The Midwife

What You Learn Attending 10,000 Births

In three decades as a nurse midwife, Cathy Moore estimates she was involved in delivering over 10,000 babies. Many she had “caught” herself. Her mission has always been to “empower women to find their voices and make good choices for themselves and their families." This profile chronicles a lifetime spent caring for mothers and bringing life into the world. Our conversation was very personal—and sometimes heartbreaking—but Cathy's commitment to her workcraft is profoundly uplifting.

At the most basic level, how do you distinguish your responsibility versus that of an OB-GYN?

The main difference between midwives and doctors starts with our training. Midwives are experts in normal pregnancy and birth. Our training reflects that. We are taught to assess if things are progressing normally—and for most healthy women, it is normal. Doctors' training is in pathology or disease, and OB/GYNs are experts in the abnormalities of pregnancy and birth.

Many women appreciate the increased attention midwives bring to having their questions answered, concerns addressed, and choices supported. The research backs this up, showing the link between midwives and better birth outcomes.

In your most recent role, you worked triage at Worcester Medical Center. Please walk me through your interaction with a typical pregnant woman coming in, believing she's in labor.

By the time I see her, a nurse has already put the woman on a stretcher bed—and likely placed a fetal monitor on her and taken a set of vital signs. Before I enter the room, I'll have a printout of their prenatal record to review, identifying any particular issues she's had during the pregnancy. I'll also have her lab results, so I'll have a general overview of who this person is, her blood pressure readings, whether this is her first baby, and her due date. Once I come in, I'll introduce myself, tell her I'm the hospital midwife, and then ask if it's okay if I evaluate her. From there, I'll ask, "What's been going on? When did you first think you might be in labor? How often are you having contractions? Have you felt the baby moving?" Then I begin my examination. I'll usually start with her belly, feeling for the baby's position and the intensity of her contractions. I'm also looking at her facial expressions and the rest of her body. All this informs me if she's in labor. I'll ask then if it's okay if I conduct an internal exam to see if her cervix is starting to dilate. Based on my findings, I'll talk to her about whether or not she's in labor--and why/what we should do about it. If she is, I'll tell her she will be admitted and begin more questions about her health history and whether she plans to use pain medication or an epidural for labor. Next, I'll do a bit more of a physical exam, looking at her ankles and checking her reflexes, all so I can report to her doctor. Then they take over. 

I might be getting ahead of myself, but what wisdom/advice would you offer future parents about the birthing process?

My primary thing is that pregnancy and birth, for the most part, are normal things. Women's bodies were designed for it. Trust your body. Trust your instincts. Trust yourself. Unfortunately, I see a lot of people doing the opposite of that: not trusting themselves. We live in a capitalist society, so someone's always trying to sell you something to make you feel better. For example, it's become a thing for people to buy little Dopplers to listen to their baby's heartbeat. That's just completely unnecessary. If you're feeling your baby move, your baby's telling you, “Hey, I'm fine.” In terms of the birthing process, the same applies. Trust your body and yourself. Today, I would say probably 75% of women choose to use epidurals for managing labor pain. And that's fine. Some women will say, “I'm a wimp. I can’t do it without.” That’s not the message I want a woman to say or hear. I want to support women to have the kind of birth experience that makes them come out feeling good about themselves and ready to tackle parenting.

Taking a big step back, please tell me about your youth.

I was born and raised in Lawrence, Massachusetts. It was a mill town when my grandparents settled there from Canada. When I grew up, all the textile shops had long been closed. I am the oldest of eight children. The youngest child in our family is just ten years younger than me. We were raised Catholic. Every family in my neighborhood also had large families, and we’d play games in the streets. We attended the Catholic school Sacred Heart for primary and high school. It was a two-block walk from home. We were working class. My father was employed in a print shop. My mother stayed home for most of my childhood.

My first job was babysitting. I had a couple of families in the neighborhood that I did this for. I was twelve when I started this. In the summers, after getting my driver's license, I’d load all my siblings into the station wagon and drive to the beach. It was 45 minutes away, and no seatbelts! We would pack sandwiches, drinks, and towels. We would build sandcastles and swim. I would constantly count heads all day to ensure we were all there. I was a guardian from an early age. One of the jobs of a midwife is to be a guardian of normal birth.

How was it being raised Catholic? How did that experience affect you?

You were supposed to be good. You weren't supposed to have sexual thoughts or feelings. So there was a lot of suppression. Then in high school, I got a job working weekends at the parish rectory where the priests live. I'd answer phone calls and do clerical work. Then this priest, who oversaw the collection of offerings, started coming around me a lot, especially when I was in the kitchen where I hung out. He would take money from the baskets and stuff it into my shirt pocket, having a little frontal feel. He kissed me once too. Then, when I was onto him, I'd hear him coming and lock myself in the bathroom. Two of my sisters experienced the same inappropriate touching from him. We didn't talk about it at the time, only way after it had happened.

I’m very sorry you faced that---that this happened to you and your family.

Yeah, me too. I'm not sure it had anything to do with midwifery for me. In my twenties, I becamesexually promiscuous. I would approach sex from an angry stance. I was aggressive and scared off a few guys. I don't know. To this day, those years feel shameful for me.

