By Cathryn Domrose
Heather Clarke, DNP, CNM, FACNM, considers nurse midwifery as nothing less than a calling, albeit one she answered “kicking and screaming.”
Although Clarke loved labor and delivery, where she worked after getting her nursing degree, she wasn’t interested in following in the footsteps of her mother, who had been a nurse midwife in England. But she wanted to continue her education, and loved working with mothers and babies.
Clarke, now a course coordinator and faculty mentor at Frontier Nursing University in Hyden, Ky., debated between specializing in psychology or midwifery. Once she chose midwifery, she said, “the forces of the universe” seemed to fall into place. She was accepted into a program at Columbia University and received a scholarship for her education. She launched a 35-year career that has included practice in rural and urban settings — from home births to tertiary care centers — promoting nurse midwives of color, working to end health disparities and instructing and precepting nurse midwifery students.
The essence of midwifery, she tells her students, is developing strong, trusting relationships with the women and families they care for. “I try to impress upon them to tap into what it means to be ‘with women,’” Clarke said, which includes listening, nurturing, and supporting the mother’s choices throughout the pregnancy and birthing process.
In the late 1970s, when Clarke entered the specialty, nurse midwives were gaining attention as a new generation of women began turning away from the extensive drugs and technology that seemed to be the norm in U.S. hospital births, and looking for more natural ways to deliver after an uncomplicated pregnancy.
More than 40 years later, healthcare reforms emphasizing preventive care and incentives to reduce unnecessary Cesarean sections are spurring a new interest in the specialty, said Nicole Rouhana, PhD, FACNM, FNP-BC, assistant professor and director of graduate programs at Binghamton University’s Decker School of Nursing in New York. In 1989, nurse midwives attended about 3% of all births; in 2013, they attended more than 8% of all births, according to the U.S. Centers for Disease Control and Prevention. Recent studies have shown births attended by nurse midwives resulted in less use of interventions and fewer cesarean births.
For nursing students and nurses interested in specializing in nurse midwifery, Clarke and Rouhana recommend becoming licensed as a doula or volunteering in a birthing center to get exposure to “normal, healthy birth,” Rouhana said. Working in a labor and delivery unit is another way for aspiring nurse midwives to understand the experiences of laboring mothers, they said, though those jobs are highly coveted and nurses who work in those positions tend to stay in them.
Rouhana recommends undergraduate students seek out nurse midwives among the faculty and express their passion for the specialty, asking what they can do to spend more time around births. Ideally, students entering a nurse midwifery education program should have at least two years of nursing experience so they feel comfortable taking care of patients and have some confidence in their clinical skills, Rouhana said, but she recommends not waiting too long to enter the specialty.
Clarke began her practice in rural South Carolina. As a young midwife, she learned the power of patience and persistence, and of giving women choices in one of the most important events of their lives. A Mormon woman who had labored all night resisted Clarke’s suggestion to break her water until she was ready and it felt right a — decision that did not put her health or the baby’s in jeopardy, Clarke said. During a home birth Clarke attended in Philadelphia, where she later practiced, a groaning and grunting woman ordered her to the other side of the room when Clarke tried to calm her, saying, “I don’t want anybody to tell me what to do.”
“She had the most wonderful birth,” Clarke said. The experiences hammered home to her “women’s ability to get in touch with their bodies and go with the process.”
Clarke was working in a tertiary care hospital in New York when she began thinking of ways to expand her specialty. She was disturbed by what she saw as the increasing “medicalization of birth” and the fact that even with all the technology, women of color had a higher risk of poor outcomes.
She and other nurse midwives started a program to educate women about their rights and responsibilities in birth and parenting. They procured grants and opened a birth center designed to serve entire families, with education and support. The program ended in the mid-1990s when funding fell through, but Clarke continued working to improve health disparities and disparities within the profession, in which most practitioners are white women.
She has worked with programs that reach out to communities of color, urging them to consider nurse midwives not only a good care option, but also a viable career choice, partnering with organizations that train doulas and offer educational support.
Clarke also became aware of the importance of preconception care — teaching young women to take care of their bodies and minds before they became pregnant. She recently developed a preconception program for primary care providers to help African-American women identify social, environmental and medical stressors, and give them tools to address these before and during pregnancy, birth and the early years of parenthood.
She sees research about what babies need to fully develop as a key to improving outcomes. Midwives, she said, “are in a wonderful place to promote preconception healthcare and giving babies what they really need before and after they are born.”
Cathryn Domrose is a staff writer.
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