A midwife–especially a Black midwife–can tilt the balance between life and death for African American infants and their mothers. Regardless of income and education level, childbirth for Black women is more dangerous than it is for White women. Even Serena Williams had a dangerous close call during her pregnancy, after doctors failed to heed her request for a CT scan and blood thinner medicine. Despite her history of blot clots, it was posited that “Williams’ pain medication must be making her confused.”
The Centers for Disease Control reports
that African American mothers die at three to four times the rate of White
women, and the mortality rate of Black infants is higher than that of any other
ethnic group in the US. Why? As AmericanProgress.org states in a 2019
policy blueprint, “Racism is part and parcel of being black in the United
States, and it compromises the health of African American women and their
infants… Put simply, structural racism compromises health.” According to Dr
David Williams, a pioneer in measuring the effects of racism on health, “We now
know that discrimination is linked to higher blood pressure, to high levels of
inflammation, to low infant birth weight…”
Enter the Midwife
One action that promises to change these dire
statistics is expansion of the midwifery movement, especially within the
African American community. Angela
Doyinsola Aina, interim director of the Black
Mamas Matter Alliance (BMMA) recently told an American Public Health
Association (APHA) conference, “We have to go beyond just talking about giving
people, especially low-income people, access to care…. We also need to ask
whether that care is high quality and culturally relevant.”
Where do Black midwives come into the picture? ProPublica
notes in a report
on how increasing the role of midwifery in the US could reduce maternal
complications and mother/infant mortality rates, “Many… [US] states
characterized by poor health outcomes and hostility to midwives also have large black populations, raising
the possibility that greater use of midwives could reduce racial disparities in
maternity care.” And Lamaze.org
suggests, “When Black families are cared for by Black health professionals,
like midwives, they are better heard, seen, respected, understood, and get
their needs met, which relates directly to health outcomes.”
One of the women at the forefront of the Black Midwives
movement is Jennie Joseph, founder of the Birth
Place in Winter Garden, FL. Joseph’s work as a provider of perinatal
services to underserved and uninsured women of color has already brought about
positive change in the CDC numbers. Trained in the UK, where half of all babies
are delivered by midwives, Jennie Joseph arrived in the US to find that in the
most affluent country in the world, owing to concerted opposition from doctors
and hospitals, midwives attend only 10% of all births. She also found that the
US has a much higher incidence of maternal and infant mortality
rates—particularly among minorities and the disenfranchised—than in countries
such as Canada, Sweden, and the UK, where midwives attend the majority of
Joseph’s “open access” clinic at the Birth Place provides pre-natal
and post-partum care for women regardless of their ability to pay and focuses
on minority and underserved women in the area. As Miriam Zoila Perez marveled
in the New
York Times, the Birth Place manages to beat the dire maternity figures for
women of color: “When you look into her statistics, you find something quite
rare: Almost all of her patients give birth to healthy, full-term babies… maybe
not surprising until you learn that the majority of them are low-income
African-Americans, Haitians and Latinas….”
Expanding the Midwives’ Movement
Another pioneering Black midwife is Shafia Monroe, who has long been one of
the major forces behind the Black midwives’ movement. Founder of the
International Center for Traditional Childbearing (which was re-formed in 2018
as the National Association to Advance Black Birth) and winner of a Lifetime
Achievement Award from the Human Rights in Childbirth Foundation, Monroe
started working with mothers and infants as a nurse’s aide in the postpartum
ward at Boston City Hospital at the age of 17. It was in 1991, when she
encountered difficulties in finding a midwife of color for her own pregnancy, that
Monroe founded her influential International Center for Traditional
Childbearing. Under the auspices of the ICTC, she became a pioneering figure in
the cause of Black midwifery. Monroe has worked tirelessly to reduce
mortalities linked to pregnancy and to increase the number of Black midwives
and doulas. To women who are interested in becoming midwives, Moore urges, “Join
an organization! There’s MANA (Midwives Alliance
of North America), ICTC, ACNM (American College of Nurse Midwives);
there’s so many organizations. Look into organizations that are familiar with
black reproductive issues, and our history.”
As the co-director of Black Mamas Matter Alliance (BMMA), Elizabeth Dawes Gay, says, “If even one more person just says they want to take up the cause, they want to become a doula, they want to become a midwife, they want to start an organization—to me that’s a success.”
The University of Vermont Medical Center recently celebrated the 50th anniversary of the Midwifery Service, the second-oldest hospital-based midwifery program in the United States. Since the program’s start in 1968, more than 13,000 births have been managed by certified nurse-midwives, who have helped with nearly 20 percent of deliveries at the Burlington hospital.
