Although it is common for midwives to attend births in most countries around the world, midwifery has not always been as available to women in the United States. Traditionally trained midwives attended most births in Louisiana through the early part of the 20th century, but as birth moved into hospital settings, the practice gradually fell out of favor.
Nurse-midwives, trained in a formal educational setting and with a background in nursing, began to expand midwifery throughout the United States again in the 1940s. One of the first university-based nurse-midwifery programs offered in the United States was at New Orleans’ Flint-Goodridge Hospital of Dillard University in 1942.
While nurse-midwifery grew as a profession in many states, Louisiana’s program closed after only two years, leaving the state without a midwifery program for nearly 80 years. Certified nurse-midwives (CNMs) are now licensed health care practitioners integrated into health system models of care in all 50 states, but without its own nurse-midwifery program, Louisiana has far fewer practicing CNMs than many other states.
C. Shannon Pfingstag, DNP, CNM, Instructor of Clinical Nursing and Director of the Nurse-Midwifery Concentration at the LSU Health New Orleans School of Nursing, says she expects the presence of CNMs to grow over the next decade “as we address the maternal healthcare disparities that exist in our state.”
When Dr. Pfingstag moved to New Orleans in 2004, only a few nurse-midwives were practicing in the entire state. Now, CNMs are practicing in hospitals in New Orleans, Baton Rouge, Hammond, Sulphur and Lafayette, as well as in office settings providing women’s health and gynecological care.
The School of Nursing has recognized the need to increase access to maternity care in Louisiana. Currently no nurse-midwifery programs are operating in the state, despite evidence that integration of midwifery into the perinatal care system improves maternal and infant outcomes. Dr. Pfingstag was hired as Director of the Nurse-Midwifery Program in August 2021.
“We are in the process of applying for pre-accreditation from the Accreditation Commission for Midwifery Education (ACME) to begin a program here at the School of Nursing,” Dr. Pfingstag says. “All of our advanced practice nursing programs are at the doctorate level, as our mission is to create leaders as well as health care providers.”
What Does a Certified Nurse-Midwife Do?
The midwifery philosophy of care is centered on self-determination, partnership, respect for normal processes and the utilization of medical interventions and technology when appropriate. Most nurse-midwives attend births in hospitals, and the benefit of midwifery care in all settings – whether in a hospital, birth center or home – is that care begins with education and informed decision-making. This model of care leads to higher levels of satisfaction among patients, fewer cesarean section deliveries, higher breastfeeding rates and more rapid identification of risks or warning signs.
“While the care obstetricians and nurse-midwives provide during the reproductive years overlaps a great deal, nurse-midwives are educated and trained in an approach that begins with normal,” Dr. Pfingstag says. “There are lots of normal things that happen during the reproductive years that are best managed through education and support. A patient with questions or issues around menstruation, sex, fertility or menopause can expect their certified nurse-midwife to act in the role of a guide or a supportive partner while also monitoring for times when intervention is necessary.”
Dr. Pfingstag says she loves her physician partners and that most obstetricians are caring people, but their training is in pathology and surgery, while the CNM’s approach is to begin by supporting normal processes.
“As an example, when a person is in labor, it’s not uncommon for the obstetrician to be called when the birth is approaching. A nurse-midwife will provide support throughout the labor, doing things like helping the woman to change positions and walk or make an informed decision about anesthesia,” she says.
Learning the Art – and Science – of Midwifery
Louisiana CNMs are licensed by the Louisiana State Board of Nursing as one of four advanced practice nursing specialties. Candidates must be licensed as registered nurses first and then complete their master’s or doctorate-level education through an ACME-accredited program, which allows them to take a national certification exam.
“While many nurse-midwife students will have a nursing background in labor and delivery, others have diverse nursing backgrounds. They all bring with them a desire to provide holistic, evidence-based care during pregnancy and birth,” Dr. Pfingstag says. “Nurse-midwives also bring a philosophy of patient-centered, individualized care to gynecology, primary care and newborn care.”
Nurses enrolled in a nurse-midwifery program develop their skills through coursework and clinical supervision.
“While many nurse-midwife students will have a nursing background in labor and delivery, others have diverse nursing backgrounds. They all bring with them a desire to provide holistic, evidence-based care during pregnancy and birth.”
C. Shannon Pfingstag, DNP, CNM
Historically, midwives were trained under an apprentice model in which the older generation passed knowledge and skills to the younger generation. Doctor of Nursing Practice (DNP) students at the School of Nursing have access to many more learning resources, from expert faculty to the school’s accredited Simulation Center.
“However, the art of midwifery is still passed down from one midwife to the next. For this reason, ACME requires that nurse-midwife students spend more than half of their clinical experiences with other CNMs,” Dr. Pfingstag says. “During these clinical experiences, the student develops skills and learns how to apply the midwifery philosophy of care while using those skills.”
While most CNMs attend hospital births, all nurse-midwifery students are prepared to work in various birth settings, including birth centers and home births, as well as in outpatient settings providing women’s health and gynecological care, sexual and reproductive health care, and some primary care services.
Midwives often say they are called to the work, Dr. Pfingstag says.
“I find a lot of folks are first inspired to be a midwife by a birth experience, their own or one they were involved in. Some people have been doing birth work for a while, as labor and delivery nurses, doulas or informal support for friends and families. Some people have just been dreaming about catching babies and know it’s something they’re interested in.”
She says it is important to realize that midwifery is a 24/7 career, so prospective midwives should assess their own strengths and the work-life balance needs of their families.
“Babies come on Christmas and Mardi Gras just like any other day,” she says. “But not all CNMs attend births at every stage of their career. Nurses who choose this path may work in an office setting or a health department, go into an administrative or leadership role, or even end up in academia after 25 years in practice, like myself!”
To learn more about nurse-midwifery, Dr. Pfingstag says the American College of Nurse-Midwives website is a great place to start. Everyone is welcome to attend the Louisiana Affiliate of the ACNM’s quarterly meetings, where CNMs talk about local issues. Zoom meeting information is available on that organization’s Facebook page.
“I’m the president of the Louisiana affiliate and I love it when midwife potentials join us!” she says. “And anyone can reach out to me with questions. I’m always happy to take a minute to talk about midwifery.”
To contact Dr. Pfingstag, call 504-568-4140 or email her at cpfing@lsuhsc.edu.
