Amy MacDonald Story Transcript

My name is Amy MacDonald. I am a certified nurse-midwife, and the founder and former director of the Duke Midwifery Service.

The Duke Midwifery Service started in August of 1999 when I joined the Department of OB-GYN at Duke [University]. I was the first inpatient nurse-midwife, there had been a prior nurse-midwife, 10 years prior to my coming. My primary mission was to partner with the OB-GYNs – and the residents because there was and is a large OB-GYN residency program – I wanted to partner with the physicians and physicians-in-training to deliver excellent care, and also to really work through the hurdle of “us and them” as had been established [laughs] for many, many years between midwives and OB-GYNs. I really felt like it was time to deliver good care, to learn from one another, and move on. So I called it the Duke Midwifery Service. I called myself the Director. When I arrived, there had never been a midwife who had done deliveries, who had done full-scope care. [For two years] I was in the OB triage unit because the then-chairman couldn’t imagine, couldn’t envision, midwifery on labor and delivery at Duke. So that’s how I started.

Midwives, women, have been caring for other women through birth and death and everything in between, since the beginning of time, right? In this country, where obstetrics is not much more than 100 years old, midwives who were not formally trained filled that role for many, many years. And enslaved women who were brought to this country filled that role in their countries of origin and then when they landed on this soil. That was true for Indigenous women. It was true for immigrant women. And during years of racism where black women were not able to be admitted into hospitals, Black grand midwives took care of women in their communities, white and Black, when poor white women weren’t able to pay for care in a hospital. So as the field of OB-GYN grew, because OB-GYN residents - doctors in training – needed to practice [and] needed to learn about women’s health care in the hospital, there really was an active campaign to outlaw midwives, and categorize midwives as untrained, as dirty, as drunkards, as, you know, lots of pejorative terms that you’re likely familiar with. And so that’s kind of how we started in this country. … Although there are pockets where midwives and OB-GYNs have learned to respect and mutually operate together, support each other together, there are many examples of that – our institutions, per se, have not really solved that problem. And so when I came to Duke in 1999, I saw this as a wonderful opportunity to try again, I’m an optimist.

What the science says about midwifery research is that patient satisfaction is high. Preterm birth is lower. C-section rates are lower. Breastfeeding rates are higher. Preparedness for not only for birth, but for parenting, right, how to take care of your new baby, are also higher.

Creating a service for midwives at Duke meant that yes, there were normal, healthy people who came to Duke to have their baby, but also realizing that all the high-risk patients needed midwifery also. They needed maternal-fetal medicine and all the incredible things that that medicine had to offer. But they were becoming parents, they were frightened. If they had MS, if they had cancer, if they were a double amputee, you know, they still had a uterus and they were pushing out a baby. And they needed to really be able to feel supported and appreciated for the wonderful things that their bodies were doing. Or if there was a loss, right? In the business of that unit, it was really the midwives who really knew what that was about. And additionally, you always have new people, right, new nurses coming in, or every year the residents are new, the medical students are new. They didn’t know what to say to a mother, who was, you know, holding her baby who was dying. But the midwives knew what to say, right? “With women” [tenet of midwifery = “with women”], right? We knew how to be with women and how to support them. So it was a real natural extension to turn to the resident who had tears streaming down her face and whisper in her ear, “Find the beauty, find the good. You can say to this mother that her baby’s lips are perfect. Or look at her feet, you know, she has the loveliest little feet.” So it was pretty easy early on to see what the need was.

There is something about midwifery, it’s not just the delivery of medical care, it’s really understanding the human condition. Whether you’re having a baby, or you’re doing your first call night. I still have residents call me routinely to tell me about something beautiful, or something tragic, and what that was like for them. So being a midwife is – it’s a remarkable profession.

Read a transcript of the full interview here.