Roughly 19 percent of the US population suffers from some sort of mental illness. As I frequently tell graduate nursing students, mental health issues are everywhere. Over the past 10-15 years, mental illness has become less stigmatized and it is more acceptable for individuals to seek help.

The first Mental Health Parity Compliance Act was passed in 1996 and has been revised multiple times over the past 23 years. In 2010, addiction was added and the law became known as the Mental Health Parity and Addiction Equity Act. This legislation essentially directed insurers to cover mental health issues in the same way medical issues are covered.

Addressing the shortage

However, even with this legislation, there is a significant shortage of mental health providers across the United States, especially in rural and underserved areas. Even in more populated areas, the wait for psychiatric care can exceed 6 months for new patients and in some cases longer for children and adolescents. In many rural and underserved areas, nurse practitioners have answered the call to care for those in need.

Psychiatric-mental health nurse practitioners (PMHNPs) are advanced practice nurses that specialize in delivering competent, safe, and patient-centric care. PMHNPs are well-equipped to meet the needs of a diverse population by providing comprehensive psychiatric care that includes medication management, psychotherapy, education, and expert consultation. PMHNPs are built for this role as they rely on nursing principles of teamwork, collaboration, and a holistic approach to caring for patients. These principles are taught in undergraduate nursing and cultivated throughout a nurse’s career.

PMHNP certification

Any registered nurse who is passionate about providing psychiatric and mental health care to patients can pursue a PMHNP as a specialty. In addition, nurse practitioners and nurse-midwives can add the PMHNP specialty certification to their current credentials. By adding a PMHNP specialty, nurse practitioners and nurse-midwives who already serve families can expand their care to include mental health, allowing them to better meet their patients’ needs.

Jacob Mearse, DNP, CNM, PMHNP, is certified as both a nurse-midwife and a psychiatric-mental health nurse practitioner and shares, “We practice in an environment where midwifery and psychiatry are inexorably intertwined. Women are much more than just a walking reproductive system. Practicing as both a CNM and PMHNP better enables me to care for the whole person.”

Opportunities for men

Finally, males are underrepresented in the nursing profession. Mental illness doesn’t discriminate against gender, race, or socioeconomic status. Therefore, it is essential that the PMHNP workforce is also diverse to best meet the unique needs of our patients. I would not have had the opportunities for leadership and to have a positive impact on those in rural and underserved areas had I not become a PMHNP. There is nothing more rewarding than seeing someone come out of darkness that is often associated with mental illness and begin their journey to recovery and wellness.

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Improving maternal health

It’s no secret that the U.S. is in the midst of a growing maternal health crisis. The statistics are staggering. Maternal mortality rates continue to rise in the U.S. while decreasing globally. More women die from pregnancy-related complications in the U.S. than in any other developed country, and the rate of preventable maternal deaths continues to rise. Major disparities in maternal mortality exist, with black women three to four times more likely than non-Hispanic white women to die during pregnancy or shortly after birth.

Moreover, for every maternal death that occurs, an estimated 100 other women suffer severe complications of pregnancy or childbirth. There are many factors contributing to these statistics, including a shortage of qualified maternal and women’s health clinicians.

Better integration of midwives and the midwifery model of care into health systems is fundamental to reducing primary and maternity care provider shortages, improving maternal health outcomes, and addressing racial and ethnic inequality deeply rooted in our country’s foundation.

The World Health Organization (WHO) has designated 2020 as the Year of the Nurse and Midwife. To say we’re ecstatic about this designation is an understatement, especially since it speaks to the professions we so proudly represent. Our male midwives play significant roles in advancing midwifery, as well as making a difference in the lives of the women, families, individuals, and communities they serve. We asked ACNM members to explain why they chose midwifery as a profession.

Peter Johnson, PhD, CNM, FACNM, FAAN

Jhpiego, Washington, DC

“I found my calling to midwifery through my service in the US Air Force. I realized after being stationed in labor and delivery as a nurse that I had an affinity for assisting women in childbirth. This led to my career in midwifery and my subsequent master’s degree and doctorate in educational psychology. I was inspired by midwives like Lisa Paine and Dorothea Lang, and I have worked closely with numerous other midwifery leaders including Judith Fullerton, Melissa Avery, Joyce Thompson, Kathy Carr, Ruth Lubic, and many others. I have been a midwifery practice director, a midwifery educator and program director, an ACNM Nominating Committee member, and the ACME chair for two terms.”

