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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

Labor Gains: From Horseback to Hospitals

Mary Meehan
Nurse Midwife JoAnne Burris tends to Emily Robertson at the UK Midwife Clinic, formerly Womankind.

Dressed in crisp blue scrubs, Certified Nurse Midwife JoAnne Burris walks briskly, the click of her sensible clogs a counterpoint to smooth jazz in the hall.

The UK Midwife Clinic with large, color prints of newborns on the earth-tone walls, still has that new furniture smell. But word-of-mouth already has the waiting room full.

Inside Exam Room 3 Emily and Johnathan Robertson wait to hear their baby’s heartbeat.

And there it is the echoing “whoosh, ump, whoosh, ump, whoosh ump” of a strong fetal heart. “Best part of the appointment,” Burris said, “every time.”

From Horseback to Hospitals

The UK Midwife Clinic opened in in early June with Burris, her mentor Melissa Courtney and two other midwives. It is the latest chapter in the long history of midwives in the Ohio Valley.  Mary Breckenridge started American nurse midwifery in Hyden, Ky., with the foundation of Frontier Nursing Service. Now operating as Frontier Nursing University, it produces 30 percent of midwives in the country. (Including Burris.)

Frontier nurses famously slogged down creek beds on horseback to get to patients. Now, according to the American College of Nurse-Midwives (ACNM), 97 percent of midwives are affiliated with hospitals and most births take place in the hospital not at home or in birthing centers.

Courtesy University of Kentucky Photo Archives

Statistics also show that across the country about 12 percent of vaginal births are delivered by midwives. According to the ACNM, that’s up about 20 percent between 2004 and 2014, the last year data is available.


The history of midwifery is the region is strong. And today, Kentucky and Ohio have  midwife programs in multiple affiliated hospitals. West Virginia also has a growing tradition of midwifery, with 19 percent of all vaginal births attended by midwives, a number higher than the national average of 12 percent.

Another reason midwifery continues to grow is that it is covered by Medicaid. That government program provides medical care to the poor and pays for nearly half of the births in the country, according to the ACNM. And, over the years, the rate of pay of midwives  through Medicaid has risen to match what Medicaid paid doctors for delivery. According to the ACNM, it’s a 100 percent match in Ohio and West Virginia and a 75 percent match in Kentucky.

Hippy Days

Still, when Emily Robertson, a school teacher, came to choose a midwife after researching on the internet, her husband needed a little convincing.

Jonathan Robertson, a mechanic, said he was worried about how safe his wife and child might be. But after learning more about how the process works, he got onboard. The basic draw to midwifery is the core focus of a healthy birth as a natural process. Over the years, Burris said, pregnancy became to be seen as something that always required medical treatment. Complex births do require medical assistance, she said. But most healthy births don’t. Giving birth is the only time people who are not sick are admitted to a hospital.

Jonathan Robertson overcame his reluctance to embrace that philosophy. “We look at it as something that is natural, we don’t look at as a medical problem,” he said.

Credit Mary Meehan / Ohio Valley ReSource
Ohio Valley ReSource
Emily and Jonathan Robertson picked a midwife to attend the birth of their first child.

Emily Robertson said she likes the personal attention and how supportive the midwives are. In fact, she has high praise for the whole office.

“When I call they listen to every little concern I have even if it is a weird pain, they’ve been ‘OK, this is normal’ or ‘this is not normal and you need to come in’. They have been really reassuring.”

The couple highlights two factors involved in the growing use of midwives. A Certified Clinical Midwife Instructor at the Wexner Medical Center at Ohio State University, Patricia Dodge said midwifery has evolved from when she began decades ago.

“When I started, I’m trying to think how I want to say it, we had more of the hippy type moms, the vegetarians, those who wanted to do everything completely natural,” she said. “Now it is very mainstream.”

And, she said, midwives not only tend births but take care of the needs of women before pregnancy through menopause ,And, yes, she said, even if a midwife delivers your baby, at delivery you can get an epidural.

A Calling

JoAnne Burris understands why women want more control.

“My first birth with my first child was natural birth, low intervention but I felt very disempowered. Really it was fairly traumatic for me,” she said.

“With the second birth I wanted a different experience,” she said. To that end, she did some research and decided on Nurse Midwife  Melissa Courtney for her second birth.

Courtney had opened an independent midwife clinic in 2011 and when Burris brought up hypnosis during childbirth, Courtney was on supported her decision.

Credit Courtesy of UKHealthCare
Nurse Midwives JoAnne Burris and Melissa Courtney are two of the four nurses at the UK Midwife Clinic which opened in early June.

But beyond that, Burris said, Courtney’s compassion and calm education helped heal her trauma  from her first birth.

She was so moved by the experience, she soon quit a 9 to 5 job in human resources, went back to school and now has a hectic, unpredictable schedule delivery babies. She’s been a midwife for seven months.

“Do I get less sleep now?” Burris said, “Yes. Do I regret it? No.”

“When I felt the calling to become a nurse midwife I felt like I was being obedient to my higher power, who I call God, and I feel like that has been confirmed over and over again. I find myself having to blink back tears during a birth. It makes me cry now.”

“It’s so very much a privilege to hold space for a woman as she becomes a mother.”

A space more moms seek as a traditional practice gets new life.

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