The Ebers Papyrus, a medical document from ancient Egypt believed to have been written around 1500 BC, is one of the earliest records of midwifery as an occupation. It describes obstetrical procedures and even offers the following “prescription” for birth control: “Smear a paste of dates, acacia, and honey to wool and apply as a pessary.”
Century after century and across all cultures, midwives have supported women through childbirth. Even into modern times, as recently as the early 20th century, midwives attended most births as the main obstetrical practitioner.
My great grandmother delivered babies in Warren County, Georgia in the early 1900s. Family lore says that she would show up at the home of the mother-to-be a week or so before the due date. She would cook, help get things ready for the new baby, keep an eye on older siblings, deliver the baby, stay a day or two to get mom and baby settled and ensure that things like breastfeeding were on target before heading home to her own family.
By the mid-20th century, home births were on the wane and more and more mothers headed to the hospital to deliver via the skilled hands of a physician.
But the times are changing (again) and the number of babies delivered by midwives has skyrocketed in the past couple of decades.
Laurie Braswell, CNM, MSN began her career in medicine as a labor and delivery nurse at Northside Hospital in 1982. She says, “At the time there were no nurse midwives at Northside. There was a small group at West Paces Ferry and at Grady.”
A chance meeting with a group of midwives led Braswell to apply to Emory for her Master’s degree in midwifery; she applied and was quickly accepted.
When she graduated in 1988, she worked for a year and a half at Grady. Then she returned to Northside. She says, “I was the third, maybe fourth midwife at Northside.”
“Today,” she exclaims, “I estimate there are at least 60 nurse midwives at Northside. Isn’t that amazing?”
In fact, the practice of midwifery has grown so much that according to statistics provided by Northside Hospital, a Certified Nurse Midwife (CNM) handled 41% of all vaginal deliveries at the hospital last year.
Braswell says that early in her career as a nurse midwife, she had to do a fair amount of education with her patients. She says, “I had to completely educate them on what a nurse midwife does.”
Many patients were still under the impression that a delivery involving a nurse midwife was the same as it had been decades before with the birth taking place at home.
Most certified nurse midwives deliver in the hospital because a CNM has to be affiliated with a physician. Braswell says that if a physician is willing to support the CNM doing home deliveries, they most certainly can. However, she says that most CNMs aren’t willing to accept the liability.
Braswell adds that she has one colleague who specializes in home deliveries within the Amish community in Pennsylvania, but for the most part, she and her colleagues deliver at the hospital.
Generally speaking, lay midwives also known as direct-entry midwives, are the ones most closely associated with home births. However, Braswell says the practice of midwifery by direct-entry midwives is unlawful in the State of Georgia because it is considered the practice of medicine without a license. Certification by the Department of Human Resources is required by law and in Georgia, that certification is not available.
Braswell says that today, most patients are fairly savvy about the role of a CNM in the pregnancy and birth experience because the number of people utilizing their services has exploded.
Only 2% of area CNMs are male, so it’s safe to assume that midwifery is still an occupation dominated by women. Braswell does point out that the men she knows who are CNMs are competent and compassionate.
Still, most expectant mothers prefer that woman-to-woman bond.
Braswell attributes some of this to the fact that women just intuitively know what the process is like and she feels that patients select a CNM in particular because the “focus” is a little different from that of a physician.
“Of course,” she says, “Healthy mother, healthy baby is always the number one goal for physicians and midwives.”
However, she feels that a physician is trained to “fix” things. She says, “They are looking at how to fix things that go wrong. Midwives are trained to look at it a little differently. We’re more focused on the woman, the family, the birth.”
For example, she says a physician might be more apt to hurry a labor with Pitocin or to offer pain medication because they don’t want to see their patient hurting. A midwife, on the other hand, tends to be more willing to let the natural process unfold according to the mother’s wishes while looking ahead to make sure mom and baby are safe.
Braswell refers to OB/GYN as a happy specialty. She says that most patients are healthy and the birth of a child is a welcome event. However, she does feel that it is best to practice as an RN for a while before pursuing a master’s degree to become a CNM.
She says that it is certainly easier to go straight through school to obtain the Master’s degree and she understands that it’s not always easy or financially possible to work for a while and then return to school. However, she thinks that it’s important to understand just what is involved in being a CNM.
For one thing, the hours can be brutal and it can be physically exhausting. Newborn babies are notorious for showing up in the wee hours of the morning and getting a mother through a safe delivery can require physical stamina including getting down on the floor with the mom if that helps ease labor pain to literally supporting the mother as she walks, sits on a birthing ball or gets in and out of the tub or shower.
It is also an emotionally demanding job. The nurse midwife is a confidant, a counselor and a cheerleader in addition to being the medical professional supervising the pregnancy and the labor and delivery.
In fact, the relationship between midwife and patient can be profound; Braswell says she has delivered multiple babies for certain patients and is at the point in her career where she is starting to deliver the babies of some of her “babies,” offering a second generation the benefit of her skill, expertise, compassion and sunny disposition.
The Nell Hodgson School of Nursing at Emory offers a CNM program training students to not only manage pregnancy, labor and delivery and the care of newborns, but to attend to a woman’s primary healthcare and gynecological needs throughout her life.
Since 1977, 370 students have graduated from this program.
For more information on this program, visit: http://www.nursing.emory.edu/admission-and-aid/msn-programs/nurse-midwifery.html
