About Kitty Ernst
Kitty Ernst is the only endowed Chair of Midwifery in the United States. She is a certified nurse-midwife graduate of Kentucky's Frontier School of Midwifery with a master's degree in public health. A renowned visionary in the field of midwifery, Kitty has pioneered pregnancy and birth care advances for more than 40 years. Highlights of her career include:
- Early president of the American College of Nurse-Midwives
- Director of the nurse-midwifery service and education program at Columbia Presbyterian Medical Center
- Midwifery consultant, lecturer, and educator,
- Director of the National Association of Childbearing Centers (NACC)
- Helped to institute the Commission for Accreditation of Freestanding Birth Centers.
- Recipient of the Martha Mae Elliot Award
- Recipient of the Hattie Hemschemeyer Award from the American College of Nurse-Midwives
- Recipient of the Maternity Center Association Medal for Distinguished Service
How did you decide to go into Nurse Midwifery? How did you discover your talent for it?
My decision to go into nurse-midwifery was made when I witnessed a birth attended by nurse-midwives at the Frontier Nursing Service in a remote cabin in the Appalachian mountains of Southeastern Kentucky. I was a student nurse during the time when scopolamine (an amnesiac) and heavy sedation was given to laboring women to relieve and help them forget their pain. Some of the women became disoriented with the medication and were restrained with bed rails and or a straitjacket to keep them from hurting themselves. The obstetrician was called at the last minute and nurses turned their focus to assisting the obstetrician and positioning the woman in the delivery room, flat on her back with her legs up in stirrups on what could be an operating table. Since the medication often made it impossible for the woman to give birth, the baby, also drugged, would be pulled out with forceps and taken to the nursery for observation until mother and baby sobered up. At age 19, with lots of experience observing animals' giving birth, it seemed barbaric to me and I vowed I would never choose to do obstetrical nursing.
On the face page of my obstetrical nursing textbook, however, was a picture of Mary Breckinridge on horseback and a brief description of the Frontier Nursing Service (FNS) she established in the Kentucky Mountains. The idea of being a public health nurse on horseback appealed to my young adventurous spirit. But when I discovered that in order to be a nurse on horseback one also had to train to be a midwife, which I translated to be an obstetrical nurse, the appeal faded and I planned to leave. The Dean of the School, a wise woman, explained that midwifery was not obstetrics and perhaps I would like to attend a home birth with her and one of her students before I left. My observation of the nurse-midwives' attending that powerful mountain woman, in her humble one- room cabin with her youngest in bed with her, was my epiphany. The other four children slept in the one other bed while her husband hovered about, tending the wood stove and keeping extra water warm for bathing the mother and baby after the birth. The midwives worked at the mother's side or on their knees before her, whispering encouragement, stroking her back, wiping her brow and laying out the small packages of supplies for the birth. The babe, given to the mother at birth, nuzzled up to her breast, while the father laid a feast of fresh biscuits, chicken and gravy on the homemade table and benches for all to have the celebration breakfast he had prepared while this extraordinary drama unfolded. I thought, so this is how "giving birth" is different from "being delivered." This is why midwifery is different from obstetrics: the midwives focused on serving the mother. I decided then that becoming a midwife was what I wanted to do.
The Frontier School of Midwifery was small at that time, and trained nurses to be midwives primarily for the FNS or for mission work in undeveloped countries. Since I had no calling to be a missionary, I enrolled in the school to become a public health nurse-midwife on horseback. I spent the next three years as a District Nurse at the Frontier Nursing Service doing public health nursing and midwifery.
What would you consider your proudest accomplishments in the field? Have you had any major setbacks along the road?
My greatest satisfaction has been in helping nurse-midwifery grow to the point where my daughter was able to give birth attended by nurse-midwives in a fabulous birthing center, without driving 50 miles as I had done to find an "obstetrician-midwife" who would allow my husband to be with me. When I became a nurse-midwife there were 3 independent schools of midwifery and a handful of places to practice in the United States. There are now 48 nurse-midwifery programs in or affiliated with some of the most prestigious universities. When I came to Pennsylvania to start my family in the 1960s, there were no nurse-midwives. There are now over 300 nurse-midwives, and 117 practice sites listed in the Membership Directory of the American College of Nurse Midwives, and there are 6 freestanding birth centers established by nurse-midwives.
I think my greatest contributions have been in helping to develop the birth center as a place for the practice of midwifery and, more recently, being able to take midwifery education to the over 1000 nurses who "have always wanted to be a midwife but could not relocate." This was made possible by a strong graduate education curriculum for the distance learning program at the Frontier School of Midwifery and Family Nursing in collaboration with Case Western Reserve University.
