Present in hospitals, birthing centers and at-home births, nurse-midwives conduct primary care services to monitor mothers' health during pregnancy, at birth and during postpartum. Independent practitioners, they also direct healthcare and educational services for women from puberty through menopause.

"Many people think that we only 'catch babies' by assisting mothers at birth," said Leah Albers, DrPH, CNM, professor, University New Mexico College School of Nursing, Albuquerque, NM.

"It's true that we are a part of the miracle of birth - and that is a privilege," said Albers, who has been teaching nurse-midwives for 17 years. "[But] we provide many services, with our strong focus being to prepare women for parenthood and teach them about preventative healthcare and health maintenance issues, because this education will assist women to lead healthy, productive lives."

The decision to refer women to medical specialists depends on how patients are responding to treatments, said Mairi Breen Rothman, MSN, CNM, professional services consultant for the American College of Nurse-Midwives. 

"Pregnancy and birth are not diseases and the act of birth does not require a medical procedure," she said. "Nurse-midwives help women to find their way through the incredible journey of birth through our physical, mental and emotional support. We have been instrumental in giving good labor support that can prevent the need for C-sections."

Multicultural Services

In addition to her association duties, Rothman is a per-diem nurse-midwife at Maryland General Hospital in Baltimore, and co-owner of the Baltimore based Metro Area Midwives and Allied Services (MOMMAS).  

"MOMMAS serves a bilingual Latino immigrant population, and we attend women at home births," she said. "It is safer for low-risk moms to deliver at home, and recent studies show 90 percent of moms achieve more positive birth results when their babies are delivered at home." 

In New Mexico, only 38 percent of New Mexico babies are delivered in hospitals; the rest are delivered by nurse-midwives at home or at birth centers," Albers added. Forty-three percent of the state's population is Hispanic and 11 percent are American Indian, she said.

Back to the Future

During the early 20th century, the majority of babies were born at home with only 1 percent born at hospitals. By the 1930s, 50 percent of babies were born in hospitals.

"This societal move created a specialty called obstetrics that produced sky rocketing rates of C-sections, "said Nancy Walters Harman, CNM, an independent nurse-midwife who runs Birthwise of Central North Carolina, a home birth midwife service. 

More than $2.5 billion is spent annually on unnecessary C-sections according to a report from the Milbank Memorial Fund, the Reforming States Group of government health policy leaders and Childbirth Connection, a research and advocacy group that recommends hospitals trim spiraling costs by hiring doulas to work in the maternity care departments.¹ 

The preference for home birth deliveries resurfaced in California during the 1970s and continues to grow in popularity nationally, Harmon pointed out. "That's because nurse-midwives don't put mothers on clocks; rather we allow the birth process to unfold as nature intended, she said. "Home birth assist by nurse-midwives is a high touch, wellness model of care."

Harman often works with doulas, certified maternal message therapists who provide massage and position changes during labor and the birth process, in addition to other services. "They are neonatal and CPR certified, and other pairs of helping hands," she said.