Blog | nurse midwife

Reducing Maternal Mortality: The Vital Role of Nurse Midwives

Wed, Oct 16, 2024 @ 01:24 PM

Maternal mortality remains one of the most critical public health challenges worldwide, with millions of women still facing life-threatening complications during pregnancy and childbirth. In the United States, maternal mortality rates are alarmingly high compared to other developed countries, and these numbers are disproportionately worse among Black, Indigenous, and Hispanic women. The factors contributing to maternal deaths include limited access to healthcare, inadequate prenatal care, underlying health conditions, and systemic inequities within healthcare systems. However, Nurse Midwives are emerging as key players in addressing this crisis.

Nurse Midwives are uniquely positioned to improve maternal outcomes. Their focus on providing holistic, patient-centered care is critical in preventing and managing complications, particularly for underserved communities. Here’s how they can help reduce maternal mortality rates:

Providing Comprehensive, Personalized Care

Nurse Midwives provide personalized, compassionate care that focuses on the entire woman—physically, emotionally, and socially. They take the time to build trusting relationships with patients, promoting open communication. This is particularly important for women in marginalized communities, who often face biases and discrimination in healthcare settings. By fostering trust, Midwives help ensure patients feel comfortable seeking care early and frequently during pregnancy, which is essential for identifying and managing complications.

Addressing Disparities in Healthcare Access

One of the leading contributors to maternal mortality is a lack of access to quality prenatal and postpartum care. Nurse Midwives often serve in underserved areas, such as rural communities or inner cities, where healthcare facilities may be scarce. Their ability to work in various settings—hospitals, birthing centers, and patients' homes—makes them accessible to a wider population. Furthermore, they can provide cost-effective care, which is critical for uninsured or underinsured women, ensuring financial barriers don’t prevent them from receiving life-saving interventions.

Expertise in Preventive Care and Early Intervention

Nurse Midwives emphasize preventive care and early intervention, both of which are key to reducing maternal deaths. They monitor women throughout pregnancy, helping to identify risk factors such as preeclampsia, gestational diabetes, or infections that could lead to severe complications if untreated. With their expertise, they can intervene early and either manage these conditions themselves or collaborate with Obstetricians and other specialists when necessary.

Promoting Safer Birth Practices

Nurse Midwives are strong advocates for evidence-based, low-intervention birth practices, which can significantly reduce the risk of complications during childbirth. For example, they support natural birthing methods and focus on minimizing unnecessary cesarean sections, which carry higher risks for infection, hemorrhage, and complications in future pregnancies. Their expertise allows them to balance safety with the mother’s birthing preferences, creating a safer and more empowering experience for women.

Providing Critical Postpartum Care

Postpartum care is often overlooked, yet it is a crucial period for preventing maternal deaths. Midwives are trained to provide extensive postpartum care, addressing both physical recovery and mental health. This includes monitoring for conditions like postpartum hemorrhage or infections and supporting mothers in managing the emotional challenges of the postpartum period. By continuing to provide care well beyond childbirth, Midwives can help identify and treat complications before they become life-threatening.

Advocating for Systemic Change

Beyond their clinical work, Nurse Midwives are strong advocates for healthcare reform. They are pushing for policies that improve maternal care across the board, including expanding Medicaid coverage for postpartum care, increasing access to Midwifery services, and addressing racial and socioeconomic disparities in healthcare. Their voices are essential in driving systemic change to reduce maternal mortality on a larger scale.

Nurse Midwives are crucial in the fight against maternal mortality. Their holistic, patient-centered approach to care, combined with their advocacy for systemic change, makes them invaluable in improving maternal outcomes. As we continue to seek solutions to this public health crisis, investing in and expanding access to Nurse Midwifery care is one of the most effective strategies we can employ. By empowering Nurse Midwives and supporting their efforts, we can save lives and create healthier futures for women and their families.

Topics: certified nurse midwife, nurse midwife, Maternal Mortality Rate, maternal health, maternity care, nurse midwives, maternal mortality

Lights, Camera, Louisville! Frontier's Documentary Debut - August 15th

Posted by Frontier Nursing University

Thu, Aug 01, 2024 @ 09:29 AM

We're Rolling Out the Blue Carpet

Join us on August 15th for a documentary premiere

Come and meet our new President, Dr. Brooke Flinders!

