When you think of a nurse-midwife, you may think that they just help delivery babies (not that this isn’t a crucial and exceptionally important part of their jobs). But they really do so much more.
Adelicia (Addie) Graham, MSN, FNP, CNM, works as a certified nurse-midwife with Connectus Health in Nashville, Tennessee. With the other midwives in her group, Graham sees patients for prenatal care and GYN care at Vine Hill Community Clinic and Priest Lake Family & Women’s Health Center, and they all are privileged to attend births at St. Thomas Midtown Hospital.
What follows is an edited version of the interview with Graham.
As a nurse-midwife, what does your job entail? What do you do on a daily basis?
My schedule varies each week as I work a mixture of day and night shifts, as well as clinic days.
My hospital shifts are mostly 12-hour call shifts with an occasional 24-hour call shift thrown in. On a clinic day, I will see patients for prenatal care visits, birth control consults, well-woman exams, and IUD placements, etc. On a hospital call shift, I take calls from my patients and triage them at the hospital. If they are in labor, I admit them and provide support as they labor and give birth. Some of our patients get epidurals and others choose to go natural.
From the moment my patients enter the hospital, I like to make sure they are provided with the information needed for them to make informed decisions about their labor/birth experiences. I want to make sure that they always feel empowered, and that we work as a team to give them a beautiful birth and a healthy baby. Midwives specialize in vaginal birth, but sometimes a C-section is needed. In those cases, we have some wonderful back-up OB/GYNs who perform surgery when needed. I will stay at the patient’s side through the procedure and continue to provide support and encouragement.
Why did you choose to work as a nurse-midwife? How long have you worked as one?
I decided I wanted to go into the medical field as a child, and I have always been drawn toward caring for people with few resources or options. When I researched organizations like Doctors Without Borders and other service organizations, midwives came up again and again as the most needed practitioners. As soon as I entered the Master’s program at Vanderbilt University School of Nursing, I knew that I was meant to be a midwife.
I love the rich history of midwives empowering women and helping them through the most difficult—and the most beautiful—times in their lives. Birth still amazes me, and the strength that I see in every woman who goes through this transformative process is so inspiring. I have been a midwife for eight years, and I am blessed to have worked in non-profit organizations for that entire time. I love the diversity of culture, language, and birth practices/preferences that I get to see every day.
What are the biggest challenges of your job?
The biggest challenge that I run into on a daily basis really is fatigue and lack of sleep. Every practice is different, and I have worked a large range of hours from 24/7 on-call to the more reasonable schedule of defined shifts that I work now.
On a more overreaching note, there is also the stress that comes with being responsible for two lives—mom and baby—and dealing with difficult births and emergencies. Fortunately, the normal births outnumber the emergencies, but I always need to have all of the possible outcomes in mind and be prepared for anything.
What are the greatest rewards?
Women’s health is an incredibly rewarding area of nursing. I love providing detailed teaching in my visits and equipping women with knowledge that will help them to live healthier lives. Providing physical exams and birth control options is just as needed as attending births and supporting women through labor. My patient population is absolutely amazing and inspiring. I love seeing how women labor, birth, and bond with their babies in such similar ways, despite cultural and language differences. I get to take care of patients who were born and grew up in the U.S. as well as patients here as New Americans from countries like Somalia, Iraq, and Mexico. Birth is a beautiful and powerful event in any language.
What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?
I would say that you are in for an intense, tiring, amazing, and beautiful journey… pretty much what I tell all my pregnant moms as they prepare for birth! Be prepared to give a lot of yourself, but also make sure that you take time to recharge and nurture yourself and your family.
As for training, if you are already an RN, you will need a Master’s degree in nursing with a certification in midwifery to become a certified nurse-midwife (CNM). If you don’t have a school near you that offers this specialty, don’t be discouraged, as there are some great distance programs out there as well. If you have a degree in something else and need a bridge program, those exist too. I would recommend asking a midwife—homebirth, birth center or hospital—if you can shadow him or her. I shadowed a homebirth midwife prior to entering school, and it really confirmed that I was headed in the right direction. You might also consider being trained as a doula and attending births as labor support to show nursing schools that you are a part of the birth community, and also to gain valuable experience.
Where can midwives work? They can work at clinics, hospitals, birth centers, and even at home. Most CNMs attend hospital births, but there are a lot of options out there for midwives who want to attend out-of-hospital births as well.