The Midwife’s Spiral Dance

By F. Josephine Arrowood
Sun contributor
Amy Marowitz always knew she wanted to be a midwife. Yet the journey along her chosen career path has followed a circuitous route that has taken her from her native Ohio to western Leelanau County, from the bustle of Midwest academia to a remote Indian reservation, and from the prevailing nursing philosophy of childbirth as medical crisis to an outlook that embraces this most natural rite of passage.
In college, Amy at first declined the expected option of nursing school, feeling it would be “too prescribed; a hoop to jump through”. Instead, as an anthropology student at the University of Michigan in the late 1970s, she found freedom to explore the rich worlds encompassed in diverse societies, traditions and points of view.

“You learn about the importance of cultures, and how that affects human behaviors,” Amy says. Now, “As a practitioner of midwifery, you see that there is more than one right way,” to approach a woman and her family in the birthing process, to support her and help ensure a positive experience. Such a respectful attitude might seem alien in the prevailing allopathic (MD) world of obstetrics and gynecology, where “Doctor knows best,” is still the norm, and technology plays an ever-increasing role in determining a birth’s outcome.
“The clock is the biggest invention that has affected how the birthing process is perceived,” she states. “A lot of ‘rules’ of practice in labor and delivery in hospitals is based on 1950s statistical research. Often there’s no science to support the many rules,” such as when a woman should push during labor.
The 1970s saw a dramatic rise in midwife-attended births, as the feminist, back-to-the-land, and consumer movements all helped educate women about their bodies, their babies and their rights as health care patients. After completing her degree at U-M, Amy headed to St. Louis University in an accelerated RN program, She attended home births for a year under the guidance of Detroit-area lay midwifery pioneer Kathy Nunez, but eventually decided to return to school for an advanced degree in nurse-midwifery at the University of Colorado.
“We [nurse-midwives] have a foot in both worlds. It’s a very complex place to be,” she explains. Lay or direct-entry midwives primarily attend home births, as well as offer some prenatal and post-natal care to mother and child. Nurse-midwives, with their clinical and academic background, typically work in hospitals or birth centers. Amy acknowledges that there are some conflicts between the two branches, but points out the validity and need for both.
“Philosophically, I’m more aligned with direct-entry midwifery,” she explains. “But to be able to move around the country and get a job in a hospital or birth center, there are more job opportunities,” for certified nurse-midwives, as well as more scope for related health practices, like family nursing.
Amy worked at St. Joseph Hospital in Ann Arbor, and for the Indian Health Service in the Navaho Nation in Arizona, before hearing the call of northern Michigan, where she’d vacationed as a child at Camp Innisfree (now Camp Leelanau-Kohana).
“Oddly, in the early 1990s, there were only two obstetricians in Traverse City,” Amy says. “Munson Hospital decided to start a midwifery service, and I was hired in 1992,” along with fellow Innisfree alumna and nurse-midwife Nancy Gallagher. In northern Michigan, Amy was also destined to meet and marry Glen Arbor’s own Ron Kramer, a social worker who now works for the state. By a strange coincidence, Ron’s cousin Pat Kramer was a leading figure in Ann Arbor’s midwifery movement of the 1980s, although she and Amy had never met downstate.
Midwifery, whether practiced by direct-entry or nurse-midwives, is an intense, demanding profession. The term literally means to be “with woman,” and midwives spend a great deal of time with their clients during births, sometimes as long as a couple of days. Increasingly, Amy found the rigors of her practice to be incompatible with her desire to be a more hands-on parent to her daughter Addie, then two. In 1994, she had begun working part-time as an online instructor through the Frontier School of Midwifery and Family Nursing, based in Hyden, Kentucky. In 1997, she quit her half-time job at Munson to teach nearly full-time for Frontier out of her home office on Wheeler Road.
“My work is intellectually challenging, which I love, although I do miss some of the intensity of attending births. I love how my job fits with my life, how I can do it at different times of the day,” around parenting Addie and now Eli, age six. “Of course, the thing I like least about it is also the lack of boundaries,” a common issue with those who work at home.
Amy feels fortunate to be affiliated with Frontier, a preeminent institution that has educated nurses in maternal and family health care issues since the 1920s. Founded by Mary Breckinridge, a wealthy Southern aristocrat (whose own tragedy of losing two children led her to a lifetime of service in the remote Appalachian region), Frontier’s visionary mission was first carried out by British-trained nurses on horseback. In the 21st century, Frontier now reaches women all over the world via cyberspace, offering master’s degrees in nursing in both midwifery and family health, and sending desperately needed expertise into rural and underserved areas both here and abroad.
“The school is amazing, with a huge variety of people, age spread, social backgrounds, and points of view,” Amy exclaims with the ardor of the anthropologist.
Her teaching focuses on the intrapartum, or labor-birth phase of pregnancy, with academic courses that build a solid foundation of knowledge for students, using actual case studies, online forums, and tools such as life-sized models of a female pelvis and fetus (students later go on to clinical studies all over the country that are monitored by Frontier). A big part of Amy’s teaching involves identifying “normal” labor to birth attendants.
“Most of my students have been labor and delivery nurses, but they don’t know what a normal, non-interventionist birth looks like,” she states. Even with nurse-midwives, “there’s enormous pressure on them to perform inductions [forcing labor], fetal monitoring and epidurals. Hospital obstetrical culture is very powerful; even if you don’t believe in it, it’s hard not to go along with traditions” that have taken on the verity of second nature.
Yet she sees hope for the future, even as she looks back along a personal and professional path shaped in ever-widening spirals. As a result of Frontier’s accreditation in 2003 to offer masters’ degrees, Amy now finds herself back in the role of student. Revisiting her anthropology roots, she’s in the process of earning her PhD online, studying international health science, and plans a dissertation on midwifery-related issues.
“It’s broadened my perspective,” she says, and mulls the enticing possibility of someday traveling to Africa, to train midwives and study firsthand the cultures she’s come to love through her academic learning.
“It’s not what I ever imagined I’d do originally,” with midwifery, Amy concludes. “Although I miss attending births and having that impact on one woman’s experience, I can do so much more,” says the educator, mentor, and lifelong student of humanity, gazing from her window on the world in rural Leelanau County.