Spotlight: Keeley McNamara, Certified Nurse Midwife, Author, and Frontline Worker
Keeley McNamara is a CNM, or Certified Nurse Midwife, based in New York City. In addition to her work counseling pregnant and postpartum womxn, she is also a mother, and the author of Mastering Your Fertility. Keeley has been working on the frontlines during the COVID-19 pandemic, and shared her experience with us, from the story of launching @askmidwifekeeley, to the things no one tells pregnant womxn, and her best “baby hack.”
Tell us about your journey to becoming a CNM. What inspired you to get started in this line of work?
In my first job out of college, I was a health educator in an adolescent, school-based health center. I loved that job. Not only did I get to run workshops about safer sex, but since it was in a school, I really got to form relationships with the students. Unfortunately, despite my best efforts, some of the kids still got pregnant. I decided that if they were going to continue on with their pregnancies, I was going to take advantage of having a captive audience. and make the most of the time I had with them during those pregnancies. I started a pregnancy and parenting group for the expecting parents in the school, where we would invite in various experts including doulas, OB/GYNs and pediatricians to answer questions and help expecting parents make plans for their upcoming labor, birth, and parenthood. A few of the girls didn’t have anyone to accompany them during delivery, and asked if I would be their support person in labor. What I witnessed in those deliveries is what called me to midwifery. Those girls were so marginalized. No one spoke to them, no one looked at them. They had things done to them, not for them. These were strong girls with big voices - girls with plans and personalities and desires - and no one in power cared. I realized that the only real way to fix the system was for me to become the person in power who cares.
You’ve talked about midwifery being “the perfect combination of activism and medicine.” Tell us more about that philosophy and how it has impacted your work.
Midwifery toes the line between worlds, blending centuries of knowledge passed down from our foremothers with evidence-based science of today. I love when I walk onto the labor floor and the doctors say “oh thank goodness you’re here! Can you go work some midwife magic in room 2? We cannot get that baby out!” While I like to believe there is midwife magic (we are pretty magical), the reality is that midwifery is the second oldest profession in the world, and with age, comes experience. We have spent centuries listening to, caring, and advocating for the needs of women and families. When no one else in the medical field would care for women of color and indigenous women, we were there. When no one else in the medical field would perform abortions or prescribe birth control, we were there. First and foremost, midwives have always been fierce advocates for our patients. Midwife means “with woman” and for me, that’s really what it’s all about; my job is to be there, advocating for my patients. To make sure that they feel heard while ensuring that they are getting the best care possible.
How did you decide to launch @askmidwifekeeley? Was there a moment when you realized that you can create content to help pregnant people navigate their reproductive journeys? What was that moment?
I get loads of texts and DMs from friends asking pregnancy and sexual health questions daily. The questions my friends were asking me in my personal life were the same questions my patients were making appointments to ask me in my practice. I realized it would likely be helpful to put that information out there for people to be able to easily access without having to schedule an appointment with their provider. Providing quick, easy access to relatable, reliable health information is my goal.
On your Instagram, you frequently cover common questions you get from patients. What are some of the things no one tells pregnant womxn?
Milk comes out of more places than just the center of your nipple (and sprays really far)
Your water probably won’t break before you go into labor
The gas bubbles you are feeling; that is your baby moving
You might not lose your mucus plug or you might lose it more than once or continually over weeks, and it will be streaked with blood, and that is all normal
Orgasms make you have contractions, but they are not dangerous unless you have a condition called placenta previa
The only home remedy scientifically proven to make you go into labor at your due date is sex (semen is a natural prostoglandin)
What are a few things you wish you knew, before you had kids?
Despite what they tell you, breastfeeding does not feel awesome that first couple of days. Think about it...someone sucking on any part of your body for twenty to forty minutes at a time every two hours around the clock is going to hurt, let alone a part as sensitive as your nipples. Once you get numb to all of the sucking, it feels better for most people and good for some people, but I truly think that the false expectation of “breastfeeding isn’t supposed to hurt” has made a whole generation of breastfeeding people feel like they are failing at breastfeeding when really, if we just told people “it might not feel great at first, but it gets better” we’d be setting them up for a better chance at long-term success.
My best “baby hack” was when I figured out that the only way for my daughter and I both to get clean was for us to shower together. I could figure out how to get her bathed, but for the life of me, I could not figure out how to prioritize getting myself in the shower. Every time I tried, she would wake up and start crying. One day I just said to myself “screw it” and brought her in with me. It was my first lightbulb moment as a mom when I realized that if I don’t take care of myself I can’t take care of anyone else.
What’s the best piece of advice you ever received?