Join Frontier Nursing University at 6:00 pm for a premiere at the Speed Museum Cinema in Louisville, Ky on August 15th for a reception and viewing of Nurse-Midwives: Addressing the Maternal Health Crisis. Produced by Frontier and Michael Breeding, this new documentary examines maternal health care and the role of nurse-midwives.

Register Now!

Unable to join us for the premiere? We invite you to view the documentary at frontier.edu/documentary or sign up to host a viewing in your community!

Appetizers will be provided during the reception. Parking is available in the museum garage. Frontier will provide parking validation at the event.

“The United States has the highest maternal mortality rate among wealthy nations, and 2022 data from the CDC shows that over 80% of pregnancy-related deaths in the U. S. from 2017-2019 were preventable by providing better care,” said FNU President Dr. Susan Stone, DNSc, CNM, FACNM, FAAN. “This documentary tells the story of how distance education paved the way to addressing this crisis by educating more nurse-midwives who play a crucial role in reducing maternal mortality.”

Before the advent of online learning, a remarkable group of nurses and nurse-midwives believed that more nurses would seek certification as nurse-midwives if they could stay in their home communities during the educational process. Thus the development of the unique and innovative Community-based Nurse-Midwifery Education Program (CNEP). CNEP was developed to allow nurses who lived in rural and underserved communities access to nurse-midwifery education without leaving home. The documentary details the development and evolution of the CNEP via interviews with visionary leaders and educators. It also shines a light on the subsequent development of family nurse practitioner, women's health care nurse practitioner, and psychiatric-mental health nurse practitioner distance education programs and their similarly vital roles in maternal health care.

“The work of nurse-midwives and nurse practitioners is reshaping the landscape of 21st-century healthcare,” Dr. Stone said. “From Alaska to Alabama to Appalachia to every state in America, these amazing healthcare providers are making a difference in the rural and underserved communities in which they live and serve.”

Topics: midwife, Frontier Nursing University, nurse midwife, FNU, midwives, maternal health, maternity care

A Career As A Certified Nurse Midwife

Posted by Erica Bettencourt

Thu, Aug 18, 2022 @ 02:04 PM

GettyImages-1394920145 Certified Nurse Midwives (CNMs) are becoming more common for women and mothers across the nation.

Overall employment of Nurse Midwives is projected to grow 45% from 2020 to 2030, much faster than the average for all occupations.

If you're interested in this career path, it's beneficial to understand what CNMs do and their role in health care.

Nurse Midwives are primary health care providers for women of all ages and provide all types of gynecological, prenatal, and post-pregnancy care.

According to Mayo Clinic College of Medicine and Science, common tasks and duties include:

Confirming and dating pregnancy
Providing prenatal and postpartum care
Caring for women during childbirth including monitoring the mother and fetus during labor, assessing labor progress, managing complications, assisting with pain management, performing episiotomies if needed, and delivering the newborn and placenta
Providing education for new parents on infant care
Supporting new mothers that are breastfeeding with education and training
Preparing pregnant women for what to expect during the birthing process
Performing preventive health screenings and tests
Diagnosing and treating gynecological disorders such as sexually transmitted diseases and infertility

There are many different paths in the Midwifery field. According to Western Governors University, various roles include:

CNM: Certified Nurse-Midwives are Registered Nurses who have additional certification as a Midwife. That double licensure gives them additional opportunity and training in the medical field. Specific Midwifery education is the same for a CNM and CM.
CM: A Certified Midwife is someone who is certified as a Midwife, but doesn’t have a Registered Nursing license as well. The certification is identical for a CM and CNM, the only difference is the Registered Nursing license.
CPM: A Certified Professional Midwife is certified and must have particular experience in home-birth or out-of-hospital settings. The certification requirements are much less than that of a CM or CNM. A Midwifery program may still be involved, but often it is less detailed and intense.
Doula: Doulas are not maternity care providers, but provide informational and emotional support for a mother during childbirth. Doulas provide services to mothers while they are pregnant, during their labor and delivery, as well as after the baby is born. Some Doulas work directly for birth centers or hospitals, while others are hired directly by expecting mothers. Because Doulas don’t provide medical support, there aren’t direct legal requirements regarding their practice. Some doulas get formal training, though it’s not required.

The average CNM salary in the United States is $116,574, as reported by Salary.com.

If you’re truly interested in becoming a Nurse Midwife, start with your BSN then find a Nursing school like Frontier Nursing University (FNU) to help get you started on your journey.

