Midwifery is a profession that is as at least as old as the Bible. In Exodus 1:15-21, Shiphrah and Puah were midwives who refused the Egyptian Pharaoh’s order to kill all newborn Hebrew males. Today, midwives continue to provide care to women who, for a variety of reasons, are vulnerable and in need. They care for women of all ages, races, ethnicities, sexual orientations, socioeconomic groups and educational backgrounds.
Certified nurse-midwives (CNMs) are educated in the disciplines of nursing and midwifery, usually at the graduate level, and have been nationally board certified through the American Midwifery Certification Board. They are trained to work in a variety of practice settings, including high-volume hospitals, small community hospitals, birth centers, health departments and clinics, as well as the home birth setting. CNMs provide care for women from puberty through menopause. The many services they provide include nurturing pregnant women through childbirth, primary care, pre-conception counseling, family planning, menopausal care and general women’s health care. In addition, they are trained to care for newborns during the first month of life.
Midwifery has had a long and significant history in the African American community. Yet despite this rich legacy, black nurses—as well as other nurses of color—continue to be substantially underrepresented in today’s nurse-midwife workforce.
History of African American Midwives
In the early 17th century, the slave trade brought many African slaves to America. Among them were women who brought generations of knowledge about childbirth to the American culture. These African slave women, along with immigrant European midwives, made significant contributions to midwifery in the early years of the United States’ existence.1 African midwives proudly handed down the skill of midwifery from mother to daughter, in an apprenticeship model, while keeping strong ties to African-based rituals and customs.2
In the years following emancipation, African American women who entered the midwifery profession often did so out of a spiritual calling. These midwives, often referred to as “granny midwives,” were matriarchs within their communities. They served as advocates, healers and liaisons between the health care system and their communities.1
By the turn of the 20th century, only 50% of all American women giving birth were attended by midwives. However, most immigrant women, African Americans and other poor women continued to almost always be cared for by a midwife. This difference in care was attributed to the inability of these women to pay physician fees, the notoriously poor care provided at segregated black hospitals and moral opposition by many women to male birth attendants.3
Today’s African American CNMs continue the legacy of the post-emancipation midwives by continuing to bring quality care to women and newborns whose need is greatest. They serve low-income families, Medicaid recipients, teen mothers and the uninsured. The Centers for Disease Control and Prevention (CDC) reported in 1998 that CNMs, more than physicians, served a greater proportion of women who were at higher risk for poor birth outcomes. These included African Americans, Native Americans, teenagers, unmarried women and those with less than a high school education.4
A Need for Diversity
In the 21st century, with the U.S. population reaching unprecedented levels of racial, ethnic and cultural diversity, nurse-midwives continue to make a consistently positive contribution to the health outcomes of women from vulnerable populations. Because of the tremendous need for health care professionals who share common bonds with the patients they treat, minority nurses can offer a wealth of cultural knowledge when providing care to patients in communities of color.
Although midwives provide care for many minority women in America today, the midwifery profession is not diverse. There is a lack of minority nurse-midwifery students entering the field, as well as a lack of minority instructors and researchers. In 2003, the American College of Nurse-Midwives (ACNM) reported that less than 4% of CNMs identified themselves as African American, approximately 1% were of Asian descent and less than 1% identified themselves as Hispanic. Furthermore, less than 1% of CNMs were men.5
In contrast, according to the American Association of Colleges of Nursing (AACN), the student population currently enrolled in general MSN degree programs is 11.3% African American, nearly 5% Hispanic, 6% Asian American and 8.9% male.
In the fall of 2006, AACN member nursing programs reported that nearly a quarter of their students (24.8%) were from racial or ethnic minority groups.6 However, nurses of color account for less than 10% of all baccalaureate and graduate school nursing faculty.7
Although these statistics suggest that there is at least a slight increase in the number of minority students entering the field of nursing, there is still a disproportionately low number of candidates from these ethnic groups entering CNM programs.
Choosing a Nurse-Midwifery Program
There are many different educational options available to minority nurses who are interested in becoming certified nurse-midwives. BSN-prepared registered nurses (RNs) can apply directly to a midwifery graduate program. Some graduate programs also allow RNs with associate’s degrees to pursue a degree in nurse midwifery.
There are also accelerated “fast-track” education programs that offer students the opportunity to become RNs and then CNMs, earning a graduate degree in approximately three years of full-time study. Like generic “master’s entry” nursing programs, these programs are typically designed for students who have obtained a four-year degree in a discipline other than nursing—such as a BA in public health—yet have completed all the traditional prerequisites for nursing school.
ACNM has a Web site that enables prospective students to explore available nurse-midwifery education programs across the United States. Instruction methods vary from 100% distance-learning programs to 100% on-campus programs. Still other institutions offer CNM programs that are a combination of both online and classroom learning.
To find the program that’s the best fit for you, it’s essential to investigate all options. When considering schools, you must be savvy and proactive. Visit the school’s Web site, talk with admission counselors and with students currently enrolled in a midwifery program. After you have narrowed your search, begin to consider factors such as cost, program size and the reputation of the program, as well as the school’s commitment to diversity and providing a supportive environment for minority students.