Jason Harvey Kennedy, BS, BSN, RN, SNM, C-EFM, CLC

New York University Rory Meyers College of Nursing, Master of Science Nurse Midwifery Program, New York, New York

“My calling to midwifery was not obvious to me right away. Throughout my clinical assignments at NYU College of Nursing, I unknowingly had more female than male patients and with these women a natural connection was made. During my first day of maternity clinical rotation, I expected to experience normal vaginal birth, but I only saw two cesarean births, which seemed like magic. When asked by the clinical site’s nurse manager if I’d ever thought about being a labor and delivery nurse, I replied, ‘I didn’t even know men were allowed to be here!’ This, of course, left me very curious. When researching men in obstetrics, I found a 2008 article, ‘Midwifery as a Career for Men’ in Men in Nursing Journal. This proved I wasn’t crazy in thinking this could be for me.

“As a labor and delivery nurse, and now a student nurse midwife, I feel such a strong sense of service to women, in their power, presence, and person. I feel my presence as someone different among the many midwives that have served the community of women, where I have learned and trained in clinical rotations, impacts women in a positive way. Many women in upper Manhattan and the Bronx come from widely varying, diverse ethnic backgrounds, so having a male midwife adds a new perspective in their view of midwives that serve their community. Women in upper Manhattan and the Bronx look to midwives in the community as their central point of care for all their health care and family centered needs. These women truly believe the community midwives are the experts and rely on their holistic approach to health and family. I believe my presence, as a male midwife that has primarily served women in upper Manhattan and the Bronx, is equal to the presence that female midwives provide for the community, just with a new twist.”

Derrick Pickering, MSN, FNP-C, APRN, SNM

Orem, Utah

“Like most people, I have gone through several events in life that lead me to midwifery. My wife and I have struggled with infertility and have experienced a long journey of heartache and excitement. During that journey, we lost two premature infants and had some traumatic experiences. From that, I gained a greater appreciation and respect for the critical and divine role women play in their community and their families. I also know firsthand the importance of proper maternal and newborn care. That is why I decided to further my education past my knowledge of a family nurse practitioner.

“I chose midwifery to be able to contribute to the profession that has benefited my family and me so much. Maternal health is such an important area that cannot be overlooked or taken for granted. Midwifery will specifically allow me to give individualized and personalized care that women and their families deserve. Utah has the highest number of births per capita in the country, and the need for midwives is growing. Last year, 11.6 percent of births were accompanied by a midwife, which is a huge benefit for the community. It is an exciting time for midwives and the women and families they serve.”

Al Runzel, CNM, MSN, AAFP ALSO Faculty Advisor

Navy Medical Center, San Diego, CA

“I became a nurse-midwife as childbirth was always fascinating. Childbirth is a very unique time in a woman’s life and to be able to share such a special time is a great honor. When I was exploring nurse-midwifery, women had very little control over their and their families’ experience. During the birth of my first child, I was not allowed in the delivery room and could only see my baby after delivery. Partners were allowed to look at their newborns through a window for the first four days and the mother was only able to have her baby six times a day. I strongly believe that women and families should have the experience they desire. Childbirth is a normal human process, not a condition that should be managed. I have made it my lifelong goal to facilitate families’ childbirth experience to allow them to decide how they will experience this very special time. I thrive on the interaction with clients during the whole pregnancy, labor, and postpartum period. This time provides an amazing time to positively promote health and wellness. Many positive lifestyle modifications can be achieved during pregnancy that can last a lifetime.”

Daniel Stec, DNP, CNM, FNP-BC

HealthNet, Indianapolis, IN

“I had no intention of practicing as a midwife when I chose to go back to school for it. I was inspired during my OB/GYN rotation in nursing school to help improve the care that women received as a group that was historically oppressed, and continues to receive inequitable care, even in today’s health care setting. It was more of a whim and a desire to know how to catch a baby, since I planned to practice health care in low-resource settings. However, once I started the program at Emory University, I became intensely passionate about midwifery and have continued to pursue more training and experiences in this field than I ever imagined. I have now become involved with ACNM as vice president of the Indiana affiliate and am working with the Coalition of Advanced Practice Nurses of Indiana, advocating for midwifery and the people that we serve. I wear the title of midwife proudly and talk about it all the time. Even my license plate says ‘Midwife!’”

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