HISTORY OF THE NURSE MIDWIFERY PROGRAM

By Sharon Bond, Ph.D. '09, MSN '92, CNM '83, FACNM Associate professor, retired 2014

Celebrating Midwives

A brief history of the Nurse-Midwifery Education Program at the MUSC College of Nursing from 1973 to 2009

By Sharon Bond, Ph.D., CNM, FACNM

For 138 years, the MUSC College of Nursing has achieved exceptional milestones educating trailblazing nurses who serve the health care needs of families, communities and populations; nurses who change what's possible through nursing care. One milestone worthy of a look back is the history of the nurse-midwifery educational program, from 1973 through 2009. In mid-20th century South Carolina, the outlook for women giving birth, especially in rural areas, was bleak. Many families lived in extremes of poverty, lacked plumbing, electricity and access to health services. Perinatal statistics at the time depicted a sad state of health for women, ranking South Carolina as having the third-highest rate of maternal and infant mortality in the United States. During these years, especially in the Lowcountry, many women received care by the "granny," or grand midwives, women whose faith, experience and wisdom called upon them to give compassionate assistance to women birthing at home during a time when hospital care was unaffordable. In 1950, about 100 grand midwives licensed by the South Carolina Department of Health and Environmental Control (DHEC) assisted in 15,799 births registered in South Carolina. Many grand midwives acquired their knowledge about birthing at the Penn Center in Beaufort, South Carolina, and some county health departments. Maude E. Callen, certified nurse-midwife (CNM) and graduate of Tuskegee University, taught at the Penn Center from 1944 to 1964, and assisted more than 800 women in giving birth in Berkeley County. Each year, Callen taught six-week initial training courses and a two-week refresher course to grand midwives. Callen is a well-recognized hero in South Carolina and the recipient of many awards, including an honorary degree from the Medical University. Her work was tenderly portrayed in W. Eugene Smith's photo essay published in a 1951 issue of Life Magazine. By 1970, the MUSC College of Nursing and the MUSC Department of Obstetrics & Gynecology began exploring the feasibility of bringing a certified nurse-midwife (CNM) education program to the Medical University. Lawrence Hester, M.D., then chair of the Department of Obstetrics & Gynecology, recognized that using registered nurses in an expanded role was necessary to meet the demand for services and improve perinatal statistics. Marcia Curtis, Ed.D., then dean of the College of Nursing, understood that a

strong education program could prepare nurses as midwives and supported the philosophy promoted by the American College of Nurse-Midwives (ACNM). Initially, it was necessary to establish a family-centered, comprehensive service to provide patient care in outpatient and hospital settings. A successful nurse-midwifery practice was essential for future student education. In 1971, Carmella Cavero, CNM, fellow of the American College of NurseMidwives (FACNM) and then ACNM president, was recruited by Curtis to plan and direct the service. Cavero quickly recruited other certified nurse-midwives to the College of Nursing. Within 18 months, the CNMs managed a busy practice, providing family planning services and care to pregnant women at multiple outlying clinics with oversight and collaboration from the Department of Obstetrics & Gynecology. Once this viable service was evident, it became time to advance the education program. In 1974, a certificate program was implemented, followed by a master's degree in nursing curriculum in the maternalchild track five years later. Nurse-midwifery practice, especially in outlying rural clinics, was not without its challenges. Since advanced practice nurses did not yet have prescribing authority, CNMs found it necessary to track down physicians at the hospital to sign prescriptions. Paper prescriptions for antibiotics and other medications were then forwarded to patients by postal mail. Fortunately, health departments were able to dispense prenatal vitamins and treat certain infections. In 1977, Helen Varney Burst, CNM, FACNM, a graduate of Yale University, became director of the nurse-midwifery program at MUSC. The college was fortunate to have Burst on board. Not only was she the president of the ACNM, but in 1978 she released the first edition of her textbook, Varney's Midwifery, regarded as the gold standard for nursemidwifery education in the United States. Cavero and Varney are pioneers and living legends to midwives everywhere. Faced with budget shortfalls in 1981 and a need to turn out more BSN-prepared nurses in the face of a critical shortage, Curtis realized she might be forced to discontinue the nursemidwifery program. The tenacious nurse-midwifery faculty and students sought to protect their program. They won the support of Lowcountry state legislators, specifically Rembert Dennis, Arthur Ravenel, Dewey Wise and W. Paul Cantrell. These representatives understood the impact of nursemidwives on the health of mothers in their districts and persuaded the state Legislature to finance the program for another two years. The South Carolina March of Dimes was also an invaluable supporter of nurse-midwifery education. It was the vision and foresight of Lawrence Hester, M.D., Curtis and Henry Heins, an MUSC obstetrician and gynecologist, who championed for nurse-midwifery in South Carolina. Through their leadership, the academic program and practice grew and contributed to improving the state's perinatal statistics. Indeed, low income, uninsured women cared for by nurse-midwives birthed substantially fewer low birthweight babies. Between 1979 and 1980, the rate of low birthweight babies in South Carolina was 8.9%. During that time, MUSC midwives completed 13,250 prenatal visits and 1,102 births, reducing the rate of low birthweight infants born to women in their care by almost half (4.8%). Pope Francis credits a nurse with having saved his life when he was just 20 years old. He said, "A great woman, brave too, to the point of arguing with the doctors." He suggested that "midwives might have the most noble of all professions."¹ I think he might be right. “The College of Nursing honors and celebrates the pioneers, leaders, and graduates of MUSC CON NurseMidwifery education program. They have been a critical part of history and improving the health of so many South Carolinians,” said Dean Linda S. Weglicki.

Original MUSC College of Nursing Nurse-Midwifery faculty (photo circa 1973): Bottom row, left to right: Harriet Simpson, Carmela Cavera, and Norma Pacenta. Top row, left to right: Margaret Ann Corbett, E. Jean Martin, and Anne Malley.

1. Hattrup KN. Pope: Midwives might have the most noble of all professions. Aleteia. January 21, 2020. https://aleteia. org/2020/01/21/pope-midwives-might-have-the-most-nobleof-all-professions. Accessed January 29, 2020.

Acknowledgements:

Brooke Fox, MUSC University archivist, Elizabeth Bear, Ph.D., CNM, FACNM, Marjorie McManus, CNM, E. Jean Martin, CNM, Carmela Cavero, CNM, FACNM, Charleston Post & Courier

Sharon Bond, Ph.D., CNM, FACNM, retired in 2014 as an associate professor in the MUSC College of Nursing. She graduated from the College of Nursing's nurse midwifery program in 1983, master's program in 1992 and Ph.D. program in 2009.