When examining the cost of a program, be mindful of potential hidden costs such as books, activity fees, health insurance and travel expenses for clinical rotations. If you think that the financial expenditure is not within your means, search for scholarship opportunities and other possible financial assistance within the schools of your choice. Some schools may have internal scholarships and awards based on criteria such as grades, academic performance and financial need. You should also explore external scholarships from professional organizations such as ACNM or the Association of Women’s Health, Obstetric and Neonatal Nurses (AWOHNN).
Other financial questions to consider when choosing a program may include the following: Are student employment opportunities available? Are there any tuition payment opportunities at an affiliated hospital? Look into whether there are any health care organizations or practices that might be willing to support you financially through a CNM program in exchange for a commitment to work for that organization after you graduate.
The size of a nurse-midwifery program is also important. Factors to consider include: Is the class large enough to encourage diversity of issues and perspectives? Is the program large enough that students can find other students whom they can identify with? How many faculty members are there? Do students seem to know faculty members well and have positive things to say about their classroom experience? How well does the faculty know the students? Are faculty members accessible to students?
In other words, the class size will impact your ability to interact with fellow students and faculty, and to establish professional relationships. Ask to meet with current or past students to gain insight and knowledge about student life. It may be beneficial to observe a class session to get a first-hand look at faculty-student interaction. Meet with at least one of the faculty members during a campus visit to discuss instructors’ expectations and involvement with students.
The reputation of a CNM program is a valuable screening tool in selecting a potential school and is directly related to the students’ success rate on the national board certification exam. Investigate such questions as: What is the pass rate on the national certification exam? Are there adequate numbers of faculty and administrative staff employed in the program? Is the program new or well established? Each of these questions may help you prioritize programs and identify the best school for you. However, it is imperative to know the pass rate because it is a reliable indication of overall graduate preparedness.
Finally, examine the school’s commitment to providing a welcoming, supportive environment for students of color and other students from underrepresented populations. Find out whether there are active organizations and programs geared towards supporting minority students during their matriculation. Is faculty mentorship available? If so, how many students does an individual faculty member mentor? How many minority instructors are in the program or in the school? Is there an active recruitment campaign to increase diversity of both students and faculty? What resources are in place to recruit and retain minority students? Are there other minority students who are willing to talk to you about their experience?
Once you have narrowed your search, it is important to visit the campus. Even if the number of minority students is few, you can still get a feel for the school’s culture and whether there are students with whom you have other things in common—e.g., students from your same geographical area, students who are parents, working students. A wealth of knowledge and information can be obtained from talking to current students, such as their perceptions of support from faculty and the school, intensity of the class work and the rigors of clinical training.
Additionally, if attending this school will result in relocation, look at the community. What does it offer you and your family? This may include housing, schools, childcare, transportation (including commute considerations), spiritual or organized religious organizations, and job opportunities.
Midwives Make a Difference
Today, as in the past, midwives are on the front lines of providing care to women from all walks of life. Research studies and federal health statistics confirm the positive impact that nurse-midwives make on the lives of women and children. Mothers, babies and entire families lead healthier lives because of the care provided by CNMs.
By making quality health care accessible to women from vulnerable populations who are most at risk for problems during childbirth, nurse-midwives can make a real difference in reducing risks of infant mortality and other health disparities. This is why the health care industry has an undeniable need for more minority CNMs who can relate to the cultural backgrounds of minority patients and provide culturally appropriate care that is sensitive to their needs.
Traveling the road to becoming a nurse-midwife is a journey filled with wonder and excitement. Each day proves to be a challenge and an opportunity to make a difference in the lives of so many. Learning more about this exciting profession and thoroughly researching schools and programs that provide nurse- midwifery training could start you on that journey to a truly rewarding and gratifying career.
References:
1. Robinson, S.A. (1984). “A Historical Development of Midwifery in the Black Community: 1600-1940.” Journal of Nurse-Midwifery, Vol. 29, No. 4, pp. 247-250. br />
2. Rooks, J.P. (1997). Midwifery and Childbirth in America. Temple University Press.
3. Litoff, J.B. (1982). “The Midwife Throughout History.” Journal of Nurse-Midwifery, Vol. 27, No. 6, pp. 3-11.
4. Centers for Disease Control and Prevention, National Center for Health Statistics (1998). “New Study Shows Lower Mortality Rates for Infants Delivered by Certified Nurse Midwives.” Retrieved from www.cdc.gov/nchs/pressroom/98news/midwife.htm.
5. Schuiling, K.D., Sipe, T.A. and Fullerton, J. (2005). “Findings from the American College of Nurse-Midwives’ Membership Surveys: 2000-2003.” Journal of Midwifery and Women’s Health, Vol. 50, No. 1, pp. 8-15.
6. American Association of Colleges of Nursing (2007). “2007 Annual State of the Schools.”
7. The Sullivan Commission (2004). Missing Persons: Minorities in the Health Professions.
