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You're a what? nurse-midwife.

You're a What?


Every day is a birthday at the Maternity Center. Every day is a celebration of life. The festivities are not cake and candle commemorations, however. They're the main event. The Center is a midwifery practice and birthing center in Bethesda, Maryland. About 30 women a month give birth either at the Center or in their own homes. All of them are attended by nurse-midwives dedicated to providing safe and satisfactory care to mother and child.

Midwives have nurtured new life through the ages, in every country and culture. Their knowledge and skills were passed from generation to generation. Today, they are health professionals, trained in both disciplines of nursing and midwifery. And their heritage of personal care and support to their patients is stronger than ever.

In this country, nurses first began to train as midwives in 1925 when Mary Breckinridge founded the Frontier Nursing Service in Hyden, Kentucky. Now, 26 colleges and universities offer nurses the additional education and clinical training they need to become nurse-midwives. According to the American College of Nurse-Midwives (ACNM), the professional organization of nurse-midwives, more than 2,800 certified nurse-midwives now practice around the country.

"Midwives view birth as a positive process, rather than a medical one or an illness,' says Marion McCartney, a certified nurse-midwife and one of the "founding mothers' of the Maternity Center. "Most of the time, women bear fine, healthy babies. We have for ages.'

Marion has been a midwife for about 10 years; but, she says, "I've been interested in obstetrics for as long as I can remember,' While working as a nurse's aide when she was in high school, she witnessed her first birth. As a certified nurse-midwife, she has assisted at more than 600.

After earning her bachelor's degree in nursing from Catholic University, she taught childbirth classes for a year and then worked for an obstetrician who performed home births. This experience sparked her interest in midwifery and prompted her to enroll in the midwifery program at Georgetown University. At the time, Georgetown offered a 9-month certificate program in midwifery. The program has since expanded to a master's program in nurse-midwifery.

After completion of her studies and certification by the American College of Nurse-Midwives, she worked for about a year in a hospital-based midwifery program. Then she and another midwife opened the Maternity Center. They had planned on having a part-time practice, but business boomed. Today, five certified nurse-midwives work at the Center.

To become certified, a nurse-midwife must meet standards established by the ACNM: A person must be a registered nurse, graduate from an educational program accredited by the ACNM, and pass the College's National Certification Examination.

Basic nurse-midwifery education may be obtained through a variety of programs: Certificate, master's degree, or combined RN/Master of Science. A spokesperson for the ACNM says that most nurse-midwives get their education either through a certificate program or a master's program. Most candidates have extensive experience in maternity or public health nursing prior to matriculation.

The structure of each program depends upon the institution where it is offered. But all emphasize instruction in certain "core competencies'--prenatal care; labor and delivery; postpartum care; and family planning/well woman gynecology.

Nurse-midwives practice in a variety of settings. Many work in hospitals, clinics, and health maintenance organizations. Some are in private practice. Others work in birthing centers like the Maternity Center. Wherever they practice, they are part of a team, working with physicians and other health professionals.

Midwives work with women who can expect a normal, healthy birth. They do not manage the care of women with major medical or obstetrical problems. Should any problem or complication arise while a woman is under a midwife's care, a physician is called in. In order to practice, a midwife must have agreements, called protocols, with a physician; these establish mechanisms for consultation and referral should problems occur.

Until about 1940, the majority of births in this country took place in the home. About one-fifth of these births were attended by midwives and the rest by physicians. Over the next 30 years, things changed. By 1970, only about 1 percent of all births occurred outside a hospital and, of the nearly 3.5 million children born that year, almost all were delivered by physicians.

In the last decade, some women and their families began to seek alternatives to hospital births. Some believed that the hospital setting contributed to the tendency to see birth as an illness rather than a natural process. Additionally, some decried the separation of a woman from her family at one of life's most joyous moments. In response, the natural childbirth movement arose and continues to grow. And midwives are playing an important role. In 1983, more than 100,000 babies, or nearly 3 percent of the year's total births, were delivered by midwives.

