Two new midwifery education programs in New Orleans aim to grow the ranks of health care workers who can help address Louisiana’s dire maternal health and birth outcomes.

The nurse-midwifery programs at LSU and Loyola University are the first to be started in Louisiana in almost 80 years. LSU has secured its first cohort of students and Loyola is recruiting for the fall, both joining a broader movement to expand the footprint of certified midwives in the South.

The graduate programs will prepare students to become certified nurse-midwives — skilled nurses with advanced schooling that equips them to care for low-risk pregnancies and births, as well as to provide reproductive and primary health care for people of all ages.

Research has shown that states where midwives are more integrated into health care systems show improved outcomes for mothers and babies, and other studies have found that women with low-risk pregnancies who receive care from nurse-midwives see a decrease in interventions such as C-sections.

The programs could play an important role in expanding access to maternity care in Louisiana, especially across the state’s under-resourced rural regions. The universities say they’re also working to recruit and retain students from underrepresented backgrounds in an effort to diversify the mostly white profession.

“We need more midwives to elevate the health of the women here, and we need more minority midwives because 43% of the reproductive-age women in this state are of color,” said Michelle Collins, dean of Loyola’s College of Nursing and Health. “We need more midwives of color to serve them.”

About a third of Louisiana parishes are considered maternity care deserts, defined by the national nonprofit March of Dimes as any parish or county where there are no hospitals or birth centers with obstetric services, no OB-GYNs, and no licensed midwives. Researchers have found that women living in these areas in Louisiana are more likely to die during pregnancy or in the year after giving birth. 

C. Shannon Pfingstag, who directs the LSU program, said she anticipates attracting local candidates who can stay and work in the state. “We need people who know Louisiana in order to create the solutions for Louisiana,” Pfingstag said. “The more options people have, the better.”

Those entering Loyola’s program will graduate with a master’s degree, while students at LSU will pursue a doctoral degree. Both schools are currently recruiting students for the upcoming academic year, and LSU already has two candidates in its program. Administrators say they are keeping cohorts small — Loyola aims to have 10 per class, and LSU two to four students.

In addition to taking classes, students in each program will gain clinical experience across the state in labor and delivery units, birthing centers and other settings. At LSU, for example, students might also spend time in medication-assisted treatment centers and rural primary care clinics, learning how to serve a variety of populations. “It’s not just catching babies,” said Pfingstag, who has worked as a nurse-midwife for more than 25 years. 

In the last few years, similar programs have been established across the Southeast, where training for midwives has been scarce and where women and infants often fare the worst in terms of health outcomes. 

Ginger Breedlove is a former president of the American College of Nurse-Midwives and a consultant who has worked with some of the schools, including Loyola, to develop their programs. Breedlove said she sees the emergence of new programs in the South as a response to a recent federal focus on maternal health.

Addressing disparities in care

Administrators say both programs will also aim to recruit diverse cohorts to better serve patients, especially given the striking disparities in maternal and infant health between Black and white mothers. The programs will also thread issues of social justice in their curricula, such as how to address issues of institutional bias and racism in medicine.

Data gathered from 2016-2020 by the American College of Nurse-Midwives tracking certified midwives showed just a handful in Louisiana were not white, and found only three midwives of color out of about 50 in clinical practice. 

Demetrice Smith recalled being the only Black nurse-midwife in the New Orleans region when she first began practicing nearly a decade ago. Now a clinical instructor at LSU’s nursing school, Smith is working with Pfingstag to put together a curriculum that incorporates antiracism and social justice components and will join the nurse-midwifery program as an assistant director.

“Where has midwifery been on the other side of this?” Smith said. “How can we … actually acknowledge the wrongs of our past? How can we continue to forge forward?”

The South was once home to thousands of Black “granny” midwives, known for their community ties and traditional knowledge. But over the course of the 20th century, those midwives were increasingly excluded from the health care system by doctors and public health officials who pushed to have babies delivered in hospitals, and the professionalization of nurse-midwives in the early 20th century further shut out these lay midwives.

A federally funded nurse-midwifery program ran briefly in Louisiana from 1942 to 1943, when the Flint-Goodridge Hospital at historically Black Dillard University launched its own school.

“The high maternal mortality among Negro mothers, especially in the southern states, points to the great need for development of widespread measures which may help to bring these mothers safely through the maternity cycle,” reads a 1943 document outlining the aims and requirements of Dillard’s program. “It is believed that 60% of these lives could be saved if adequate care were available and could be given.”

The program shut down in part due to funding issues, said Sharon Hutchinson, dean of Dillard’s School of Nursing, though Dillard has continued to educate nurses through its bachelor’s program and has a pipeline partnership with the University of Tennessee Health Science Center, which also offers a nurse-midwifery program.

LSU is also seeking partnerships with historically Black colleges and universities to help develop pipelines for aspiring Black nurse-midwives, Pfingstag said. Students from neighboring Mississippi, which has no nurse-midwife education programs, will be able to pay in-state tuition rates.

Collins, who has secured grants from philanthropic foundations such as Kellogg to defray initial costs at Loyola, said some of that money will be used toward scholarships to help attract students from diverse backgrounds. 

Still, increasing the number of educational opportunities for midwives won’t solve all of the profession’s problems, as midwives have faced misconceptions over their qualifications from patients and other providers alike. Nurse-midwives and nurse practitioners in Louisiana have also clashed with doctors in recent, failed legislative efforts to give such advanced nurses “full practice authority,” allowing them to practice without physician approval, as about half of states have done. 

Collins, who is herself still a practicing nurse-midwife at Ochsner Baptist, remains optimistic that teaching more midwives in the state will help expand opportunities for those midwives to practice in New Orleans and in Louisiana, citing conversations she’s had with doctors and other state experts on maternal health.

“We all recognize that midwifery care can elevate the health of these women,” Collins said.

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Michelle previously worked for The Associated Press in South Carolina and was an inaugural corps member with the Report for America initiative. She also covered statewide criminal justice issues for Mississippi...