Karen Kelly was diagnosed with polycystic ovarian syndrome, or PCOS, in her early 20s. Doctors told her she may never be able to have children.
Grieving her chances of becoming a mother, Kelly sought treatment options for the life changing diagnosis. Her search brought her to midwives.
Kelly felt her doctors were harsh, diagnosing her with devastating news and releasing her into the world with limited tools to manage the diagnosis.
After graduating from college, Kelly pursued a degree in midwifery, influenced by her positive experience with being treated for PCOS by a midwife in her college town.
“I really felt there was a feminist pull towards helping women understand their bodies that I saw in the care I received,” she said. “Of course, you want to know what's going on with your body. This is your body. You deserve to have that information.”
Kelly was eventually able to have children of her own, and she delivered both daughters with the help of a midwife.
Midwives are health professionals that specialize in pregnancy, childbirth and postpartum care. They typically take a more natural approach to the birthing process than doctors and provide more comprehensive and personalized care. They can help deliver babies in hospitals, birthing centers and even in people’s homes, depending on their licensure.
Kelly practiced in New York City after receiving her certified midwife certification (CM) and moved with her husband to Virginia, where she was no longer able to practice because Virginia does not license CMs, only certified nurse midwives (CNM), which requires midwives to have a nursing degree before pursuing the midwife certification. The same is true in Pennsylvania, in which only CNMs are licensed to practice.
No longer being able to practice as a midwife led her to midwife advocacy. She’s now a national committee representative for the American College of Nurse Midwives, which led her to Pennsylvania’s state capital earlier this week.
Legislative action
Kelly joined state Sen. Rosemary Brown, who represents Monroe and parts of Lackawanna and Wayne counties. Brown hosted advocates and midwives for an advocacy day to start off National Midwifery Week, which was Oct. 6 - 12.
The senator used the day to promote legislation she’s currently sponsoring, Senate Bill 1262, which provides, “definitions for midwifery and for nurse-midwife license; and providing for certified midwife license.”
The bill would amend the Medical Practice Act of 1985 with those changes, allowing for a more modernized midwife workforce and expanding the midwife ranks.
According to the U.S. Bureau of Labor, Pennsylvania has the fifth highest employment rate of nurse midwives nationally as of 2023. However, Pennsylvania ranks 39th out of 50 states plus Washington, D.C. in midwife integration, according to the Pennsylvania affiliate of the American College of Nurse-Midwives. The affiliate says there are 557 licensed midwives practicing in the state.
The U.S. Government Accountability Office found that 12% of births were attended by midwives in 2021.
Local midwife Christel Gillette said of the bill, “It basically gives midwives who are already licensed more autonomy, so perhaps not so subject to hospital policy or policy of the obstetrician, but they have more autonomy to practice and make their own decisions which will benefit women.”
Brown has worked on this bill for years and has a strong relationship with Pennsylvania’s midwife community. She described passing this bill as a “legislative priority” and hopes that will happen next session, which begins Oct. 21.
According to the Hospital and Healthsystem Association of Pennsylvania, Pennsylvania has five counties, including Wyoming and Sullivan, that are maternal healthcare deserts and 12 more that have insufficient access to maternal healthcare. Brown believes the bill’s passage will help solve this problem.
“We need to do something to help supplement the maternal care throughout our state of Pennsylvania, because there is a shortage, and we don't want to see anyone not have that care,” she said. “We want to see people have more comprehensive care, and that's what a midwife does.”
However, she acknowledged that this bill would be just the start of addressing limited maternal healthcare.
“There's all types of issues that affect access and availability of care,” she said. “So I think this is definitely a very strong piece of the puzzle.”
Certification differences
Brown’s bill allows for updates for CMs and CNMs, but not the certified professional midwife, or CPM certification, which is what Gillette has. CPMs are governed by the North American Registry of Midwives, or NARM.
CPMs are certified for out of hospital care and help women deliver during home births. Only 36 states license CPMs, and Pennsylvania is not one of them.
While excited for the changes that could come from the passage of Brown’s bill, she hopes the conversation expands to licensing CPMs in Pennsylvania. Without the licensure, CPMs like Gillette are unable to accept women’s insurance, making the practice available to less women than they want to reach.
“It becomes an out of pocket fee, which is actually quite difficult for families,” she said. “It doesn't allow us to serve all women, and that's really unfortunate.”
However, Gillette noted that home births with midwives are much cheaper than giving birth in a hospital. She said the average cost for home births is between $5,000 and $7,000, and if covered by insurance, would be much less of a financial burden on families than hospital births.
According to the KFF-Peterson Health System Tracker, costs associated with pregnancy, birthing and postpartum care come to almost $19,000, with out-of- pocket costs coming to nearly $3,000.
Gillette is a mother, and has had both hospital and home births. She began reflecting on her hospital births after her home births.
“My experience in the hospital was just that of being a number kind of going through the system and having to have certain interventions that perhaps I hadn't planned on or didn't want to have, but kind of just had feeling like I needed to go through that cycle,” she said.
She wants all women to have the opportunity to choose a home birth for the financial, emotional and quality of care benefits. She became a CPM in 2020, making a huge career change. She travels throughout Northeast Pennsylvania to assist women with home births with her company, Scarlet Thread Midwifery.
“So many women feel like when they go to the hospital, all the decisions are kind of taken from them,” she said. “And as a midwife in the community, I try to empower them to make their own decisions for themselves and for their baby.”
Comprehensive care
Both Gillette and Kelly appreciated the comprehensive care they received from midwives and that they give to patients as practicing midwives. They said check-ups with midwives are monthly during a woman’s pregnancy and often take place at home. The appointments usually last an hour, and topics discussed range from the health of the baby to nutrition to self-care.
During her first pregnancy, Kelly experienced hyperemesis gravidarum, which is extreme and sustained nausea and vomiting throughout the pregnancy. Her midwife helped her navigate insurance to get the medication she needed to mitigate her symptoms. She feels that her midwife was able to treat her much better than a doctor in a traditional hospital setting would have.
“You feel confident in going to them and knowing that your symptoms aren't going to be brushed off,” Kelly said.
For Gillette, one of the highlights of midwifery is the focus on postpartum recovery, both mentally and physically.
“In our country, women are expected to just get back at it, and just be normal a couple days after they give birth,” she said. “We know that that is not really how it works, and we need care and we need nurturing, and we need support, and the midwifery model really allows for that, which is a beautiful thing for moms.”
Midwives help fill in the gaps left by doctors’ busy schedules, providing women with more well-rounded care, according to Brown.
“OBGYNs have a wonderful role, but they also don't have that time frame to offer that type of comprehensive care. And they love the midwives, many of them for that reason,” she said.
Common misconceptions
Midwifery comes with misconceptions. Brown hopes her advocacy day in Harrisburg helped to correct them.
“When you say midwife, people go back and they think like something from the 1800s, something that's not modernized,” she said. “This is actually, I believe, what most people really want. They want more attachment and more connection with their health care provider, and more ability to discuss things in deeper detail and have some more time.”
Kelly has dealt with misconceptions regarding her field and expressed frustration with people who don’t realize the amount of education that goes into becoming a midwife. She’s tired of the question, “You had to go to school for that?”
“The reality is, there is a lot more to it than just catching the baby at the end,” she said.
Gillette sees a differing ideology between the traditional view of pregnancy and hers as a midwife.
“I think that the conventional model views pregnancy as a pathology, so kind of like a sickness,” she said. “So when pregnancy occurs, it's something that needs to be treated and managed. In midwifery care, we don't view it that way. We see pregnancy as a condition of health that needs to be supported.”
