Graduate students looking for a degree in nursing have many schools to choose from, but for those interested in becoming midwives, the options are fewer, making the Yale School of Nursing’s midwifery program unique in a university setting.
The Yale School of Nursing was recognized for its midwifery program in a talk on Tuesday sponsored by the Yale Women’s Organization. The public discussion, which featured former Yale dean and midwife Helen Burst, focused on the history of midwifery both in the field of health care at large and at Yale specifically. The session was one installment of the monthly lecture series “Lunch and Learn,” which features a different topic of interest each month, YWO Director Patty Pollard said.
YSN first recognized the importance of the practice of midwifery in 1956, when it became one of the first graduate schools in the nation to prepare midwives, second only to Columbia. Today, Yale, Columbia and the University of Pennsylvania are the only three Ivy League institutions to offer a midwifery program.
Although many elite institutions do not recognize the field, Nurse-Midwifery lecturer Terri Clark said the discipline should be a vital component of any liberal arts institution. She said many universities, including John Hopkins and Stanford, closed their midwifery programs in a feminist effort to break away from maternal and non-scientific roles in society during the 1970s. These hasty decisions have had negative consequences for health care in the country, she said.
“Midwifery is an outgrowth of society which promotes individual choice and decision-making within the context of a lot of available resources,” Clark said. “When the best universities don’t open the door for this discipline to the brightest students, health care suffers because these nurses are the health care professionals that people tend to trust the most.”
Lecturer Meredith Goff said that despite the relatively small number of programs available, the number of midwife-attended births has grown steadily over the years, indicating a high demand for midwives over regular physicians. She said many physicians are choosing to practice only gynecology because of the high malpractice rate associated with OB-GYN practice and the unpredictable hours that come with delivering babies. As a result, midwives are finding more and more work for mothers from a greater variety of socioeconomic levels, Goff said.
But midwives are not a perfect substitute for doctors, experts said, because they cannot perform surgery and are not equipped to perform high-risk deliveries. Midwives are educated to be experts in normal pregnancy and labor, and are equipped to provide OB-GYN and postpartum care, Goff said. Midwives’ specialization in ongoing personal care for women often makes them more appealing to women, she said.
“We have always been the primary providers of these services to women who are poor and do not have insurance,” she said. “But now we are often the choice of women who do have private insurance and have deliberately chosen a midwife because they view pregnancy as a normal life event and not a medical procedure.”
Midwife Joy Buehrer, who studied at the Frontier School of Family Nursing and Midwifery, one of the first midwifery institutions in the country, said the field is an important profession because it provides more of a partnership than medical delivery does. She said one of the main benefits is that midwives stay with women throughout the labor, while doctors only come in at the final moment. Although doctors can do more in terms of medical procedures, Buehrer said, many women with low-risk pregnancies prefer to have the support of a midwife when possible.
In practice, though, certain limitations in the field can cause problems for midwives who are trying to find work. Buehrer said midwifery is challenging because it is constantly competing with physicians both for clients and for students.
“There are jobs out there, but the medical profession sees midwives as competitors so they make it hard to practice by favoring [obstetrics] residents and closing midwives out of jobs,” Buehrer said. “It is a very challenging position, and nowadays many women would just rather become doctors because there’s more security.”
The tension in the health care system is a result of a shift in the distribution of health care money toward administrative bureaucracy rather than health care services, Clark said. Although doctors and midwives should be working in a collaborative effort to provide the best health care to women, she said, the competition between doctors and midwives is an indication that the health care providers have lost sight of that purpose.
But according to YSN faculty members, the problems with the job market are not affecting the popularity of the midwifery program at Yale. Both Clark and Goff said the program sees a wide variety of applicants each year, many of whom are studying midwifery as their second career. Clark said many of the applicants come to Yale with international experience, which equips them to work in lower socioeconomic areas, where there is often a great demand for midwife services.
“Midwives are more likely to work in poorer areas where there aren’t enough doctors,” she said. “We offer them a way to go back to the developing world and make a meaningful contribution.”