Midwives offer care alternative for women at all stages of life

Joanne Burris, APRN, CNM

In honor of National Midwifery Week, we asked certified nurse midwife Joanne Burris of the UK Midwife Clinic a few questions about midwifery as well as the care and services offered at the UK Midwife Clinic.

UK HealthCare is proud to work in collaboration with the midwives at the UK Midwife Clinic. The partnership began this spring as the clinic, formerly Womankind Midwives, merged with UK HealthCare to promote positive health experiences for women and provide more opportunities for research and exceptional, compassionate care.

What kind of training do midwives go through?

There are several different types of midwives, but all of the midwives at UK are certified nurse midwives. This means our midwives have attended nursing school to earn their registered nurse (RN) license as well as graduate school to earn a Master of Science in Nursing (MSN) specializing in midwifery. Additionally, CNMs must pass a national board exam after earning their master’s degree. They are then called advanced practice registered nurses, or APRNs.

What kind of services can a midwife provide?

From the American College of Nurse-Midwives (ACNM): Midwifery as practiced by certified nurse midwives (CNMs) encompasses a full range of primary health care services for women from adolescence to beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, and care during pregnancy, childbirth and the postpartum period.

How is the midwife approach to care different than that of a traditional obstetrician?

Certified nurse midwives are experts in normal pregnancy. We care for healthy, low-risk women. One of the hallmarks of midwifery is refraining from intervention in the absence of complications, so we value allowing nature to take its course when things are going well.

A physician is an expert in pathology and we are grateful for our collaborative relationships with OBs when our patients present with risk factors.

Can I deliver at a hospital if I use a midwife?

Absolutely! According to the ACNM, 94 percent of CNMs attend births in hospitals. All of UK’s midwives attend births only at UK Albert B. Chandler Hospital.

Can my midwife prescribe any medications that I may need?

With the exception of some controlled substances, midwives with the proper certification can prescribe most medications.

Who should seek midwifery care?

Midwives are experts in low-risk, healthy pregnancies. Women who have known high-risk factors would be better served by an obstetrician.

What’s a doula, and do we have them as part of our UK midwifery practice?

A doula provides continuous non-clinical support to women during their birth. They offer education, physical and emotional support, and advocacy. They should not offer medical advice, perform clinical exams or speak for the patient. We do not have doulas as a part of the UK Midwife Clinic staff, but some insurance policies will cover the cost of a doula and we encourage our patients to use them.

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Making the Rounds with Dr. Shubham Gupta

Dr. Shubham Gupta on what drew him to a career in surgical urology

Making the RoundsFor our latest Making the Rounds interview, we had a chance to talk with urologist Dr. Shubham Gupta. Dr. Gupta is one of the region’s leading reconstructive urologists and also helps genitourinary cancer patients recover from complications stemming from treatment.

Why did you decide to pursue medicine as a career?

My father is a physician, and when I was growing up, I always looked up to him. That was really the first thing that inspired me to investigate medicine as a career choice.

And over the course of my education, that choice was just solidified and consolidated into what I think has been a pretty great career thus far.

What conditions do you treat?

My practice focuses on reconstructive urology and cancer survivorship. The cancer survivorship part of it is for patients who have had cancer removed or radiated, but now they have complications from that treatment itself. Women with cervical cancer will have issues with their bladder after treatment, while men with prostate cancer will have leakage of urine after prostate removal. We are able to perform the entire breadth and spectrum of survivorship care to these patients.

The other aspect of my practice is reconstructive urology, which, to put it in very simplistic terms, is like plumbing. If your plumbing is blocked, you can remove the bad stuff and put good things back together, which is really what I do. Within urology, it’s a very small niche, and we are the only center in the entire state that provides these services.

How did you land on surgical urology as a specialty?

When I initially started med school, I thought I was going to do internal medicine, which is what my father practices. And then I rotated on internal medicine and I didn’t really like it a whole lot.

Surgical specialties, on the other hand, allow one to make a diagnosis, have a deductive reasoning and then act on it, and then maybe provide a faster way of helping the patient. During my rotations, urologists were always the most fun people to work with. They were always laid back and just loved what they did. Urology involves a little bit of medicine as well as a lot of surgery, so it’s a perfect balance.

Describe your patient-care philosophy.

The patient needs a resolution of the problem that they have, which is not just a physical manifestation of the disease, it’s everything else that goes along with it – societal aspects as well as domestic aspects.

