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For years, Sarah Stetina, MSN, CNM, APRN-FPA, MSCP, of Good Energy Women’s Health, built a career many nurses picture when they think of becoming a certified nurse-midwife.
She worked in labor and delivery and postpartum care, attended births in hospitals, homes, and birth centers, and became clinical director of a freestanding birth center.
Then she left birth work.
What Stetina discovered next challenged her assumptions about the profession. Her career moved into gynecology, abortion care, and menopause care, areas she had not fully considered when she became a midwife.
For nurses who associate nurse-midwifery primarily with pregnancy and childbirth, Stetina’s path illustrates a much broader career.
As National Midwifery Week is recognized Oct. 4-10, her experience also offers a look at the range of roles nurses can pursue after becoming certified nurse-midwives.
“I wish more nurses knew that midwifery is a philosophy of care, not a single event,” Stetina said. “Certified nurse-midwives care for people from their first period through menopause and beyond, and we care for newborns in their first 28 days of life.”
One Birth Changed Her Career
Stetina did not enter nursing school planning to work in women’s health. That changed during her OB/GYN rotation when she witnessed her first birth.
“I had never considered women’s health before, so feeling that pull so strongly was really surprising for me,” she said. “My professor introduced me to midwifery, and I knew before I graduated that it was the right path for me.”
But what she witnessed during that birth also troubled her.
“I watched the woman giving birth be ignored, dismissed, and shouted at on one of the most important days of her life,” Stetina said. “It contradicted everything I was learning about holistic, person-centered care, which is at the heart of nursing.”
When she discussed the experience with her professor, the professor suggested that midwifery’s philosophy might resonate with her.
It did.
Stetina began her nursing career on an orthopedic surgical unit while waiting for a labor and delivery position to become available. When a night-shift opening did, she joined an L&D unit that worked with midwives.
Watching them care for patients reinforced her decision to pursue the profession.
The Reality of Birth Work
Becoming a midwife, however, challenged some of Stetina’s expectations.
“I definitely had rose-colored glasses on before becoming a midwife,” she said.
She had imagined greater authority over patient care and viewed working at a birth center as the pinnacle of the profession. Instead, she encountered long call shifts, high liability, difficult emergencies, and the challenge of advocating for the midwifery model within healthcare systems that did not always support it.
“The reality is that midwifery is the hardest thing I’ve ever done,” Stetina said.
When she eventually became clinical director of a birth center, Stetina said she could practice in a setting that fully embraced the midwifery model. But limited staffing, pay, and insurance reimbursement made the work unsustainable.
The breaking point came after she gave birth to her first child.
Stetina was working 60 to 80 hours a week while navigating postpartum depression and burnout. Her breast milk dried up.
“I knew it wasn’t sustainable,” she said.
She left birth work and moved into virtual gynecology, stepping away from 24-hour call shifts and emergency care.
“Since leaving birth work, I’ve been happy to discover a side of midwifery I had never really considered as a nurse,” Stetina said. “Midwives care for people across the whole lifespan, not just in pregnancy.”
Midwifery Beyond Labor and Delivery
Stetina’s subsequent work has included gynecology, abortion and menopause care. She is now opening her own gynecology and menopause practice in Batavia, Illinois.
“We provide annual exams, contraception including IUDs and implants, STI care, abortion care, preconception and fertility support, and menopause care,” Stetina said.
Midwives can also work in research, academia, political advocacy, and health system leadership, she said.
“It turns out the care I fell in love with was never really about birth,” she said. “It was about how we treat people.”
Working across community hospitals, home birth, birth centers, federally qualified health centers, and virtual care also expanded her understanding of what a midwife can contribute.
In community birth settings, she saw what care could look like with greater patient autonomy. As a birth center director, she worked with local EMS and a hospital to help patients move safely between settings when they needed a higher level of care. At an FQHC, she saw the role midwives could play in caring for underserved patients. Virtual care showed her that the model could extend across geographic boundaries.
“Together, those experiences taught me that a midwife can be a listener, an advocate, a bridge and a change agent, often all in the same visit,” she said.
The Nursing Skills That Followed Her
Although Stetina’s career has moved far from the orthopedic unit where she began, she said the lessons she learned as an RN continue to shape how she practices.
“Nursing humbled me, and it made me a better provider,” she said. “As a nurse, you’re alongside people in their most vulnerable moments, and your job is to preserve their dignity when they can’t do it themselves.”
Attention to detail, organization, communication, and interdisciplinary teamwork remained important, as did clinical skills such as medication administration, starting IVs, and taking blood pressure. At the birth center, where someone else wasn’t always available to do those tasks, her nursing background proved particularly useful.
Stetina believes nursing experience is important before becoming an advanced practice nurse. But she does not believe aspiring midwives need to come from labor and delivery.
“For years, I’ve encouraged nurses without L&D experience to become midwives,” she said. “I truly don’t believe you need it to be an exceptional midwife.”
Stetina began on an orthopedic surgical floor, moved into labor and delivery, trained in NICU care and ultimately practiced across multiple areas of women’s health.
“The right background isn’t a specific unit; it’s a commitment to the kind of care you want to give,” she said.
Her own career also required her to reconsider what it meant to remain a midwife after leaving birth work.
“Stepping away from birth work didn’t mean stepping away from midwifery for me,” Stetina said. “It meant finding a version of it that was sustainable for my life.”
For nurses considering the profession, that may be the larger lesson: midwifery is bigger than birth.
“Wherever your passions or talents lie, there’s a place for you in midwifery.”