Set the parenting bar super low that first year. Did you get dressed? You win! Made it outside with all the baby stuff you needed on the first attempt? Congratulations! Washed your hair this week? Throw yourself a little party! Signed your baby up for a parent and me class and actually went? Okay…stop bragging. You’re amazing!
How has your experience been raising children and being an essential worker, as the pandemic has continued on for close to a year? What have you done to protect your family from contracting COVID-19?
It’s been scary. I work at Health and Hospitals Elmhurst, which in the Spring was coined “the epicenter of the epicenter” of COVID. Our OB/GYN department is very close, like a family, and we all worked together to figure out how to best protect ourselves, our families and our patients. My partner is a teacher who has been teaching remotely and our daughters have been in all remote schools, so for many months I was the only person leaving our house. I did all of our grocery shopping and outside of the house errands to reduce the chances of anyone else in our home being exposed. I drive to work instead of taking the subway to limit my exposure. I change into scrubs once I’m at work and keep my home clothes in a large paper bag. I wear an N-95 with a surgical mask over it and eye protection when I’m seeing patients whose COVID status is unknown or negative. If I’m seeing a COVID-positive patient, I add a surgical gown and hair cover to my outfit for extra protection. I make sure to never have my masks off for more than fifteen minutes in a twenty-four hour period among my co-workers in case someone is asymptomatic positive, or finds out they are positive or exposed later on. At the end of the day, I change back into my home clothes, drive home, wipe down my car, and get directly into the shower before I see my family. This has been my routine every single work day for the last 10 months. One nice thing that’s come out of this COVID routine is that my younger daughter comes into the bathroom to read stories to me while I’m in the shower every day, so I’m not lonely. She’s six.
In March 2019, when the outbreak took hold in the U.S., what were your initial thoughts on how the pandemic would impact your work? How has that changed over time?
Elmhurst got hit hard with COVID in the Spring, so by March we were already fully aware of how the outbreak would impact our work because we were living it. We saw other hospitals and practices stop allowing partners and doulas on labor and delivery but we knew that wasn’t right for our practice. Our patients are already some of the most at-risk, marginalized people in the city even before the pandemic and are some of the most affected by the pandemic. Putting up more barriers to care was simply not an option.
How has your work in support, labor, and delivery been impacted by the pandemic?
Some things are clearly different, but the core of the care is the same. At first wearing a mask and eye shield while caring for patients felt like a barrier. I wasn’t sure how I was going to be able to connect with people without my face, but we have all adapted. I guess my eyes must have gotten more expressive.
Personally, the biggest adjustment is that my brain literally never stops. I’m constantly thinking:
Is this safe?
Am I protected?
Am I wearing this right?
How do I put this on?
How do I take this off?
Is that symptom COVID-19?
When was she exposed?
Does she need to quarantine?
And that’s on top of the usual million things I think about in order to take care of healthy pregnant people when it isn’t a pandemic. It’s exhausting.
In early January, you posted a series of Instagram stories encouraging pregnant and postpartum people to discuss getting the COVID-19 vaccine with their provider. Tell us more about your positioning on that, and about your recommendations in general for how pregnant and postpartum people can protect themselves and their children from the virus.
The question of whether or not to get the COVID vaccine in pregnancy is truly such a personal choice. I got the vaccine as soon as I was able to, but I am not pregnant. I do work with some pregnant health care providers who have gotten the vaccine immediately, others who decided to wait until after 20 weeks and others who have decided to wait until they deliver. Everyone’s situation is different, so there is never going to be a one-size-fits-all answer to the “should I get the COVID vaccine in pregnancy” question.
The American College of Obstetrics and Gynecology (ACOG) recommends that “COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there is also no data to indicate that the vaccines should be contraindicated, and no safety signals were generated from DART studies for the Pfizer-BioNtech and Moderna COVID-19 vaccines.
Therefore, in the interest of allowing pregnant individuals who would otherwise be considered a priority population for vaccines approved for use under EUA to make their own decisions regarding their health, ACOG recommends that pregnant individuals should be free to make their own decision in conjunction with their clinical care team.” What does this mean? It means that while we don’t yet have studies showing that the vaccine is safe in pregnancy, there is no reason to believe it wouldn’t be safe. We do know that COVID is dangerous. So if you are at high risk for exposure to COVID, or have a health condition that makes you have a higher risk for complications from COVID, the known risk of COVID may outweigh the theoretical risk of the vaccine. Trust me, all of us health care providers are struggling with this too. Please tell us if you are in a priority group and aren’t sure what to do. We’re happy to help you talk through your risk and we’ll figure out the best plan for you together.
To keep up with Keeley, follow her on Instagram at @askmidwifekeeley.