In September 2023, Melissa Nelson, MSN, CNM, WHNP-BC, became the chief of the Midwifery Service within the Department of Obstetrics and Gynecology at Massachusetts General Hospital. In addition to her clinical work, she was a 2023 fellow in the Advanced Practice Provider Leadership Institute at Duke University School of Medicine and is an active member of the Massachusetts Affiliate of the American College of Nurse-Midwives.

Below, Melissa shares why she pursued a career in midwifery, what she most wants people to know about this area of care, and her advice for patients.

Question: What drew you to Mass General?

Answer: I was drawn to the midwifery's practice commitment to providing evidence-based care that supports normal physiologic birth.

The practice also has a strong history and a commitment to the future, especially to providing excellent care to underserved populations in local communities. There’s a desire throughout the OB/GYN group to be excellent, to be leaders in the field, and to be agents of change for historical and systemic inequities. A lot of places talk the talk but don’t walk it. I was impressed that Mass General invests in initiatives that have been proven to change outcomes, like the Striving Towards Equity in Obstetric Outcomes Through Cultural and Language Concordant Doula Care Initiative. I’m excited to be part of a place dedicated to doing better for patients and each other.

Q: Clinically, what drives your passion for midwifery?

A: Midwifery is a profession rooted in cultural traditions. I appreciate that long history and the intersection that exists today—that it is both a holistic and evidence-based practice. We treat people as not simply a pregnant patient, but a whole person, because pregnancy touches every aspect of their life and their family’s life. It’s an honor and a privilege to provide care for people at this milestone moment in their life.

Q: What advice would you give to patients considering a midwife for their prenatal care?

A: We are taking all of you into account. The relationship we have with our patients is not one direction. We’re going to be buddies for nearly a whole year, so it’s important to build a relationship based on trust, understanding, and honest feedback. We encourage you to be honest about your goals and values and express any fears or concerns as they arise throughout your care with us.

We work as independent providers who can lead prenatal care like our obstetric colleagues, and we collaborate across the department and beyond to ensure our patients receive the very best care if they do become high risk. 

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Q: What are common misconceptions about midwifery?

A: There are two I hear most consistently: that midwives are not as trained as obstetricians (OBs) and that you can’t have an epidural if you deliver with a midwife. Neither are true.

For the first, both CNMs and OBGYNs receive training to expertly provide routine gynecologic, family planning, and pregnancy care. Certified Nurse-Midwives are independent practitioners and do not need to be overseen by a physician. The main difference is that OBGYNs are trained as experts in managing high-risk pregnancies and are trained in performing gynecological and obstetrical surgeries like c-sections. This is not to say that midwives can't provide care to those that are high risk, however we believe that it is important to have a seamless interdisciplinary and collaborative model of care with our OB specialists if a pregnancy becomes high risk.

For the second, midwifery patients have the same access to pain management care as OB patients, including epidurals. We will ask you for your labor and delivery preferences—including pain management and the different positions in which you can deliver your baby, like on your hands and knees.

Q: What’s the future of midwifery at Mass General?

A: The future of midwifery at Mass General will be collaborative and culturally congruent. My leadership style is anchored in my belief that my team is as important as my vision. We all will be involved in creating the future of the midwifery service.

I want to continue growing the practice and ensuring that we remain a patient-focused service that supports normal physiologic birth in a home-like, low intervention setting for childbirth while continuing to remain closely collaborative with our OB colleagues should the need for medical care arise. This model of care has been proven to improve maternal-child health outcomes.

Part of what drew me to Mass General was its commitment to dismantling historical and systemic inequities. A piece of that work is recruiting and hiring midwives who culturally reflect the populations we serve. I think about this beyond racial diversity to aspects like understanding the local landscape of where they practice. After all, Boston is a city of neighborhoods.

Q: What’s changed in midwifery over the course of your career?

A: As whole health providers, midwives have long advocated for expanding the meaning of pregnancy care to include pelvic floor therapy, lactation support, mental health care, and parental leave. There’s greater awareness of these topics now, so we’re seeing positive change in health care, especially postpartum care.

The field of OB/GYN has also developed an improved integration of care providers—OB/GYNs, maternal-fetal medicine specialists, midwives, nurses, doulas—which enables us to collaborate more effectively than compete, which is better for our patients. True patient-centered care is the future, and the more we all work as a team to deliver exceptional results for our patients, the better we all are.

Q: How can midwifery be a force for social justice?

A: How we interact with and approach treating our patients are our best tools. Midwives deeply believe birthing to be a normal physiological process; yet our systems have become embedded with risks, especially for Black birthing people and babies. While policies and structural inequities take time to change, our daily work to help patients feel empowered, informed, and capable can change their outcomes. We provide care that is trauma-informed and is committed to acknowledging that cultural values and traditions are just as important. Wholistic care is the best care and allows the family unit to continue to strengthen and grow.

Our midwifery philosophy continues to encourage that the patients be at the center of the care we provide. Trusting patients to know their own bodies, being transparent with them about potential complications or risks, and empowering them to speak up throughout the pregnancy journey can be powerful for patients.