For instance, I commonly see patients who have had prostate cancer and now have leakage of urine. You can say, ‘There’s leakage of urine, there’s the problem. How can we mitigate that?’ But the larger view is that that problem prevents that patient from going to church, from hanging out with his buddies and playing golf, and from engaging in sexual intercourse. We have to integrate all of these concerns before we decide what treatment to offer that patient.

What are your hobbies outside of medicine?

I like to read a lot – I’m a leisure reader. I like to bike; I enjoy hitting up the Legacy Trail in Lexington.

And I’m trying to pick up golf, but I am not very good at it. One of my colleagues, Dr. Ali Ziada, who is a pediatric urologist at UK HealthCare, he is as awful as I am. We go together and hit some balls and pretend that we did something fruitful with our day.

What do you enjoy most about living in Lexington?

It’s a small, fun city. It’s got things to do for young professionals, and it’s surrounded by lots of beautiful country.

And it’s got lots of bourbon, too, which is great.

Check out our video interview with Dr. Gupta, where he tells us more about the types of conditions he treats and the specialized procedures he performs.

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Annual Walk to Remember set for Oct. 1 at UK Arboretum

This Sunday, Oct. 1, UK HealthCare’s Neonatal Intensive Care Unit and Labor and Delivery Unit will host the Walk to Remember at 4 p.m. at The Arboretum at the University of Kentucky.

Each year, about 100 families gather to mourn a loss from miscarriage, stillbirth or neonatal death. The ceremony – open to all families who have suffered loss whether or not affiliated with UK – is a chance to remember and to ensure those children are never forgotten.

“This service provides a way for families to honor and remember their child and to let them know they are not alone in their grief,” said Michelle Steele, chair of the NICU/Labor and Delivery Bereavement Committee. “Many families didn’t have a funeral or service when their infant died through miscarriage or an early loss, and this is a way to help provide that closure and outlet for their grief.”

The event also reunites families with healthcare providers and staff members who provided compassionate care for their child. The walk occurs on Oct. 1 because October is National Pregnancy and Infant Loss Awareness Month.

The Walk to Remember includes a craft table for children, a tree planting that includes an engraved memorial plaque, special readings and music, a balloon release, and the walk through The Arboretum.

Families who wish to can write a message to their baby and plant the message with the tree. The tree also includes an inscription and bronze plaque provided by UK HealthCare administration that reads, “In memory of your baby’s life, gone but still cherished. Your baby will always be remembered.”

“The walk has become an important annual event, and some families now come year after year and bring their children they have had since their loss so they can also remember and honor their lost sibling,” said Sandra Mojesky, divisional charge nurse in Labor and Delivery and a longtime committee member. “It is really meant as a time for healing and remembrance, and we hope anyone in the community who has suffered an infant loss will feel welcomed to attend.”

It is not necessary to register for the walk, but those who need additional information may contact the UK Pastoral Care Office at 859-323-5301.

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knee replacement

Don’t fear knee replacement, says surgeon Dr. Stephen Duncan

Dr. Stephen Duncan

Dr. Stephen Duncan

Written by Dr. Stephen Duncan, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

From simple wear and tear to an old high school sports injury, there are many reasons why you might develop debilitating knee arthritis that affects your daily life.

Over time, this arthritis causes the cartilage – protective cushion between the bones in your knee – to wear out. Unfortunately, once the knee cartilage has worn out, there are not great regenerative treatment options to help restore it.

At this point, you might be offered a knee replacement.

Fear of replacement

Once the word “replacement” is said, some patients fear the worst. And this fear prevents many individuals from going through with the surgery.

Although it takes about a year to fully recover from knee replacement, the truth is that the surgery can help you get back to enjoying the activities you love.

One common misconception is that knee replacement is only for older patients. That’s not the case. There isn’t a minimum age for knee replacement, and younger and older patients alike can undergo the surgery.

Surgery specifics

Another misconception about knee replacement is that we remove a large portion of the thigh bone (femur) or shin bone (tibia). Actually, we only remove about 5-9 millimeters of bone, which is about the size of a pen or pencil.

It’s almost better to think of knee replacement as a “recapping” or “resurfacing” procedure. We remove the worn-out portion of the cartilage and place caps of metal on the ends of the femur and the tibia.

This provides a strong surface to then place a plastic or polyethylene spacer in between these two surfaces. The replacement is often held to your bone with cement, which helps keep it in place.

Partial replacement

Another fear about replacement surgery is that it won’t last for very long.

Although early iterations of this surgery typically lasted around 10-15 years, the current implants are designed to last twice as long – between 20-30 years.

