Not so long ago, Ebony Monique Simpson, RN, BSN, CNM (Class 104), would have more likely written this story than been its subject. After graduating from Howard University with a journalism degree, she worked for a global public relations firm in Manhattan, representing pharmaceutical companies. But she knew that was not where she wanted to be. Her true passion had always been to become a midwife.

“I was always fascinated with the human body,” Simpson said, reflecting on her days growing up in Brooklyn. “In the fifth grade, there was this wonderful extracurricular program called the Science Skills Center. Classes were taught by black scientists and medical professionals in Brooklyn. In the summer after fifth grade, I participated in a college biology course. About 60 percent of everything the professor said went over my head, but I stayed committed and finished the program. Part of it involved being present for the dissection of a cadaver. I recall being the only one left in the room after 10-15 minutes. People were dropping like flies, and I was right there until the end.”

Seeing her interest and aptitude, Simpson’s parents enrolled her in programs like the Science Skills Center to foster her goals and dreams. It was around this time that she began to dream of being an OBGYN doctor.

“Around age 11, I decided my job would be to attend births,” Simpson said. “My mother was pregnant with her second child, and she had this wonderful book called A Child is Born and it had the most fascinating intrauterine photos. I read it cover to cover. She had another book called What to Expect When You’re Expecting, and I read that whole book quickly.”

She entered college as a pre-med student at a City University of New York school before transferring to Howard University, where the international allure of Washington, D.C., piqued her interest in journalism. What ultimately brought her back to her dream of attending births was the birth of her daughter.

“Before I graduated, I became pregnant with my daughter,” Simpson said. “I went home and decided to be with my family. A friend of mine from high school told me about a birthing center. It was just two midwives and two birthing rooms called The Brooklyn Birthing Center. They plopped me in a Jacuzzi, gave me a cup of noodles, lit a candle, put some mellow music on, and left me to labor with my friend. I had a short, efficient birth and a wonderful postpartum period. When people would ask me about my experience, all I could say was it was the most fun, exciting, adventurous day of my life. Their response to that let me know I had an uncommon experience. It was in those moments that I knew I would dedicate my life to helping other people have similar experiences. That’s when I started the journey in earnest.”

She went back to school, completing the prerequisites and enrolling in nursing school at Emory University in 2008. She graduated in 2011, and in 2013, she began working in Washington, D.C., hospital-based women and infant services. Around the same time, she enrolled at Frontier Nursing University to become a certified nurse-midwife and completed her studies while working as a nurse.

With her time split between being a mother, a student, and a nurse, she progressed at Frontier steadily but at a manageable pace.

“I like that my process took four years because the process of becoming a midwife isn’t something you should rush. I had to grow and mature and learn,” she said. “The role of a midwife is a role for a mature woman, and I like that the program gives you the option to do that.”

Simpson values the lifelong friendships she made at Frontier and the ability to connect with fellow alumni.

“I think the Frontier network is unmatched,” she said. “At any given time, I can go on Facebook, and there’s a group of thousands of midwives across the country I can communicate with. Any question you ask, tons of people will answer. That’s powerful. Midwifery can be isolating, depending on where you live. There are places where midwives are working solo in a hostile environment.”

Simpson does not work in such an environment. She joined the University of Maryland Medical System (UMMS) as a full-time staff midwife in February 2023.

The University of Maryland Capital Medical System is an 11-hospital system headquartered in Baltimore. The hospital where Simpson works is in Largo, Maryland, about 20 miles from Washington, D.C.

She works with roughly 19 midwives, most of whom are per diem midwives. It is a collaborative practice with physicians, physician assistants, and Maternal Fetal Medicine providers. The practice attends roughly 180 births per month.

“We have a 24/7 service that includes either one or two midwives, and we attend roughly 130 of those 180 births,” Simpson said. “In the time I have been in that practice, I have attended over 170 births. It’s been a busy year and a half, but I love it.”

Simpson describes the community they serve as a high-risk population primarily consisting of African Americans, African immigrants, and Central American immigrants. Collaboration with Maternal Fetal Medicine providers is frequently a part of the care plan.

“I feel like I’m making a huge difference,” Simpson said. “Midwifery care is needed in these kinds of settings. It’s a big change for me because, before this, I was doing out-of-hospital births in private homes and at a birth center.”

Before joining UMMS, Simpson worked for two years at BirthCare and Women’s Health in Alexandria, Virginia. She did most of her student clinical training with George Washington University Hospital’s midwifery service.

“At the time, it was a thriving nine-midwife practice that was practicing hospital midwifery,” Simpson said of practice at George Washington University Hospital. “They were providing high-touch, low-tech care, supporting normal physiological birth in the setting of a hospital. They had a great collaborative arrangement with the physicians. Out of the 50 births I attended as a student, 47 of those births resulted in a normal spontaneous vaginal delivery with no epidurals. The clients (most of whom were first-time parents) would come into the hospital with their doulas at eight centimeters and have these wonderful, empowered births.”

