Department of Labor

The school also offers a type of fast-track program for students who don't have a bachelor's degree in nursing. Often called a "direct entry" or "graduate entry program," they are typically three years and begin with an accelerated nursing program followed

by the midwifery program. Once they graduate, students are eligible to take the American Midwifery Certification Board's national certification exam.

Classes cover topics such as gynecology and prenatal care, the roles and responsibilities of midwives and complex midwifery. At the University of Maryland, students practice delivering babies with a birth simulator, a mechanized, full-sized model of a woman that can imitate vaginal births. The machine can also imitate complications like breech birth or shoulder dystocia, in which the baby's shoulder is lodged behind the pubic bone. It offers students valuable experience before working on live patients.

While there are more than 400 midwives practicing in the D.C. metro area, the University of Maryland's midwifery program director Carol Snapp said the school graduates only four to eight students each year.

"The number of students is fairly stable," she said. "The difference I've seen is an increase in employment opportunities over the last couple of years. Now the opportunities seem to be increasing for nurse midwives."

The statistics prove her right. According to the U.S. Bureau of Labor Statistics, there were 5,500 practicing CNMs in 1995, and the number is projected to rise in the next few years. Why? The costs of going with an ob/gyn continue to increase, and the expenses for a certified nurse-midwife are lower by comparison, often because midwives are more successful at birthing without the use of costly drugs and other interventions. Also, birth centers and home births cost less than paying hospital fees (although the fees of midwifery are covered by insurance in most cases). And while those figures may be chalked up to the fact that midwives usually only take on low-risk pregnancies, midwifery has a record of successful births. This, in turn, encourages more mothers-to-be to seek the method.

Thirty-year-old Melody Mast, a Harrisonburg, Va., resident, is a midwifery student at a Kentucky school. She's doing her clinical work at the Maternity Center in Bethesda. Mast said the difference between her time working in a hospital and a birth center is considerable.

"At the birthing center, it was like, 'This is what it's supposed to be.' It was so natural, with low lights. The mom could do what her body needed to do. It just felt right."

Mast said she was inspired to study midwifery after seeing how a home birth affected a close friend.

"She'd had a hard life, but working with a midwife was healing for her," said Mast. "Birth is hard, but this was empowering."

On Feb. 2, 2007, Mast helped deliver Rachel Deitrich's son, Andrew. The 30-year-old Gaithersburg resident said she was pleased with her experience.

"They treated me more like a person than a patient," Deitrich said. "I was a much more active person in the delivery process. They talked me through things, they responded to what I said and how I felt. That wouldn't have happened in another location with an obstetrician."

Snapp said a degree in nursing makes a good foundation for midwifery. You'll also find it's a good foundation for a pay raise. The U.S. Bureau of Labor and Statistics reports that, on average, the income of certified nurse-midwives will surpass the pay of a typical registered nurse. For example, in 2000, while an RN earned approximately $44,840 a year, certified nurse-midwives earned an average of $70,100. The extra schooling and training that makes independent practice possible for CNMs is responsible for the higher salary.

But if you're considering a career in midwifery, don't be held back by a lack of a nursing degree.

"The issue is that there are misconceptions," Snapp said. "People think they need to have labor and delivery experience before going into nurse-midwifery. It's very individual, the amount of experience people feel they need."

She also said people who are committed to women's health and the health care of both mothers and babies make excellent midwives.

"We work nights and weekends. Babies come at all hours. It's very gratifying, but it's very tiring work. It takes a special person to be dedicated to this career."