That means instead of having to wait until a patient is older, we can offer knee replacement to younger patients to help improve their quality of life earlier in life.

For some individuals, a partial knee replacement may be an option. This entails only recapping one part of the knee. If only one part is worn out, it doesn’t make sense to replace the entire knee, and a partial replacement might be a better option. Today, we’re doing more and more partial knee replacements to help improve patients’ pain and function.


Regardless of the surgery, it does take about one year to fully recover and get back to trusting your knee to do activities such as hiking, jogging or tennis.

The good news is that you should be able to return to simple activities like shopping within four to six weeks after the procedure.

How we can help

The team at UK Orthopaedic Surgery & Sports Medicine offers a comprehensive knee replacement program, including advanced partial knee replacement techniques.

This year, the U.S. News & World Report’s Best Hospitals Rankings designated our program as High Performing in Knee Replacement. Learn more about our program and what you can expect during the knee replacement process.

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flu shot heart

A flu shot may protect your heart, says Gill Director Dr. Susan Smyth

Dr. Susan Smyth

Dr. Susan Smyth

Written by Dr. Susan Smyth, the medical director of the UK Gill Heart & Vascular Institute.

Flu season is here, which means it’s time to get your flu shot.

It’s common knowledge that the flu vaccine prevents the misery of influenza and helps protect vulnerable populations, such as the elderly, young children and the chronically ill.

But did you know that getting a flu shot might also prevent a heart attack or stroke?

The flu can be dangerous, even deadly

Influenza, or the flu, is a highly contagious respiratory viral infection easily spread from person to person when people with the flu cough, sneeze or talk. Flu can cause high – sometimes dangerous – fevers as well as chills, sore throat, cough, congestion, muscle or body aches, and headaches. Some people, commonly children, may also have vomiting and diarrhea.

And flu can be dangerous: according to the Centers for Disease Control and Prevention, as many as 49,000 flu-related deaths occur each year.

How a flu shot might help those with heart problems

While anyone can have complications from the flu, people with cardiovascular problems are at higher risk to develop them, which can lead to respiratory failure, pneumonia, heart attack and/or stroke, and can also worsen pre-existing conditions like heart failure, diabetes or lung disease, including asthma.

A study published in the prestigious medical journal JAMA found that getting a flu vaccine reduced the risk of heart attack, stroke, heart failure or other major cardiac events – including death – by about a third over the following year.

It’s possible, although not yet proven, that flu increases the risk of a clot forming in blood vessels and/or that flu virus can provoke inflammatory changes in the blood vessels that contribute to heart attacks.

Help prevent the spread of flu

The best way to prevent influenza is to get vaccinated every year. The CDC recommends that everyone 6 months and older get a flu vaccine every fall. While most people have no side effects from the vaccine, some people might develop a mild fever, muscle aches or mild arm soreness.

Although some people claim that the flu vaccine actually causes the flu, this is simply not true.

Everyday preventive actions, such as avoiding close contact with infected people, covering your mouth and nose when coughing or sneezing, and frequent handwashing are also recommended to help reduce the spread of germs that cause the flu.

It is important to remember that the more people who get vaccinated against the flu, the fewer people who are likely to have it. By lowering your own risk you are also lowering the risk for those around us – your children, your grandchildren, your coworkers and friends.

And finally, if you have a higher risk for heart attack or stroke, talk to your doctor about whether a flu vaccine is a wise choice for additional, potentially life-saving protection.

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Dr. Mark Newman

Video: Joining UK HealthCare is a homecoming for Dr. Newman

Don’t miss our video interview with Dr. Newman at the end of this blog post!

Dr. Mark Newman’s kids have grown up in North Carolina, where he has practiced medicine for nearly 20 years.

But when Newman talks about home, there’s no mistaking what he means.

“When I say let’s go home,” Newman said recently, “it has always been about going to Kentucky.”

Coming home has taken on even more importance to Newman as he recently assumed the pivotal leadership position as UK’s executive vice president for health affairs.

Newman now leads UK HealthCare, Kentucky’s largest healthcare system – a sprawling, $1.5 billion enterprise that will discharge nearly 40,000 patients this year, includes the state’s only nationally recognized cancer center and is forging partnerships throughout the Commonwealth to provide advanced, subspecialty care to those who need it most.

