Nurse-Midwives Elevate Birthing Experience and Care Options for Expecting Mothers in Oakland County

Alexandrea Garbus, CNM

Expecting mothers at Trinity Health Oakland now have increased access to high quality evidence-based care through pregnancy and labor with Certified Nurse-Midwives.

If you are not familiar, midwives are nurses specialized in advanced practice nursing. These experienced medical professionals have both a nursing degree and a master’s degree. Though midwife services are not a new concept, the hospital’s introduction of them in our outpatient office in Bloomfield Hills greatly expands access to their services in northern Oakland County.

As midwives, our focus with every patient is to empower them, to ensure their voice is heard and listened to, and to have them actively participate in decision making throughout their prenatal care and labor. At the end of the day, we advocate for our mothers, and we work to provide them with the best options available so they can have a customized birthing experience in keeping with their faith, traditions and expectations. We do so in the safest possible environment, while ensuring the safety and wellbeing of both the mother and her baby.

Another reason expecting mothers choose nurse-midwives as their healthcare provider is for the guidance and counseling we offer, including preparing for labor. From start to finish, the process of bringing a newborn into the world can be daunting, so our nurse-midwives offer critical support and anticipatory guidance, so mothers feel informed and supported.

The specialty care provided by nurse-midwives is proven to be very effective. When women use a midwife, the chances of them needing a cesarean section are greatly reduced, as are preterm birth rates, according to a study conducted by the National Library of Medicine. Midwives can combine the necessary prenatal care while also providing additional support and encouragement during this critical time in a woman’s life.

At Trinity Health Oakland we are part of a large medical care team.  Our nurse-midwives can collaborate with Obstetrics and Gynecology physicians as necessary throughout the pregnancy and delivery, including in the event a delivery becomes high-risk or if an emergency procedure is required. Nurse-midwives and physicians work closely together to ensure the mother is part of the decision-making process, all while making it the safest environment for both the mother and the baby.

Beyond the birthing experience, midwifery services are also used after the pregnancy, from annual exams, well-woman care, cancer screening, preconception counseling, pregnancy, postpartum and peri- and postmenopausal needs.

We are thrilled to now offer this service in Oakland County and encourage every expecting mother to ask questions, do their homework, and choose a care provider that best meets their needs.

To schedule an appointment with a nurse-midwife, please call the Trinity Health IHA Medical Group, Nurse Midwives – Bloomfield Hills office at (248) 334-3213.

Better Balance: Fall Prevention for Seniors

Have you experienced falls or a loss of balance within the last year? Did you know that more than one out of four seniors fall each year?1

Less than half tell their doctor.2 Get educated on what you can do to prevent falls!

Common Causes of Falls:

People can take a fall for many reasons but some of the most common are:

  1. Weakness in the lower body (i.e. hips, legs, ankles, feet)
  2. Poor lighting at home
  3. Rugs

What can I do to prevent myself from falling?

  1. Regular strengthening and balance exercises.
  2. Use night lights or ensure there is good lighting in your home so you can get to and from the bathroom.
  3. Remove rugs from frequently used pathways in the home as they are a common tripping hazard.

There are many exercises to help you build strength and endurance to help prevent falling. One of the most common helpful exercises supports transitioning from sitting to standing.

Sitting to Standing:

  • Scoot to the front of the chair, feet underneath you, and stand up. Sit back down and repeat!
  • Ensure the chair is not going to slip out behind you
  • Perform 10 sit to stands 2-3 times per day.*
  • Try not to use your hands if your balance is good enough for extra strengthening.

*Please consult your physician before performing any exercises to ensure they are appropriate for you.

Ready to improve your balance?

Schedule an appointment with one of our physical therapy specialists today.


  1. Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI:
  2. Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. Am J Prev Med 2012;43:59–62.

Urinary Tract Infections: What Women Need to Know

In practice since 2019, Trinity Health IHA Medical Group Obstetrics and Gynecologist, Sara Muszynski, MD, is no stranger to the annoying condition of having a urinary tract infection (UTI). She is happy to share her expertise with the many women who have — and will — get them in their lifetimes. This is what she wants all women to know:

Why Us?

Up to 60 percent of women will experience a UTI in their lifetime, and for some women, it will be multiple times. Unfortunately, women are more prone to UTIs as a function of the female anatomy.

Female gastrointestinal tracts and vaginas are colonized with bacteria — some of which are pathogenic, or capable of causing disease. Because of the short distance from the rectum to the vagina to the urethra, the pathogenic bacteria have easier access to the urethra in women. The bacteria can enter the urethra and travel to the bladder, causing symptoms.

Other causes of UTIs include kidney reflux or bladder reflux, where the kidneys or bladder don’t fully empty. The use of catheters is also a way for UTIs to develop.


Classic symptoms of a UTI include burning when urinating, a sensation of needing to urinate frequently, urgency, or lower abdominal pain. The color of the urine may also be an indicator of a UTI, such as urine that appears a darker amber color or cloudy, but not always.

Prevention and Treatment

Many women first experience a UTI once they become sexually active. Sexual intercourse tends to move around the bacteria in the area of the vagina, rectum, and urethra.

  • A personal hygiene reminder: It is always good practice to wipe from “front to back” when using the restroom.
  • Urinating following sex may decrease the bacteria that gain access to the urethra.
  • Another way to prevent a UTI is to urinate when you need to. Don’t “hold it.”
  • Cranberry supplements are often promoted as a source of prevention. Yet clinical studies have not been able to verify what dosing and frequency of cranberry supplements are needed to determine if this is truly effective.
  • Frequent hydration is also crucial. Drinking pure water is best for flushing fluids.
  • My colleagues and I recommend that women wear cotton underwear. Other materials may lead to excess moisture (an environment in which bacteria thrive).

The treatment for UTIs is a short course of antibiotics.

I tell patients that over-the-counter treatments for UTIs are like a “bladder Tylenol.” They don’t remove the bacteria, but they help with the symptoms of pain and urgency to urinate. The only treatment is truly antibiotics. To target the antibiotic, we need to get a urine sample.

When Symptoms Don’t Necessarily Indicate a UTI

Women should also be aware that the symptom of urgency to urinate does not always indicate a UTI. Caffeine in general, diet sodas, and alcohol are bladder irritants that can cause urgency, but not necessarily a UTI.

Taking any antibiotic for a UTI, upper respiratory infection, or sinusitis can promote a yeast infection in the vagina because it changes the bacteria in the vagina. Most women can differentiate between a yeast infection and a UTI, but sometimes there can be confusion. These points will help you to differentiate:

  • Vaginal itching
  • Vaginal discharge
  • Sensation of burning even when not urinating

Finally, the decrease in estrogen in women going through menopause may lead to a woman having vaginal and urethral burning, which is not related to a UTI.

Parting Thoughts

If you are in your reproductive years, it is easier for physicians to order a lab for a urine sample and to tell from your symptoms if you should begin treatment immediately. You may not need to schedule an appointment; it can be handled on the patient portal.

If you are having recurring UTIs or if you are taking antibiotics and symptoms are not improving, this warrants further evaluation and I would advise coming in for an office visit.

Dr. Muszynski sees patients at Trinity Health IHA Medical Group, Obstetrics & Gynecology – West Arbor. To make an appointment with her, call 734-995-2259 or schedule an appointment online.