There are always setbacks to the development of a "new" profession, but great progress has been made. The setbacks to nurse-midwifery education and practice have related primarily to the way we view birth in America. In almost all other industrialized countries, midwifery became a profession alongside the specialty of obstetrics. Most of the childbearing women in those countries are attended by midwives,and by an obstetrician only when the services of a medical specialist are indicated. Since the establishment of the American College of Nurse-Midwives in 1955, nurse-midwives and others in the United States have worked continuously with great success at state and federal policy levels to establish nurse-midwifery within the health care delivery system. Nurse-midwives are licensed in every state, reimbursed for their services by most insurance companies, and carry their own malpractice insurance. Before the distance learning program was established at the Frontier School of Midwifery and Family Nursing, educational opportunities were limited by the number of students that could be admitted to a teaching university where the priority was medical education. In the distance learning program the opportunity is unlimited. All applicants meeting admission requirements are accepted. The opportunities for the graduates to practice will depend on the desires of the midwife and the needs of a given community. Although no one can guarantee a student her dream position upon graduation from an education program, the recent expansion of nurse-midwifery practice arenas, and a growing interest from women seeking midwifery care, present a promising future for those entering the profession. For the creative midwife entrepreneur, the opportunities to create a innovative practice or birth center services are almost unlimited.
What are the greatest challenges facing nurse-midwifery professionals in the field today?
The most important challenge today is to educate enough nurse-midwives to meet the growing demand from women seeking their services. If nurses do not meet this challenge, it may be left to the growing number of direct entry (non-nursing) midwifery education programs to meet the need.
The second most important challenge is to educate the public on the benefits of the midwife/obstetrician team. This has begun. Even celebrities like Wesley Snipes, John Travolta and Demi Moore have sought midwifery services for childbirth.
What do you enjoy most about your work?
Helping others realize their potential:
- women and families to become confident and empowered through their birth experience;
- nurses to realize the difference between giving birth and being delivered and, if called, to realize their full potential in a career as a midwife;
- physicians to overcome what they have been taught about midwifery and embrace it in order to bring the best of midwifery and obstetrics to childbearing families and.
- educating the public to the benefits of the obstetrician midwife team.
What have been your personal keys to success in nurse midwifery?
I have never really thought about it, but my daughter says it is probably
- A sense of humor,
- Being able to start where people are, appreciate their talents, and build from there,
- Willing to work hard and risk all.
Careers and Jobs
What does a typical day of work for a nurse-midwife entail? What are key responsibilities?
Nurse-midwives have an opportunity to practice in a variety of settings: hospitals, clinics, community health centers, private obstetrician offices, private family physician offices, birth centers, private midwifery or home birth practices. What they do is determined in part by the setting, but also by the needs of the women they serve and/or the practice in which they are employed. Most nurse-midwives work in hospitals or in private obstetrician practices. There, their day may consist of clinic or office hours seeing women for prenatal or postpartum care, gynecological care or family planning, or a variety of educational and counseling services. Their day (and their night if they are on call) may be interrupted by a woman starting labor or telephone calls from women with problems. If they have their own practice or birth center, they also will be responsible for the business which, like any business, involves financial operations, staffing, facility maintenance, etc.
What are some of the trends you see that point to a future need for nurse-midwives?
In the United States, maternity care is the most frequent hospital admission. It constitutes a large portion of our employer-base health insurance dollar. As the cost of care continues to escalate, it will become apparent that the midwife/obstetrician team is part of the solution to containing costs for these services. It costs less to educate a nurse-midwife. Nurse-midwives earn less than obstetricians, their malpractice insurance is less, and because they use fewer routine medical interventions, it costs the hospital less for a nurse-midwife birth. In addition, women who use nurse-midwifery services have a high rate of satisfaction with their care. In the 21st century, we can no longer afford to ignore these factors. It is estimated that nurse-midwives can safely care for 70-75 % of all childbearing women. This means that to meet future needs, we should train four to six midwives for every obstetrician instead of four to six obstetricians for every nurse-midwife. Nurse-midwifery birth centers are providing care at half the charges of hospitals for normal birth. This represents enormous change, and change does not come quickly or easily. Nursing, however, has an opportunity now to direct such changes for improving the delivery of maternity care services.
Who are some of the most important figures in the field of Nursing Midwifery today?
They are all important to me. If one wanted to interview a variety of nurse-midwives I would suggest the following:
- Ruth Lubic - an innovator with a long list of accomplishments
- Judith Rooks - a researcher and historian - widely published
- Joni Slager - developed and now manages a large hospital nurse-midwifery service
- Susan Stapleton - founder and director of successful freestanding birth center - highly respected
What are some common myths about your profession?
- The most common myth is that midwives only do home births.
- That midwives practice without the collaboration of a physician.
- That they are all hippies or old grannies.
- That care by a midwife is not as good as that of an obstetrician and "I want the best."
What's the pay scale for someone just starting a career? How about for those at the mid and senior level?