“I think when you see the kind of trajectory that UK HealthCare has been on, you see the opportunity to continue to drive a difference, to be able to reach out and be the university and the healthcare for Kentucky,” Newman said. “You see the opportunity to make that difference. What we’ve done has really put us on a firm foundation to continue to build and reach out to improve the healthcare of Kentucky.”

To that bold vision and direction, Newman brings a distinctive blend of skills, service and background.

He grew up on a family farm near Owensboro, Ky., was educated in Kentucky schools and universities and then served in the Air Force, where he says he received “leadership training in an environment where there’s an expectation that you’re going to learn and make mistakes.”

That environment included deployments in Operations Just Cause, Desert Shield and Desert Storm.

Since 1992, he has served at Duke University, most recently as president of the Private Diagnostic Clinic, one of nation’s leading physician practice plans. A former department chair and professor of medicine, Newman has published and practiced extensively as a cardiothoracic anesthesiologist.

It’s a career that has taken him to considerable professional heights and around the globe, serving his country during times of strife and need.

Now, he has been called to serve again – this time at the place he has always called home.

“This seems like kind of a dream come true for me,” Newman said. “At each step, you see the opportunities to reach out and help people. To make a difference. I’m excited to work to create an even greater vision and an even greater tomorrow, not only as part of this university, but for the entire state of Kentucky.”

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Move it now or lose it later, says new research

When it comes to mobility, if you don’t use it, you stand a good chance of losing it.

That’s according to new research that analyzed a decade’s worth of data from more than 130,000 people between the ages of 50 and 71. The findings were reported last month in The Journals of Gerontology.

The data showed a relationship between TV watching and disability. Between 1995 and 2006, those who reported watching more than five hours of TV daily and got three or fewer hours of physical activity weekly were three times more likely to be unable to walk or have trouble walking by study’s end.

In other words, if you sit around now, you might not be able to walk later.

“Physical activity” in the study included light-intensity exercise such as housework and shopping, as well as moderate-to-vigorous–intensity movements including brisk walking, yard work and jogging.

Although computers, mobile phones and the ability to stream movies and TV shows have increased the amount of time people spend sitting, it’s possible and beneficial to build exercise into everyday activities. Here are some tips:

  • If you’re using the computer, get up and move around at least once an hour.
  • Try using a standing desk.
  • If you’re watching TV, stand up and move around during the commercials.
  • Take the stairs instead of the elevator.
  • Park farther from the store or the workplace.

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How to safely manage chronic pain with and without opioids

Dr. Kristy Deep

Dr. Kristy Deep

Written by Dr. Kristy Deep, associate professor of internal medicine in the UK College of Medicine and co-chair of the UK HealthCare Opioid Stewardship Committee.

Treating pain is important, and for many people, the reliance on opioids or narcotics may not be the best answer.

The amount of opioids prescribed in the U.S. has quadrupled since 1999 despite the fact that the overall amount of pain reported hasn’t changed. There are also risks from opioid pain medicines, including side effects and the risk of overdose. According to some studies, as many as 1 in 4 people receiving prescription opioids long-term in a primary care setting struggle with addiction.

Chronic pain

Chronic pain, or pain that lasts longer than six months, is different than acute pain like the pain that comes from an injury. In chronic pain, there are changes in the way the brain “listens” to signals from the body. The goal in treating chronic pain is to help the brain interpret those signals in a different way so that the pain is less severe and does not impact a person’s quality of life.

New evidence and serious risks

New evidence shows opioid pain medications may not be the best answer for chronic pain. The risks of harmful side effects or addiction must be taken into consideration before prescribing or taking opioid pain medications.

In some cases of moderate to severe acute pain, such as after surgery or in the treatment of cancer pain, prescription opioids are important treatment options. However, it is important to remember the serious risks, especially if you have other medical conditions or are taking medications that can interfere with opioids. You should also work with your health care provider to make sure you are getting the safest, most effective care.

Controlling your pain

People often believe that they won’t be able to control pain without opioids, but non-narcotic medicines are often found to be better for providing pain relief. In short, if you suffer from chronic pain, many medications and non-medication treatments should be considered as an alternative to opioids.

The most important action you can take is to talk to your healthcare provider about ways to manage your pain that doesn’t involve prescription opioids – or keeps your dose as low as possible. Some of these options may actually work better and have fewer risks and side effects.

Options may include:

  • Pain relievers such as acetaminophen, ibuprofen and naproxen.
  • Some medications that are also used for depression or seizures.
  • Physical therapy and exercise.
  • Cognitive behavioral therapy – a psychological approach in which patients learn how to modify physical, behavioral and emotional triggers of pain and stress.