Certified nurse-midwives assist with the maintenance of healthy pregnancies and provide education, counseling, prenatal care, hands-on assistance during labor and delivery, and postpartum support to mothers who opt-in for midwife care.
Marti Churchill, CNM, who is currently leading the program says that nurse-midwives are regularly sought after because studies show better outcomes associated with deliveries attended by nurse-midwives. “No pregnancy happens in a vacuum,” Churchill shared with the UVM Medical Center Newsroom. “We attend to the mother’s psychosocial and emotional health and assess how she takes care of herself, her access to healthy food, how is she treated in her workplace, her housing situation — everything that can have an impact on a positive outcome.”
The UVM Medical Center Midwifery Service was founded by Dr. John Maeck, chair of the Obstetrics and Gynecology Department at the Medical Center Hospital of Vermont, in tandem with Clair Lintilhac, a retired nurse and English-trained midwife. Lintilhac went on to provide financial support of the program once it expanded in 1978; that support has continued today through the Lintilhac Foundation. The Midwifery Service has continued to grow and include research sabbaticals, a lactation clinic, and a perinatal mental health service.
The program also includes a weekly Maternal Fetal Medicine clinic, which provides mothers with high-risk or complicated pregnancies to receive care from both midwives and physicians. Kelley McLean, MD, is medical director of the Midwifery Service and knows that their patients are hardpressed to find the same kind and quality of care elsewhere for their pregnancies.
“I’m not aware of any other clinic like it in the country,” McLean said. “It is great to see these patients benefitting from a range of expertise in an integrated fashion.”
For more information about the UVM Medical Center Midwifery Service, click here.
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.
Fairfield University recently announced that they will be launching a new Doctor of Nursing Practice program in Nurse Midwifery beginning in Fall 2017. The DNP program will be offered through Fairfield’s Marion Peckham Egan School of Nursing and Health Studies.
According to Fairfield.edu, the Doctor of Nursing Practice (DNP) in Nurse Midwifery is designed to meet the competencies for the practice doctorate in midwifery set forth by the American College of Nurse Midwives (ACNM) and to meet the ACNM Core Competencies for Basic Midwifery Practice. Students in the program will graduate as expert nurse midwives for every stage and in every setting where midwifery care is delivered to women. Jenna LoGiudice, PhD, CNM, RN, Nurse Midwifery Program Director, tells Patch.com:
“Students in the Egan School Nurse Midwifery DNP program will foster their commitment to empowering women throughout the lifespan. The program’s philosophy highlights a dedication to trauma-informed care and perinatal loss. Interprofessional simulation opportunities will occur throughout the program in the brand new Egan School Simulation Center. Midwives are the cornerstone of women’s healthcare and I look forward to welcoming our first cohort of midwifery students this fall.”
DNP students in Fairfield’s Nurse Midwifery program will gain clinical experience by attending births and providing gynecologic, antepartum, intrapartum, postpartum, newborn, and breastfeeding care under the supervision of Certified Nurse Midwife (CNM) faculty. To learn more about Fairfield University’s DNP in Nurse Midwifery, visit here.
Frontier Nursing University has announced a planned expansion to Versailles, KY, scheduled to take place later this year. After enrollment grew from 200 to more than 1,600 over the past decade, an expansion was necessary to accommodate the growing student population.
The university is buying Kentucky Methodist Homes’ property in Versailles which includes a dozen buildings. It is being sold by the Kentucky United Methodist Homes for Children & youth, a nonprofit corporation that cares for abused, neglected, or abandoned children, which will be downsizing to another location.
Frontier President Dr. Susan Stone released the following statement according to www.Kentucky.com:
“We are expanding our Central Kentucky operations by moving our administrative office to Versailles, where we will develop additional capacity to serve students. Frontier Nursing University will leverage this property in new ways, but with the same focus on improving health and wellness for families in Kentucky and beyond.”
Frontier offers digital graduate level education to registered nurses who want to become nurse practitioners or nurse midwives. However, students are required to travel to the Kentucky campus for orientations and education sessions to prepare them for online work and clinical experiences. The use of the new space will be determined at a later date, and the school’s present headquarters will continue to be used in addition to the new campus space.
To learn more about Frontier Nursing University’s planned expansion, visit here.
According to the U.S. Bureau of Labor Statistics, the certified nurse-midwife (CNM) profession is expected to grow as much as 31% from 2014 to 2024—which is unusually fast. As a result, there will be a need for many more CNMs.
In honor of National Midwifery Week, we break down what a CNM does and why you consider becoming one. After all, they do a lot more than “deliver” babies.
