Special Deliveries: Certified Nurse-Midwifery Programs Lacking in New England

With Boston serving as a hub of both educational and medical excellence, it’s no wonder that New England has a high reputation to uphold in both of these areas. However, Boston and the rest of the region lack a specific degree program that is putting New England below the radars of potential midwives.

Certified nurse-midwifery is a popular field with registered nurses seeking higher education who wish to have a larger role in managing prenatal patient care than they would as labor and delivery nurses. Expectant mothers are also showing interest in using the midwife model for a more holistic method of perinatal care than they might get with the traditional obstetric approach. There has been extensive research done showing the benefits of the midwife model of care. Notably, the Cochrane Pregnancy and Childbirth Group published its report “Midwife-led Versus Other Models of Care for Childbearing Women” that noted promising outcomes of midwife care, concluding that most women should at the very least be offered the choice of the midwife model.

But New England, home to more than 250 colleges and universities, offers this degree in only two places: a satellite program at Baystate Medical Center in Springfield, Mass. (in which the degree-granting institution is Philadelphia University) and Yale University. With the nation focused intensely on the cost of healthcare, it would be beneficial for New England to train and employ nurse-midwives, who have proven to provide clinically competent perinatal care to women at a lower price. According to the American College of Nurse Midwives’ 2012 report “A Summary of Research on Certified Nurse Midwives in the United States,” the philosophy of midwives to use more touch than technology results in the same healthy outcomes for low-risk women in labor with fewer expensive medical interventions and an overall lower cost.

Leslie Ludka, MSN, CNM, director of midwifery at Cambridge Health Alliance in Cambridge, Mass., and former senior practice advisor for the American College of Nurse-Midwives (ACNM) believes that midwives are a major part of the solution to healthcare reform. “Midwives have been practicing healthcare reform since the beginning,” she noted. “Our hallmarks include a dedication to patient education, which leads to better overall patient health. In addition, although high-cost equipment is readily available today, midwives are taught to use less-costly methods to gather the same important information.”

Moreover, the goals of midwifery care, as defined by the ACNM, include honoring the normalcy of women’s healthcare and providing minimal intervention when intervention is not warranted In contrast, nearly a third of all births in the U.S. end in Cesarean section, adding more than $2.5 billion to the cost annually, according to “Evidenced-Based Maternity Care,” a 2008 from the Milbank Memorial Fund.

So why don’t New England’s colleges and universities see the potential in educating certified nurse-midwives? If there’s interest and support from the midwifery community, it seems like the decision would be an easy one. Unfortunately, programs in the region have found that it’s not that simple. The University of Rhode Island initiated a certified nurse-midwifery program in 1993, but despite student interest, a strong faculty, and exceptional community support from midwives in the area, budget cuts throughout higher education resulted in the program’s loss of funding and as a result the program was suspended in 2007. Debra Erickson-Owens, PhD, CNM, RN, former director of the graduate program in nurse-midwifery at URI, states that there are no immediate plans to revive the program. She said that, despite the fact that the school still gets inquiries from interested students, a master’s program in nurse-midwifery is an expensive program to run and without the proper funding it just isn’t feasible.

But it’s that very degree that sets a CNM apart. According to the ACNM, a certified nurse-midwife must have two degrees: a bachelor of science in nursing and a master’s in nurse midwifery. He or she must earn a master’s degree in an accredited midwifery education program, and pass a national certification exam administered by the American Midwifery Certification Board. This differs from a certified midwife (CM) and a certified professional midwife (CPM), neither of whom are required to have a degree in nursing of any kind.

Being certified as a professional midwife is a perfectly reasonable option, but many RNs won’t choose this option, as it requires lateral as opposed to vertical movement in the healthcare field and doesn’t officially utilize their training as nurses. CNMs have the training and certification required to work in a hospital as well as home setting, a higher salary potential, and still be certified as midwives.

Nina Harris is a certified midwife and student in the Accelerated Bachelor of Science in Nursing program at Massachusetts General Hospital Institute for Health Professions. Though she established herself as a midwife, she chose to go the nursing route for a few reasons. She said that, as opposed to being a certified professional midwife, “As a CNM, you have more flexibility in where you can work, you are more accepted and empowered in the medical community, and you have more political clout. There is reciprocity anywhere you go and you can deliver midwifery care to a greater volume of women in settings where the midwifery model of care is not otherwise practiced.”

Harris also stated, “It is very hard to make a living as a CPM. I value balance in my life. I want to create a lifestyle in which I can love my work, but also have time off, and also sustain myself and my family financially.” Harris added that she would prefer to stay in New England not only because this is where her family is, but also because there is an often-overlooked population of women living in underserved communities who need care here. Nurse-midwives are directly poised to provide this kind of care if given the chance to learn and practice in the region.

However, to think that women who choose to use midwives are primarily of a lower-income status would be a misconception. In fact, there is marked diversity in the population of women who choose midwifery care over that of a physician. According to a 1998 study in Family Planning Perspectives that examined the use of midwives versus physicians in Michigan, women on Medicaid were 3.5 times more likely to use a midwife than those on private insurance. However, a college degree also increased the likelihood of a midwife-led birth among white women. And the ACNM notes that among Hispanic women, non-Hispanic white women, non-Hispanic black women and Asian or Pacific Island women, the percentage that chooses midwifery care is proportional, with a deviation of only about one to two percent between ethnicities.

There may also be a misconception that using a midwife implies giving birth at home, or without the availability of emergency intervention should the birth have complications. However, according to the ACNM, in 2009, 96% of all midwife-attended births occurred in hospitals. For the most part, it is the difference in model of care not the physical setting that women seek out when choosing a midwife over a physician.

In 2011, the ACNM published its “Midwifery Trends in Education Report” stating that it hopes to reach a goal of 1,000 certified midwives (including CNMs) by 2015. However, as of their most recent numbers, they are at 335. With 39 accredited programs in the U.S., the goal is attainable, but will need to see growth in terms of interest and accessibility. Ludka noted that, though Massachusetts has a fairly high number of employed midwives, many of them were not educated in this region. She said, “We need more midwives. We have open midwifery positions right now in Massachusetts, and two major hospitals are exploring the possibility of adding midwifery practices to their institution. Educating more midwives locally will fill those positions with midwives who are established in Massachusetts and more likely to remain.”

With a wealth of both public and private nursing programs in New England churning out qualified RNs annually, the region has the opportunity to get in on the increasing pool of CNMs and better serve the community.

Alyssa Franzosa is pursuing a bachelor’s degree in nursing at the MGH Institute of Health Professions. She is a former intern with NEJHE.

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