You'll find this interesting. I chose not to have children. That was directly influenced by the fact that I was taking care of my siblings from a young age, and I remember specific instances where I felt like my mother wasn't doing a good job of protecting us. So I took on a lot of responsibility in caring for my siblings. As a child, I was not equipped with the tools you need to be a parent. So there's somewhere deep psychologically in me where I feel like I was a failure as a parent, and therefore, I shouldn't be a parent as an adult. I don't regret not having children. I have a fulfilling life, and I’ve branched off into belly dancing and my creative soul.

But looking back on my experiences with the priest and how I was a protector to my siblings, and I never felt protected by my mother, I am always moved during childbirth when the woman first takes her baby in her arms, the whole Mother Bear thing. I get choked up a bit over it.

How did you become a certified nurse midwife? What’s the training/education?

I got my Bachelor of Science in Nursing (BSN) from the closest state college. For the next five years, I worked as a registered nurse in general medicine/surgery and the surgical ICU. Even though I didn't know what a midwife did, I sensed that's what I wanted to do. I was finally able to get a job in a Labor & Delivery unit, which is where I really learned about birth from the women that I took care of. You learn by sitting at the bedside, supporting women during labor and birth. Several nurses who I worked with there also go on to become midwives. We all worked the night shift together. We LOVED birth!

In 1995, after getting a Master of Science in Nursing (MSN) and part-timing in an OB-GYN office, I was accepted into a yearlong nurse-midwifery certificate program, and it was one of the best years of my life. I found my tribe in midwifery. The program was exactly what I wanted – very focused on clinical midwifery, with very little bullshit. This was compared to my master’s program, which had a lot of nursing theory and a thesis, etc. – which I did NOT love. My midwifery class was six other women plus me. We became very close over that year. I dubbed us the Pleiades, a constellation of seven stars often referred to as the seven sisters. We studied together, performed pelvic exams on each other, and offered support through a very intensive year. 

Certified Nurse Midwives (CNM) take a certification exam and then are licensed by the state where they practice. In most states, CNMs can also be licensed to prescribe medications.

Can men be midwives?

Yes, though there are not many. And no, these men are not called mid-husbands! The word midwife comes from old English and means "with woman."

How is a midwife separate from a doula?

A doula is a non-medical supporter of women for labor, birth, and postpartum. They usually do a training program; I’m unsure if they are licensed. Like with midwives, many studies show that the use of doulas results in better birth outcomes and fewer C-sections.

What’s the range of care that you offered as a midwife?

For most of my career, I practiced what is referred to as “full scope.” I provided prenatal care, attended to women through labor and birth, and provided postpartum and gynecological care. My most satisfying job was as part of a small, full-scope practice with four other midwives. In this group, I got to know and love the women I cared for during the entire pregnancy, then attended the births and followed up with them during the postpartum period. At the hospital, the doctors pretty much stayed away unless called.

I liked being there through the whole journey. The woman gets to know who you are and trusts you. It's satisfying to understand her situation, her past birth experiences, her anxieties and hopes, and then be able to sit with her while she's in labor, knowing all that you do. That's an essential part of how things will work well in labor...if you trust the person attending to you.

Beyond medical care, what do you consider the purpose of your work?

Being able to support women to have the birth experience they wanted—and to help them find their voices and power. Some midwife friends love being the person to first touch the baby. It's spiritual for them. But, for me, it's always about the woman. I want birth to be good for the woman.

How does that play out in the room during birth?

There's a lot of subtlety to the job. I always think about it as managing the "energy" in the room, making it a safe place for the mother. Most animals go off to a dark place to give birth. They want to feel safe; if they don't, the labor will stop. It's similar in humans. I used to hear this old French doctor speak; he talked a lot about that. In hospital births, we put on the bright lights and monitors, and we stare at the woman in labor—and this can completely disrupt the normal hormonal pathways that make labor and birth progress normally. So I'm trying to counteract that invasiveness. One patient I remember wanted the room dark and everybody to be silent. She labored like a little animal and gave birth on her hands and knees, and I was squatting on the floor, getting ready to catch the baby. It was a beautiful birth that reminded me of that French doctor's philosophy.

How do you manage a pregnant woman's partners in the delivery room?

You know, the process of birth for a mother is very inward. They get into a very primitive part of their brain, very deep. I love this, but it's not for everyone. I've met a few men with amazing instincts for supporting women in labor. But most don't. They don't like to see their loved ones in pain. It makes them anxious and uncomfortable, and they don't know what to do. So sometimes my job is to say, "Hold her hand. Tell her you love her," or I ask them to press a wet cloth on her forehead or give her a little drink of water. A laboring woman wants to feel cared for and loved at that moment.

What was one of your most rewarding experiences as a midwife?

At a large Boston hospital, we cared for many underserved women in the community. They were immigrants, often poor, many with social issues. These women often don't get much positive feedback in their lives, and they're struggling, sometimes even taking four buses to get to a prenatal appointment or not having enough to eat or feed their kids. Working with them, helping them to give birth and feel powerful and accomplished, goes a long way for someone who's about to become a parent and take on one of the world's most demanding jobs. Giving them a sense of empowerment is everything.

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Thank you to Cathy for sharing her remarkable story. May she enjoy retirement!

Neal