Title:Labor of love

Georgetown’s renowned nurse-midwifery program celebrates 50 years

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When reports in the early 1970s revealed alarmingly high infant mortality rates in the District of Columbia, leadership at Georgetown’s School of Nursing were moved to respond. In 1972, the school’s dean, Sister Rita Marie Bergeron, OSB, announced the establishment of a nine-month post-baccalaureate certificate program in nurse-midwifery.

The first of its kind in the DC area and one of only 10 in the country when it launched in 1973, the midwifery program at Georgetown emphasized holistic care, patient autonomy, and support for healthy births without unnecessary medical intervention. The trailblazing program began at a time when some states still prohibited certified nurse-midwives from legally practicing.

That year the School of Nursing and School of Medicine partnered to select Yuen Chou Liu as the program’s first director. Liu received her nurse-midwife certification at the Booth Maternity Center in Philadelphia and delivered over 300 babies herself before becoming program director.

“Above all, the human dignity of the mother must be respected,” Liu said in an interview at the time about her appointment. “She is the one having the baby and not the professional.”

Importantly, midwives refer to their role at the birth as catching the baby, rather than delivering. They prefer language that centers the work of birth on the one giving birth.

The autonomy of the pregnant person in making health decisions, especially during labor and birth, was a pillar of Liu’s vision of a midwifery education and remains central to the program today.

In the 1970s the typical hospital birth experience was dramatically changing, recalls Jeanne McDermott (N’72), who spent five years working as a labor and delivery nurse at Georgetown University Hospital before joining the midwifery education program in 1978.

“We were evolving into giving women more of a voice, empowering women for labor and delivery, allowing their partners to come in to observe the birth,” McDermott says. “We were just beginning to allow women to give birth in the labor room, rather than the old way of scrambling to move them onto a stretcher to transport them to the delivery room right before the birth. There was quite a bit of resistance to this from some physicians at the time.”

The director of the midwifery education program during that period was Marilynn Schmidt, who brought her international background to the classroom and inspired students like McDermott to look globally at the practice. McDermott went on to teach nursing and midwifery in Malawi and Swaziland for several years before returning to the U.S. for a long career at National Institutes of Health, first in maternal health and then in international HIV research and training.

Birth care and beyond

What began as a nine-month in-person certificate program at Georgetown has evolved today into three online programs for the study of midwifery: a 27-month Master of Science dual degree in nurse-midwifery (NM) and women’s health nurse practitioner (WHNP), a 33-month Doctor of Nursing Practice in NM/WHNP, and a post-graduate certificate in NM. The programs include on-campus objective clinical intensives, in addition to synchronous and asynchronous online coursework, and clinical placement.

In addition to reproductive health care from pregnancy to postpartum, midwives study primary care, sexual and gynecologic health care, family planning, preconception care, and more. Steeped in the mission and Jesuit values of the School of Nursing, the program emphasizes health equity and trauma-informed, person-centered, culturally responsive care for women, transgender, and gender diverse people throughout the lifespan.

Melicia Escobar (NHS’04, DNP’22), program director for the NM/WHNP program and currently based in Philadelphia, notes that many people do not realize that midwifery is more than taking care of people prenatally. To be a midwife means to be many things, including champions of the physiologic or normal, natural processes of the body.

“Really, what you’re signing up for is being an advocate for your patients, advocating for yourself, and advocating for your profession because many people still don’t know what midwives are or what we do,” says Escobar. “In short, we are the protectors of the physiologic, whether that’s physiologic antepartum care, well- person care, birth care, postpartum care, and newborn care up to the first 28 days of life.”

Different from doulas who provide labor support at birth and postpartum support in the home, midwives provide complete primary, gynecologic, pregnancy and birth care as independent practitioners who also partner with physicians on an as-needed basis. “We’re collaborators with our physician colleagues when aspects of the care reach a level of complexity outside our scope, resulting in the most comprehensive care,” she notes.

