Nancy Mathias didn't spend two years and thousands of dollars to change careers just so she could become a walking stereotype. But she has endured quizzical looks from folks who expect her to wrap a kerchief around her head and launch into a monologue about "birthin' babies."
"People get their ideas about midwives from that one scene in Gone With The Wind, and that's it. There's a tremendous lack of knowledge about the profession," says Mathias, 49, one of three certified nurse-midwives at Greater Carolinas Women's Center in Charlotte.
She can afford to laugh at the image. Since getting her license in 1994, her annual income has ballooned past $50,000 - roughly 40% more than she earned as a registered nurse in the labor/delivery unit of Carolinas Medical Center in Charlotte. She delivers about 10 babies a month. Her fees range from $2,500 to $3,500, about the same as hospitals charge. The rest of her time is spent providing prenatal and postpartum care, giving gynecological exams, prescribing medicine and tending to other health-care needs.
Mathias is one of 132 CNMs in North Carolina. That's three times the number who practiced a decade ago. Expectant mothers choose midwives for a number of reasons. Some prefer their holistic nature. Midwives don't administer pain relievers during childbirth and usually have more time to spend with patients. Others, mainly Muslims, choose midwives because religious beliefs prohibit them from using male doctors for childbirth. Some women feel midwives offer them a chance to develop longer-term relationships with those who deliver their kids.
Yet the practice continues to struggle for acceptance among patients, health-maintenance organizations and insurance companies. Part of the problem - a big part - is image. Many people still equate midwifery with 19th century "mammies" and rural "wise women," unaware that CNMs in North Carolina have to be registered nurses and pass a strict set of academic and professional criteria.
Then there's guilt by association: CNMs are often grouped with uncertified "lay" midwives who, in North Carolina, operate illegally when they deliver babies. State medical regulators can't say how many lay midwives are here. But the practice made headlines this summer when Amy Medwin, a Yadkin County woman who had reportedly delivered more than 750 babies since 1979, was charged with practicing without a license.
Medwin's troubles began in September 1997, when a baby she delivered lost...