Maternity Care in America: Thoughts by Nuria Nelkin, Certified Nurse Midwife


How does society view pregnancy and birth? How do YOU view pregnancy? How do YOU view birth? Is it automatically an illness/problem? Are pregnant women ill, weak? Is it a natural state of the body? Can things go wrong? When are interventions appropriate?


The belief and attitude towards pregnancy and birth as a normal part of life versus an illness waiting to happen is the basis between the medical versus midwifery models of obstetric care. The short answer is, NO. Most pregnancies are not a medical problem. Because there is always a possibility of complication during the amazing transformation of a woman growing a person, it is sensible to monitor pregnancies closely to be able to recognize potential or actual problems, and refer to appropriate providers (that can manage a higher risk/problem) as needed.

Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife.

Approximately 90% of births in the U.S. are attended by physicians (National Vital Statistics Reports, 2014). All women do not need a surgeon to directly manage their pregnancy, labor, and birth. Physicians/surgeons are taught how to analyze situations by identifying a medical problem and solving it. Labor and birth don’t always need that type of analysis or intervention. The midwifery model approaches pregnancy and birth as a normal process until proven otherwise.

Midwives are taught to educate women about the process of labor, birth, and motherhood and help a woman manage labor and birth, while also having the skills to identify complications. They are taught to handle small complications and identify which ones they need to send on to a physician. Sometimes that means using their amazing, life-saving surgical skills; sometimes it does not. Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife. 

Midwives and obstetricians working as a team is the perfect answer. Having hands-on care treating pregnancy as normal unless it presents otherwise, and involving the obstetrician/physician in the care if concern arises, gives women high-touch, low-intervention care unless otherwise necessary.

About Nuria:
After working as a nurse for several years and experiencing the pregnancy and birth of her second child, she knew pursuing a career in midwifery was her calling and dream, and completed her MSN in Nurse-Midwifery at Frontier Nursing University. Nuria is also a wife and mother of two young, active boys. She enjoys spending time with her family and friends, reading, and exercising. She offers waterbirth with Providence Midwifery at North Fulton Regional Hospital.

Liljestrand, Jerker. Midwives are Essential to Global Health. Time Magazine. May 5, 2016.

National Vital Statistics Reports, Volume, 64, Number 12. Births: Final Data for 2014. December 23, 2015. Obstetric Care Consensus. Levels of Maternity Care. Number 2. February 2015.


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