The Old English root of midwife means "with woman.' This simple phrase applies, to the modern practice of midwifery, for today's nurse-midwife is with her patient in the fullest sense of the word. Midwives provide the same care and testing that physicians do. But beyond medical care, midwives offer personal support and education. "We recognize that birth is one of the central events in a family's life,' says McCartney. She continues, "Women appreciate the teaching role of the midwife and the chance to talk over their concerns and problems. We are here to listen.'

From the start, patients at the Maternity Center take an active role in managing their pregnancy. "We emphasize taking care of yourself, getting yourself ready, and not depending upon last-minute intervention.' Each woman carefully reviews her own medical records and in encouraged to ask questions. Childbirth classes play an important role in preparation. "We insist that everyone participate in childbirth classes,' says McCartney.

During the course of her pregnancy, a woman will consult with all the Center's midwives so that when delivery day arrives she will have established rapport with whichever midwife is on call. "We maintain a fairly intricate schedule so that we can have as normal a life as possible. There is a lot of burnout in obstetrics,' she says.

Women have the option of delivering in their own home or in the Center. Most choose the Center.

Located in a townhouse on the outskirts of Washington, D.C., the Center seems more like a home than a medical facility. That's just the atmosphere the midwives wish to convey. But a few things point out the difference.

As you enter, what first catches your eye is a small sign that admonishes, "No Smoking--Fetal Growth in Progress,' Next your gaze shifts to a wall laden with diplomas and certificates, testimony to professional preparation and recognition. As you move to sit down, you must step nimbly to negotiate an obstacle course of stuffed animals, plastic toys, and little people playing with them.

The upstairs resembles a home. There are three bedrooms, a family room, and a bathroom. The bedrooms are birthing rooms. Emergency medical equipment is handy but out of sight. Everything is designed to be as natural as possible.

When a woman begins labor, she'll notify the Center that she's on the way in. When she arrives, "We do what is necessary in each case,' says McCartney. "We follow no routines.' Natural childbirth, with minimal intervention and little or no use of pain medication, is the goal.

The woman's husband, or whoever is acting as the childbirth coach, is present, and, says McCartney, "anyone else the family wishes to attend.' Sometimes the birthing room will be filled with parents, grandparents, and children. The central role of the family is always emphasized.

At birth, the mother usually nurses immediately. Then the midwife will examine mother and child. In 6 hours or so, the mother is usually showered and out the door. "We try to get the new mother up and around as soon as possible.'

The next day, mother and child return to the Center. The nurse-midwife will check on her patient, and a pediatrician will examine the baby. Followup visits are scheduled at 2 weeks, 6 weeks, 6 months, and a year.

While midwifery care focuses upon pregnancy and delivery, more and more women are beginning to visit nurse-midwives for basic gynecological care. This care includes normal testing, such as breast exams and Pap smears. These visits are increasing for the same reasons that midwifery practice is growing generally--the combination of personal and professional care that midwives provide for their patients.

A framed cartoon sits on a corner table in the reception room of the Maternity Center. Two witches, broomsticks at the ready, are talking beside a bubbling cauldron. "I love the profession,' says one, "but, after all these years, I'm still not used to night work.' McCartney agrees smilingly. "The nights are the worst part of the job,' she says. Babies respect no one's schedule but their own.

Money is rarely an incentive for midwives. "If I wanted to make a lot of money, I would have gone to law school,' she jokes. The average salary isn't bad, though. A spokesperson for the ACNM estimates a national average of $25,000.

The principal compensation is the work itself, welcoming new life into the world. "It's just a very, very positive experience.'

For more information on nurse-midwifery, write

American College of Nurse-Midwives

1522 K Street NW,

Suite 1120

Washington, D.C. 20005.
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Author:Stanton, Michael
Publication:Occupational Outlook Quarterly
Date:Mar 22, 1986
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