The first nurse-midwife program in the state will launch in August at Montana State University, giving practitioners the opportunity to take on a specialty and improve maternal health care in their communities.
Starting this August, eight to 10 practicing nurses will begin a three-year, full-time program to become nurse-midwives. The degree will focus on increasing maternal health care access in rural and tribal communities.
“The beauty of (this) is that we are educating nurses in place,” said Mariah Hill, an assistant clinical professor at MSU who leads the program. “The idea is that we are finding nurses who are already embedded, rooted in these communities and getting them additional education.”
Over half of Montana counties are classified as maternity care deserts, according to a report from nonprofit March of Dimes, which means there are no hospitals that provide obstetric care, no birth centers, no OB/GYN doctors and no certified midwives. Only four other states have a greater share of counties without maternal health care.
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Outcomes for parents and babies show the consequences of this landscape.
Montana has the sixth-highest maternal mortality rate in the United States with a maternal morbidity rate — when severe complications arise for the woman giving birth — 35% higher than the national average. Disparities are especially severe among rural and tribal communities. Native American infants in Montana are three times more likely to die than non-Native newborns, and rural residents’ chances of facing complications during pregnancy are double that of women who live in the state’s few higher-density areas.
Women are often forced to drive long distances on rural roads or brave inclement weather to reach adequate health care. This might require taking time off work or finding replacement caregivers for children and relatives. When that’s not possible, people are often forced to deprioritize prenatal care altogether.
“This program will really expand the scope of practice, the type of work that we can bring to rural communities to provide this really critical piece,” said Maggie Thorsen, an MSU associate professor who focuses on health care equity.
Nurse-midwives deliver babies for low-risk pregnancies, and they work closely with OB/GYNs in higher risk scenarios or when a C-section is required. They provide extensive prenatal care and postnatal care that would otherwise be inaccessible. Research shows that receiving regular care during a pregnancy improves the health of the parent and baby.
“We think of midwifery as birth providers, but that’s just one piece of the puzzle,” Hill said. “Most of our births in Montana do happen at a major hospital. The hope is that we are bringing perinatal, postpartum, contraceptive and mental health care right there at home. They may still have to travel three hours for their birth, but at least all those earlier visits are within reach.”
Access to maternal health care in tribal communities
A major focus will be expanding access within tribal communities, where many people have experienced harmful interactions with the health care system that’s caused lingering distrust.
Janelle Palacios grew up on the Flathead Reservation. She has “specific memories” of her friends becoming pregnant when they were teenagers, and “knowing, even then, that my friends were not treated well where they went for care.”
When Palacios first saw what maternal health care looked like off the reservation when visiting a birthing center in Washington state, it changed things for her almost instantaneously. “The birth I knew happened in a very sterile, very stern, very icy, unfriendly institute,” she said.
Today, she works as a midwife in California, where Palacios incorporates Indigenous caretaking practices into her clinical work as well as into her instruction of OB/GYN residents.
“The knowledge that we use today is rooted in human practices, and it’s only today that we have the so-called scientific tools to measure what we have known for millennia,” she said. “This is not new information, it just happens to be new to the so-called evidence of science, but it’s something that has been passed on and carried."
Palacios takes seriously her identity as a Native health care provider, and the impact she could have on patients and people who come from historically marginalized groups.
“When you have an opportunity to see someone who looks like you, talks like you, comes from a similar background as you, there is a familiarity and trust that’s already built-in because you’re coming from a place of understanding,” she said. "Who knows, there might be a young kid who saw someone like me who spoke like and who inspired them.”
MSU's existing initiative, called Caring for Our Own Program (CO-OP), bolsters support for Native American students studying nursing. It provides tailored counseling, financial aid and other resources. There are over 130 CO-OP alums living in Montana, and the director has been actively reaching out to these nurses to encourage them to consider the nurse-midwife program so they can serve Native families in this way.
Additionally, all registered nurses in the state of Montana received an email from MSU alerting them of the opportunity to apply for the nurse-midwife degree.
Montana’s first nurse-midwife program
There are only about 50 certified nurse-midwives in Montana, according to Hill. All had to receive their education out-of-state or complete an online program provided by an institution based elsewhere. MSU already offers undergraduate nursing degrees as well as two types of advanced nurse practitioner tracks. The nurse-midwife program will be the third.
Funding for the program comes partly from a private donation from Mark and Robyn Jones. In 2021, the couple donated $101 million to the College of Nursing to help it grow and graduate more nurses, with $3 million earmarked specifically for the nurse-midwife track. St. Vincent Regional Hospital in Billings donated another $3 million to help cover operating costs such as travel expenses typically borne by students to reach their clinical sites.
Classroom instruction for the first half of the program will be delivered online so students can complete their coursework at home. In-person gatherings will take place about once a semester at one of MSU’s nursing campuses for orientation as well as labs and simulations. Hill said during this time continuing to work as a part-time provider would be feasible. Then, students must complete four semesters of clinical work in a health care facility, where they will manage at least 40 vaginal births in order to graduate. Clinical placements will try to be made as close to home as possible, she said, but there will be more driving for people who live in particularly rural areas.
“You name it, and the health outcomes get better the more you have midwives integrated into the health care system,” Hill said. “When you have more midwives providing care, what happens to those maternal newborn outcomes is really just pretty stunning across the board.”