Stephanie VanderHorst, CNM, MSN, Class 28, had a plan. She was going to open a freestanding birthing center in Auburn, Ind., a rural community of 13,000 people located in DeKalb County, two hours north of Indianapolis. There was no birthing center in the community and she knew there was a need.
As part of her coursework at Frontier Nursing University (FNU), she developed a business plan for the birthing center in 2000. The results were not what she expected.
“I realized my plan for a birthing center in Auburn wouldn’t work,” she said. Working as the manager of the obstetrics department at DeKalb Memorial Hospital, her interviews with patients revealed a glaring problem. “I realized people didn’t know what a certified nurse-midwife (CNM) was.”
Understanding that the reason the plan wouldn’t work wasn’t a lack of need, but rather a lack of awareness, she held onto her dream and took steps to make it a reality.
“I conducted exit interviews with patients postpartum,” she said. “During those exit interviews, I asked ‘What is your ideal birth? When you have your next baby, what do you want the experience to be?’ People started talking about birth centers. In having those conversations, I was able to lay a foundation that there are options.”
It took longer than expected, but her diligence paid off with the opening of the Auburn Birthing Center in 2010. In addition to co-owning the birthing center, Stephanie is employed by Auburn OB/GYN and Midwifery and has privileges at Parkview DeKalb Hospital.
As of March 2020, Stephanie has welcomed nearly 2,000 births. She has also welcomed nearly 30 students, serving as their preceptor and helping her to earn FNU’s Distinguished Service to Alma Mater Award in 2019. Remembering that she had difficulty finding a preceptor when she was a student, Stephanie is happy to serve in this role but also screens prospective students carefully before agreeing to work with them.
“I’m looking for nurse-midwives who are going to grow the profession,” she said. “Precepting is helping to identify midwives who are going to live the profession and provide quality care that is research-driven and evidence-based. I take about one out of every 10 students who come to me.”
Stephanie is earnest about guiding students interested in growing the profession because she herself has become an active leader and advocate for nurse-midwifery throughout the state. She served consecutive two-year terms as the president of the American College of Nurse-Midwives Indiana Affiliate and is on the board of the Coalition of Advanced Practice Registered Nurses of Indiana. She served on a cervical cancer task force and is on the Governing Council of the Indiana Perinatal Quality Improvement Collaborative (IPQIC) as part of a state-wide initiative to reduce maternal mortality.
“Governor Holcomb wants Indiana to be the best in the midwest in maternal mortality and neonatal mortality rates, and that has launched a huge initiative,” Stephanie said. “We are looking at every birth center and rewriting the policies and standards for birth centers.”
Stephanie, who makes the drive to the state board of health in Indianapolis three to four times per month, studied the state’s policies and utilized resources from the American Association of Birth Centers (AABC) and the Commission for the Accreditation of Birth Centers (CABC) as guides to help review and suggest revisions to the the state’s existing policies and guidelines. The collaborative effort led to the creation of a revised document that is scheduled to be reviewed by the state board of health at a meeting in March 2020.
Stephanie described the past six years in these leadership roles as, “Two years of asking what the problem is, two years of exploring what other ideas are out there, and two years of instituting change.”
Estimating that the world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030, the World Health Organization designated 2020 as the International Year of the Nurse and the Midwife. Stephanie’s experiences serve as an example of how nurses and midwives play a vital role in healthcare and why they must be included in policy-making decisions.
“We are the boots on the ground,” she said. “When doctors give direction and say ‘you need to stop smoking or you need to lose weight,’ the nurse-midwife is the one who sits down with the patient and says ‘Let’s talk about it. What’s really going on inside this family? What are the triggers? What are some realistic ways we can make healthier choices?’ We are digging deeper and getting a clearer picture of the situation because we have a little more time to spend with the patient.”
Stephanie said that, as is the case in many communities across the country, there is a shortage of psychiatric-mental health providers in Auburn and across the state. Serving on IPQIC’s maternal mortality review board, she has seen evidence of the impact mental health plays in the overall health of the patient.
“Mental health can have a big impact on these women and them not seeking the help and care that they need,” she said. “Substance abuse, depression, and mental health permeate everywhere.”
With leadership roles as co-owner of a birthing center, preceptor, and active participant in state healthcare initiatives, Stephanie may seem to have been destined for this profession. That, however, was not the case.
“I became a midwife by default,” she said. “As a nurse, I had those rose-colored glasses, but soon realized that some of the nurses were really taking care of the doctors more than the patients. I became more and more disheartened. I had changed as much as I could as a manager. I needed to be a provider.”
She was also helping provide for her family, which at the time consisted of her husband Dean and two sons.
“The only options I had for midwifery school other than FNU were Michigan or Case Western,” said Stephanie, who now has three sons, a daughter, and a grandson. “Do I want to travel every week to Michigan or Case Western or do the distance-based program at FNU? I needed to work. I had two boys at the time and I carried our insurance. I worked throughout the completion of my midwifery program.”
Stephanie credits FNU with helping her direct her passion to open a birthing center by creating a plan that served the needs of the community and could succeed as a business. “The program did well in instilling that there are different ways to practice and finding out what your community needs are,” she said.
She recalled attending FNU’s Midwifery Bound where the attendees shared their dreams and motivations. She remembers both FNU President Dr. Susan Stone and FNU Board of Directors member Kitty Ernst being in the circle. When it was her turn to share her story, Stephanie said, “I’m going to open a birth center in northern Indiana.”
She shared her voice that day with a relatively small group of people. Today, Stephanie continues to share her message with a much larger audience, her voice resonating as a leader, advocate, educator, and caregiver.
What is a Certified Nurse–Midwife (CNM)?
Certified Nurse-Midwives (CNMs) are educated in two disciplines: midwifery and nursing. They earn graduate degrees, complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM. Certified Midwives (CMs) are educated in the discipline of midwifery. They earn graduate degrees, meet health and science education requirements, complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM.
2020: Year of the Nurse and the Midwife
Frontier Nursing University (FNU) is proud to support and join the World Health Organization’s international campaign designating 2020 as the “Year of the Nurse and the Midwife.” In recognizing the International Year of the Nurse and the Midwife, FNU joins the efforts to raise awareness of healthcare shortages in the U.S. and abroad; demonstrate the need for more nurses and nurse-midwives; educate the public of the value of nurses and nurse-midwives in their communities and advocate for access to quality healthcare for every individual.