FNU graduates make up nearly 40% of the nation's Midwives!

At FNU, their goal is to educate more Certified Nurse-Midwives so that Midwifery care is available to all women who seek it.

"The passion in my life—besides my own babies—is being with women as they’re growing their families and being with students as they’re growing their dreams to be with women and families … It’s a privilege to get to do what I do. I do not take it for granted. I am thankful every day," says Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM, FNU Faculty.

Topics: midwife, certified nurse midwife, nurse midwife, midwives, Midwifery

OBGYN Shortage Is Extremely Dangerous For Expecting Mothers

Posted by Pat Magrath

Thu, Aug 18, 2016 @ 11:55 AM

As our population continues to grow, there are increasing demands on our healthcare system to handle the growth in the number of babies born every year in the US. Do we have enough physicians and midwives to handle the demand for medical services? The answer is No, we don’t. If you’re in a major city, the chances of receiving good maternal healthcare increases, but for those in rural areas, it’s becoming very difficult.

This article explains the situation in our country and offers some potential ways to increase access and delivery of good maternal healthcare. What do you think about the suggestions offered? Do you have any ideas to share on this subject?

Faced with a shortage of obstetricians and gynecologists and nurse midwives, several states are considering proposals that advocates say would improve healthcare for women.

But with the female population of the United States and number of babies born here projected to increase sharply over the next decade and beyond, scholars and medical organizations say more dramatic changes are needed to ensure that the medical needs of American women are met.

One possibility: easing restrictions on nurse midwives, who attend to labor and delivery and also provide routine primary and gynecological care for women of all ages. Other steps under consideration include offering financial incentives to encourage more medical professionals to specialize in maternal health care and to encourage them to locate in regions with extreme shortages, particularly in rural areas.

“It’s very simple,” said William Rayburn, a professor of obstetrics and gynecology at the University of New Mexico who has written on maternal health issues. “Our population is continuing to grow faster than we are producing ob-gyns.”

Nearly half the counties in the U.S. don’t have a single obstetrician/gynecologist and 56 percent are without a nurse midwife, according to the American College of Nurse-Midwives (ACNM).

“There are women in California who have to drive hours in order to see an ob-gyn,” said California Assemblywoman Autumn Burke, a Democrat.

The workforce shortage can have dangerous consequences, and may help explain why a relatively high percentage of American women die as a result of pregnancy, said Eugene Declercq, a professor of community health sciences at Boston University who has studied the ob-gyn workforce.

Burke is author of a bill in the California Legislature that would remove the requirement that nurse midwives practice under the supervision of doctors, a change that supporters say would boost maternal health services in underserved areas. There is a similar effort in North Carolina, and many other states have adopted those reforms over the last decade.

As restrictions have been lifted, the numbers of nurse midwives has risen. The number of nurse midwives has grown by 30 percent since 2012, according to the Bureau of Labor Statistics. But their overall numbers remain low, with about 11,200 in the whole country. There are about 20,000 ob-gyns.

Meanwhile, the American Congress of Obstetricians and Gynecologists (ACOG) is pushing measures in the U.S. Congress that would provide financial incentives to encourage medical school graduates to go into the field.

But even that may not be enough. By ACOG’s estimate, the U.S. will have between 6,000 and 8,800 fewer ob-gyns than needed by the year 2020 and a shortage of possibly 22,000 by the year 2050.

Demographic Shifts

The number of women in the United States is expected to climb by nearly 18 percent between 2010 and 2030, and, with it, the number of births. The Centers for Disease Control and Prevention recorded 3.9 million births in 2014 and projects that number will rise steadily in the years to come, reaching about 4.2 million births a year by the year 2030.

The number of medical school graduates going into obstetrics and gynecology residency programs has remained steady since 1980, with about 1,205 residents entering the specialty each year, according to Thomas Gellhaus, ACOG’s president.

Most ob-gyns over age 55 are men. But women are almost equal in number in the 45-54 age group and outnumber men at the younger end of the profession. In 2013, more than four out of five first-year ob-gyns were women.

That’s important, Gellhaus said, because female ob-gyns retire about 10 years earlier than their male counterparts and often prefer part-time schedules.

At the same time, Gellhaus and others familiar with workforce issues say, both women and men entering the field are less inclined to make themselves available around-the-clock in the way older practitioners did.

