by Monica Jackson
The medical field is one of the most challenging and exciting fields of study within today’s society. It is all about maintaining our health while also teaching us how to better maintain our health outside of the doctor’s office simultaneously. One of the most unconventional forms to help us maintain our health is the midwifery field. This field empowers women with the opportunity to be more involved in the decision making process regarding their health, including during pregnancy. To help us better understand the significance and benefits of midwifery, I talked to two certified nurse-midwives (CNMs), Cynthia Mason, who works in private practice for a CNM- owned midwifery practice in Oak Park, IL (West Suburban Midwife Associates, Ltd. ) and Sherri Ruerup, who is a CNM and director of the Nurse-Midwifery group at Swedish Covenant Hospital, Chicago, IL.
Cynthia Mason works as a private practice midwife at West Suburban Midwife Associates
Midwives are trained specialists who handle low-risk pregnancies. Their job is to help women through the process of labor and birthing as well as to teach them about post partum care. CNMs practice in hospitals, medical clinics, and private offices and may deliver babies in hospitals, birth centers, and at home. They are also able to prescribe medications (in all 50 states, as CNMs are recognized in the U.S.).
Midwives can even be a part of a woman’s pregnancy before the woman is actually pregnant. This is because many midwives act as the primary caregiver for many women, but it is more like a partnership between the women and the midwives, known as well-woman care. Similar to a gynecologist visit, well-woman care includes Pap smears, breast exams, birth control, family planning, and menopausal care. According to Mason, the specific duties of a midwife depend on the area and location the midwife is stationed in. She says that some midwives work in hospital settings where they teach and mentor OB/GYN residents and/or evaluate and care for pregnant women.
Other midwives work in office settings where they provide health for women throughout their life span in concordance with well-women care. According to Mason, most midwives work in both hospital and office settings.
“A full scope certified nurse midwife cares for women before, during, and after pregnancy. We provide well women care… [and] prenatal care for healthy, low-risk women who are pregnant. During a typical day, we will see patients in the office providing these services or can be on call attending births and supporting women during labor,” said Ruerup about CNMs working in a hospital setting. Midwives, overall, can be beneficial to the health of women throughout her life, especially during the biggest, most difficult moment of a woman’s life—childbirth.
For those of you who are considering getting into this important medical field, both Mason and Ruerup offer helpful information to move you in the right direction. As Ruerup explains, CNMs usually have a Master’s degree in science specializing in midwifery. They also have to pass a board exam to become certified. Other midwives, according to Mason, have Bachelor’s degrees, in which they have to pass a rigorous written and oral exam, as well as complete their clinical hours and competencies, in order to become certified.
Interestingly, Mason also refers to some midwife careers that do not require a high school or college diploma; instead the midwives receive their training and develop their skills through apprenticeships (referred to as Direct-Entry Midwives). Some midwives have even learned the field through self-study. However, these types of midwives are not recognized by medical officials in all 50 states, like CNMs.
Another important issue when learning and practicing to become a CNM is to know how to handle the various issues that can occur within a pregnancy, as well as deciding when the pregnancy needs to move to care beyond midwifery. So having good judgment is key within this field. As previously mentioned, CNMs typically deal without low- risk pregnancies; however, sometimes CNMs work with physicians (usually OB/GYN physicians) through collaborative agreements According to both Mason and Ruerup, the physician and midwife together decide what situations classify as “high-risk” and whether or not the physician and midwife will co-manage the patient, or transfer the patient out of midwifery care.
Overall, though, it depends on the individual midwife’s practice and the collaborative agreement as to what level of involvement the midwife may or may not have. For example, Ruerup says that her midwifery group will transfer patients with twins or triplets or insulin dependent diabetes to physician care because these patients are what they consider high-risk.
Mason states that when the midwives do manage or co- manage a high risk pregnancy, they require more fetal monitoring and surveillance (usually ultrasounds to monitor the baby’s heartbeat) and during birthing they have a neonatal or pediatric team member on hand for support.
Midwives, like Sherri Ruerup, attend to more than just pregnancies, such as conducting Pap smears or breast examinations.
Some other interpersonal skills Ruerup and Mason feel CNMs should have are approachability and good listening skills, and they are expected to “provide holistic, supportive care to women and their families following evidence based guidelines”[Ruerup] and “support empowering women to make informed choices and making safe health decisions.”[Mason]
Furthermore, Mason and Ruerup offer what they believe are the benefits and challenges of going into midwifery. For Mason, she feels the best part about her career is getting to be present and involved in such a significant moment of a woman’s and family’s life. She also finds herself to be drawn to the unconventional scheduling of the job. She finds it to be an adrenaline rush when she receives a call in the middle of the night and hurries out to a delivery. However, she feels that this may not be as rewarding in the eyes of other midwives. Mason also likes that her career empowers women to take an active role in maintaining their health. Ruerup echoes this sentiment, adding that she enjoys being able to support a woman during the birth of a child.
Pertaining to the challenges within the field, Mason sites the difficulty with reimbursement that midwife practices face from insurance companies, which makes it difficult for midwife practices to stay in business. Also, she refers to the lack of opportunity to educate other health care provides about midwives and their significance, something that is very important right now due to the many misconceptions about midwives within the field. As for Ruerup, she too mentions the challenges with the misconceptions in the medical field. Ruerup also finds it difficult to collaborate with physicians due to the differences in birthing philosophies and management. However, despite the various challenges Mason and Ruerup discussed, both women feel that the rewards long outweigh the challenges.
As for salaries, according to mshealthcareer.com, the average salary is $57,600, and it can range between $55,600- $87,100. Keep in mind, however, that similar to doctors and other medical professionals, insurance costs are going to be a factor that deducts from yearly salaries.
To sum, I asked both women why they felt this career is important and they both offered some important reasons. Ruerup refers to the belief among midwives that pregnancy needs to be treated as a natural stage of life, and not as a condition that needs to be treated. “Nurse midwives are trained to partner with and empower patients, which will give them a higher level of satisfaction with their care and their birth experience.” Ruerup also refers to the fact that midwives have lower cesarean section and operative delivery (forceps and vacuum extraction) rates than physicians and how this relates back to “non-interventive birth and being present during the labor to ensure frequent position changes and provide relaxation techniques to support the labor process.”
Mason spoke of the fact that midwifery gives women more health care options than just seeing a physician. She also notes that midwives are more cost-effective than physicians when providing care for women.. She even refers to the influence midwives have had historically and internationally on health care. “Midwives have been used as health care providers and caretakers for women during pregnancy and throughout the lifespan for thousands of years. Internationally, midwives are the primary caregivers for pregnancy and women are only transferred to physicians’ care if a high-risk condition arises. Therefore, all women should inform themselves of using midwives as their primary women’s health care professional because it just may be the best option for them!”
For those interested in pursuing a career as a midwife, here are some sites that may be of use to your quest, provided by Cynthia Mason.
www.acnm.org (The American College of Nurse Midwives Website)
http://www.delivermybaby.org (A questionnaire that women may take so that they can find out who/what may be the best “provider choice” for them…whether a physician or midwife would be better suited)
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