That is the model she hopes all hospitals will adopt to address the maternal mortality crisis in the United States.

“We have to incorporate the knowledge and skills of our out-of-hospital midwives,” Simpson said. “They know how to get people delivered in a low-risk way. Why are we ostracizing them? Why are we putting them on the fringes? Everyone is talking about maternal mortality right now. The number one thing we could do to improve maternal mortality is to integrate community midwives. We need to integrate the system so a woman has a choice, no matter her economic status, whether she wants to have a hospital birth, home birth, or birth center birth. It should be according to her clinical picture, not according to how much money she has.”

Simpson adds that patients need to be able to have longer visits with more time to express their concerns and preferences and to become more comfortable with their providers.

“The backbone of midwifery is relationships,” she said. “You need time to develop relationships. People are saying loud and clear ‘Providers don’t listen to me. They don’t take time.’ All of that could be solved by giving providers more time to care about clients.”

“Birth has to come out of a sick care institution because it doesn’t fit,” Simpson added. “Yes, sometimes tertiary care is needed, but for the majority of women who have a normal physiological birth process, what’s needed is to be in a safe environment with people that they know. They need to feel respected and listened to, and they need the time and space to allow their bodies to do what they naturally do.”

Simpson says it is common for a woman to present with stalled labor, but the provider might not have the time or knowledge to utilize non-pharmacological methods. Instead, higher-risk solutions are employed.

“A woman who needs to move more than anything is instead epiduralized, meaning she’s immobilized from the waist down, often in early labor,” Simpson said. “Now she has to rely on a nurse who is busy with other patients and doesn’t always have time to help the patient move. After hours of stalled labor and a baby starting to show signs of stress, Guess who’s going back for a C-section, who’s getting exposed to hemorrhage, infection, and future C-sections? There is a lack of awareness of what natural physiological birth is, how to recognize when things are off, and what are some low risk things we can do to resolve the issue that don’t put mother and baby at heightened risk. You have to be given the time and space to do these things, but oh boy, do they work.”

Simpson points to the common occurrence of persistent posterior presentation, where the baby is sitting in the womb facing forward. This can lead to prolonged, non-progressing labor with painful contractions. Simpson says these issues can almost always be resolved with bodywork and maternal repositioning.

“Community midwives know how to lay their hands on a woman, how to diagnose without ultrasound, and they know the specific movements,” Simpson said. “They understand the clinical picture. They know what it looks and sounds like when the baby is not in a good position. They know the solution, and they have the time and the space to enact the solution.”

Simpson proposes that a system in which nurses and nurse-midwives rotate and learn in all three settings – birth center, home, and hospital – would produce better outcomes. In a time where Black women in America are three to four times more likely to die in childbirth than white women, systemic change is needed.

“Is there some economic motivation for Black women to be sicker heading into pregnancy, sicker in pregnancy, and sicker after?” Simpson said. “Where does the motivation come from to be highly interventive instead of offering more low-tech, low-risk solutions? What’s the motivation to offer expensive epidurals and neglect to offer birthing tubs? Why do we rely more heavily on continuous monitoring, which doesn’t have evidence that it improves outcomes, when we could employ the continuous presence of doulas, which has been proven to improve health outcomes? Why are C-sections the most common surgery done in any hospital center? This is not just about Black women. This is about all women and the perverse economic incentives that are making too many women sick in the perinatal period It’s time to move midwives into the mainstream administration of maternal care.”

Simpson is taking an active approach to integrating midwifery care into the hospital setting and teaching nurses and doctors more about the midwifery approach. She has accepted a clinical faculty position in which she will teach intern physicians about normal birth. She hopes someday to open her own birth center and pledges to be a vocal thought leader via broadcast, publications, and public speaking.

“My goal is to help all women in my sphere, that I have access to, to have more power and safer, healthier birth experiences.”

Simpson is writing her own story – an action-packed narrative that she hopes concludes with the end of the nation’s maternal mortality crisis.

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At the heart of Frontier Nursing University is a talented community of students, alumni, faculty, staff, couriers and preceptors. Spotlight blogs feature members of our FNU community who are focused on the mission of educating nurse-midwives and nurse practitioners to deliver quality healthcare to underserved and rural populations.

Frontier graduate Marianna Holland, DNP, CNM, filled a crucial gap in healthcare in her community when she opened her own birth center, New Phase at the Birth Nest in Glendale, Arizona. New Phase, which was opened after Dr. Holland graduated from FNU with a Master of Science degree in nurse-midwifery and a Doctor of Nursing Practice, is the only BIPOC-led birth center in the state.

