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Liz Howard, Certified Nurse Midwife,
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Liz Howard was interviewed by Susan Kuner April 8, 1998.
Q: Liz, would you tell us about your career and what exactly you do?
Liz: I'm a Certified Nurse Midwife, so I have a degree in Nursing and
a Masters also in Nursing with a specialty in midwifery, which is care of women and babies
throughout the lifespan. I do gynecology, well-woman gynecology, pre-natal care and
delivery and immediate newborn care. I set up this practice at Vanderbilt Hospital. We
started out at a hospital in the rural counties west of here three years ago and moved to
Vanderbilt a year ago.
Q: So the midwifery program is just one year old here?
Liz: Yes.
Q: That's wonderful. Tell us what you do in a typical day.
Liz: Normally I get up and come here and visit any patients we have delivered. I check on the moms and the babies. Then I'll go to clinic and usually spend the day there. If I'm the midwife on call, three of us share call, then my time extends to after clinic hours. You go home with a beeper and if somebody thinks they're in labor, they'll call the answering service, then I'll get paged. I'll talk to a mom in early labor and we'll decide when she wants to meet me here at the hospital. So I might come back in several hours after most people's workday is over. I might come in at 2 or 3 in the morning and be with someone in labor until they deliver.
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Liz Howard reads a print-out from the fetal heart monitor. |
Q: So someone would have to choose between a midwife and a more traditional obstetrician, is that how it would work?
Liz: Women choose whether they want to come to a midwife or a doctor when they get pregnant. When they come to a midwife, if they develop medical complications we work in collaboration with a doctor. So we would call and consult them. Normally we can contain and take care of them if they develop complications. Occasionally we feel like they would be better cared for by a physician and we'll refer them on. But if something comes up and both the midwife and doctor need to take care of them, then that's what we do. We work together.
Q: Midwives have a great tradition, yes?
Liz: Yes, really all over the world, midwives are the primary care providers for women and their babies and do the deliveries. The United States is actually the only country that outlawed midwifery. 95% of births world-wide are done by midwives. In this country only 5% of births are done by midwives. But that trend is starting to turn around for several reasons. One of them has to do with managed care, and health care costs. People are trying to cut healthcare costs and midwifery has been shown to be very cost effective. Also women are consumers of their healthcare and want to be more involved and more in control of what happens to them. They want to be informed about what their choices are, such as where they want it delivered, or how they want it delivered, and how it happens. And that's one reason why midwifery is becoming a little more popular.
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Sitting area in a birthing suite at Vanderbilt Hospital. |
Q: What are the advantages of choosing a midwife?
Liz: Generally, midwives are women, but that's not always true. Someone might prefer to see a female provider. Also midwives spend more time with patients. We don't jam our schedules like many physicians need to do to keep up with the costs. We focus on prevention and education. If someone comes to us we'll spend a lot of time focusing on nutrition and what she can do to have an optimal pregnancy outcome.
We view pregnancy as normal. We try to facilitate normal, natural processes. It does not mean that someone cannot get pain relief during labor. It means that someone goes into labor prepared for what the choices are going to be along the way. We do promote natural processes and facilitate that. Basically we have a lower C-section rate than physicians do. National studies have shown that if you go to a midwife your chances for having a C-section are less than half than if you had gone to a physician for care.
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The suite is designed to look comfortable, |
Statistics show that we do just as well as physicians do, but there are some things that we're better at. We're better at taking care of adolescents than physicians are, and that might be because we spend more time with them. And because we try to focus on prevention and we try to encourage them to eat healthily. And we do give them support that may be lacking in their current life.
We talk to people who aren't pregnant yet. I do preconception classes here at Health Plus and I talk to people about taking prenatal vitamins before they decide to get pregnant, because we know that the Folic Acid will help decrease their incidence of birth defect. I talk to them about what their lifestyle is, if they smoke, how to stop smoking. So all those things that we try to encourage them to stop doing before they get pregnant. Obviously if anyone takes drugs or drinks then that would enter into it too. We ask people to evaluate their health behavior now. Good healthy behaviors for pregnancy are the same kind of behaviors that everyone should have for a healthy lifestyle really
Q: So, in terms of the students what advice would you give about their health in the present and future in relation to what you do?
Liz: We advocate that teenagers wait until they are older to become mothers. We know statistically it's much better if they wait. Women who are not alone do better in pregnancy. We know that in teen pregnancy there's a higher pre-term birth rate. There's a higher infant mortality rate. They have more complications, partly due to nutritional factors, partly due to less support for the pregnancy than there would be if they were in a more traditional type of relationship. So those things go against them.
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Birthing bed. |
Q: What is your educational background? Where did you go to school and where did you go to study to be a midwife?
Liz: I went to William Smith College where I got my undergraduate degree in sociology. And I became interested in midwifery through some sociology of childbirth classes. I worked in women's health for about five years after that and went to Yale University where they had an accelerated combined program where I could get my nursing degree in one year and then go right into a Master's portion which was midwifery.
Q: What would you recommend for the student if they were interested in becoming a midwife?
Liz: I would recommend they contact the American College of Nurse Midwives which is in Washington D.C. They have a list of all the nurse midwifery programs. You have to have a nursing degree first before you can. Vanderbilt has a program similar to Yale's where if you have a non-nurse college degree you can apply and get the accelerated portion of nursing. If you're thinking of it as a second career, most of you wouldn't be thinking of that, but we do get an older group of people into the program that way. And then it's five semesters after the nursing portion. So it's like 2 1/2 years.
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A bassinet for the baby. |
Q: About how many programs are there in the country?
Liz: There are about 30 right now. And really all of them except for Vanderbilt and Yale want you to have a nursing degree prior. So if you're thinking about nurse midwifery I would recommend getting a nursing degree.
Q: If someone wanted to go into it would there be volunteer opportunities? If somebody's thinking about this, how can they start now?
Liz: A great place to volunteer would be looking at one of the local midwifery services. If someone would like to come here, that would be fine with me, if I clear it with everybody here, if they wanted to come in for a delivery too, to watch.
Q: That would be fabulous, so if they want more information they could just e-mail you?
Liz: They could e-mail me and then I could try and set it up.
Q: Would you recommend this as a career?
Liz: Oh, absolutely. You have to really, really love birth, because you have to remember the hours are terrible. You have to really enjoy getting out of the bed at 2 and 3 in the morning and helping people in labor. I've never been bored. I've been a midwife for seven years and I'm not tired of it yet.
For further reading:
American College of Nurse Midwives
Would you like to ask Liz Howard a question? You can email her at elisabeth.howard@mcmail.vanderbilt.edu.