The most rewarding aspects for me are empowering women throughout their pregnancies and beyond, supporting them through their delivery in a way that makes them feel honored, respected, and listened to, without compromising their health or the babies’ health. That moment when a baby delivers into your hands, and your hands are the first one that they touch, it is a privilege and a very special gift to be able to be in that position. Midwife means “with women,” and that is exactly what we do.
About Sonya Jubb, MSN, CNM: Sonya Jubb is a Certified Nurse Midwife at John Muir Medical Center, where she provides full-scope midwifery care and primary care services to women across the lifespan. Prior to her role at John Muir Medical Center, Ms. Jubb worked as a CNM at El Rio Community Center and La Clinica De La Raza, where she served women in underserved and vulnerable communities.
Ms. Jubb earned her Bachelor of Arts and Science in Sociology in 2003 through Long Island University’s Friends World Program, a program that involved three years of international travel and working at 7 health and social welfare centers in Central America and Europe. She also volunteered at a maternity clinic in West Africa, which motivated her to complete her MSN with a specialization in Certified Nurse Midwife in 2008 from the University of California, San Francisco (UCSF).
[OnlineFNPPrograms.com] May we please have a brief description of your educational and professional background?
[Sonya Jubb, MSN, CNM] I was born and raised in Oakland and Berkeley, CA. I grew up surrounded by a diverse community of people, and Spanish was one of my first languages since my family lived in Cuba when I was a toddler. For my undergraduate degree in Sociology, I chose an alternative program called The Friends World Program through Long Island University. This program emphasized learning through social change and required its students to study abroad for three out of their four years. After my freshman year, each year I studied in one of their 7 centers around the world and did internships working in the area of health or social welfare. I studied in Costa Rica, and traveled throughout Central America, and I studied in London, England and traveled throughout Europe.
Summer before my senior year I worked in a maternity clinic just outside of Accra, Ghana, West Africa. The two months I spent volunteering in this maternity center opened my eyes and my heart to the important, critical work that nurse midwives provide worldwide. I had always been interested in health, and felt connected to midwives (I was delivered by a nurse midwife), but I wasn’t sure which pathway to becoming a midwife would be the right choice for me. This work in Ghana made it clear that becoming a nurse midwife would be my vocation, and getting my RN license first was critical, so that I would have an important medical background to be able to provide the best possible care to my patients.
After I graduated, I immediately started to take my prerequisites for the MEPN program at UCSF and within two years I was ready to go! I started the program in the summer of 2005, as a single mother of an 18 month old. The program was challenging and rigorous, but I knew I was in the right place and was set on completing my goals. Having been surrounded my whole life by diversity, and working abroad, I felt a sense of commitment to providing high quality maternity care to women and families from underserved backgrounds, but also dispelling myths and stereotypes by bringing midwifery care to communities of women that may not know the type of high quality care they an receive from nurse midwives throughout their childbearing years and beyond. This is the reason I have worked in various types of settings including community health centers, and now in private practice.
My work with La Clinica de La Raza was my first job out of school. As a community health center and federally qualified health center (FQHC), La Clinica de La Raza serves mostly families from underserved communities and women and children from low socio economic backgrounds. My Clinic served many Spanish-speaking families and as a fluent Spanish speaker, I knew this was such an important community to work with, as many things in health care can get lost in translation when there are language barriers. I was able to provide antepartum, postpartum, family planning services and well women exams to women in their primary language. I continued this type of work after moving to Tucson to work for another FQHC, El Rio Community Health Center. In this job I worked as a full scope CNM and was a National Health Service Loan Repayment recipient for committing to work as a provider in an underserved community for 2 years. I ended up staying beyond two years!
After the birth of my third daughter (skipped some steps in between), my husband and I felt it was important to move back to the Bay Area to be closer to our families. I took a position in a private practice working as a full scope CNM with an OB/GYN. This was a very different population of women and was a hard transition to switch to private practice, as I wasn’t sure if my role within the practice was important or impactful in the lives of these women. I quickly adjusted and realized that I was having an impact on this group of women, because I was providing them with high quality prenatal, intrapartum and postpartum care, and dispelling their stereotypes about midwives, by educating them on what we can do medically and also through supporting their birth choices without compromising their care. I was a trailblazer. I was the first midwife to have privileges at John Muir, and many women began to seek out our practice because it had a midwife. Women were having such an incredible experience with the care I provided, and a great birthing experience, that they went back out into the community and the word spread! In the 3.5 years that I have now been in private practice three other private practices have added midwives and our practice now has two!
