Backgrounds of CNMs/CMs Rich in Diversity

A career in midwifery offers an individual diversity and independence in practice and attracts prospective students from all walks of life. America's certified nurse-midwives (CNMs) and certifed midwives (CMs) are former elementary school teachers, writers, missionaries, general practice nurses, etc. They mirror today's society--rich in diversity. However, they all share a deep commitment to bettering maternal and child health, not only in this country but throughout the world. Today's CNMs and CMs provide personal, family-centered, understanding care in many different practice settings. CNMs and CMs are highly skilled health professionals who are able to draw on the vast resources of modern science to give women the best care possible no matter where the practice setting.

Hospitals

According to a 1990 survey by the American College of Nurse-Midwives (ACNM), 23.2% of CNMs/CMs are employed by hospitals: either public, private, university or military. In addition, almost 95% of births attended by CNMs/CMs were in hospitals. The roles they play in such a setting vary greatly--from intrapartum care only to prenatal care to well-woman care to full scope care. The most recent innovation in hospital obstetrics is the creation of labor and delivery rooms that provide a more comfortable atmosphere for deliveries. Added features include showers or jacuzzis to ease labor and more privacy to begin breastfeeding.

Working in a hospital is a wonderful set up for CNMs who like practicing with physicians always around. If we ever need doctors, they're only a page away. My particular hospital is a teaching hospital, which gives me the best of both worlds. In addition to seeing my own patients, I also have the opportunity to teach medical students. Because every medical student here learns how to do a pelvic exam from a certified nurse-midwife instructor, we take great delight in knowing that we're making a difference in how the future medical community will view and treat the importance of nurse-midwifery as well as individual CNMs. I see the growing acceptance of nurse-midwifery by students and residents.

Barbara Orza, CNM, University of Oklahoma School of Medicine Health Sciences Ctr., Oklahoma City, OK

Health Maintenance Organizations and Managed Care

With the advent of Health Maintenance Organizations (HMOs) 20 years ago, the managed health care system was initiated. Today, Preferred Provider Organizations (PPOs) and Independent Practice Associations (IPAs) have been added to the health plans that offer a variety of capitated payment systems through provider networks set up by insurance companies and employers to control soaring healthcare costs. CNMs/CMs are being employed by these managed care medical facilities, primarily in HMOs. CNMs/CMs have proven themselves as cost-effective, quality healthcare providers for OB/GYN care and family planning. In 1992, Kaiser Permanente, a California HMO, reported CNMs managed 70% of the low-risk patients and had lowered the C-section rate to 12%, compared to the national average of 23.5%.

I really didn't know much about nurse-midwifery until after I had my own children. I was working as a nurse in many different areas...Then, I had children. My birth experiences were absolutely wonderful and, consequently, changed my career outlook...So I decided midwifery was the answer for me. As a CNM, I have considerably more opportunity to effect change...An HMO is like a whole health care community or family. Patients can come to our facility for any problem under the sun and we'll have the specialists and means to treat them...I never have a problem finding someone to discuss various aspects of a case or finding someone I trust to refer my patients to, either for high-risk obstetrics or a completely unrelated problem. Furthermore, HMOs allow me the opportunity to build long-term relationships with clients.

Lisa Wachholz is a staff CNM at Physicians Plus, an HMO in Madison, WI.

Private Practices

A large number of CNMs/CMs work in private practices. These practices include: private OB/GYN practices with physicians, private all-CNM/CM practices, freestanding birth centers and home birth practices. CNMs/CMs seek to work in private practice for more independence, less bureaucracy and institutional rules, allowing them to empower their patients in making healthcare decisions.

I feel working in a private practice with a physician creates a perfectly balanced setting...I am able to be my own boss and practice in the way I want. Because I don't feel providing health care and birthing babies is a "business," I don't run my practice as one. Too many health care "businesses" forget their objective: caring for people...Working with a physician is not only rewarding and convenient for me, but also my patients. I have developed a strong relationship with my partner physician...He knows what kind of care I've been giving to those patients I refer him, and I know what kind of treatment they're going to receive from him--the best.

Pady Dusing, CNM, practices with Dr. Birky, Kalispell, MT

Birth Centers

CNM/CM care in birth centers to date indicates that birth centers result in financial savings, are well-liked by women and families, who generally return for care in subsequent pregnancies, and, with application of recommended criteria and standards for operation, are as safe for normal childbirth as short-stay and conventional hospital care. When CNMs/CMs are asked, "Why a birth center?" the general response is, "So that I can provide the kind of care that healthy women and childbearing families need and want."

