Decades after NJ was among first states with graduate-level midwifery training, options expand for students
Shirley White-Walker was a divorced, single mother working full time as a nurse in 1974 when her best friend, recently hired as a faculty member at a new graduate midwifery program in Newark, convinced her to join the first class.
“At the time, I had never heard of midwifes and I didn’t know what they did,” White-Walker recalled in September. But the way her friend talked about the power of this work — caring for pregnant women and families, delivering babies, all in a holistic, patient-centered way — White-Walker said, “I thought, this really must be something.”
Two years later, White-Walker would be one of 10 graduates in the initial midwifery class at what was then the University of Medicine and Dentistry of New Jersey and, by 1977, the first Black midwife to be licensed in New Jersey. Rutgers School of Nursing, which has since taken over the program — among one of the oldest in the nation — celebrated its 50th birthday this spring.
For White-Walker, the training led to a four-decade career she calls “a phenomenal experience,” adding, “It’s not for the faint of heart, but at the same time, it’s such a joyful experience.”
Restoring master’s degree track
In September another 10 students started their midwifery training, half of them as part of a new master’s degree track designed to make the education more accessible. The hope is that with more graduates the state can further expand what birthing advocates say is a critical workforce in New Jersey, which continues to face high maternal mortality rates, especially for Black women.
Midwives are clinically trained primary care providers whose involvement in the birthing process has been shown to improve the health of mothers and babies in dozens of ways, according to a 2022 report from the New Jersey Health Care Quality Institute, a nonprofit working to improve health outcomes and control health care costs. Midwives can reduce maternal and infant deaths and the need for surgical interventions at birth and improve rates of breastfeeding and child immunization.
Midwives are trained to attend to vaginal births. They are instructed in how to make incisions if needed and suture repairs post-birth, but they do not perform surgical deliveries. If a patient needs an emergency cesarean section, a surgeon steps in. New Jersey has close to 450 licensed midwifes, the vast majority certified nurse midwives, who together deliver roughly 10% of the babies in the state each year.
Birthing advocates have for years argued more midwives are needed to improve birth outcomes in New Jersey, where maternal death rates outpace those in neighboring states and the nation at large. Midwives also help reduce racial disparities in care, advocates say, something that is particularly prevalent here, where state data shows Black women are nearly seven times more likely to die of maternal-related incidents — and Hispanic women 3.5 times more likely — than white mothers.
To grow its maternal health workforce, New Jersey should reform how it pays and credentials midwives, advocates say, and improve access to nonhospital birth centers, where midwives oversee almost all deliveries. Advocates — led recently by Nurture NJ, first lady Tammy Murphy’s campaign to reduce maternal and infant deaths and racial disparities — have also called for changes in midwifery education to make it easier for more people to get trained, licensed and start practicing.
This conversation led Rutgers School of Nursing to reintroduce its master’s degree in midwifery this fall, an option phased out nearly a decade ago, according to Julie Blumenfeld, director of the nurse-midwifery program. The school will also continue to offer a doctorate degree, she said, which provides the same clinical training students receive in the master’s track, but also prepares them for teaching and administrative roles.
Diversifying the workforce
A master’s degree costs less, however, and takes less time to obtain. Reintroducing the master’s option “allows for diversification of the workforce,” Blumenfeld said, noting that the cost and time required for a doctorate tend to limit participation to people who have more privilege. She called the change “a workforce expansion and diversification effort.”
A diverse midwifery workforce matters to White-Walker, who agreed that increasing the number of Black and Hispanic midwives could help reduce New Jersey’s racial disparities. “I really do believe it makes a difference,” she said. “You can get good outcomes if you care about the patients,” she added. “They have to be treated with dignity. They have to trust you.”
Nationwide there are nearly 16,000 midwives — some 85% of whom are white — who attended nearly 430,000 births in 2021, about 12% of the total deliveries that year, according to a U.S. Government Accountability Office report, up from less than 10% in 2016. Use of midwives varies by state, ranging from nearly one-third of all births in Alaska and three in 10 in Vermont to 1.1% in Arkansas, it found.
Midwives in training (Rutgers School of Nursing)
There are now more than 4,000 midwives in training nationwide, attending accredited graduate programs at 45 colleges, according to the Accreditation Commission for Midwifery Education, a credentialling body. Most are part of nursing schools. Only a few on this list predate New Jersey: The University of Utah founded its midwifery program in 1969 while Columbia University and Yale launched in 1972. Other sources cite a handful of programs that were launched even earlier, Blumenfeld said.
