U.S. midwife stats
- Certified nurse-midwives and certified midwives attended 332,107 births in 2014, according to the American College of Nurse-Midwives. This represents 8.3 percent of total U.S. births.
- In 2015, there were about 11,200 certified nurse-midwives and about 100 certified midwives in the United States, according to the American Midwifery Certification Board.
- Certified nurse-midwives attended 3.3 percent of births in 1989 compared to 7.9 percent in 2012, according to the National Institutes of Health.
Why did midwives diminish in the United States?
- Midwives have been present during U.S. births since the British colonization in the early 17th century. When medicine became professionalized in the 19th century, a massive decline in midwives occurred.
- By the early 20th century, the vast majority of births occurred in hospitals under the supervision of physicians.
- Recently, the midwifery field has experienced a rise in demand for certified nurse-midwives, as they have expanded their services into hospital and birth center settings.
It’s as realistic a birthing experience as any nursing student can hope for – aside from attending an actual, live birth of course.
In the Nursing Simulation Center of Cal State Fullerton’s School of Nursing is a birthing simulation room. There, a robotic woman – her name changes every few years as incoming students vote on a new moniker – lies in an imitation hospital room with all of the signs, sights and even noises of a woman in labor.
On some days the woman is programmed to have a healthy, by-the-books birth. On other days however, things can get complicated for the CSUF nursing students assigned to deliver the faux baby.
“Certainly birth is a very special, intimate experience,” said nursing student Vanessa Domush, 35. “So I think it is very valuable to allow a student to become very comfortable with the manipulations and movements. This allows us to work through some of the emergencies that can come up without having to practice on an actual patient.”
Domush is enrolled in CSUF’s Women’s Heath Care nurse-midwife program. While midwifery may be thought of as a profession of the past, the field has been steadily rising, with the number of midwife-attended births doubling since the early 1990s.
CSUF nurse-midwife students go on to take the American Midwifery Certification Board’s national exam.
There are two types of midwives.
A licensed midwife is an individual who is licensed by the medical board to attend births.
A nurse-midwife is a registered nurse who is certified by the American Midwifery Certification Board.
The vast majority of midwives in the United States are nurse-midwives; midwifery laws and procedures vary by state.
According to the U.S. Bureau of Labor Statistics, the employment of nurse-midwives, nurse-anesthetists and nurse practitioners is projected to rise 31 percent from 2014 to 2024.
A 2015 report from the bureau indicated nurse-midwives have a median annual wage of $92,510 compared to a registered nurse’s median annual wage of $67,490.
A nurse-midwife is a healthcare professional who can independently manage the prenatal care, delivery, birth and postpartum care of a woman, as well as newborn care.
These certified nurses take a physiological approach to maternity care, opting only for surgical intervention when there is risk to the mother or child.
“We are trying to facilitate something that is natural,” Domush said.
A personalized birth experience
The rise in demand for midwives does not surprise Ruth Mielke, associate professor of nursing and coordinator of the CSUF women’s healthcare concentration.
“I think a part of it is coming from consumers actively looking for midwives because they know that they want to avoid an unnecessary cesarean and want to have choices during labor and birth such as showering, changing positions and not having continuous electronic fetal monitoring,” Mielke said.
“Women throughout history have had their babies in bed or sitting on some sort of birthing stool and not in fancy stirrups,” she said.
Mielke is a certified nursing-midwife at the Eisner Pediatric and Family Medical Center in Los Angeles. Shes estimates that she has attended more than 3,000 births in her 30 years of midwifery experience.
Prior to attending nursing school, she spent nine months assisting in a Guatemalan clinic, where she was exposed to birthing issues like prolonged labor and fetal malpositions that would normally require surgical intervention.
“…interestingly, I saw that most women birthed very well and just needed some support and guidance,” Mielke said.
The experience led to her interest in midwifery.
“We are experts with regards to the normalcy of birth; that means trusting that it typically goes well but also identifying signals that mean we need a consultant, whether it’s that we need help as it’s getting too complicated and even need an obstetrician to step in and do a cesarean,” Mielke said.
She’s very careful not to disregard obstetricians and their significance in the maternity and childbirth fields; in fact, Mielke thinks midwives and physicians can learn from each other by working together.
“Physicians are our collaborators; we need them,” Mielke said. “And in the practices where we are working together, they need us.”
While growing in popularity, the midwifery field faces a number of obstacles.
A common misconception about midwives is that they only deliver babies at home; throughout the United States, midwives attend births at home, hospitals and birth centers, Mielke said.
Many also are not aware that large hospital groups – such as Kaiser Permanente – offer midwife services.
The work and skill sets needed to be a midwife are also oftentimes disregarded, said Domush.
“I would say the biggest misconceptions are that we are not educated, that midwives are people who go out into the back country and deliver babies,” Domush said. “In fact we are very educated and have a lot of experience and education behind our degrees; most people don’t even realize we have a degree.”
Through CSUF’s partnerships with local healthcare institutions like Kaiser Permanente and Eisner Pediatric and Family Medical Center, midwife students are able to complete their 1,000 required clinical service hours at facilities that provide them with real-life training situations.
While assisting in births is a core component of the job, it’s not all it entails. Nurse-midwives specialize in providing healthcare throughout a woman’s entire life.
This can include prenatal care, postpartum care, routine exams, biopsies and prescription needs.
“Many women never have a baby but they still have women-specific gynecology needs,” Mielke said. “And those needs get more complex sometimes after they get into menopause.”
CSUF midwifery program offers options for nursing students
The CSUF Women’s Health Care nurse practitioner and nurse-midwife emphases were founded in 2003 by nursing professor emeritus B.J. Snell. The program received accreditation by the American College of Nurse-Midwives in 2004.
CSUF is among three universities in the state that offer nurse-midwifery education programs; about 40 universities throughout the United States offer similar programs.
With the growth of midwife programs throughout the United States, Mielke hopes the number of cesarean deliveries in the country will drop, especially in California, where according to the California Health Care Foundation, one-third of babies born in the state are delivered via surgical measures.
The rise in midwives also means less money spent. Vaginal births cost approximately 50 percent less than cesarean births because of the absence of technological features and surgical procedures.
Midwifery services can also be the answer to maternity and women’s healthcare in rural areas, Mielke said.
The School of Nursing is contemplating creating a student-run women’s healthcare program in California’s rural communities.
Mielke is also considering expanding the course online.
“I see that there is a benefit to exploring at least an online presence just because I feel that there are probably registered nurses with an interest in midwifery,” she said. “There are national (programs) and there are private universities that run online programs and they’re very popular, but they’re not cheap.”
Since its launch, about 120 students have graduated from the CSUF nurse-midwife program.
The School of Nursing is currently only able to accept 12 to 15 applicants annually, although it receives nearly five times the number of applications. In the coming years, Mielke hopes to expand the program through grants.
The program offers its students three-year and two-year course options.