Important things to remember

However, if you are prescribed opioids and your doctor believes it is the best regimen for your pain, keep in mind some important tips:

  • Never take opioids in greater amounts or more often than prescribed.
  • Talk about ways to help manage chronic pain without prescription opioids.
  • Talk about any concerns and side effects like sleepiness or constipation.
  • Help prevent misuse and abuse by never selling or sharing prescription opioids.
  • Never use another person’s prescription opioids.
  • Store prescription opioids in a secure place and out of reach of others.

Next steps:

  • Check out our post on the positive effects of using physical therapy to treat chronic pain.
  • Read about our own Dr. Rae Brown, an anesthesiologist at UK HealthCare whose work has helped tackle the opioid crisis.
Making the Rounds with Dr. Ryan Muchow

Dr. Ryan Muchow on the ‘amazing’ field of pediatric orthopaedics

Making the RoundsWe caught up with pediatric orthopaedic surgeon Dr. Ryan Muchow for our latest Making the Rounds conversation. Dr. Muchow works at Kentucky Children’s Hospital and Shriners Hospitals for Children Medical Center – Lexington, where he specializes in hip surgery and hip preservation treatments. 

What conditions do you treat?

We treat the entirety of pediatric orthopaedics, from birth to the young adult years. We take care of all kinds of musculoskeletal injury and conditions.

We see kids at both the Shriners Hospital as well as the Kentucky Children’s Hospital. Most of the kiddos that we work with at KCH are kids that come in in an urgent or emergent basis with an acute injury. We’re able to take care of them at a time of great need as they’ve broken bones or have been involved in a serious accident.

Most of those kids at Shriners were either born with a condition or have developed a condition. They’ve been living with it for some time, and it’s not necessarily an acute or urgent setting. But we get to meet them and help them through their journey with whatever condition they have.

What makes pediatric orthopaedics so enjoyable?

It’s this amazing field where we have the opportunity to restore activity to kids. One of the top motivations for a child is to be able to play, to be able to run around and do things carefree. And we have the ability and opportunity to come in at a special time of their life and provide that service or need to get them to a point where they can do that activity.

Why did you decide to pursue medicine as a career?

Medicine in some ways chose me. I was thinking about other interests in high school, and someone recommended to me that I look at medicine. I got involved in a program that led me into medical school. After that, it was kind of affirmation after affirmation of, “Hey, being with people is awesome, getting to do the sciences is awesome.” And so it all kind of came together in medicine.

Describe your ideal weekend.

I’d come home Friday night after work and make pizza with my wife and kids. We’d put the kids to bed and then watch a movie.

Saturday morning, I’d get up and go for a run with the family, pushing the kids and running with my wife. We’d go get donuts, and then we love to do things outside – hiking, running around and doing crazy kid stuff.

What’s your favorite food?

If I can have two favorite foods, I’d say I like pizza a lot and I also like steak a lot. Those are two completely different foods, but those are where I’d go.

Steak if I could have a nice meal out and pizza if I could do something every day of the week.

Check out our video interview with Dr. Muchow, where he tells us more about the comprehensive orthopaedic care provided by Shriners and KCH.

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You should know about the dangers of childhood concussions.

Know the signs of childhood concussions

Does a child in your family play sports? If so, there are things you should know about the risks and dangers of childhood concussions.

Concussions are serious, traumatic brain injuries that get worse each time they happen. A second concussion can even be fatal to anyone not yet recovered from the first, a condition called second impact syndrome (SIS).

Be able to recognize concussion symptoms

It’s important to know the warning signs when you may be dealing with something as serious as brain trauma. A few concussion symptoms include:

  • Headache, vomiting or nausea.
  • Trouble thinking normally.
  • Memory problems.
  • Fatigue and trouble walking.
  • Dizziness and vision problems.
  • Changes in sleep patterns.

These symptoms can occur right away, but may not start for weeks or even months. If your child has any of these symptoms, see a doctor immediately.

Don’t forget a helmet

Helmets are a required standard in team sports like football, but even backyard activities like riding a bicycle and skating call for protection.

Keep coaches in the know

If your child is playing team sports and has or may have had a concussion, be sure the coaches know. Continuing to play is not worth the risk of a second concussion, so when in doubt, sit them out.

Know your head injury ABCs

The Centers for Disease Control and Prevention recommends you know your ABCs. That means you will Assess the situation, Be alert for the signs and symptoms, and Contact a healthcare provider when there is a head injury.

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