Although their focus is on care of healthy, low-risk people, midwives have a role even in precarious situations.

“I’ve taken care of really acute patients at Children’s Hospital of Philadelphia in the Special Delivery Unit,” Escobar says. “There, midwives work closely with physician colleagues to preserve any elements of that person’s experience that can be normalized. Even though your fetus may be at risk for neonatal complications—or maybe you are at higher risk because of a pregnancy-related complication—if it is still safe to have a vaginal birth, I, as a midwife, am there to facilitate that experience and work with you to make sure that it happens in a way you’d like it to happen.”

Escobar is the oldest of five and daughter to a teen mom. She planned to become an OB/GYN, but after shadowing one at a hospital during college, knew she wanted to be part of a different model of birth care. She learned about midwives and moved to DC to work at Mary’s Center, a community health center, in the teen program focusing on primary and secondary pregnancy prevention and wellness. It was there that she was first exposed to midwives in clinical practice and was encouraged to apply to Georgetown by its founder Maria Gomez (N’77). She completed a second bachelor’s degree in nursing from Georgetown, returned to Philadelphia for her midwifery degree at University of Pennsylvania, and later returned to Georgetown as faculty.

“Midwifery care is underutilized in this country,” says Escobar. “Traditionally midwives were wise women embedded in the community who saw and knew the whole family. Learning about someone’s context is part of the model of care in addition to having relevant health care knowledge. But it’s the marriage of the two—the art and the science of it—that is so beautiful and has proven time and time again the positive outcomes associated with midwifery care.”

Expanding the reach

In 2011, the Department of Nursing at the former School of Nursing & Health Studies made the leap to become Georgetown University’s first online degree-granting program. Entering the world of distance-based learning created a transformative opportunity to expand midwifery education beyond the Washington, DC area. Now both students and faculty across the country can be a part of Georgetown’s renowned program while based in their hometowns, and can remain to practice midwifery and women’s health in their communities upon graduation.

In addition, Georgetown partners with hundreds of clinical sites across the country to help match each student to a clinical preceptor in their region for hands-on learning. In many cases, Georgetown alumni serve in this critical role.

“When we think about workforce development, that’s one of the reasons Georgetown moved to an online platform. We’re able to reach students nationally and fill geographical areas of need, what we call perinatal health deserts,” notes Escobar.

Today there are close to 300 students in 49 states who are enrolled in the three tracks in the midwifery education program. A big draw is the faculty who live in different regions across the country and bring a diverse set of experiences and expertise, including areas such as health equity in the care of populations that are vulnerable and marginalized, global health, legislative advocacy, community-based and complex birth, and expanded scope of practice and specialization.

Minnesota midwife Emily Rumsey (G’15) chose Georgetown’s program because she could attend remotely and study with faculty who are leaders in the field.

“I wanted to learn midwifery from the textbook writers,” she says, adding that the academically rigorous coursework made her a better midwife and that even a decade ago Georgetown’s technology for distance learning was impressive.

While Escobar is based in Philadelphia, the Assistant Program Director Heather Bradford is based in Seattle. Since her midwifery career began over 20 years ago, Bradford has attended almost 800 births and is currently researching weight bias among perinatal care providers and whether it may contribute to unnecessary cesarean births. She sees the regional diversity among faculty and students as a big plus.

“It’s a great part of the program that we can grow wherever students are,” Bradford says.

Faculty member Cindy Farley, based in Ohio, is co-editor of the classic midwifery text, Clinical Practice Guidelines for Midwifery and Women’s Health, now in its 6th edition. She is also co-editor and contributing author to the award-winning Prenatal and Postnatal Care: A Woman Centered Approach. She serves as a locum tenens midwife to a rural hospital and a birth center in Holmes County, Ohio, one of the largest Amish populations in the world. She has partnered with humanitarian organizations to provide education to midwives across the globe, including Honduras, Haiti, Guatemala, Liberia, Kenya, and Tanzania.