New Phase offers prenatal care, labor and delivery, newborn and postpartum care, and well woman care. At the birth center, Dr. Holland is supported by a dedicated team of midwives and staff members. In fact, Dr. Holland is not the only FNU graduate on staff, with Bethany Mainville-Brooks, DNP, FNP, CNM, also serving as a nurse-midwife at the birth center and hospital.

In addition to being the only birth center in Arizona owned and operated by midwives of color, New Phase is the only community practice in the Glendale area that maintains hospital privileges for safe community transfers when necessary. The birth center also hosts special events, such as postpartum classes, mom meet-ups and more.

As a Frontier graduate, Dr. Holland recognizes the unique challenges and disparities that BIPOC individuals and underserved communities face in accessing quality healthcare, particularly maternal and reproductive healthcare.

“My goal is to help my community find midwifery and other resources to further support health promotion,” she said. This is also one of the reasons she started precepting.

Dr. Holland is a preceptor to several midwifery programs and has worked with six FNU students so far. The birth center strives to support future midwives by providing opportunities to  strengthen their skill sets and build confidence.

Dr. Holland is not only a preceptor, but also a faculty member at the University of Arizona with a focus on midwifery education.

“I want to teach, along with precepting, to be able to encourage more midwives of color,” Dr. Holland said.

Before graduating from Frontier, Dr. Holland served for nearly a decade as an acute care labor and delivery nurse. She said while in nursing school, she was taught by an FNU graduate, an experience that inspired her to study at FNU. She said she was also motivated by the distance learning model offered by FNU, which enabled her to balance her education with her family responsibilities.

Earlier this year, Dr. Holland was inducted as an American College of Nurse-Midwives (ACNM) fellow, joining 47 fellow inductees who have led exemplary careers in midwifery. Fellowship in the American College of Nurse-Midwives is given to midwives whose demonstrated leadership within ACNM, clinical excellence, outstanding scholarship, and professional achievement have merited special recognition both within and outside of the midwifery profession. Dr. Holland said she attended her first ACNM conference as a student ambassador with FNU.

Outside of her work, Dr. Holland, a married mother of two, enjoys cooking, baking, and reading.

Thank you, Marianna, for advancing women’s healthcare in your community, for helping to train the next generation of nurse-midwives and for exemplifying the excellence of Frontier graduates.

To read more alumni stories, visit the FNU Alumni stories page. For more on precepting, visit Become a Preceptor.

Learn more about advanced nursing degrees and specialties at Frontier Nursing University. Subscribe to our blog for the latest news and events at FNU and to get inspired with stories featuring our alumni, students, faculty, preceptors and staff!

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Dr. Victoria Buchanan, DNP (Class 40), CNM, believes that hospital-based nurse-midwifery is one of the key solutions to the maternal mortality crisis in the United States. She believes it because she sees the results daily as a Certified Nurse-Midwife at Sentara Midwifery Specialists in Hampton, Virginia.

“The reason I’m very passionate about hospital-based midwifery is because everyone thinks about midwifery in the home,” Buchanan said. “I love it and think it should be an option, but the majority of women are going into hospitals and giving birth. Why not give them access to midwifery care which will improve outcomes?”

Sentara Midwifery Specialists, which is under the Sentara Health hospital system in Virginia, is the first independent, in-hospital midwifery practice in the Hampton Roads region, which boasts a population of approximately 1.8 million. Sentara Midwifery Specialists is comprised of five midwives, with four additional flex midwives who help cover during vacations. The group collaborates with an OB group but employs no obstetricians. With only one OB group in the area – the one that Sentara Midwifery Specialists partners with – Buchanan says Hampton is considered a healthcare desert for obstetric care.

Buchanan estimates that 65 to 75 percent of Sentara Midwifery Specialists’ patient population are Black and that the majority of their patients are on Medicaid.

“We have a great relationship with our high-risk specialists. They work with us, so we make sure we keep our patients safe,” Buchanan said. “Our outcomes speak for themselves. We don’t just take care of people who are low-risk. We are proudly in the moderate risk category, which means we care for people who have higher BMIs, preexisting conditions, controllable levels of high blood pressure, and thyroid disorders.”

“For the last two years, we have maintained a C-section rate below 16 percent. This year, we are at 14 percent, with a patient population that would typically be closer to 30 percent. It proves my theory – and the theory of our entire practice – that if you give high-quality care to people and give them access to midwifery care specifically, people at higher risk can still have excellent outcomes.”

Buchanan’s determination to fill the healthcare gap in Hampton stems from being born at Langley Air Force Base in Hampton. Though her military family moved around frequently, Buchanan has always considered Hampton home, and rightly so. After all, it was in Hampton that she first dreamt of a career in healthcare.

