Q&A with Blake Rainie Slack: From a Global Health Career to Midwifery

After a trip to the Philippines, Blake Rainie Slack, CNM, was so inspired by the national policy work in women’s and family health being done by the midwives there that she decided to change careers when she returned to the US. She has now been a midwife for 13 years. In the following Q&A, Blake shares what she loves most about her career, what motivates her and the future she envisions for midwifery.

Q. What is your work as a midwife like?

I’ve been a certified nurse-midwife for 13 years, the last nine of which have been at Massachusetts General Hospital. In addition to working on the labor and delivery floor at Mass General, I see patients at the Mass General Waltham practice for the full scope of gynecological and obstetrical (OB) care, including:

• well-woman annual visits
• contraception
• problem visits for abnormal bleeding and sexually transmitted infections
• preconception
• prenatal
• postpartum

Q. Why did you choose to become a midwife?

I initially had a career as an administrator in global health. On a trip to the Philippines, I was so inspired by the work done by midwives there that I came home to explore the career option in the US. I volunteered with a midwife in Washington, DC who was working predominantly with patients who were disadvantaged and/or immigrants. I was so inspired by the need for improved maternal child healthcare both internationally and domestically that I quit my job and signed up for prerequisites for direct entry nursing to midwifery programs.

Q. What motivates you to do what you do? 

I am inspired every day by my patients to meet them where they are, to set goals for a healthy pregnancy or person and to take steps toward those goals. I am particularly motivated by patients who have experienced trauma in life or in previous childbirth experiences, as we know many women have, and who need extra care taken to restore their sense of empowerment, agency and optimism.

I often feel the most important and humbling visit of my entire week is the one where I have a woman in front of me crying or just talking, pouring out her soul, and working with me to find her way to a better day tomorrow. Women hold so much on their shoulders every day—I am honored to walk with them, and when I am lucky enough for them to let me, carry a bit of their burdens on my shoulders too.

Q. What is the most rewarding part of your job?

As a midwife, being the first one to touch a new life and gently hand over this newest member of a family is the most rewarding part. As an educator, introducing learners to the midwifery philosophy of care, so they can carry it with them throughout their careers is a great honor.

Q. What are the benefits of being a midwife at a place like Mass General?

The greatest benefit is working in the ultimate model of interdisciplinary collaborative care. We have wonderful physician colleagues who support the low-intervention midwifery model of care, but they are ready to consult and/or assume care as needed.

We also have brilliant nurses who support us and help our patients achieve their wellness goals and fight for their ideal birth experiences. I also can’t say enough about all the knowledgeable and highly capable support staff in the offices and the hospital – my medical assistant and patient services coordinator are absolute gems, who teach me every day. Additionally, the OB/GYN team embraces evidence-based practice, so we always have great practice guidance based on the best evidence.

Q. Can you describe your role as Education Director within the Midwifery Division?

When I first joined Mass General, I was the Education Coordinator for the Midwifery Division and then became the Education Director in 2018. In this role I facilitate trainings for the midwives to help improve the group’s skills as preceptors (instructors) and oversee students who train within our practice including midwifery students, Harvard Medical School medical students, Emergency Department residents and Family Medicine / Internal Medicine residents.

With two physician colleagues, we developed a program in 2017 for Mass General midwives to attain Harvard Faculty status. To my knowledge, we are still the only non-physician group to have Harvard Faculty status, but we have been providing information to help other advanced practice registered nurse educators at Mass General achieve this recognition as well.

Q. What do you wish people knew about midwifery?

There is a misconception that midwives only provide obstetric care and that we only attend home births or unmedicated births. Although there are several different types of midwives in the US, certified nurse-midwives are the largest group, are independent advanced practice nurses, see routine gynecology patients and obstetric patients and work largely in hospitals and traditional healthcare settings. You can get an epidural with a hospital midwife if you wish. What we share with other types of midwives is a belief in the power of a woman’s body and in physiologic birth.

I also wish there was a better understand that any low or moderate risk patient is a good candidate for midwifery care. Many women think they are “high risk” because of a thyroid condition or a history of PCOS, but most are not. There are actually very few conditions that truly make a patient ineligible for midwifery care.

The Lancet published a series of articles in 2014 that purport midwifery care may help improve global maternal child health outcomes and should be considered an important element in high-quality collaborative care for women.

Q. What do you consider to be your greatest accomplishment as a midwife?

When patients say midwifery care has restored their faith and trust in the medical care system. It makes me feel there is something special in our discipline that is intangible but an important component for the bigger picture of the health of our nation.  I hope someday in the future midwives will be the default providers for pregnancy and routine women’s healthcare with appropriate transfer and referral to physicians when needed.