Rutgers is not alone in embracing a midwifery master’s, according to research by the nonprofit KFF, formerly known as Kaiser Family Fund. Currently, all but a few accredited programs issue doctorates, according to the commission, while 30 schools also offer a master’s degree option. The University of Alabama-Birmingham restarted its master’s program in 2022, KFF reported, and Loyola University in New Orleans and University of Nevada-Las Vegas did so last year.
The University of California-San Francisco, which launched its program in 1978, is taking a different tack, according to KFF. It will graduate the last master’s degree class this coming spring and, in the fall, limit enrollment to doctoral students. The school estimates tuition and fees will cost $152,000 for the three-year doctoral program, compared to $65,000 for the two-year master’s, KFF reported.
Other changes
In New Jersey, Rutgers also created a seamless transition from nursing education to the midwifery program to make the latter more accessible to non-nurses, Blumenfeld said. Rutgers has also provided two dozen scholarships this year, totaling $440,000, thanks to funding from the state.
Both the master’s and doctorate programs are part-time, so students can also work, Blumenfeld said. The master’s is spread over three years, the doctorate spans four. Fees for both programs are similar (topping $4,400 a year) and tuition for the full master’s program is roughly $55,000 for in-state students and $80,000 for those from out of state, while the doctorate costs $84,700 in state and $123,200 for non-Jersey residents, according to Rutgers.
Rutgers is also altering its midwifery program to enable students to obtain their nursing degree at the same time they learn midwifery, another effort to make the midwifery program more accessible.
“I’m excited because the reality is that people who aren’t nurses have a lot to contribute. We can get them up to speed and teach them the skills they need to be successful midwives,” Blumenfeld said, in addition to providing the nursing curriculum. The American College of Nurse Midwives has found up to 15% of practicing midwives have never worked as nurses, she said.
Kate Shamszad, director of policy at the Quality Institute, is also encouraged by the changes at Rutgers. “By adding a master’s degree pathway, the school expands the academic options for nurses who want to pursue midwifery and are able to complete the degree and training in less time,” she said, and “can also increase the workforce pipeline by graduating and training [certified nurse midwives] at a quicker pace.”
Teresa Marsico, a pioneer
New Jersey’s midwifery program reflects the legacy of Teresa Marsico, of Manasquan, who became a nurse at age 21 and found her calling as a midwife seven years later, according to her 2005 obituary online. Marsico had the vision, commitment and connections to build a clinical education program at UMDMJ, as it was then known, organize the critical stakeholders and secure federal funding to support the program and cover tuition for the first class, Blumenfeld said.
“As a clinician, she could not rest until all the women, regardless of their ability to pay, received the best care available. She served as president of the American College of Nurse-Midwifes and is remembered as a wise woman, tireless worker and gentle soul,” reads Marsico’s obituary.
“She was just this exceptional person who was able to leverage these opportunities,” Blumenfeld said, and “one of the most famous midwives ever in the history of midwifery in the United States.”
Classes have historically been diverse, Blumenfeld said, and this year’s program includes a mix of younger people straight out of college and others who have been in the nursing workforce. Most are from New Jersey, she said, and one is a man.
White-Walker remains grateful for the federal funding that allowed her to join UMDNJ’s first midwifery class, although she still worked weekends to support herself and her daughter. After graduating she was hired by the program as a staff midwife, working in local hospitals and the school’s clinic. Many of the patients were poor women of color, she recalled, including pregnant girls as young as 12 years old. “It was a trial by fire,” White-Walker recalled. By the time she left, “I had so much experience. I had pretty much seen it all.”
Attitudes change slowly
In her time, midwives had little independence and limited respect, White-Walker said, something she said is changing, albeit slowly. “Some physicians wanted a relationship with midwives,” she recalled, “but maybe their colleagues didn’t want us around, or didn’t trust us.” Turf battles with doctors remain, she said, often driven by revenue.
White-Walker eventually went on to work at a federally funded health clinic in Plainfield, where she remained for 17 years, treating patients many of whom were poor and new to the United States. Her team oversaw 800 deliveries a year, she said, and set state records for the lowest numbers of underweight babies and surgical, or cesarean births, which involve extra health risks. “We had good outcomes and big, healthy babies,” she said.
“This population is Black and brown women,” White-Walker said. “I reminded [my staff], ‘If you have a problem because a patient needs a translator, or the patient is poor, or is a person of color, this isn’t the place for you’,” she said. “I always felt like every patient should be treated like my daughter, my mother, my sister.”
— Editor’s note: This story has been updated to clarify details about how midwives are trained, the Rutgers program and its history.
Cover photo: File photo (AP Photo/Damian Dovarganes)