Penn midwives deliver a warmer kind of care

A Nursing School program adds a new dimension to midwifery. The walls in Amy Levi's examination room are filled with pictures of the dozens of babies she has delivered over the past 10 years in the arms of their beaming mothers. "I have been through pregnancies with these moms and gotten to know the babies while they are in the womb," she said. "I almost feel like part of the family." But Levi is no ordinary obstetrician -- she is one of the instructors in the Nursing School's midwifery program, which currently has about 25 students. She explained that the term "midwife" -- which means "with woman" in old English -- reflects the profession's commitment to "caring for essentially healthy women before, during and after childbirth with specific emphasis on the needs of the individual woman and her family." Unlike physicians, who often quickly examine patients before telling them to "try a certain treatment and come back in two weeks," Levi said nurse midwives seek to actively involve women in decisions about their own health. While physicians often order extensive tests "just to be on the safe side," midwives provide natural care and only turn to medical technology when absolutely necessary. The growth of the University's nurse midwifery program, which was founded in 1980, parallels the growth of the profession across the country. The University offers a master's degree in nursing for midwifery students who already have an undergraduate nursing degree. About five students are currently enrolled in the program, which takes 16 months to complete. Midwifery students with a liberal arts background can obtain both a bachelor's and a master's degree in under four years. Between 15 and 20 students enroll in the bachelor's/master's program each year. The Nursing School also offers a distance learning program in conjunction with the Pennsylvania Department of Health which is designed to meet the need for midwives in rural parts of the state where patients do not have access to hospitals. In the distance learning program, which was founded in 1994 and currently has five participants, the students typically come to the University on three occasions for clinical orientations. The rest of the time, they go to teleconference centers in Hershey, Coleport, Scranton and Pittsburgh to participate in interactive seminars. Reina Dastous, a student in the bachelor's/master's program, earned a liberal arts degree and worked with special education students before realizing that teaching wasn't for her. After reconsidering her career options, she decided to pursue nurse midwifery because she has "always been fascinated by the miracle of pregnancy and childbirth." Dastous was attracted to the program because its "philosophy about birth and caring for women" was compatible with her own. "Physicians tend to assume something will go wrong rather than watching and waiting before intervening," she said. "Midwives trust that the body nature has provided women with knows what to do in labor." The demand for nurse midwives continues to grow as women seek care that is sensitive to their needs, Levi said. The American College of Nurse Midwives currently has more than 6,300 members. And the number of nurse midwives who are certified annually by the nation's 50 accredited nurse midwifery education programs has increased 25 percent since 1991. Levi said midwives are also gaining respectability with insurance companies. Medicaid reimbursement for nurse midwifery services is mandatory in every state and 31 states require private insurance companies to compensate nurse midwives. She added that managed care organizations tend to be especially supportive of nurse midwives because their reluctance to use expensive technology and procedures tends to contain costs.

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