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The 21st Century Nurse-Midwife: Different Than You Might Think

VERSAILLES In 2019, a nurse-midwife’s full scope of practice includes primary care, family planning services, care for mother and baby during pregnancy, childbirth, and postpartum, newborn care up to 28 days of life, and treatment of male partners for sexually transmitted infections.

Midwifery care can decrease the cost of healthcare while increasing positive health outcomes for mothers and babies by improving maternal and infant mortality rates. Nurse-midwives can be agents of change in the lives of their individual patients and in healthcare.

The number of nurse-midwives in the US and in Kentucky continues to increase as they fill the need for prenatal and childbirth care among the population of women who, for a variety of reasons, choose midwifery. According to the American Midwifery Certification Board, as of August 2017, there are 11,826 certified nurse-midwives and 101 certified midwives in the US.

Innovators in Kentucky

Frontier Nursing University (FNU), founded in Appalachian Kentucky in 1939 by pioneer Mary Breckinridge, has provided 80 years of nursing and midwifery education. The rural midwifery school has evolved into an accredited university and now offers master of science in nursing degrees or post-graduate certificates with concentrations in nurse-midwifery, family nurse practitioner, women’s health care nurse practitioner, and psychiatric-mental health nurse practitioner. FNU also offers a doctor of nursing practice degree.

Students from across the US and internationally are enrolled at FNU through a distance curriculum. FNU is consistently listed among the Top 100 Best Nursing Schools in U.S. News & World Reports. Each graduate completes a didactic course program and a clinical study experience in their home community. FNU has over 6,000 graduates with a current enrollment of more than 2,000 nursing students.

“Nurse-midwives are educated and trained to care for women across the lifespan.”— Tonya Nicholson

The Miracle of Birth and Women’s Health through Midwifery

Tonya B Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM, associate dean of midwifery and women’s health at Frontier Nursing University

A nurse-midwife is an advanced practice nurse, APRN, who specializes in primary health care services for women from adolescence to menopause and beyond. The entry level to practice requires a master’s degree and many nurse-midwives are doctorally prepared. “Nurse-midwives are educated and trained to care for women across the lifespan,” says Tonya B. Nicholson, DNP, CNM, and associate dean of midwifery and women’s health at FNU. “We do basic primary care for women, as well as gynecologic care, pregnancy care, and labor, birth, and newborn care. There’s an old quote that a midwife should have a lady’s hand, a hawk’s eye, and a lion’s heart. It is part of our work to bring gentleness, watchfulness, and courage to the women that we serve.”

Certified nurse-midwives attend births in a variety of settings. According to the American College of Nurse-Midwives, over 90% of the births that nurse-midwives attend occur in hospitals. A small percent of births take place in birth centers or private homes. Many nurse-midwives find work in private practices, clinics, birth centers, and hospitals to best serve the needs of women in their communities.

Understanding the Responsibilities. Dealing with the Highs and Lows.

Going to work each day is anything but routine for Nicholson. “I participate in some of the most important, vulnerable, and yet strongest times in a woman’s life,” explains the longtime nurse-midwife. “The emotional connection is huge. One of the most transformational experiences in a woman’s life is becoming a mother.”

Nicholson says that while childbirth is typically a happy time, that’s not always the case. “Everybody expects the experience and the outcome to be perfect, and the vast majority of the time that is the reality. Yet the human experience is not perfect. There are those rare genetic errors, occasional systems failures, and errors in judgment,” she states.

“I participate in some of the most important, vulnerable and yet, strongest times in a woman’s life. The emotional connection is huge.”— Tonya Nicholson

“Labor and birth are awesome and wonderful so much of the time that when there is a bad outcome, it’s horrible for everyone involved. Along with the joy of birth, there is the potential for grief. We share in the grief of the family when there is a loss. Our hearts break alongside theirs.”

The New Reality in Prenatal Care

Collaborating with OB-GYNs and other trained providers is part of the nurse-midwife paradigm. According to a 2016 Ob Hospitalist Group article by Kristine Harvigsen, the American College of Obstetricians and Gynecologists projects an 18% shortage of OB-GYNs by 2030. Many OB-GYN doctors are now only practicing gynecology. Almost half of the counties in the US do not have a single OB-GYN provider. “The advancing gap in OB workforce and perinatal care access must be addressed,” and nurse-midwives must be considered “part of the solution,” writes Harvigsen.

A passion for midwifery is also essential because midwifery is not for the weak of heart, says Nicholson. “Even on the busiest, craziest weekend, with one baby after another, I’m so excited and energized. Not for one second have I regretted choosing something that is so beautifully hard and so beautifully wonderful.”