'With Women': Helping Meet the Global Shortage of Midwives

Midwife in training, Celesta Bargatze assesses fetal heart tones while the mother labors in a birth pool.

Midwife literally means “with woman,” and the role itself embodies that.  A midwife is a person educated in being ‘with women’ through pregnancy, childbirth and postpartum as a healthcare provider.  Throughout history, nearly every culture has utilized a model of midwifery, usually informal, with mothers, grandmothers, neighbors, or extended members of the family helping women through birth. Midwives played a significant role in their communities.  They were responsible for welcoming new life. They looked after the sick and even served as a pediatrician during the baby’s first year of life.(1)

Midwife in training, Elise Buckner, weighs a baby at a home birth. Midwives are trained in all the essentials, from prenatal care to newborn exams. 

Today, the midwifery model of care is based on the fact that pregnancy and birth are normal life processes, not diseases to be treated.  This model of care includes monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care; continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions and identifying and referring women who require obstetrical attention. The application of this woman-centered model of care has proven to reduce the incidence of birth injury, trauma, and cesarean section.(2)

In 2009, midwives attended just 8% of U.S. births, while the remaining 92% of American women utilize obstetricians (trained surgeons) for their care.  This appears quite backwards when compared to the rest of the world’s birth practices.  In first world nations that are statistically losing less mothers and babies in pregnancy and childbirth than the U.S., midwives are the primary caregivers for expecting women. Obstetricians are utilized only when necessary, for complicated pregnancies and births.

A significant skill of midwives is efficiently documenting and time stamping every aspect of the labor, birth and postpartum period.

In comparing national benchmarking data of 90 midwifery practices (3)  to national survey (4) and birth data (5) on obstetric procedures, women receiving care from midwives had lower than the national average rate for episiotomy (3.6% compared to 25%), lower than the national average rate for primary cesarean (9.9% compared to 32%), and higher than the national average rate for breastfeeding initiation (78.6% compared to 51%). In short, midwives are producing healthier birth outcomes. The numbers prove it as do the mothers who claim higher satisfaction rates of their birth experiences and care.

According to World Health Organization, of all the need existing around the world in the field of healthcare, the most critical shortage of workers is not doctors, nurses, or dentists, but midwives!  When women in developing countries don’t have a midwife to ‘be with’ them in pregnancy, birth and after delivery, their chance for survival is bleak, as is their unborn child’s.  When mothers die prematurely, husbands are left widowed and children orphaned and the unrelenting cycle of poverty repeats. Women should never die trying to bring new life into the world, and this is why we do what we do as an organization: educate women in the natural processes of pregnancy and birth, support them through the process, and also increase the number of competent midwives in the world.

Celesta Bargatze does the work of a midwife by charting mother and baby's vital signs after delivery.

I am excited to share that currently we have 1 Certified Professional Midwife, Heather Munoz, and 3 other women participating in midwifery apprenticeships!  Training through apprenticeship is how professional midwives become most competent in the art and skill of midwifery.  Celesta Bargatze, Kathryn Montgomery, and Elise Buckner are each being trained by 3 different seasoned and highly reputable midwives.  They are working towards their NARM (North American Registry of Midwives) Certification and are gaining essential midwifery care experience, as well as developing specific skills to assist women throughout their prenatal care, labor and delivery, and postpartum care.

Elise Buckner performs a routine newborn exam at a home birth, with the guidance of experienced CPM, Talitha Mills.

The Certification requires that they attend and document 55 births, 115 prenatal appointments, 50 postpartum appointments, and 40 newborn exams.  With just 17 midwives in the greater Nashville area, these apprenticeship relationships are not easy to come by as most of these midwives have multiple year-long wait lists of candidates, many of them with advanced nursing and medical backgrounds, hoping for an opportunity to be trained.

We are so thankful to God who has opened the door for women in our organization to receive such invaluable training. We can’t help but feel God partnering with us in our life-saving endeavor to help meet the global shortage of midwives. Theologian Frederick Buechner wrote that “Vocation is where our greatest passion meets the world’s greatest need.” Being ‘with women’ in pregnancy and birth is something we, as birth workers, consider the highest privilege, and one to be lived out with the highest amount of compassionate care.  In recognizing that the world health experts consider our training in midwifery to be answering an ever-pressing global need, we humbly and gratefully accept our charge by God to humanize mothers and babies in birth through our service to them.  This is our passion.  This is our work.


(1) Cassidy, Tina. Birth: the surprising history of how we are born. Large print ed. Detroit [Mich.: Thorndike Press, 2007. Print.

(2) "Midwives Model of Care." Citizens for Midwifery - Comprehensive Midwives ~ Midwife Resource. N.p., n.d. Web. 26 Aug. 2013. .

(3) American College of Nurse-Midwives. The ACNM benchmarking project results summary. http://www.midwife.org/benchmarking. Accessed March 26, 2012.

(4) Declerque. Sakala, C Corry, MP, et al. Listening to mothers II: report of the second national survey of women’s childbearing experiences. Declerque. New York: Childbirth Connection, October 2006.

(5) Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2009 [online]. National vital statistics reports; vol 59 no 3. National Center for Health Statistics. 2010.