MUSCMedical LinksCharleston LinksArchivesMedical EducatorSpeakers BureauSeminars and EventsResearch StudiesResearch GrantsCatalyst PDF FileCommunity HappeningsCampus News

Return to Main Menu

Midwifery's heritage finds its modern niche

by Cindy Abole
Public Relations
The role of midwives among women has remained constant throughout history. For centuries, the presence of a woman during childbirth shares an important legacy across many cultures. These “wise women” and their acquired skills, knowledge and experience have evolved to gain prominence and acceptance within healthcare and communities as a modern pratitioner.
 
For almost 30 years, MUSC has been at the forefront in establishing the country’s nurse-midwifery curriculum among several select institutions. At its height of popularity in the 1970s and 1980s, the number of certified nurse midwives dramatically rose from 275 in 1963 to 2,550 in 1982. MUSC established its nurse-midwifery service in 1973 in a partnership between the College of Nursing and the Department of Obstetrics and Gynecology. In 1975, the college graduated its first class of certified nurse-midwives and continues to be accredited by the American College of Nurse-Midwives (ACNM) since 1976. In1987, nurse-midwifery education was established within the college's graduate track.
 
Although national nurse-midwifery programs may differ in the manner in which they approach course studies, they do share the same core competencies, curriculum standards and clinical practice experiences as set by the ACNM. 
 
“MUSC is distinguished by its track record among certified nurse-midwifery graduates,” said Marcella Hickey, CNM, director of the Nurse-Midwifery program. “We’ve been at it for almost three decades and have proudly contributed to the growth of midwifery in the country and throughout the health care world. Our reputation precedes us.” 
 
The program has graduated more than 250 students and boasts a stellar percentage of board testing success. Its alumni list reads like a who’s who among rising stars within the profession. "U.S. News and World Report" has ranked the MUSC program as one of the top 10 in the nation.
 
The role of nurse midwives share the same principle foundations with nursing: to provide care by maintaining the health of an individual through education, wellness and prevention. 
 
South Carolina and other southern states suffer from high infant mortality rates due to health disparities and problems with access to care as reported in the Department of Health and Human Services program, Healthy People 2010, a national health promotion and disease prevention program.
 
“I know that people need care,” Hickey said. “What we needed was to develop an education program to help students understand issues related to mothers and infants.”
 
In 2001, the College of Nursing teamed with the College of Medicine’s Family Practice program to create a model of care that would feature family medicine practitioners, CNMs and nurse-midwifery students work side-by-side to provide care in  primary care practice clinic.
 
Instrumental in this partnership was MUSC Family Medicine Chairman William J. Hueston, M.D. Hueston applied his experiences in family and primary care to create a model of care involving multidisciplinary partnerships and communities.
 
“There are big gaps in maternity care throughout our country,” said Catherine Francis-Baldesari, the nurse-midwife who is coordinator of the collaborative nurse-midwifery practice at Family Medicine. “These gaps can be filled beautifully with family physician practices and nurse midwives to help provide maternity care. Dr. Hueston was able to do it successfully in Kentucky and is currently working with us to provide that same level of high quality care in South Carolina.” 
 
"Women are in need of good perinatal health care," Francis-Baldesari said. "This means that women receive risk-appropriate care. If a woman has a high-risk condition, she is referred to the Department of OB/GYN."
 
As America’s population ages, the women followed by nurse-midwives are also aging. Nurse-midwives take care of women through menopause and beyond. Recent studies show that as women age, they choose to become more active in a healthcare partnership with their health care provider. Not only do more women want to be informed, they also want to be empowered to make decisions concerning their care and treatment options, said Deborah Williamson, CNM, MSN director of the Faculty Practice in the College of Nursing. One example of this is in the area of hormone replacement therapy.
 
"As faculty at MUSC, I believe I have a responsibility to serve as a“catalyst” within the community," Williamson said. “By bringing diverse groups together and pooling resources, adequate health care for women can be achieved—even with limited financial resources.” 
 
“Women feel best receiving care within their communities,” Williamson said. “They want care within their own community. They feel more centered within familiar surroundings without the hassle of parking, language barriers, etc.  
 
To support this concept of community-based care, last January, Williamson teamed with Hueston to write and submit a Duke Endowment grant proposal to coordinate maternal and infant care among rural migrant populations, specifically in the Johns Island area. The grant helps pay for the services of a part-time nurse-midwife and family physician with additional funding for other support services. These services will be provided in collaboration with the Wellness House and the Sea Island Medical Center. 
 
“This setting is ideal for MUSC students because it provides an opportunity to integrate  clinical learning in a rural community setting," Williamson said. "The educational experience is based on a service learning model. The students learn from the community but also "give back" through projects identified by the community."
 
"In the community, students learn about the broader issues that impact health care delivery—a perspective that is very different from that gained within MUSC," Williamson said. "In midwifery, our philosophy is that our students are here to assist the woman and her family in meeting their health care needs. This is how we teach midwifery. Students and faculty provide a very nice partnerhsip in the delivery of care."
 
What is new to the program are minor curriculum changes to accomodate  qualified candidates holding other degrees who are entering nursing and nurse-midwifery.
 
"Curricula change all the time,"Hickey said. "We view our program as a dynamic entity and the information we work with changes continually especially  in research and practice style."
 
Another improvement is the ability for nurse-midwifery students to interact with more graduate-level students. especially beyone the nine nurse graduate tracks. According to Hickey, MUSC continues to retain the same high quality program in comparison to other programs. 
 
Certified nurse midwives are licensed to practice throughout the 50 states and territories. In some practice settings, nurse midwives enter as mid-level practitioners in various medical settings. In the Lowcountry area, nurse midwives are able to practice within most hospitals and provide services in both the public and private sector. 
 
The specialty can also provide care to high-risk patients including multiple gestation clinics, diabetic and hypertensive management and AIDS patients when working within a collaborative relationship with  OB/GYN physicians. This exposes these populations to the CNM philosophy approach to care.

Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.