From International Public Health Specialist to American Certified Midwife

After a career in international public health, Renee Fiorentino earned her CM degree and switched to clinical midwifery.
After a career in international public health, Renee Fiorentino earned her CM degree and switched to clinical midwifery.

After a 15-year international career in public health spanning 20 countries, Renée Fiorentino, LM, CM, MPH earned her Advanced Certificate in Midwifery in 2016 from State University of New York, Downstate. Since becoming a certified midwife (CM) she has co-founded a private practice, become the first CM granted privileges at Forest Hills Hospital in Queens, New York, and began consulting for ACNM in Madagascar.

Karen Jefferson:  Renee, you had such an illustrious career in public health. Why, after all those years, did you decide to become a certified midwife?

Renee Fiorentino:  I could tell a good story about Deborah Maine lighting a fire in all of our bellies in public health school about maternal mortality, and then the World Health Organization (WHO) impressing me with the assertion that midwifery had the potential to reduce excess maternal and neonatal morbidity and mortality by two-thirds—essentially, that midwifery is a genius public health intervention. But if I am completely honest, my decision was the result of a garden-variety midlife crisis that made me want to get out from behind a computer and acquire skills that would enable me to connect with people in a more meaningful way.

KJ:  How did you transition from public health to clinical midwifery? 

RF:  I don’t think of it as a transition so much as an addition to the skills I already had. As a public health practitioner, I was able to hone my analytic and writing skills, and midwifery school helped me realize how grateful I was for those skills.

KJ:  What kind of clinical midwifery practice do you enjoy?

RF: I wasn’t good at memorizing things in midwifery school and I still have to make a conscious effort not to over think things. So, I enjoy providing low-volume continuous-care midwifery. It fits the slower approach to things I’d like this phase of my life to be about, generally. I figured out pretty quickly that high-volume clinical settings, in which midwives are used to fill gaps in a spectacularly fractured system, were not for me. 

KJ:  What do you hope to achieve in midwifery in the United States? 

RF:  I’d like to be part of an increase in the percent of births attended by continuous-care midwifery, case-load midwifery, relationship-based care—whatever we’re calling the idea that a small group of midwives cares for a small group of families “continuously” throughout their pregnancies (and ideally longer). The fact that only approximately 10% of births are attended by midwives in the U.S. says something really depressing to me about the status of women in our country. The 10% also doesn’t capture quality of care, something else I’m really interested in and which consumers need to know to inform decisions about care seeking. That’s why I feel lucky to be keeping my public health skills active doing things like abstracting cases and facilitating quality assurance meetings around the findings as part of the NYC Department of Health’s expanding Severe Maternal Morbidity surveillance initiative.  

KJ:  How has your global experience influenced your clinical experience as a midwife in the US? 

RF:  My international experience left me with a default macro-level lens I can’t shake. I can’t put systems aside and focus only on the one person in front of me. I’m not sure yet what that means for my midwifery practice, but I have gotten enough signs that a public health midwife is employable so I’m not worried yet. Striving to become a better listener one-on-one is a humbling exercise I wish more people would undertake!

Working with donor funding in places where there is an acknowledged need for improvement, even if incredibly fraught, seems more straightforward to me than trying to sell physiologic birth in the context of incentivization for everything but, where there does not seem to be consensus that something is massively off. While public health protocols can seem reductionist, I might in the long run be more interested in scale than depth. I hope I won’t have to choose and can find a way to balance the practice of public health and continuous-care midwifery. 

KJ:  What lessons do you want to keep from your global experience?

RF:  Whether in relation to my new clinical role or in relation to any other aspect of life in the U.S., the things I’d like to hang on to most from my time overseas (and the reason going back from time to time is helpful and enjoyable) are an acceptance (on good days) that things take as long as they take (within reason), and the knowledge that what one needs to be happy, materially, is quite minimal. If I can’t always aspire to these values in the U.S., I hope I’ll have the wisdom to leave.

KJ:  Oh, we hope you stay! 

RF:  Our New York State senate seems poised to make me want to stick around. Fingers crossed for single-payer and other obvious signs that progressive democracy still has a fighting chance.

KJ:  If that happens, what do you see yourself doing a year from now? 

RF:  I think I could be really happy operating out of a store front in East New York or eastern Queens, offering single-payer-funded prenatal, gynecological and postpartum care (maybe yoga, childbirth education and lactation support too?!) as part of a collective, catching wherever is both pro-midwifery and accessible to as many families as possible. I would also like to keep supporting public health and midwifery abroad if I can find a way to balance both.

By Karen Jefferson, LM, CM, FACNM
Chair, ACNM Committee 
of Midwife Advocates for the Certified Midwife (C-MAC)