Advocacy and justice

Another standout feature of Georgetown’s program is advocacy, says Escobar, who notes that the program brings a new cohort of students to DC every 15 weeks to meet with their representatives and senators on Capitol Hill “as both constituents and as members of our professional associations.

“As a student, they may feel intimidated,” Escobar shares. “But I remind them that they have knowledge about midwifery, and they are nurses. They know what is happening in their communities—how people are being cared for, where there are gaps. The education and advocacy serve a dual purpose: to empower students to step into their knowledge and expertise, and to convey important information that will inform their legislators’ health policy decisions.”

Many aspiring midwives are drawn to Georgetown’s health equity focus, says Escobar. The innovative curriculum was developed in response to students’ concerns about having the skills to meet the complex needs of their patients.

Students said they could “easily perform a speculum exam and palpate an abdomen. What’s really hard is talking to someone about their sexual health without feeling awkward, or taking care of someone who is trans for the first time, or someone who is living in a higher weight body without causing shame, or talking with patients who live with food insecurity about nutrition,” Escobar notes. “How do I speak with a pregnant Black person about entering a perinatal health system that statistically fails them?”

Emily Rumsey works at a federally qualified health center caring primarily for an underserved immigrant population without insurance. “The social justice emphasis at Georgetown helped put my philosophical roots into action.”

She laments the modern medical system’s emphasis on dollars and cents over the more traditional practice of relationship-based care, which can take time to build.

“Midwives are able to care for high-risk patients who deserve midwifery too,” she adds. “We continue to work to reach them in appropriate ways. The quick turnaround for labor and delivery rooms often doesn’t leave time for the physiologic process to take place. Let it be low risk when it is low risk. Understanding the difference is what midwifery is all about.”

In some parts of the country, notes Bradford, midwives are still supervised by physicians—something the midwifery profession hopes to see change.

“Midwives are trained as independent health care clinicians. It can help expand midwifery tremendously and improve health outcomes if everyone was able to practice to their full scope allowed by their certification,” Bradford says.

A simple, natural process

Marsha Jackson (G’82) was a nurse and pregnant with her first child when she decided to become a childbirth educator. After her second child was born, she began assisting midwives at home births. Pregnant with her third child in 1979, she learned about a new master’s level midwifery program starting at Georgetown.

At first she was uncertain she’d be able to attend graduate school full-time due to financial concerns of a two-income family with three young children. But the program director at the time, Judy Melson Mercer, “encouraged me to go ahead and apply, and she would help find the funds,” Jackson recalls. “I was accepted, I took out a loan for our living expenses, and Judy was able to line up a grant to cover tuition. That was a real blessing!”

She remembers faculty and other students being very supportive as she pumped breastmilk during class. Overall the quality of the education was first rate, Jackson notes, shaped in part by Melson Mercer’s leadership as a midwife with a home birth practice of her own. The students gained clinical experience at DC General Hospital, serving primarily uninsured and poor communities. Jackson went on to become the first midwife to gain privileges at Georgetown University Hospital—no small feat for a Black woman who has encountered many instances of discrimination based not only on race, but also related to her clinical specialty.

“Midwifery brings out more of your inner workings,” she says. “I wasn’t always a very outgoing person. I was quiet, but I realized I had to reach deeper into myself to become more assertive. In order to be a midwife, and to be an advocate for clients, you have to really learn to pull that part of your being more to the surface.”

At Georgetown, in addition to the standard midwifery coursework, she remembers a very informative required class about starting and maintaining a small business—a critical skill set that some students may not have viewed as important when there was so much basic midwifery coursework and skills to learn, Jackson says. “In hindsight, that business course served as a springboard for structuring my own private midwifery services.”

Jackson ran her own home birth practice in the DC area for five years. In addition, she worked with Cities-in-Schools, a single-site Education Program and Adolescent Health Center providing comprehensive maternity and family planning services with births at DC General and Georgetown University Hospitals. In 1987, she and her midwifery classmate, Alice Bailes (G’82), cofounded BirthCare & Women’s Health, a home birth practice providing services in the District, Maryland, and Virginia. In 1991, they expanded the service to include the first accredited birth center in Alexandria. Bailes retired in 2013 and Jackson has continued leading the flourishing practice.