“The traditional model was that ob-gyns made this extraordinary commitment,” said Boston University’s Declercq. “I’ll be there for you, pre-natal, delivery and post-delivery. Women patients loved it, but today’s obs are looking for a better balance in their lives and don’t want to make that kind of sacrifice in their lives and their families’ lives.”

Those shifting attitudes have given rise to the growing use of “laborists” — ob-gyns or nurse midwives who do nothing but attend labor and deliveries in the hospital. That model leaves ob-gyns with time to concentrate on other maternal health issues. More than 250 hospitals now have a laborist on staff.

Another factor is the growing number of doctors entering obstetrics and gynecology who are choosing subspecialties such as gynecologic oncology, reproductive endocrinology and infertility, and female pelvic medicine and reconstructive surgery, further reducing the number available for routine maternal preventive care and normal deliveries. According to ACNM, 7 percent of ob-gyns residents entered a subspecialty in 2000. By 2012, the percentage had grown to 19.5 percent.

To help address the shortage, ACOG and other physicians’ groups are supporting congressional proposals to increase the number of medical residencies by 15,000 positions over a five-year period, with half of those designated for medical specialties in short supply, including ob-gyns.

The federal government spends about $15 billion a year on medical residency education, most of it by way of Medicare, the health plan for the elderly, and Medicaid, the state-federal partnership health plan for lower income Americans. It now funds about 30,000 residency positions a year.

Another proposal backed by ACOG would have the federal government designate obstetrical shortage areas in the country as it currently does with primary care, mental health and dental services. That would make ob-gyns and nurse midwives eligible for financial help with their education debts from the National Health Service Corps.

At least one state, Wisconsin, has begun an initiative to address the shortage. Starting next year, the University of Wisconsin School of Medicine will designate one resident in obstetrics and gynecology who will do at least a quarter of his or her training in rural areas with too few maternal health providers.

“The goal is to give them experience in these underserved areas because residents who train in certain settings are likely to locate their practices in similar settings,” said Ellen Hartenbach, an ob-gyn professor and residency program director at the Wisconsin medical school.

The program is the first to train ob-gyns in underserved areas, she said, and it has already attracted interest from medical schools elsewhere in the country.

Bigger Role for Midwives?

Nurse midwives see themselves as part of the solution to the shortage of maternal health services, but they face some legislative hurdles if they are going to play a greater role.

Nurse midwives are registered nurses who also complete an accredited graduate school course of study in midwifery. Licensed (or its equivalent) in all 50 states, nurse midwives are trained in all areas of maternal health, usually can prescribe and administer medications, and they deliver babies, almost exclusively in hospitals or birthing centers. (Another class of midwives, called “certified professional midwives,” perform home births in the U.S., but they are licensed or statutorily authorized in only 29 states.)

In half the states, nurse midwives are permitted to practice independently.

But 25 states require them to practice under the supervision of a doctor or in collaborative arrangements with doctors. But the ACNM and its state affiliates have complained for years that many doctors are unwilling to take on midwives, denying women access to these maternal health care providers.

While ACOG opposes the restrictions on nurse midwives, other physician organizations, including the American Medical Association and many of its state affiliates, have continued to insist that doctor supervision of nurse midwives is essential to patient health.

In North Carolina, where 31 of 100 counties do not have an ob-gyn, nurse midwives must have signed supervisory agreements with a doctor in order to practice. Nurse midwives are fighting a legislative battle to remove the restrictions.

Suzanne Wertman, president of the state chapter of the ACNM, said few doctors are willing to enter into such arrangements because they regard the nurse midwives as competition or can’t afford the steep increases in their medical malpractice premiums such agreements would require.

John Thorp, Jr. a professor of obstetrics and gynecology at the University of North Carolina agreed that malpractice concerns discourage doctors from entering into those supervisory agreements with nurse midwives.

The ACNM says state Medicaid programs should pay nurse midwives at the same rate they pay doctors for performing the same services, and states should require hospitals to offer nurse midwives the same clinical and staff privileges, including hospital admitting privileges that they extend to physicians.

There is precedent for nurse midwives to play a larger role. In the U.S., physicians deliver 90 percent of the babies. But in other countries, midwives attend the majority of births. In England, for example, over half of deliveries are performed by midwiveswhile ob-gyns concentrate on patients with higher risk pregnancies.

“That model has proven to work,” Declercq said, “and it just makes sense.”

Topics: ob gyn, nurse shortage, nurse midwife

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