The pay scale depends on the setting and the benefits included such as education time and expenses, holidays and vacations, sick leave, health insurance, malpractice insurance coverage, retirement funds and profit sharing plans. A beginning salary, depending on experience and work expectations, may range from $50, 000 to $75,000. The greater the income the nurse-midwife produces for the practice or the higher the responsibility, the higher the salary. It can go into six figures for high levels of productivity or senior level practitioners. It can also be lower for those establishing a practice.
Do you have any advice regarding how people can best get started and be successful in midwifery?
Education today is expensive but a solid education is a must. Choose the school for its curriculum, student support structures and financial aid available. Talk with current students and graduates to see if it is the right fit for you. Ask about results of national board exams. Be prepared to work hard and learn all that you can while in the program. Participate in the affairs of the professional organizations.
Midwifery is a service profession. I believe that once you are well educated and clinically competent, personality is the key to success.
You have hired many professionals; what do you look for when considering hiring someone?
Knowledge base for the position, integrity, clinical competence, ability to interact positively with all people, commitment to service, sense of humor.
Can you provide any advice on how students can prepare themselves for interviewing?
Do your homework on the position you are seeking. Be aware of the myths about midwives and get advice on how you plan to present yourself. Identify what contributions you can make to the practice.
How is the job market right now? How do you think it will be in the next 5-10 years?
The health care delivery system has problems. Research shows that midwifery can be part of the solution to these problems. Some obstetricians are leaving practice because of high malpractice insurance premiums. Some, facing ever lower payment for services, are realizing that working with midwives not only expands the referral base for their obstetric and gynecologic specialty, but brings high client satisfaction for services rendered. Over 40 million people are uninsured and looking for affordable quality care. Alternatives to traditional medical care are growing. Midwifery offers an opportunity for nurses to create their own practices, their own birth centers. Until midwifery care is available to every woman seeking a midwife, the future is a wide road of opportunity for nurses.
School and Education Perspectives
Can you give us an introduction to nurse midwifery education - programs and degrees available, ranges of length of programs and costs?
All nurse-midwifery education programs are now at a master's degree level. Most programs are two years for full time students. The tuition varies but is on a par with other graduate education programs in an institution. Current information may be obtained from the American College of Nurse-Midwives in Washington DC.
What schools/colleges have the strongest reputation for education in midwifery?
The Frontier School is the oldest, and with the advent of distance education, the largest. It has one of the highest pass rates on the national certifying exam and has received high marks on periodic surveys of graduates and their employers.
What is right and wrong with nursing education in America today?
N/A I'm not qualified to answer this. In obstetrics, students get little or no hands on experience in most programs.
What can students applying to schools do to increase their chances of being accepted?
Check the admission criteria and the number of applicants accepted annually for all programs.
The Distance Learning Program of the Frontier School of Midwifery and Family Nursing has no limit on admissions for qualified applicants.
Who are the accrediting bodies for nurse-midwifery education? How important is their stamp of approval?
Two types of accreditation are involved.
- The Division of Accreditation of the American College of Nurse-Midwives accredits the nurse-midwifery education program.
- The college or university offering or affiliated with the nurse-midwifery education program must have institutional accreditation approved by the US Department of Education.
A graduate from a non-accredited program will not be eligible to sit the national certifying exam which is the basis for licensure in most states.
Before we talk about the future, can you please provide a brief history of nurse midwifery to bring us up to today?
Nurse-midwifery was introduced in the United States by Mary Breckinridge at the Frontier Nursing Service in Kentucky in 1925. The first school was opened by Maternity Center Association in New York City in 1931. Nurse-midwifery in the United States began with services to the poor or the new immigrants from countries where midwifery was the norm. In the 1950s the nurse-midwifery services connected with Maternity Center Association moved from home birth into hospitals, and education programs began to be developed on university campuses (Yale, Columbia, Johns Hopkins). The American College of Nurse-Midwives was established to develop the standards for the profession. During the 1960s under funding from the federal government, new schools of nurse-midwifery opened in universities across the nation. Women seeking an alternative to the medicalization of childbirth turned to the consumer driven education movements like Lamaze and La Leche League for natural childbirth and a return to breastfeeding their infants. Hospitals and physicians were slow to respond to these movements and the rate of home birth, sometimes unattended, began to rise. These activities prompted Maternity Center Association in New York to establish and evaluate a demonstration of a freestanding birth center where the nurse-midwife/obstetrician team would work together to identify what women wanted, and try to meet their desires within protocols for safe practice. The birth center created a place for displaying the practice of midwifery. In spite of obstacles the concept has grown both in and out of hospitals.
Is there anything else you can tell us about yourself, your career or the profession, that would be interesting or helpful to others aspiring to become nurse-midwives?
I would like to see every nurse entering obstetric nursing to have the knowledge base of a nurse-midwife. It is unfair to ask nurses who work in labor and delivery to manage a woman's care during labor with the limited knowledge and experience she obtains in her basic nursing education. When all nurses who want to attend women in labor are educated as midwives, maternity care will change to bring the best we have to offer to childbearing families.