Women’s History Month: Lori Swain and Heather Carrion

Legacy midwives strive to help women with menopause care

Lori Swain, DNP, CNM, MSCP, FACNM, and Heather Carrion, CNM, MSCP, are both certified nurse midwives who are intent on getting the word out that their work goes beyond childbirth. The two, who both work with Legacy Medical Group, especially want to help women with menopause.

In the past year, the two have furthered their careers and care for women by receiving certification from the Menopause Society. The two frequently consult with each other and serve as sounding boards to help their patients.

They recently spoke with us about their careers, Women’s History Month at Legacy and how they help their patients take ownership of their health care. While people with uteruses are referred to as women in this story, Lori and Heather both welcome non-binary and transgender individuals to seek respectful care in our practices.

 

Tell us about your background and how it relates to women’s health.

Lori – I started with my own experience of being pregnant in which I became fascinated with the process. In the early 2000s, I got involved as a childbirth educator, then became a doula in the Chicago area where I worked with families all over the Chicago area and saw how there was a wide variation in the quality of maternity care. Given that the majority of people give birth in the hospital setting, I continued with more education and experience and started nursing school with the intention of becoming a nurse-midwife. I have been a nurse-midwife at Silverton for the last nine years.

I learned from being a doula how to walk parents through their birthing experience. Working as a doula first was a great foundational experience for moving into the midwifery model of care – in which the focus is on person-centered care, using shared decision making to respect the physiology of birth, minimize interventions and prioritizing patient autonomy.

Heather – I’ve been a midwife for 15 years, 10 of those with Legacy serving East County. What drew me to women’s health care was catching babies. But when I started school at Columbia University for my BSN to MSN program, I developed a greater appreciation for the full scope of women’s health care.

I practiced full scope midwifery for 14 years then shifted to menopause and gynecological care in the past year because I wanted to do more for patients and women, especially in an area that is so ignored and dismissed and affects so many people.

 

You both recently became certified by the Menopause Society and share an interest in that care. Can you please talk about why you are interested in this area of health care.

Lori – What drew me to pursue this certification is the current gap in evidence- based menopause care for women. All females experience this transition, so it’s a great opportunity to experience midwifery care during this time in life.

During a visit in which we discuss perimenopausal symptoms, we focus on the safest most effective way to manage symptoms for each person. It is largely a conversation where we talk about what you’re noticing in your body, validate the real experience of living through these changes and make a plan.

There are people in my own life who didn’t know they could see a midwife beyond pregnancy and childbirth.

Heather – I want women to know there are providers in our area who want to know what they are going through and will listen to them. For too long, women have been dismissed as too young to experience menopause or told that their symptoms aren’t that severe. Discounting quality of life for someone experiencing menopause furthers this innate dismissal of women that has been prevalent in the medical field for a long time. We want people in the community as well as other providers to know that there are people who specialize in this field.

 

This year’s Women’s History Month theme at Legacy is Women’s Health: Moving beyond “I’m fine.” How does this theme resonate with your personal and professional experiences?

Lori – If you ever follow me through the clinic day, you’ll notice that one of my “go to" phrases is, “just because you’re pregnant or perimenopausal or female doesn’t mean you need to suffer,” I get a chuckle, but it is because women are so used to downplaying their symptoms. I ask patients what changes they are noticing in their bodies and ask them what questions and concerns they have. We do have lots of tools available to us, but if we don’t build that trust and vulnerability to say, “I’m not fine,” then as providers we can’t help. In menopause care, we create time and space to have these conversations and address concerns with appropriate evidence-based interventions.

Heather – Women have, for a long time, put their own care on the backburner. They’re often working parents who might also be caring for their own aging parents. They’re taught that their health isn’t that important, that they need to get the kids and the partners to their appointments. They’re ignored by the system. Women are taught by the medical field to ignore menopause.

I was listening to a podcast when one of the speakers said mother nature is not a feminist. I thought that was an interesting way to phrase that and it rings true: once someone is no longer able to produce children, they start having numerous symptoms in the transition. If we open conversation and women are willing to talk about this, it can be a freeing time of their life. They are getting to the point where they care about themselves. It can be a great time of life if their symptoms are acknowledged and managed.

 

How do you advocate for women at Legacy Health?

Lori – Every day at work is an opportunity to show women and families that healthcare can be better. Outside of work, I am an advocate for all things related to reproductive health, maternity care and the profession of midwifery. Living in Salem, I frequently show up at the state capital to advocate for health legislation that improves our communities. In February, I testified alongside other Legacy midwives in support of legislation that would increase funding and expand access to Project Nurture, a program providing care to women experiencing substance use disorder during pregnancy.

I frequently precept midwifery students as there is a national shortage in maternity care providers – about 40% of U.S. counties do not have maternity care providers. I am committed to doing my part to ensure that all birthing people have access to skilled providers.

Heather – Largely through direct patient care. When I have a person coming to me for care, I put them first and foremost. I encourage them not to feel guilty for not coming to an appointment for a long time. I tell them to feel proud that they came that day. I let them talk. I listen and acknowledge how they feel. I often hear in those moments that they haven’t been heard in the past.

 

If a woman feels uncertain about advocating for themself, how would you encourage them? What specific advice or resources would you share with them?

Lori – I recommend going to an appointment with a list of questions. Sometimes a visit can feel intimidating. I know from talking to friends and family that they forget what to ask. Having a list can be grounding. Or take someone you trust with you.

If you don’t feel like you left the visit with your questions answered and a good plan for moving forward, find a different provider. It’s okay to find a good fit.

Heather – I give them as much education as to what we are talking about and make myself open. I had to learn this over time. It allows them to decide if they want to move forward with an exam or a procedure or anything else. Rather than telling someone what to do, it’s putting the person as the decision maker.