Moving on

Retiring midwives honored for work at HCMC

When the Nurse-Midwife Unit at Hennepin County Medical Center needed a new director 25 years ago, Claire Nelson and Nancy Schamber stepped forward with a plan to do the job together.

It seemed like a fitting proposal from two women whose lives in many ways have been mirror images of each other's. Both women had fathers who were physicians and mothers who were nurses. Both received training from the University of Minnesota Nurse-Midwifery program shortly after it was founded in 1973. And both were hired on at HCMC by Margaret Hewitt, who founded the hospital's Nurse-Midwife Unit in 1971.

Neither Nelson, who lives in Fulton, nor Schamber of the Seward neighborhood wanted to shoulder the role of director alone. The two nurse-midwives reasoned that by splitting the administrative position, they could each continue doing the work they really loved: interacting with patients and assisting with births. Administrators at the Downtown hospital were initially skeptical that having two people perform seamlessly as one director would work, but Nelson and Schamber took over in 1981 and proved they have a knack for drawing from each other's strengths.

Under their guidance, the Nurse-Midwife Unit at HCMC has steadily grown. More than 17,000 babies have been delivered in the HCMC Nurse-Midwife Unit during their tenure as co-directors, and the number of nurse-midwives practicing at the hospital has grown from five to 15. The unit's eight patient rooms have been remodeled to look more like home than a hospital, and services such as the option of giving birth in water have been added.

But just like they stepped into the role of director together, Nelson and Schamber both decided to step down this year. Ending nurse-midwife careers that spanned more than three decades, Schamber, 58, retired in January and Nelson, 57, followed her earlier this month. Colleagues and friends surprised the two by creating the &#8220Claire Nelson and Nancy Schamber Student Nurse-Midwife Fellowship” at the University of Minnesota. The fellowship was presented to Nelson at her retirement party Sept. 10 at Lake Harriet.

&#8220I was just glowing,” Nelson said about learning of the fellowship, adding that she's proud it will support students in the U of M's nurse-midwifery program, with whom she has worked for years as part of HCMC's teaching program.

The fellowship is a testament to the respect the two women have from their colleagues.

&#8220They're just very steady, supportive, compassionate women who feel very strongly that birth is a normal process,” said HCMC nurse-midwife and Lynnhurst neighborhood resident Laurel Riedel.

And while both women seem to know it's time to move on, they won't exactly be leaving the profession for good. Both have agreed to continue working in the unit occasionally, meeting with patients and performing exams. After all, they both said, that's what makes the job great.

&#8220Any nurse-midwife feels that one of the most rewarding things is being present at a birth,” Schamber said. &#8220You're there for that very precious beginning of a life.”

&#8220And it's an opportunity to shape that experience for people,” Nelson added.

A ‘low-tech, high-touch' experience

When Nelson and Schamber joined the Nurse-Midwife Unit at HCMC more than three decades ago, they were among a relatively small number of nurse-midwives in the state. At that time, nurse-midwifery, which focuses on keeping labor as natural as possible and providing an individualized approach to pregnancy and childbirth, was still considered an alternative form of medical care. But Nelson and Schamber joined a strong program at HCMC, which had the first full-scope, certified nurse-midwife practice in the state. According to the website of the American College of Nurse-Midwives, Hewitt was instrumental in changing traditional hospital maternity care practices, eliminating then-routine procedures like using enemas and IVs, and creating a more home-like atmosphere where women could labor, give birth and receive post-partum care all in the same room.

Nurse-midwives are trained in both nursing and midwifery and are certified by the American College of Nurse-Midwives and registered by the state of Minnesota. It's a type of care that Nelson said nurse-midwives call &#8220more low-tech, high-touch.”

&#8220We believe that women's bodies are made to go through birth,” Nelson said.

As Nelson and Schamber walked through the horseshoe-shaped Nurse-Midwife Unit at HCMC, they said everything from the physical environment of the unit to the patients they serve has changed dramatically over the years. The rooms in the Nurse-Midwife Unit once resembled a stereotypical hospital room, with two patients sharing a room. Now, the eight private rooms resemble home more than a hospital, with light-grained wood framing rooms painted in soft colors. Mothers are encouraged to keep their babies with them in their room at all hours of the day, and a chair next to each bed pulls out into a sleeping area for new fathers or partners.

A diverse clientele

And the patients the Nurse-Midwife Unit serves have changed as well. Most of the women who sought their services in the early 1970s were white and were looking for an &#8220alternative” birthing process, Schamber and Nelson said. By the late 1970s, an influx of Hmong refugees and other immigrants from Southeast Asia dramatically changed the landscape of patients. These women were looking for providers who would be sensitive to their cultural needs and traditions, Nelson said.

They sought out the care of nurse-midwives because they wanted a provider who was flexible in allowing them to squat or kneel while giving birth. They also wanted very little medical intervention and wanted to be with their babies immediately after giving birth. The Nurse-Midwife Unit at HCMC provided this flexibility, and Nelson and Schamber said as populations of immigrants from other parts of the world began arriving in greater numbers in the Twin Cities, they too sought out the services of nurse-midwives.

&#8220We learned a lot from the women who have come to us,” Schamber said.

The Nurse-Midwife Unit at HCMC now serves a diverse, mostly nonwhite population, and roughly 50 percent of patients who receive care from the Nurse-Midwife Unit at HCMC do not speak English. HCMC has 50 full-time interpreters of 42 languages, and interpreters for more than 60 additional languages are available on a freelance basis, according to the hospital's website. Nelson said she speaks &#8220second stage” Spanish, referring to the fact that she knows how to tell Spanish-speaking women when to push and breathe during their second stage of labor. Four or five of the nurse-midwives are truly bilingual in Spanish, Nelson said, and another is slowly picking up Somali.

A growing service

The Nurse-Midwife Unit is steadily growing. In 2005, it recorded a record number of births, with 761 babies delivered into the hands of a nurse-midwife. This year, the unit broke another record by delivering 84 babies in the month of July alone. And the practice of nurse-midwifery has become more accepted as a form of medical practice rather than an &#8220alternative” service, Nelson and Schamber said. Insurance companies now pay for most nurse-midwife services. And for the most part, nurse-midwives are seen as an equal part of the medical provider group.

While a lot has changed, some things have remained the same.

&#8220Mothers are still having babies,” Nelson said. &#8220And they're still looking for a provider who will listen to them and support them during their pregnancy.”