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Photo By: Rachel Lau
Joan Thompson, CNM, (center),
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Tucked in its fairly new location by the back parking lot of Molokai General Hospital, the Women's Health Center continues to thrive after 25 years of service to the Molokai community.
Practicing a midwifery model of women's healthcare, the WHC, in its new location since July 2007, is one of the last standing of its kind in the nation.
"What makes it unique is that … we truly do see women early in their life through the childbearing years, through family planning, through pregnancy, through delivery and then through their post childbearing and menopausal years. So we see their whole lifespan," said Joan Thompson, the Certified Nurse Midwife at the WHC.
"It's a real family-centered model. It's also a very eclectic model that we bring in. It's integrated medicine … not just treatment. It involves psychological, spiritual, family and all aspects of health care," she added.
The medical model of healthcare is more treatment-focused and involves obstetrician-gynecologists (OBGYNs), as well as anesthesiologists and surgical units. Although the center delivers roughly 30 babies per year, most women on Molokai will travel off island to have their babies.
Desiree Puhi, Director of Outpatient Services, which the WHC operates under, said that the reason Molokai doesn't have an OBGYN is because the population on the island is too low to sustain the doctor's practice.
However, many expecting mothers still want their babies born on Molokai, and some prefer the more natural midwifery model of care offered to them.
Child birth at WHC
Levie - and Miyako - Yamazaki Gray, who just had their second daughter Tamara Kai at the WHC, said they wanted to have their children on the island because neither of them are from Molokai; having a child born here would make them feel more connected to the island and more a part of the community. They were also interested in working with a midwife throughout the pregnancy.
Levie, father of the newborn, said the transition from family planning to the pregnancy and birth was extremely smooth because Thompson worked with them throughout the entire process.
"Every step of the way, she really was very positive and optimistic. She just exudes that," he said. "Watching her work through the delivery, she seemed to have an approach of trusting the body and trusting the process and doing as little as possible. I think that made everything a lot easier and really made the [experience and delivery] easier.
An OBGYN visits the center twice a month for anyone who needs more specialized care or complex medical procedures. Together, they do a thorough job of screening pregnant women to determine if they make a good candidate for a Molokai delivery. Women have to be at low risk in order to have their babies on island. For those who choose to give birth here, Thompson says they have a wide availability of emergency options through the hospital if ever needed, including registered nurses, physicians, medical equipment and even quick access to medical evacuation.
Thompson said the midwifery model of care is dying nationwide mainly because of economic and financial reasons. "The kind of care that I give does take time, and thank goodness they give me the time to take time with patients … Others places I've worked, they want me to see people for five minutes. You can't really do much with five minutes, but that's what they needed me to do in order to make ends meet financially," she said.
Miyako, who had her first child off island, said that she felt her recent experience at the WHC was excellent, and that the staff at the center treated her more like family and less like a patient. "I felt really comfortable and safe and loved. People loved me and took care of me, and that is really important for pregnant mothers."
Gray also said she appreciated the family environment surrounding her daughter's birth, having had her family spend the night with her just as if she were at home.
Other services
The WHC specializes not only in prenatal support, but are qualified in all aspects of women's health. This includes pap smears, cervical examinations and counseling on topics ranging from menopausal and contraceptive options to abstinence and natural family planning.
Strategically located out of the public's eye, women of all ages can now visit the center with a bit more privacy. Thompson said many women come in just to talk and get counseling. "Some of the women in the community - the moms - have actually brought their young teen girls in - pre-puberty or early adolescence - just to meet me and to get comfortable with the place so that they can come here if they have any questions or problems," she said.
She hopes in the future, they will have a "teens-only" afternoon for young girls who have questions or concerns to feel safe and have their privacy.
The staff also performs a number of education awareness and outreach programs, not just to people that walk in, but to the community as well. In the next year, they want to start reaching out and conducting workshops, especially with the high school and church communities.
"My role here is to make sure that women are informed … I just want to make sure that women are educated and knowledgeable and can make informed decisions," she added.
The center accepts anyone, even walk-ins, and although Thompson said they prefer appointments, they try to accommodate anyone that needs help.
"Women don't know how special this place is because of how long it's run," said Puhi. She said the WHC has been able to continue serving the community because of state and federal grants. However, she says that these funds are not always guaranteed or permanent. She is currently working on a few grants to continue supporting the center, including a grant in continued support of family planning counseling. She said Hawaii is the 49th lowest state in granted funding for family planning.
Thompson is currently the only CNM running the center; however, the process for hiring another midwife to meet their usual two is underway.
"I really strongly believe in women and I really like to empower women. My whole purpose right from the very beginning was to be involved in the empowerment and the education of women so that they can become more empowered at all ages," Thompson said.
"I hope that across the nation, other healthcare systems will see that this is a really good model - that it works very well."
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