Certified Nurse-Mother

July 2004 -- One of the two main winners of Good Housekeeping's Award for Women in Government is Jill Alliman, RN, MSN, CNM, a Tennessee nurse-midwife who, as explained in this month's issue, directs a rural maternity center that has vastly improved the health of poor Appalachian women and their children for two decades. Unfortunately, Margaret Magnarelli's piece on Ms. Alliman, "Midwife on a Mission," undermines the magazine's admirable choice by virtually ignoring nursing and instead offers maternal and angel stereotypes to describe the maternity center's very real substantive achievements.

The article begins well, explaining how Ms. Alliman has spent the last 18 years at the Women's Wellness & Maternity Center in Madisonville, Tennessee, first as a nurse-midwife--the piece's lone reference to nursing--and now as director. According to the piece, before the Center opened in 1983, pregnant women had difficulty getting proper prenatal care, as there were "no OB-GYNs in the area," and women in the area could "scarcely afford" to visit the local family practice physicians who provided obstetric care. This piece, like most about nurse practitioners who practice in underserved areas, does not give the NP's sufficient credit for being willing to work in difficult settings for far less money than most physicians. Such pieces note that a key reason poor areas are in dire straights is a lack of affordable, qualified physicians, but they tend to treat the problem as if it were a law of nature--of course there are no physicans here, any more than tropical flowers grow in cold weather--rather than a result of conscious economic choices by the physicians.

But the Women's Wellness & Maternity Center, where "midwives manage low-risk births" has "significantly reduced the number of low birthweight babies born in the county." A good point, though the piece might have explained that this means lives have been saved and serious illness and disability avoided. As for Ms. Alliman, she not only found alternate sources of funding when the Center's state funding was eliminated in 2003, allowing the Center to keep offering free cancer screenings and other services, but also helped develop four new maternity centers in Tennessee.

Unfortunately, rather than attributing any of these achievements to the nursing skills and experience of Ms. Alliman and her colleagues, the piece marginalizes the profession through a remarkable mix of omissions and stereotypes. The piece does not list Ms. Alliman's academic degrees, which include an MSN, even though it identifies one of the runner-up winners--whose prize is only one tenth as large--as "Anna Ramirez, M.P.H." Ms. Alliman is also a clinical instructor for Vanderbilt University's certified nurse-midwiife program, and that too is entirely ignored. The article does not even identify Ms. Alliman as an RN, much less a CNM. And though it includes the one reference above to Ms. Alliman's status as a "nurse-midwife," its other references to Center professionals are simply to "midwives."

To the extent readers do get that Ms. Alliman is a nurse, they are invited to think of her as a committed, energetic mother--the mother of the mothers. Rather than learning about the lives she's saved with her nursing skills, we learn that she "held the hands of more than 1,000 women during delivery." The director of the National Association of Childbearing Centers Consulting Group is quoted as saying that Ms. Alliman has the "the qualities of the Energizer Bunny and Mother Teresa mixed into one." In other words, she's a mixture of cutesy energy and saintly yet maternal commitment, qualities that have traditionally been associated with nursing but that do not reflect the professional nature of modern nursing. Likewise, last year's funding crisis tested Ms. Alliman's "tireless devotion," a neat two word evocation of the bunny and the saint. To us, Ms. Alliman really seems to be following in the footsteps of the great rural health pioneer Mary Breckinridge--a nurse whose achievements, many believe, actually rival those of the Energizer Bunny.

The piece concludes by noting that Ms. Alliman's "favorite part of the job is still being with women in labor" because "[e]very birth is special." We don't doubt that, but we do wish the article had made it clearer that nurse-midwives do a little more than "be with" women in labor. In fact, they and the staff nurses typically provide all pre-, intra- and post-partal care for these mothers. The piece largely fails to convey the nature or effects of these critical responsibilities.

See Margaret Magnarelli's article "Midwife on a Mission" in the July 2004 issue of Good Housekeeping. Also see a better, more detailed article with the same headline in the Daily Times of Tennessee. Also see "New center provides teen moms-to-be with affordable medical care" in the June, 29 2000 edition of the Tennessean, which better describes the effects of Ms. Alliman and colleagues' care on patient health.

Send a letter to the Editor of Good Housekeeping and please blind carbon the Center for Nursing Advocacy at letters@truthaboutnursing.org. Also please post a copy of your letters on our discussion board so that we can all follow your letters. Thank you.