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School of Medicine
A Labor of Love
Nurse midwife Jackie Notes has helped bring more than 3,000 babies into the world.
Jackie Notes (right) with Ella Wagoner, one of the more than 3,000 infants she’s helped bring into the world in Howard County. Looking on is mother Tenille Wagoner.
While working as a young nurse at a large Chicago hospital in the 1970s, Jackie Notes decided to specialize in midwifery after observing what she believed was insensitive care and unnecessary medical procedures being administered to women giving birth.
"I chose midwifery," she recalls, "because it offered continuity of care and a respect for women that, at the time, wasn't always obvious in the medical world."
Three thousand babies later, Notes is the longest-practicing midwife in Howard County, having worked in the Gyn/Ob practice Mayer and Hogan at Howard County General Hospital for 22 years of her 32-year career.
Although the profession of nurse midwifery was still in its infancy when Notes arrived at the practice, the groundwork had been laid by Ellen Ray, a labor and delivery nurse who had become certified as a nurse midwife. "Ellen had already established respect with the hospital nurses and the Gyn/Ob physicians," Notes says.
Still, full acceptance was a gradual process. "Early in my career, nurse midwives had to be supervised by a physician," she says. "Now we have more autonomy and work in close collaboration as a team of midwives and doctors. Overall, this provides the best of both worlds for our patients."
Midwives are indispensable at busy hospitals like Howard County General, says Phyllis Campbell, who chairs the hospital's Gyn/Ob department, because they take care of low-risk patients, freeing physicians to concentrate on more high-risk pregnancies.
"They have proved to be essential for our practice and the hospital because of the large number of patients in our community in need of obstetrical care," she says.
"Being nurses, they are also nurturing, and that is essential in obstetrical care," says Campbell, who also works with Mayer and Hogan.
Currently, the community practice of Johns Hopkins Medicine employees seven nurse midwives, who have been responsible for 32 percent of the babies delivered in Howard County.
"But we do much more than deliver babies," Notes says. "We also help provide well-woman care long before and long after birth." As a result, she adds, many patients come to nurse midwives by word of mouth.
Notes herself also helped paved the way for the profession. In 1978, after graduating as a nurse midwife from the University of Mississippi, she moved to Palo Alto, Calif., where she helped wage a 10-year legal battle to gain midwife privileges at Stanford University Hospital.
Midwifery dates back to early mankind and thrived in this country through the early 20th century. Until then, most women gave birth at home and only went to a hospital if there were complications.
It was a crusading nurse, Mary Breckinridge, who advocated for educational programs to train nurses in midwifery. Her efforts ultimately lead to the formation of a professional society to certify nurse midwives.
In 2008, according to the American College of Nurse Midwives, there were more than 11,300 nurse midwives who were attending to more than 300,000 deliveries in hospitals.
Twenty-two years after beginning work at Howard County General, Notes is proud of the work she and other midwives have done to support as many natural births as possible at Howard County General. Of their 11,000-plus deliveries, they have consistently maintained a cesarean section rate of under 14 percent.
"I've learned to be objective while guiding women to birth and providing empathetic care," she says. "If you swing too far in being objective, you may become too insensitive to what that woman needs. If you become overly empathetic and lose your objectivity, you may be unable to see what is safe."