“As midwives, we address the health needs of the full person and we focus on birth as a normal, natural process. We screen for complications, of course, but in most cases birth is very simple. These babies just come, and it’s wonderful.”

Jackson said she feels the support of her ancestors in her work. One of her grandmothers owned a nursing home in New Jersey. Her other grandmother was a mid- wife in North Carolina—a part of her family history she learned about from her grandfather only after becoming a midwife herself.

Always active in her church, she serves as a deacon there, and sees a strong faith connection to her midwifery work. “I feel like this is why God put me here on earth, to be there for women and families, and be that instrument to help them give birth in a way that’s empowering. Empowered people help make this a better world.”

The power of birth stories

Susana Mendez (G’19) comes from a long line of Mexican immigrant farm workers. As a child she would spend summers in Sahuayo, Mexico with her grandmother, a small town businesswoman who took care of their family farm and who gave birth to nine children, all at home assisted by a homebirth midwife. As a young girl, Mendez loved listening to her grandmother’s riveting birth stories, so much that she would often find herself playing midwife with her cousins, recreating her grandmother’s birth stories and delivering dolls tucked under her cousins’ shirts.

Her passion for birth led her to become an obstetrical flight nurse with Stanford Hospital, traveling by helicopter for high risk obstetrical transfers requiring emergent delivery. But in her heart she felt called to midwifery, so she joined the master’s program at Georgetown. Today she practices in her home state of California at a large inner-city hospital with immigrant families like her own. “The number of Latina midwives is small. Being here, Spanish-speaking in Northern California, I find myself taking care of a lot of women that look like me, my mother, and my grandmother, and who also face the same systemic obstacles. It’s really fulfilling to be able to give back to the pregnant people of this community.”

She chose to work particularly with marginalized, low-income, underserved people in her community using a model of group prenatal care. In addition to individualized care, her practice incorporates group-led visits with other pregnant people, fostering a sense of shared experience, and validating many aspects of pregnancy to build a sense of community.

“In this country, motherhood can be so isolating,” says Mendez. “There’s no support for people who are estranged from their family members. The group care model brings that sense of community back to the birthing and pregnancy experiences so that they can lean on each other, because birthing and raising children takes a village. And sometimes, it’s impossible to provide that support with one-on-one care.”

Mendez notes that midwives overcome many obstacles in the health care system to give women the care they deserve.

“It really comes down to fostering a safe birthing space for women, facilitating physiological birth, and minimizing intervention when possible,” she says. “They deserve to birth the way that their body was made to. It’s really easy for marginalized women and women of color to have that voice in their care and in their birth when they are cared for by midwives.”

The benefits of midwifery care continue beyond the birth experience, Mendez adds. “The mother-child duo is getting off to a good start that will ripple into the rest of their lives.”

As a student, she appreciated the extra support Georgetown provided during challenging times. “They did a really good job of making sure that I stayed with the program. They provided me with the necessary guardrails, and they protected me—in essence what I do with the women that I take care of everyday.”

Mendez sees her own birth story among the people she cares for.

“I am the daughter of an immigrant just like the babies I help birth everyday. I want nothing more than to see these families succeed,” she says. “I want to create the most safe and beautiful environment for the babies that are coming into this new world. In my family I am the first generation to have gone to college, first to get my master’s, and now to bring new life into this world and give them as much as was given to me.”

She pauses.

“Birth is this miracle that I get to participate in every day. It’s so beautiful. Why wouldn’t everyone want to be a midwife?” 

Heather Wilpone-Wellborn contributed to this article.
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The School of Nursing’s midwifery program is just one of the many ways Georgetown is advancing the health and security of people and the planet as we become the university we are called to be. Learn more at calledtobe.georgetown.edu.