[OnlineFNPPrograms.com] Could you please give an overview of the daily and long-term responsibilities you hold as a Certified Nurse Midwife at John Muir Medical Center? What types of low-intervention care, education, and support do you provide women before, during, and after pregnancy? What types of medical services are included in full-scope midwifery care?
[Sonya Jubb, MSN, CNM] I am a full scope nurse midwife in a private practice; I work with an OB/GYN as my back up, a consulting physician, two NPs and one other CNM. We see our patients in the office, and when our pregnant patients have any complications or go into labor, we (the two CNMs or the MD) take turns being on call and cover 24/7 care for our patients that are inpatient at John Muir. Full scope midwifery means you take care of patients during the antepartum, intrapartum and postpartum period, as well as throughout their childbearing years. We see women for their well woman exams, family planning, and gynecologic issues, through menopause and beyond. I also do first assisting during cesarean sections, which is a skill that many CNMs throughout the country are doing more of. I think more settings are realizing how important it is to have CNMs be able to provide that continuity with their patients beyond the normal vaginal delivery, but also assist with cesarean sections. I have found that my patients are greatly appreciative and impressed that I am able to be there beyond just a supportive role, but actually assisting.
When you are a part of a private practice, or small practice setting, you have the opportunity to really establish a strong, trusting relationship with your patients and that continuity of care is incredibly fulfilling. It is such a wonderful feeling to have families where you have delivered all of their babies! Then you get to see them yearly when you do your patients annual exam and birth control maintenance visit. In larger settings that I have worked in we have used the group model of prenatal care called “Centering Pregnancy,” in private practice that model is more difficult. We do a lot of teaching and education throughout the pregnancy in the visits, and make ourselves available to our patients 24/7 if any issues or concerns come up.
[OnlineFNPPrograms.com] You were also a CNM at El Rio Community Center and La Clinica De La Raza. Could you elaborate on your daily and long-term responsibilities in these roles, and how they differed from your current work at John Muir? How did your patient population, the team on which you worked, and your main tasks differ across the three settings?
[Sonya Jubb, MSN, CNM] At La Clinica I did not do full scope midwifery. I only saw patients in the clinic outpatient setting. The patients we saw in the clinic would all deliver at Sutter Solano, which did not have any CNMs that had privileges there, and unfortunately, it wasn’t the right time politically to try and move towards getting CNMs credentialed. You have to have a lot of multidisciplinary support from administration, MDs, nurses and people in higher positions at the hospital. This was a disservice to its patients because we would see them throughout their pregnancy, and then they would likely be delivered by an on call MD that they had never met. This was my main motivation for leaving and in the end took the job in Tucson, AZ at El Rio Community Health Center so I could continue my work with a similar population but also gain more delivery experience and practice full scope midwifery.
It was at El Rio that I received the National Health Service Corps (NHSC) Loan Repayment program because they were an accredited health center by the NHSC. My on call shifts would be at Tucson Medical Center which is where my patients from El Rio would deliver their babies when it was time. We were a group of 8 midwives that rotated call and clinic, and our back up physicians were the in house perinatologists at Tucson Medical Center. We would consult with them or transfer care to them if a woman’s pregnancy became too high risk for us to manage. In this setting though, unlike my current practice setting, the CNMs did not first assist with cesarean sections because the perinatology group we worked with had residents and medical students that would assist them in the C/S’s to gain experience.
My work at El Rio and La Clinica was very similar in that both are FQHCs and the patient population was comprised of underserved women, from low socio economic backgrounds that had Medi-Cal type health coverage. Very different from the privately insured, less diverse, more upper and middle class families I work with currently in private practice. At El Rio many of the women were undocumented, monolingual Spanish speaking women that had no health insurance when they weren’t pregnant, but had what Arizona calls emergency insurance to cover the pregnancy. Because of this, we really provided more than just prenatal, intrapartum and postpartum care to these women; we did a lot of primary care for them too. We would try to connect them to social workers, dentists, psychologists and primary care doctors during the pregnancy so they could have the tools and be already dialed in to other services in the community, in order to ensure their health and well being long beyond their deliveries. Whereas with my current population, they all have insurance and most of them have never known or had to experience being uninsured.
