Friday, May 4, 2007

Department of Labor -

Department of Labor -

By Lynn Thorne
Thursday, February 15, 2007; 2:48 PM

Midwives attend to the smallest details in life’s biggest event

Midwife Chris Bontrager of Silver Spring will never forget her first day on the job. “I was starting my training at a hospital in Fredericksburg, and a woman was having her ninth baby. She was nine centimeters dilated when she arrived and she had the baby 30 minutes later. I thought, ‘Birth can be pretty simple sometimes.’ I didn’t even really have a chance to get nervous.”

Now 33 years old, Bontrager was a student at the time, and the experience set the stage for her future career as a certified nurse midwife.

Why midwives? For women with low-risk, uncomplicated pregnancies, these childbirth assistants are an excellent alternative to the more traditional obstetrician/gynecologist. The word “midwife” means “with woman” in Old English, and the role is exactly what you’d expect.

“We work with families to help them have the kind of birth they want, so they have more control over the experience,” said Marsha Jackson, co-director of Birthcare and Women’s Health in Alexandria. “We want it to be an empowering experience and one that solidifies the family.” The Old Town center specializes in births outside of a hospital, whether in the client’s home or at the center’s birthing facility.

Jackson has been a nurse-midwife for nearly 26 years. She said the hours are terrible but she loves her career.

“You can be called at any time. You get that phone call in the middle of the night and you think, ‘Oh, no,’” she said. “You get dressed and on your way. But once you get connected to that birth, being up all night isn’t so horrible.”

Midwives have different titles depending on their level of education. Certified nurse-midwives (CNMs) must have received a nursing degree prior to becoming a midwife. Certified midwives (CMs) don’t have previous medical training, but must study and pass certification exams to work in the field, and are currently licensed only in New York, New Jersey and Rhode Island. Midwives cannot perform Caesarian sections, but they can do nearly everything else an obstetrician would do, including fetal monitoring, and administering drugs, epidurals and episiotomies when needed. They also offer a degree of emotional comfort many doctors can’t, because they try to stay with the mother as much as possible during labor.

Midwives practice in a variety of settings. According to Rebecca Jacob of the American College of Nurse-Midwives, the oldest U.S. women’s health care organization, roughly 65 percent of its midwife members are employed by hospitals and doctor’s offices. Smaller numbers work in birth centers, in their own practices, or at universities, nonprofits, military or federally funded health centers. And they don’t just deliver babies.

“In addition to attending over 10 percent of the vaginal births in the United States, certified nurse-midwives provide primary health care for women across the life span, from adolescence through menopause,” Jacob said.

Several schools offer distance learning opportunities, but few institutions in the Washington area provide certified nurse-midwife education. The University of Maryland offers a full-time program at its Baltimore campus. To graduate, students must get 55 credit hours, which takes roughly 21 months. Wannabe baby deliverers can also attend part time.

Georgetown University also offers a degree in nurse-midwifery. It’s a 45-hour program and students can elect full- or part-time status. It includes four semesters spent in a clinical setting to give students hands-on experience in hospitals, birth centers, public health clinics and private practices.

The school also offers a type of fast-track program for students who don’t have a bachelor’s degree in nursing. Often called a “direct entry” or “graduate entry program,” they are typically three years and begin with an accelerated nursing program followed

by the midwifery program. Once they graduate, students are eligible to take the American Midwifery Certification Board’s national certification exam.

Classes cover topics such as gynecology and prenatal care, the roles and responsibilities of midwives and complex midwifery. At the University of Maryland, students practice delivering babies with a birth simulator, a mechanized, full-sized model of a woman that can imitate vaginal births. The machine can also imitate complications like breech birth or shoulder dystocia, in which the baby’s shoulder is lodged behind the pubic bone. It offers students valuable experience before working on live patients.

While there are more than 400 midwives practicing in the D.C. metro area, the University of Maryland’s midwifery program director Carol Snapp said the school graduates only four to eight students each year.

“The number of students is fairly stable,” she said. “The difference I’ve seen is an increase in employment opportunities over the last couple of years. Now the opportunities seem to be increasing for nurse midwives.”

The statistics prove her right. According to the U.S. Bureau of Labor Statistics, there were 5,500 practicing CNMs in 1995, and the number is projected to rise in the next few years. Why? The costs of going with an ob/gyn continue to increase, and the expenses for a certified nurse-midwife are lower by comparison, often because midwives are more successful at birthing without the use of costly drugs and other interventions. Also, birth centers and home births cost less than paying hospital fees (although the fees of midwifery are covered by insurance in most cases). And while those figures may be chalked up to the fact that midwives usually only take on low-risk pregnancies, midwifery has a record of successful births. This, in turn, encourages more mothers-to-be to seek the method.

Thirty-year-old Melody Mast, a Harrisonburg, Va., resident, is a midwifery student at a Kentucky school. She’s doing her clinical work at the Maternity Center in Bethesda. Mast said the difference between her time working in a hospital and a birth center is considerable.

“At the birthing center, it was like, ‘This is what it’s supposed to be.’ It was so natural, with low lights. The mom could do what her body needed to do. It just felt right.”

Mast said she was inspired to study midwifery after seeing how a home birth affected a close friend.

“She’d had a hard life, but working with a midwife was healing for her,” said Mast. “Birth is hard, but this was empowering.”

On Feb. 2, 2007, Mast helped deliver Rachel Deitrich’s son, Andrew. The 30-year-old Gaithersburg resident said she was pleased with her experience.

“They treated me more like a person than a patient,” Deitrich said. “I was a much more active person in the delivery process. They talked me through things, they responded to what I said and how I felt. That wouldn’t have happened in another location with an obstetrician.”

Snapp said a degree in nursing makes a good foundation for midwifery. You’ll also find it’s a good foundation for a pay raise. The U.S. Bureau of Labor and Statistics reports that, on average, the income of certified nurse-midwives will surpass the pay of a typical registered nurse. For example, in 2000, while an RN earned approximately $44,840 a year, certified nurse-midwives earned an average of $70,100. The extra schooling and training that makes independent practice possible for CNMs is responsible for the higher salary.

But if you’re considering a career in midwifery, don’t be held back by a lack of a nursing degree.

“The issue is that there are misconceptions,” Snapp said. “People think they need to have labor and delivery experience before going into nurse-midwifery. It’s very individual, the amount of experience people feel they need.”

She also said people who are committed to women’s health and the health care of both mothers and babies make excellent midwives.

“We work nights and weekends. Babies come at all hours. It’s very gratifying, but it’s very tiring work. It takes a special person to be dedicated to this career.”

Posted in National News, Birth.

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