Before I became a certified nurse-midwife, I worked as an OB/GYN nurse-practitioner. As a nurse-practitioner I had a great deal of independence, but I was unable to provide continuity of care...I wanted to deliver my patients who I had given prenatal care to and developed a relationship with. So, I enrolled in the University of Pennsylvania's nurse-midwifery program and here I am now--delivering babies...The biggest advantage of working in a birth center is that I don't have to adhere to any institutional guidelines other than those designed to insure my patients' safety...In our birth center, women have control over their environment at a time when they have no control over their body.

Amy Levi, CNM, The Birth Center, a freestanding birth center in Bryn Mawr, PA.

Clinics

Public health clinics--both independent clinics and those associated with a hospital--have long served as facilities that specifically cater to the needs of indigent and underserved populations. Since the beginning of nurse-midwifery in the U.S., CNMs/CMs have been dedicated to providing care to less fortunate women. Today CNMs/CMs in all types of practices are providing care to women from populations that are vulnerable to poorer than average outcomes of childbirth because of age, socioeconomic status, refugee status, and ethnicity. A study on vulnerable populations published in the Journal of Nurse-Midwifery concluded that CNMs/CMs, as a group, make a major contribution to the care of vulnerable populations.

Part of my practice is devoted to Lincoln Hospital's satellite clinics. In both the hospital and the clinics, I care for a great number of adolescents. Because of their youth, they require very personalized, education-oriented care--the kind of care I am able to give them in our clinics. I have always enjoyed the health promotion aspect of my profession, and in my situation, I am able to see results and make a difference. I find pregnant women to be very receptive to education. We try to get their families and boyfriends involved in the educational process, too. The combination of the educational philosophy and family involvement really works to make the woman's childbirth experience comfortable and, more importantly, successful.

Mary Widhalm, CNM, Lincoln Hospital Midwifery Practice, New York City

Home Birth

CNM/CM assisted home birth assures that women will have access to needed technology if required. Home births attended by CNMs/CMs meet the needs of many childbearing families for more personalized care in which the woman retains control while the CNM/CM insures the patient's safety and provides emotional support during birth.

I became interested in midwifery through gathering information on birth options. I soon found my niche in home births. Being self-employed has always been a dream of mine. When I became a nurse-midwife, my dream became a reality. It's wonderful being a home birth midwife! One has to have excellent skills and lots of self-confidence in order to function in the home setting. The relationship with my consulting physicians is truly collegial, with mutual respect. Home birth clients are generally very motivated and well informed people. The most wonderful aspect of home birth is helping clients give birth on their own "turf"! The client and midwife have a shared responsibility for the birth. Therefore, the client and her family have more control and are secure in knowing that their birth attendant is a highly skilled and sensitive person who will take an active role in helping them accomplish their birth plans.

Marsha Jackson, CNM, Co-Director of BirthCare & Women's Health, Alexandria, VA

International Health

Before nurse-midwifery was widely recognized and accepted in the U.S., a great number of nurse-midwives focused their energies on the betterment of maternal-child health worldwide. ACNM established its Special Projects Section to accommodate the demand for CNMs/CMs to be involved in international projects, as more and more international health organizations are funding projects for nurse-midwives.

Before I became a certified nurse-midwife, I worked in many different fields and obtained many different educational degrees...I always had an interest in health, especially public and international health, but during my time in the Peace Corps I developed a deep interest in maternal and child health...Thus, when I returned to the United States, I looked into nurse-midwifery, for it would allow me more freedom in doing the kind of work with women and children that I wanted to do...In international health, much of the work benefits underprivileged women. I get so much satisfaction out of getting health care services out to women who can't afford it or who are geographically disadvantaged. I also find it particularly exciting to work with the local people and learn their culture.

Gail Allison, CNM, Oakland, CA, recently returned from Nigeria, where she worked for the Special Projects Section of the American College of Nurse-Midwives.

Uniformed Services

Certified nurse-midwives (CNMs) in the Uniformed Services provide family-centered care and essential support within the military community and to those in need at home and abroad.  Click HERE to view ACNM's Gallery of CNMs in the Uniformed Services.