What CNMs Do (and Don’t)
First of all, it’s important to use the correct terminology. “We use the words ‘attend the birth,’ as the mother ‘delivers’ her baby—it is a more respectful term for the mother,” says Barbara A. Anderson, DrPH, CNM, RN, FACNM, FAAN, owner and manager of an educational consulting company which offers private consulting for educational programs including midwifery, nursing, and public health. She also serves on the Board of Directors for the American College of Nurse-Midwives (ACNM).
“We like to say we ‘catch’ them because the mother does all the work of delivering them,” says Kerri D. Schuiling, PhD, CNM, FACNM, FAAN, provost and vice president of academic affairs at Northern Michigan University in Marquette, Michigan. “The CNM’s role during a birth is to attend to the mother during her labor, and carefully assess the progress of the labor and how the fetus is withstanding the stress of the labor. It is a supporting role. We see ourselves as working with women during labor and birth. We also provide support to family members present, but our main role is supporting the mother as she labors to give birth.”
A huge misconception regarding CNMs is that they only attend to a woman during birth. In fact, CNMs as well as certified midwives (CM) are legally qualified to provide full care to women throughout their lives, explains Anderson. According to the Birth Institute, CNMs don’t solely focus on birth; they can provide care for women from puberty through menopause.
“They are educated to provide pre-conceptual, interconceptual, prenatal, intrapartum, and postpartum care to women,” says Anderson, as well as “care of the newborn, family planning services, and ongoing women’s health care including primary care, gynecological care, and health education of the well woman.” Just as there are both male and female OB-GYNs, there are also both male and female CNMs. “There are no gender differences on scope of practice.”
Schuiling says that CNMs work in hospitals (and they are credentialed to do so by the hospital) as well as birthing centers and homes. Anderson adds that in the United States, most CNMs practice in a hospital setting. There are, however, a number of freestanding birth centers owned and operated by CNMs, CMs, and certified professional midwives (CPM).
The Differences: CNMs, CMs, and CPMs
There are quite a few differences between CNMs, CMs, and CPMs. Schuiling explains that, overall, for an RN to become a CNM, s/he must earn a bachelor’s degree in nursing and then a graduate degree in nurse-midwifery.
The ACNM states on its website, “Certified nurse-midwives are registered nurses who have graduated from a nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the U.S. since the 1920s.”
According to the ACNM, some programs do work with people who are not RNs: “If the applicant has a bachelor’s degree, but not an RN license, some programs will require attainment of an RN license prior to entry into the midwifery program; others will allow the student to attain an RN license prior to graduate study. If the applicant is an RN, but does not have a bachelor’s degree, some programs provide a bridge program to a bachelor’s degree prior to the midwifery portion of the program; other programs require a bachelor’s degree before entry into the midwifery program.”
Like CNMs, CMs also need a bachelor’s degree from an accredited college/university as well as successful completion of specific science courses. Then CMs need to graduate from a midwifery education program accredited by ACME.
The International Confederation of Midwives, says Anderson, a branch of the World Health Organization, is the body that sets global standards for the education of midwives as well as the practice of the profession, and allows for country-specific adaptation. The ICM standards are supported by the ACNM, which is the national organization of CNMs and CMs. Both CNMs and CMs must pass the American Midwifery Certification Board’s examination and continue to get recertified every five years.
CPMs are the most different in that they only are required to have a high school diploma or equivalent. “CPMs do not necessarily have formal education and may be trained in the apprenticeship model. They do not meet the educational standards of the ICM, but they are regulated and certified by the North American Registry of Midwives. The CPM credential is accredited by the National Commission for Certifying Agencies,” explains Anderson. Unlike CNMs and CMs, CPMs do not treat women throughout their entire lives. Their work is focused on “the management of prenatal birth and postpartum care for women and newborns” says the ACNM.
Another big difference between CNMs, CMs, and CPMs is their legal status. The ACNM states that CNMs can be licensed in all 50 states in addition to Washington, DC, and the United States territories. CMs can be licensed in New Jersey, New York, and Rhode Island. They may also be authorized to practice in Missouri or Delaware. CPMs are regulated in 28 states, but this may vary “by licensure, certification, registration, voluntary licensure, or permit.”
Rewards of the Job
“I love the autonomy of advanced practice nursing and the ability to provide the type of care you believe in and that you know you make a difference,” says Schuiling, who is also a co-editor of the ICM’s official publication, the International Journal of Childbirth. “The hours are definitely hectic and long, but the rewards of working with new families are so very hard to explain. It really is such a miracle to be present at birth.”
Anderson says that “I love working with families, helping women to experience personal fulfillment and good health in childbearing, helping fathers and family members to feel engaged in this powerful life experience, and helping infants to be welcomed and embraced in their families.”
As for the best part of working as a CNM: “The best part is being part of this miracle,” says Anderson. “There is a wonderful proverb that states, ‘The greatest job is to become a mother; the second greatest is to be a midwife.”