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.”
Despite Hurricane Helene and the ensuing high winds and heavy rains that befell many states as the storm moved north, more than 1,600 people attended Frontier Nursing University’s 2024 commencement on Saturday, September 28, at Rupp Arena in Lexington, Kentucky.
“We want you to know that Frontier will always be here to support you and to cheer for you. You are forever part of the FNU family. Please take the time to check in with us now and then. Let us know how and what you’re doing, and share your accomplishments with us. Stay connected to your classmates and your faculty on our social media platforms. Ensure that we have your preferred email address so you can stay informed via our e-newsletters and the Quarterly Bulletin. Look for career and continuing education opportunities on our alumni portal. And take it from me, you never know when or how you might return to Frontier. We look forward to it!
Dr. Paula Alexander-Delpech, FNU Dean of Inclusive Excellence and Student Success, then addressed the graduates and encouraged them to be active agents in improving healthcare in their communities, large and small:
FNU Presents Honorary Doctorate to Keynote Speaker Dr. Bernadette Melnyk
Dr. Melnyk served a four-year term on the United States Preventive Services Task Force, the National Advisory Council for the National Institute for Nursing Research, and the Behavioral Health Standing Committee of the National Quality Forum. In addition, she served as dean of The Ohio State University College of Nursing for 12 years where she led the college to top 10 U.S. News & World Report and NIH funding rankings.
“I picked FNU for many reasons, but a big one was from Nicole’s experience,” Dr. Dodge said. “While in school, Nicole raved about FNU’s program.” 