Getting Ahead

Department of Labor

Student midwives take turns cutting the umbilical cord of a newborn mannequin.
Student midwives take turns cutting the umbilical cord of a newborn mannequin. (Michelle Repiso -- Express)
By Lynn Thorne
Thursday, February 15, 2007; 2:48 PM

Midwives attend to the smallest details in life's biggest event

Midwife Chris Bontrager of Silver Spring will never forget her first day on the job. "I was starting my training at a hospital in Fredericksburg, and a woman was having her ninth baby. She was nine centimeters dilated when she arrived and she had the baby 30 minutes later. I thought, 'Birth can be pretty simple sometimes.' I didn't even really have a chance to get nervous."

Now 33 years old, Bontrager was a student at the time, and the experience set the stage for her future career as a certified nurse midwife.

Why midwives? For women with low-risk, uncomplicated pregnancies, these childbirth assistants are an excellent alternative to the more traditional obstetrician/gynecologist. The word "midwife" means "with woman" in Old English, and the role is exactly what you'd expect.

"We work with families to help them have the kind of birth they want, so they have more control over the experience," said Marsha Jackson, co-director of Birthcare and Women's Health in Alexandria. "We want it to be an empowering experience and one that solidifies the family." The Old Town center specializes in births outside of a hospital, whether in the client's home or at the center's birthing facility.

Jackson has been a nurse-midwife for nearly 26 years. She said the hours are terrible but she loves her career.

"You can be called at any time. You get that phone call in the middle of the night and you think, 'Oh, no,'" she said. "You get dressed and on your way. But once you get connected to that birth, being up all night isn't so horrible."

Midwives have different titles depending on their level of education. Certified nurse-midwives (CNMs) must have received a nursing degree prior to becoming a midwife. Certified midwives (CMs) don't have previous medical training, but must study and pass certification exams to work in the field, and are currently licensed only in New York, New Jersey and Rhode Island. Midwives cannot perform Caesarian sections, but they can do nearly everything else an obstetrician would do, including fetal monitoring, and administering drugs, epidurals and episiotomies when needed. They also offer a degree of emotional comfort many doctors can't, because they try to stay with the mother as much as possible during labor.

Midwives practice in a variety of settings. According to Rebecca Jacob of the American College of Nurse-Midwives, the oldest U.S. women's health care organization, roughly 65 percent of its midwife members are employed by hospitals and doctor's offices. Smaller numbers work in birth centers, in their own practices, or at universities, nonprofits, military or federally funded health centers. And they don't just deliver babies.

"In addition to attending over 10 percent of the vaginal births in the United States, certified nurse-midwives provide primary health care for women across the life span, from adolescence through menopause," Jacob said.

Several schools offer distance learning opportunities, but few institutions in the Washington area provide certified nurse-midwife education. The University of Maryland offers a full-time program at its Baltimore campus. To graduate, students must get 55 credit hours, which takes roughly 21 months. Wannabe baby deliverers can also attend part time.

Georgetown University also offers a degree in nurse-midwifery. It's a 45-hour program and students can elect full- or part-time status. It includes four semesters spent in a clinical setting to give students hands-on experience in hospitals, birth centers, public health clinics and private practices.

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