“When I was a kid, I wanted to be a pediatrician,” Buchanan said. “Then I heard there were about eight years of medical school on top of your bachelor’s degree, and I thought that was a long time before I actually do what I want to do.”

As a teen volunteer at a local hospital, she began noticing the important role of nurses.

“I thought, ‘Nurses do a whole lot of great things. Let me try doing that.’ So I went to school for nursing to become a nurse practitioner,” said Buchanan, who graduated from Hampton University. “When I went to clinicals, one of the nurses actually let me check a cervix, and I was able to feel the baby’s head. That was the start for me. I saw the birth, cried my eyes out, and knew I was hooked. I decided I wanted to be a labor and delivery nurse.”

After college, she began her nursing career and, by 2015, was a labor and delivery nurse. The experience was eye-opening.

“I enjoyed it a lot, but I kept on seeing that these women were not getting the births that they wanted to have,” Buchanan said. “They were coming in here with their goals and their birth plans but were not getting the results. A lot of them were getting C-sections when they could have had a vaginal birth. Many of the patients were not given enough time in labor, or they were being induced electively. Often the patients’ desired providers weren’t available, and they were stuck in the bed, unable to move around throughout labor.”

“We as nurses try to advocate for our patients, but I realized that the damage has already been done. Your provider makes an enormous difference in what kind of birth experience you have. These clients wanted a type of birth that was more natural, less intervention unless it was medically necessary.”

It wasn’t until she had a conversation with one of her coworkers who was studying to become a midwife that Buchanan considered midwifery. When Buchanan asked her colleague why she wanted to become a midwife, the simple answer was, “Because we have to make a difference.”

Those words inspired Buchanan to become a Certified Nurse-Midwife at Frontier Nursing University.

“I learned that if we intervene unnecessarily, it usually causes more harm than good,” Buchanan said. “I saw how midwifery can make a change in those statistics.”

Buchanan continued working as a nurse while attending Frontier, but she already knew that midwifery was for her.

“My mindset as a midwife, the belief in physiologic birth, came from Frontier,” said Buchanan, who also earned her DNP at Frontier so she could potentially teach someday. “Frontier gave me the research to back up what I believed. Midwifery is researched and evidence-based. It made me more confident in my decisions. We want to support women’s choices but also keep them safe.”

That’s why Buchanan believes so strongly in the collaboration between midwifery and obstetrics practices. The data demonstrates that it is a successful model.

“Trust and believe that I stay within my scope of practice,” Buchanan said. “Once you step outside that scope and you are high risk, then I bring in my doctors, sometimes in a collaboration and sometimes in a complete transfer. That’s why I like having our high-risk specialists collaborate with us. The system can work.”

It works, Buchanan says, because the patients are the top priority. The approach, she says, begins with listening and understanding.

“It is a true pleasure to be able to live in this area and see my patients in the community,” she said. “When our clients come back, they say, ‘You cared about me and took the time to listen.’ I think the number one factor in improving maternal mortality is listening to women and being able to believe women. I find that when my clients call me because they are not sure what’s going on or why they are having some discomfort or pain, that’s new. A lot of women – especially Black women – are dismissed and are told that their pain is not important. One of the reasons why our clients are doing better and are having these good results, I believe, is because we are allowed to have longer visits to figure out what’s going on.”

Just like the expectant mothers come in with their birth plans and goals, Buchanan says she and her fellow nurse-midwives at Sentara also have a plan. Their plan is to create the best possible birth experience for the best possible outcomes.

“We want you to leave this birth experience without having trauma that you have to live with,” she said. “We have a very high obligation to make sure you feel loved, safe, and secure. When you feel safe and secure, you do better. When we listen, we respond to danger signs earlier.”

“More hospitals need to invest in midwifery care,” Buchanan continued. “If midwifery was supported by the hospital systems, there would not only be better care, but the hospitals could also utilize their surgeons to do more procedures. Your results will improve if you utilize your advanced practice practitioners – nurse practitioners and midwives.”

For her part, Buchanan is investing in midwifery care by being a frequent preceptor for nurse-midwifery students, including many from Frontier. She estimates that she has precepted 15 students in the past four years, about 75 percent of whom were FNU students. “As long as I have the ability and the space, I will continue to precept students,” Buchanan said. “I learn a lot from my students, and they learn from me. It’s a mutual experience.”

If she has her way, many of those students could very well wind up joining Buchanan at Sentara. She hopes to see her own practice grow and expand to other Sentara locations.

“For the hospital, our hope is that the goal is to replicate ourselves,” she said. “Our system is very large. If I could see a Sentara Midwifery Specialists in every hospital that has obstetric care, that would be perfect. Virginia would flourish, and we would be the prime place to go to for birth. That’s what I see in the future.”

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