From Ashley Kliewer, PA-C, Director, Advanced Practice
Tell me about your background.
In 1969, during the Vietnam War, I entered the Army as a Private First Class and Officer Candidate, two days before my 18th birthday. I received a scholarship to the Walter Reed Army Institute of Nursing, a special program developed by Congress to increase the number of nurses in the Army. After two years at Villanova University, I transferred to Walter Reed to complete the coursework for my BSN, graduating in 1973 as a 1st Lieutenant.
Prior to pursuing a Nurse-Midwifery program in 1976, I worked on gynecology, postpartum, and labor and delivery units. I graduated from the University of Kentucky with my MSN and Nurse-Midwifery degrees in 1977. My inspiration to become a CNM came from my Obstetrics instructor at Walter Reed, Col. Mary Mulqueen, an Irish midwife. She kept telling me she was going to make a midwife out of me, even though I had no idea what that was.
I remained in the Army for almost 23 years, working at Fort Campbell and Fort Knox in Kentucky and the 97th General Hospital in Frankfurt, Germany, where I was promoted to Lieutenant Colonel. In 1992, I retired from the Army out of Fort Hood, Texas. I worked for a small Nurse-Midwifery practice in Connecticut before moving to Lancaster in 1995, where I was the third Nurse Midwife hired by Drs. May-Grant Associates. My next retirement is planned for Dec. 31, 2020.
Describe your role as a midwife.
CNMs attend the majority of the typical deliveries for our practice. We care for women through their life cycles, from teen years to advanced age. We provide OB and GYN care, along with family planning, as well as teaching, counseling, supportive care and emotional support. One of my most enjoyable experiences is seeing patients yearly and watching their children and lives grow and change. Additionally, our nurse-midwives have specific niches. Mine is supportive care and guidance of women with postpartum depression. Several years ago, I helped with a local postpartum support group.
What have been some of your career highlights?
My first delivery was a young woman's first baby in Hawaii on Christmas Eve 1974, which felt amazing, very powerful and humbling. I had several car deliveries at Fort Campbell. The hospital was an old cantonment-type hospital built in 1938, comprising 7 miles of corridors with wards between. Patients would drive up, and we would run out to the cars. While at the 97th General Hospital in Frankfurt, due to limited radiology staff, CNMs were taught ultrasound. I diagnosed six twin pregnancies in one eight-week period. Those were the happy times. Over the years, there have been a lot of sad times, too.
At Fort Hood, I acted as the representative for Nurse-Midwifery to the Surgeon General. Along with our staff nurse-midwives at Fort Hood, I was responsible for coordinating a lecture for the Chief Nurse of the Army concerning issues found during Desert Storm, both on our post and overseas. Our concerns dealt with the care active-duty women received in combat or staging zones, which included painting trucks without protective gear and being given antibiotics for UTIs without their pregnancies being diagnosed.
What are some of the changes you have seen in Nurse-Midwifery?
We have had an increase in our patient care responsibilities, which includes treating a lot more gynecological issues now. The progress of medicine over the last 40-plus years has been incredible. Therefore, we are constantly learning new practices and treatments. At the same time, certain abilities have been lost over the years. Pudendal nerve blocks used to be very common and very useful, but this is something I have not used in years. Previously, we were able to do more "labor sitting.” Today, due to the size of our practice, we rely on nurses to provide supportive care during labor. In the military, we still used delivery rooms when I retired. In civilian life, I had to retrain to deliver in the labor rooms.
What makes working with your collaborating physicians successful?
Our physicians are supportive and see nurse-midwives as a way to provide high-quality, cost-effective care for a large number of patients. If a patient is not a good fit for midwifery care, we can easily switch the patient to a physician. Certain patients may be considered for co-management, depending on their risk. Our physicians also permit CNMs to choose what to incorporate into our practice, depending on comfort and skill levels.
Tell me about your life outside of work.
My daughter, Erin, is a practicing nurse who graduated from the LGH nursing program. Erin plans to become a Family Nurse Practitioner once her two children are older. When I can, I enjoy dancing, photography, watercolor painting and reading.