of the Mary Washington team of certified nurse midwives—Gustava Zimmer, who is both an Adult Nurse Practitioner and a Certified Nurse Midwife, and Mariah Battle, Certified Nurse Midwife and Board-Certified Women’s Health Nurse Practitioner—join us to talk about how midwives approach prenatal care, and how this benefits women.


Q: What is a certified nurse midwife?

Gustava Zimmer, CNM, AGNP-C: A certified nurse midwife (CNM) has completed a bachelor’s of science in nursing, followed by a master’s degree in nursing and the practice of midwifery. According to the American College of Nurse Midwives (ACNM) “the midwifery model-of-care achieves optimal health for women through the lifespan and CNM’s have expertise in primary and gynecologic care, promote optimal pregnancy, physiologic birth, postpartum care, and care of the newborn for the first 28 days of life. A CNM’s biggest focuses is to teach, support and empower women in their decisions.”

Mariah Battle, CNM, WHNP-BC: A midwife can be an important healthcare partner throughout several different developmental processes in your life, from when you first start menstruation on through menopause. We are there to hold your hand and give you the educated information you need so that you can be empowered to make healthy decisions for yourself and your family.


Q: What brought you into this work?

Mariah: I’ve worked at Mary Washington Hospital since 2017 as a labor and delivery nurse. I’ve always valued autonomy in labor and birth and have loved being an advocate for women during labor. But I found myself disappointed that I would build such great relationships with women during labor and birth but would often not get to see them again. I decided to continue  my education so that I could continue to take care of women during all aspects of their lives.

Gustava: I was brought up in a very remote area of Brazil. There was one pediatrician in the village who did everything—including home birth deliverie—as the nearest hospital was many miles away. He asked my American mother, Catherine, if she would be willing to be “his birth assistant”, and she jumped at the opportunity!  She travelled a long distance to Rio de Janeiro to take a lay midwifery course offered by the Red Cross, and after she achieved certification, she became his birth assistant, helping him in many deliveries. In that part of the country, where medical resources were scarce, the community, which was underserved, benefited from caring hearts and critical thinking minds. She was a lay midwife, but being trained by the Red Cross allowed her to be of much help to the only doctor in the village and the women in that very isolated and underserved area. Many times she would take me with her to the births and I learned through watching that birth is a natural, normal process, and although it might require intervention sometimes, pregnancy and birth are a normal, natural, physiological process for women. The power of being a woman, the beauty of conception, the gentle mystery of life and the ancient instinct of birth is what calls me to the baby’s beating heart and the woman’s pregnant belly every day!


Q: How can a midwife fit into my prenatal care plan?

Mariah: A midwife can follow you for your whole pregnancy – you don’t have to see a doctor the whole time unless you are at higher risk.

Gustava: While we can take care of women through their entire reproductive lives, our scope of practice includes normal, low-risk events. As a CNM, I am prepared to address issues such as polycystic ovarian syndrome, birth control, abnormal vaginal bleeding, Nexplannon insertions and removals, annual exams, PAP Smears, some issues in infertility, mild hypertension, normal pregnancy and normal delivery, among others. For more complex clinical presentations, I refer out to the doctor, and if for instance, the laboring woman presents with any emergencies that require a cesarean section, the care is immediately transferred to the physician, as we are together 24/7/365. Both CNM and physician are on-call together to the hospital. CNMs do not perform surgeries of any kind. That’s why it’s so beneficial to have midwives in a practice along with a team of physicians who specialize in obstetrics and gynecology. Women can enjoy the high-touch, intensely present CNM while knowing that their CNM and physician are both supported by a team of professionals who dedicate their whole lives to women’s care with a profound humanistic approach.


Q: What are some specific parts of pregnancy and labor that midwives can help with?

Mariah: During pregnancy, I think it’s important for women to understand the choices and rights they have regarding their labor. Whether it’s different labor positions, wanting Dad to assist in the delivery, not wanting Pitocin, or not wanting a cervical check—it’s very important for me to build that relationship with the patient where I can advocate for what they wanted when they weren’t in pain.

Gustava: During labor, my job is to be an advocate for the woman. I support the women who desire an unmedicated birth and I support the women who desire pain control. I also find it important to involve the partner, and maintain open communication with the new  family that is being created. I believe the partner also plays a big role, as he or she can supply a lot of love and support through the labor process.

I find that motherhood is the hardest, most challenging and meaningful work we women can do. I try to prepare women. I try to help them discover their love towards self and that little unborn baby in her womb, and I encourage women to trust their instincts as they discover themselves to be the powerful goddesses that all women are!

Mary Washington Obstetrics and Gynecology is accepting new patients at its offices at 1300 Hospital Drive, suite 300. Call 540-656-2830 to schedule an appointment, or visit

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