Nurse-Midwives Labor to Dispel Stereotypes About Their Profession

It isn’t unusual for new acquaintances to express surprise when they learn that Janice Emerling is a midwife.

“The first thing they say is that they didn’t know that midwives are still around delivering babies,” Emerling said. “They think midwives were only around for their grandmothers.”

“They also think we didn’t have any formal preparation,” added Lisa Paine, another local midwife who expects to earn her doctoral degree this summer from the Johns Hopkins University School of Hygiene and Public Health. “And there’s a widespread misconception that we deliver all of our babies at home. In fact, 85% of midwife-attended births are in hospitals and 11% in birthing centers.”

Dodging old stereotypes is an occupational hazard for today’s midwives. While providing obstetrical and gynecological care for another generation of women, this new breed of skilled professionals is also working to dispel old images and to establish a sound reputation in the field of medicine.

Not Just Midwives

They are not just midwives but certified nurse-midwives. Their business cards display RN and CNM and strings of other letters indicating advanced degrees in fields ranging from public health to educational psychology to law. Their resumes list teaching posts at medical and nursing schools, policy-making positions in government and research projects in maternal and child health.

Those with law degrees might be consultants to nurse-midwives in the areas of malpractice or medical ethics. Others may work as missionaries in developing countries to help improve the care provided to mothers and babies.

Emerling started her nursing career at a Boston hospital and then worked in labor and delivery rooms at the University of Maryland Medical System Hospital for five years. She earned a master’s degree in maternal and child health and attended an 18-month midwifery school in England. She then went to Arizona for a refresher course for foreign-trained midwives.

Now she works at a Baltimore clinic providing prenatal care and family planning services and is on call to deliver babies for a colleague’s private practice every other weekend. The 35-year-old native New Yorker chairs the Maryland Chapter of the American College of Nurse-Midwives, a membership organization that sets standards for the profession through accreditation and certification.

Attained Captain’s Rank

Paine joined the Air Force at age 21 and became a midwife. In 10 years of service, she attained the rank of captain, earned a master’s degree in nurse-midwifery and taught in the Air Force midwifery program. Now 33 and a civilian, she is director of the Nurse Midwifery Service at Johns Hopkins Hospital as well as the founding chairperson of the Division of Research of the American College of Nurse-Midwives.

“Nurse-midwives need to take a greater lead in research,” Paine said. “We’ve been criticized as being too low-tech, too voodoo. We’ve been criticized for using procedures that have not been validated. We need to develop a uniform data collection instrument to document the processes and outcomes of our care.”

Paine and her partner, nurse-midwife Carolyn Gegor, have a small practice, delivering between three and five babies a month. Gegor is also a sonographer, using ultrasound visualizations to study the fetus in the uterus. She parlayed her skills in obstetrics and sonography into a specialty in fetal assessment. Now she uses ultrasound to evaluate the health of the fetus and to determine whether medical intervention--from bed rest for the mother to medication to early delivery--is needed.

The two women are also on the faculty of Johns Hopkins University School of Medicine.

Hoping for Trend

“There are not a lot of nurse-midwives involved in teaching physicians,” said Gegor, 40. “But we’re hoping it will be a trend. Midwives are the experts in normal births. Our focus is on what is normal instead of looking at what is illness.”

Impressive credentials notwithstanding, the growing popularity of midwives may be a reflection of their low-tech management of normal, healthy pregnancies and births in a world dominated by high-technology medicine. Midwives are noted for their personalized attention and the amount of time they spend with each patient, “allowing normal processes to happen” during labor and delivery, one practitioner said.

Until the 1970s, the work of the midwife was confined primarily to remote areas with very poor populations. Then consumers started looking for options in childbirth and the demand for midwife services began to rise. From 1976 to 1986, the number of nurse-midwives doubled and the total births they attended tripled.

“We’re still in the growing stages,” said Sandra Hvidsten, communications coordinator for the American College of Nurse-Midwives. And with consumers, hospitals, physicians, health maintenance organizations and clinics all demanding their services, there are more jobs than there are applicants.

Average Salary $33,000

At an average salary of $33,000, the nurse-midwife can be “very cost effective,” while also “freeing the physician to care for the high-risk patients,” Hvidsten said. Nurse-midwives have a professional association with a physician, and a patient who becomes high-risk may be transferred to the doctor’s care.

There are about 4,000 certified nurse-midwives in the United States, all registered nurses with advanced education in midwifery. They differ from lay midwives who have learned their trade either through apprenticeships or in a lay midwifery training program. It is illegal for lay midwives to practice in some states. “They are controversial,” Hvidsten said. “You don’t have a standard to compare them to.”

The United States has 24 institutions that offer accredited nurse-midwifery programs averaging from one to two years. Most offer master’s programs. There are also a few certificate and doctoral programs.

To be certified, a nurse-midwife must pass a national examination and also meet state licensing requirements. Continuing education is mandatory to keep skills up to date, Hvidsten said.