Vika: Health Care Interview

I was unable to successfully contract several people of the health care list provided, but I did interview my midwife at Memorial Hospital today. Her name is Julie Bosak and she is a lovely person.

  1. Nurse mid-wives generally

Nurse-Midwifery in New Hampshire, Certified Nurse-Midwives are property called Advanced Practice Registered Nurses in NH. APRNs have been practicing in New Hampshire since 1972. The first nurse-midwifery practice in the state was established in Dover.

They can legally practice in a variety of locations including hospitals, private physician practices, private CNM practices, HMOs, home birth practices, and community health centers.

Education: There are currently 43 accredited education programs in the United States offering post-baccalaureate certificate and masters degree programs in nurse-midwifery and midwifery. A number of these programs have distance learning education options. But there is no program in NH, although there is one in Massachusetts. For more information, see http://www.midwife.org/map.cfm.

Practice and Reimbursement Issues: CNMs in New Hampshire practice under the Nurse Practice Act as advanced registered nurse practitioners and are regulated by the Board of Nursing.  Since 1985, New Hampshire CNMs have had prescription writing privileges.

  1. Personal history?

She has been a midwife for 14 years. She moved to NH 2005. She likes NH; likes the outdoor; NH good strong laws regarding CNMs allowing for a lot of flexibility with practice. At the Hospital we works as part of the team, she can really focus on her work, the Hospital takes care of all the management; overhead; ect. Memorial is very midwifery oriented.

Education: Georgetown University, Washington, DC; New York University, New York, NY; Lehigh University, Bethlehem, PA

Board Certified: American College of Nurse Midwives

  1. Could you describe your position Memorial? What is your daily      workload/schedule/routine as an nurse mid-wife?

Midwives work office days at the Hospital and the White Mnt. Community Center and deliver babies at the Hospital. The office days include: ob exams; birth control; post-partum checks. They spend about 30% on call, averaging 2-3 days per week on call. At this Hospital, the average monthly birth rate is 18-20 births. Memorial can handle a lot of complications here; but it does work very closely with Maine Medical in Portland and sometimes it must transfer mothers there pre-birth or the babies post birth.

  1. What have been the positive and negative effects of the      Affordable Care Act on the New Hampshire health care industry in general,      have you seen any direct effects in your practice?

In her experience is has been positive. Now birth control is 100% covered now. March 1- a lot of insurance kicked in, so she has seen many patients who are coming for the first time in years because they now have insurance.

  1. Medicaid expansion: if the bill to expand Medicaid in NH      passes, how is that likely affect the state generally; the budget;      coverage for low-income adults?

Prenatally a large portion of people have in State based insurance, so an expansion of Medicate would be good for the people. It would cover more people in need. In her experience, many medial issues develop because people cannot afford preventative or maintenance care.  

  1. Do you have any general leadership advice/ effective      leadership, etc?

Good leaders: good communication; leading by example; give people opportunity to build their on strengths.

Midwives are not nurses’ bosses and but they delegate to them, so they serve in a leadership capacity. As such leaders, the midwives try to tone of the office by leading by example.

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