[OnlineFNPPrograms.com] Why did you decide to become a certified nurse midwife, and what academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Sonya Jubb, MSN, CNM] My experience volunteering in the maternity clinic outside Accra, Ghana was really what solidified my desires to become a nurse midwife. When I was a kid I used to say I wanted to be a pediatrician, then as I got older and went off to college I thought I wanted to be a social worker, specializing in areas around maternal-child welfare. I did many internships in the field here and abroad, and got really saddened by the social welfare system in this country and the systems abroad. I didn’t feel I could make a big enough difference in people’s lives because I potentially hadn’t faced the same hardships they had, and the system itself was flawed.
That’s when I started to seek out experiences in the area of childbirth. I became a doula and did the volunteer work in Ghana, when I saw my first live birth I almost fainted but it was so amazing I couldn’t take my eyes away! The incredibly high quality, loving, holistic and important work this midwife did in this small town, that hundreds of women came to from many miles away, was humbling and eye opening for me. This clinic did so much to provide maternity care, vaccinations, nutritional care for the babies they delivered, with so little resources, yet women and their family’s lives were changed for the good. After this experience and continuing to attend deliveries as a support person, I read many books written by famous midwives and childbirth educators, and I knew I wanted to be a nurse midwife. I realized becoming a nurse first would give me an important foundation and medical background, as well as open doors for me to practice in a variety of settings.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in nurse midwifery? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Sonya Jubb, MSN, CNM] The most rewarding aspects for me are empowering women throughout their pregnancies and beyond, supporting them through their delivery in a way that makes them feel honored, respected, and listened to, without compromising their health or the babies’ health. That moment when a baby delivers into your hands, and your hands are the first one that they touch, it is a privilege and a very special gift to be able to be in that position. Midwife means “with women,” and that is exactly what we do.
I think as a nurse midwife we will continue to have to educate the public and other practitioners about our scope of practice, what we do and how important our role is. In many settings in which you work you will likely encounter medical staff that have never worked with CNMs. My advice is to be clear with them on what your scope of practice is, be confident in a humble way, be clear when you consult with doctors and other providers, and be direct and clear with your nursing staff, and respectful and honoring that we are all part of the team, while continuing to be an advocate for your patients. We will continue to have to dispel myths and stereotypes throughout our entire careers and hopefully catch up with our European and Canadian counterparts where midwifery is more the standard model of care. In parts of Europe CNMs deliver >90% of normal vaginal deliveries; compared to here in the United States the number is around <9% of deliveries are attended by CNMs. Midwives both in this country and abroad provide a very important service to women who live in urban areas, but also in rural settings where women are far from large hospitals. If we could help support both midwives here and internationally that work in rural areas, we could give them more comprehensive medical training, tools, instruments and medications that could help to improve maternal child outcomes in rural settings. Many women’s lives could also be saved.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming certified nurse midwives, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Sonya Jubb, MSN, CNM] I think having some experience in the large field of maternal child health, or labor and delivery is helpful as an incoming MSN student specializing in midwifery. I think that experience can be in the form of having been a doula, a childbirth educator, a lactation consultant, or having worked as a registered nurse in a labor and delivery unit, or postpartum unit. I also think reading about the history of midwifery in this country and internationally is an important part of understanding the modern role of midwives today. It is also an important lesson in the history of midwifery because many professors you have throughout your educational experience to become a midwife, will have been of the generation of midwives that fought really hard to get CNMs the recognition they have now. And there is still a lot more work to do to continue to get that recognition and see our practice grow!
[OnlineFNPPrograms.com] How do you see the CNM role evolving over the next few years? How does the role of nurse midwife overlap with other advanced practice nursing professions, such as women’s health nurse practitioners, family nurse practitioners, and clinical nurse specialists?
[Sonya Jubb, MSN, CNM] In larger settings like community health centers, and in the Kaiser type models, CNMs are a very integral part of the healthcare team in the management of low to moderate risk pregnancies. As the health of women across the country shifts and changes, OB/GYNs and perinatologists are taking care of women who have many health problems and high risk pregnancies, midwives play an important role in caring for low to moderate risk women. My hope is that over time all hospitals with have CNMs attending deliveries so patients have that as a valid and realistic option for their labor and delivery experience. Midwives are a cost effective way to provide women with high quality, well-rounded and important care throughout pregnancy, and the childbearing years. There are many women’s health nurse practitioners (WHNPs) and family nurse practitioners (FNPs) that also see pregnant women for prenatal care, and postpartum care after delivery, depending on the settings they work in. In these ways these specialties overlap and have some commonality. Many CNMs are dual board certified as CNMs and WHNPs, and some when they arrive at the end of their careers and do not do labor and delivery anymore, often take on a more of a WHNP, FNP type role.
Thank you Ms. Jubb for participating in our APRN career guide interview series!