Nurses and Midwives: Combining Forces to Keep Women Healthy

by, Tina Johnson, CNM, MS


The US is strapped with increasing maternal morbidity and mortality, widening racial and ethnic disparities, and skyrocketing health care expenditures. The maternity workforce is suffering from worsening shortages. National leaders in women’s health are coming together to create and implement models for optimizing quality, safety, education and policy.

Nurses and midwives together play a critical role in this effort, particularly in educating women and families, and implementing strategies and evidence-based practices that improve outcomes. Yet there are locations in which the paths of nurses and midwives have never crossed. In many developed nations such as Sweden, the UK and the Netherlands, midwives are the front line providers for all women, but on average midwives in the US attend only 8% of the births. This National Midwifery Week, as we focus on increased access to US midwifery care, we should also address the confusion that may occur when nurses interface with midwives for the first time. Misconceptions can exist, trust may need building, and careful communication is fundamental.

This reality hit home for me when my birth center’s collaborative obstetrician relocated to a different hospital, and I became the first midwife ever credentialed to admit and care for women there. This inner city community hospital had done things the same way for a long time. I will never forget the first night I needed to transfer a woman to the hospital. As is most commonly the case, the reason was failure to progress, and we had called ahead to notify the health care team that we were on our way. Upon arrival, however, the nurse up next for an admission flatly refused to accept the assignment, confronting me and the rest of the team at the front desk, claiming: “I have never taken orders from a midwife. I refuse to put my license at risk! Call the nursing supervisor!”

This reaction was shocking to me, unlike anything we’d encountered at other hospitals. The nursing supervisor came down and called the chief of OB/GYN at home at what was now midnight to ask for guidance.  Even though my management plan was very straightforward, to include augmentation, routine monitoring and other standard orders, the nurse continued to refuse until the chief firmly explained that the nurses were required to admit and care for this woman under the midwives’ direction. The woman’s care proceeded without incident, resulting in a healthy birth.

A year later, the OB/GYN chief hired midwives to staff the labor and delivery unit 24/7. The midwives evaluated all women presenting for care, attended the vaginal births, first assisted for cesareans, and educated residents and midwifery students. This model expanded over the years, resulting in a decrease in cesarean birth and preterm birth rates, and an increase in successful vaginal birth after cesarean. The nurses quickly grew to appreciate our management style. Trusting relationships were formed. The nurses, physicians and midwives coalesced into a fully functioning, close-knit family. Ironically, the nurse who originally refused to admit my client eventually became one of our strongest supporters.

Our organizations – AWHONN and ACNM – are committed to optimal health for women and infants. We promote women’s capacity for healthy term pregnancy and birth, and we work tirelessly to advance the highest standards of care. This week, take a moment to connect with the midwives in your community.  Check out the ACNM Affiliate map to locate midwife leaders in your area. Get ideas for supporting the National Midwifery Week celebration using our daily action plan and new video “Midwives in Hospitals: A Great Choice for Childbirth.” Happy Midwifery Week, and thank you for all you do for women and families. Together we can transform our systems to keep women healthy!

Tina_Johnson-webTina Johnson, CNM, MS
Tina Johnson, CNM, MS, is Director of Professional Practice and Health Policy at the American College of Nurse-Midwives (ACNM) in Silver Spring, MD, the professional association representing the nearly 12,000 certified nurse-midwives and certified midwives in the U.S.