Strengthening the Profession Going Forward

Midwifery leader and pioneer Kitty Ernst reflects on the need to continue not only expanding the number of midwives, but also rededicating ourselves to the birth center concept.

Kitty Ernst at the A.C.N.M. Foundation, Inc. 2017 Founders Hall of Fame event in Chicago
Kitty Ernst at the A.C.N.M. Foundation, Inc. 2017 Founders Hall of Fame event in Chicago

Kitty Ernst, CNM, MPH, FACNM is a leading figure in midwifery— dynamic, dedicated, and innovative. Her pioneering vision and exceptional contributions over the years have done much to grow and institutionalize the profession. She was a seminal leader in the birth center movement as the domain of midwives and led the move toward credentialing. Additionally, she served as the founding director of the American Association of Birth Centers. At ACNM, she was one of its first and youngest presidents and has made many other contributions. To honor her, ACNM established the Kitty Ernst Award, given yearly to a midwife certified for fewer than 10 years who exemplifies Kitty’s commitment to excellence, innovation, and creativity in clinical practice, administration, education, or research. Below is an adaptation of a reflection Kitty shared this summer with members of her Pennsylvania Affiliate.

I recently celebrated 67 years as a nurse-midwife. I spent the first six of those years in two of the only three places employing nurse-midwives at that time: Frontier Nursing Service in Kentucky (now Frontier Nursing University) and the Maternity Center Association (MCA) in New York City. The third employer was the Catholic Maternity Institute in Santa Fe; all three provided home birth services. I think I was the first nurse-midwife to reside in Pennsylvania, with Edie Wonnell, CNM, FACNM, as the second. It was after the birth of my children and working with and for Ruth Lubic, CNM, EdD, FACNM, FAAN at MCA as a consultant that I commuted to Downstate College of Nursing for a refresher course (launched by MCA). My goal was to return to practice where I was then an MCA consultant for the founding of the Booth Maternity Center in Philadelphia.

Yet early in my experience at Booth, my aspiration to once again practice midwifery was firmly denied. Instead, I ended up devoting my life to “midwifing midwifery.” Dr. John Franklin, who collaborated with Mabel Ford, CNM on the founding of Booth’s family-center care service, made that path clear to me. One day when I was helping to relieve the backup of patients waiting for their prenatal visits, we bumped into one another in the hallway. He asked, “What are you doing here?” When I replied that I was seeing a few patients who had been waiting a bit, he answered, “My God, Kitty, you need to get back to your office and get that grant for that refresher program you told me about, or none of us are going to be here!” I did, and the rest is history.

Tipping Points, Then and Now

Why am I telling you this now? Because we were at a tipping point then. The Booth, Mississippi, and Downstate refresher programs opened much-needed clinical sites. Booth, alone, prepared more than 200 foreign-trained nurse-midwives to sit for the ACNM certifying exam, as well as provided internships for American-trained nurse-midwives. Downstate opened the door for diversity to excellent women of color who became certified and made contributions to developing midwifery programs in service to the underserved. These refresher programs were essential to the growth needed then. Just as the past 30 years were critical to “exponentially increasing” our production of midwives, today we need to continue not only producing midwives, but also greatly expanding the birth center concept. The ACNM regions will have to play a critical role in protecting the midwifery-led, primary care units called birth centers and other midwifery-led units that have made midwifery visible to women seeking this care. We cannot be subsumed by acute care services again if midwifery is to flourish and grow to be the missing link to a team-approach to care. For almost a century—from Mary Breckinridge’s Metropolitan Insurance Company’s data-based evidence to today’s multiple large studies of home- and birth-center births—researchers have documented that this approach to care leads to not only as good as or better outcomes than the medical in-hospital model of care, but also care provided at significantly lower cost.

Equally important, we cannot build the profession without keeping all the clinical sites open for all students.”

Supporting the Birth Center Concept

Equally important, we cannot build the profession without keeping all clinical sites open for all students—no exclusive contracts. Be aware of the ways that well-intentioned others may be proposing practice designs that will result in changing or controlling the visibility and the growth of the profession. The years of hard work of educating ACOG toward a different paradigm of care, which includes certified nurse-midwives/certified midwives and accredited birth centers, will support your quest to be able to take responsibility and control of your practice. Remember, accredited birth centers, regardless of who owns them, were designed to be the midwife’s place of business, so even if they are not your choice for practice, please support the concept.

I think that with my last breath, I will be pleading for all sites to precept students. The mission for growth will fail without your help. Be sure to negotiate it in all your employment contracts. As many are already doing, precept midwifery students along with the nurses and medical students and residents. Find new ways to make it happen. For example, when a senior staff retires, maybe she could consider cost-based work as a part-time student preceptor, so her experience and wisdom would not be lost. Maybe the ACNM national office or its regions could get a grant to give that a try.

Lastly, Mary Breckinridge said, “Our aim is to see ourselves surpassed.” I see this happening at all levels of education and practice and wish you Godspeed in making it happen for you. Although it is sometimes tough, remember you are tougher, and that “Love, not fear is the answer.”