Marsha Caldwell Jackson, co-founder of CABC-accredited BirthCare & Women's Health, Ltd recently “retired” after 50 years in the field of maternal-child health and 43 years practicing as a midwife. We had the honor of chatting with Marsha to learn more about her amazing journey as a midwifery leader and a trailblazer for birth centers.
Tell Us Your Story
Marsha knew she wanted to be a nurse from a young age, following in the footsteps of her grandmothers both as an entrepreneur and a midwife. One grandmother established and owned a convalescent home in Orange, NJ, providing care to elderly people who were unable to live in their own home or with family. As an adult, Marsha learned that her other grandmother had practiced as a midwife in North Carolina.
In 1974, she graduated Magna Cum Laude in the second graduating class of the Howard University baccalaureate nursing program, starting her nursing career working in NBN/NICU. Along with the Clinical Nurse Specialist for maternity and newborn care, Marsha developed and implemented a new childbirth education program at Howard University Hospital and also became certified as an ASPO/Lamaze instructor.
Her introduction to midwifery came when she worked as a birth assistant for midwives who had home birth practices in the DC metro area. Marsha did work in the 1970s as a birth assistant with Maternity Center Associates, a birth center and home birth practice in Bethesda, MD that would be one casualty, after 20 years of operation, of rising malpractice insurance premiums and low health insurance company reimbursement.
While still raising her young family, Marsha returned to school in the Georgetown University Midwifery Program, receiving a Robert Wood Johnson fellowship and completing her master’s degree in 1981. She then worked with Cities-in-Schools (CIS), serving as the Chief Midwife for 3-years of the program’s 5-year grant. At the same time, a small, limited solo home birth service evolved for Marsha, prompted not only by women desiring the service , but also by two supportive DC physicians who provided the majority of the prenatal/postpartum follow-up, and accepted transfers to the hospital if needed. Through the CIS Program, Marsha became the first midwife granted hospital privileges at Georgetown University Hospital. The path was not always smooth. Marsha recounted an incident in which an attending obstetrician yelled and shook his finger in her face in front of her patient. “I went to him afterwards and confronted him in the hallway saying ‘Don’t you ever talk to me that way again…. The nurses were amazed and so was I!’”. She notes, “As a midwife you must learn to be assertive – a gentle effective assertiveness - even if you don’t feel like it is a part of your character.”
In 1987, while attending an ACNM annual meeting, Marsha reconnected with Alice Bailes, who had been her classmate at Georgetown. Marsha was preparing to leave the CIS service and expand her home birth service since the grant was ending and it was not clear if the program would be refunded. Alice was working in a home birth practice that was closing and was interested in opening a home birth practice. They brainstormed together and BirthCare was born in 1987, initially as a home birth practice. In 1992, responding to a gap in the availability of homebirth professional liability insurance, they established a freestanding birth center to provide their clients with continued access to community birth. Even though they envisioned that the birth center would be “temporary” in order to continue both liability insurance coverage and health insurance contracts, there was a growing interest in the birth center, and they quickly realized that it was definitely not going to be temporary. Marsha and Alice sought CABC-accreditation from the beginning, opening and achieving accreditation in the same year. “We wanted to do it right. And it also made us look closely at our home birth practice.” This “temporary” birth center has been open 32 years. Over the years, they expanded their health insurance coverage, and have welcomed over 7,500 babies! Following Alice’s retirement in 2013, Marsha became the sole owner of BirthCare.
A Midwife is More than a Clinician
Marsha has, throughout her career, been active as a leader, author, teacher, and advocate. She and Alice spearheaded a study of home birth practice with certified nurse-midwives that was published in 1995 and 2002. They also edited and co-authored the ACNM Handbook on Home Birth Practice (1997, 2004). Marsha has also authored chapters in multiple textbooks, including Varney’s Midwifery (ed. King, et al, 1997,2004,2013); Supporting a Physiologic Approach to Pregnancy & Birth – A Practical Guide (ed. Avery, 2013); and Into These Hands (ed. Simpkins, 2011). BirthCare has been dedicated in collecting data in both the AABC PDR and MANA Stats.
She has been active at the national level, chairing and/or serving on multiple ACNM committees, including Home Birth, Midwives of Color, Nominating, and DEIB Committees, Division of Research, and has served on the boards of the ACNM Foundation and the ACNM Fellowship.
Marsha has been generous in sharing her wisdom with aspiring midwives by serving as faculty for eleven different midwifery education programs and as preceptor for nurse-midwifery and certified professional midwifery students.
A Smithsonian Museum exhibition from November 2005 through August 2006, “Reclaiming Midwives: Pillars of Community Support,” highlighted the many important contributions of the grand midwives of the South. This exhibit profiled Marsha as a modern-day home birth midwife. Marsha believes that the grand midwives paved the way for midwives today, and the spirit of the grand midwives gives her the strength to continue her journey.
Marsha received two prestigious awards in 2024. She was awarded ACNM’s Life-time Visionary Award (formerly the Hattie Hemschemeyer Award). This award “honors an exceptional CNM/CM who is an ACNM member, has been certified for at least ten years, and has provided either continuous outstanding contributions or distinguished service to midwifery and/or MCH, or contributions of historical significance to the development and advancement of midwifery, ACNM, or MCH.”
The National Black Midwives Alliance awarded Marsha their Mkunga Mkongwe Award for Lifetime Excellence in Midwifery, “in recognition for your decades of devoted practice and the outstanding impact you have had on midwifery, perinatal health, and the communities you have served.”
How Can Midwives Help to Address our Country’s Racial Disparities?
“Midwives have to come together – we have more in common than we have differences.” More funding is needed for midwifery education. We know that racially and culturally congruent providers achieve better outcomes. We need more midwives who represent different cultures.
What are the Important Lessons that You Have Learned?
It is important to strive for work-life balance. “Midwifery is not a 9-5 job, and you must create boundaries.” It is important to be clear where you are spiritually and to have a clear vision. Ask for help when you need it. Remember that you don’t do this by yourself. And most importantly, I have learned that “this is what I was put on this earth to do.”
What’s Next for You?
Marsha looks forward to gardening and traveling with her soon-to-be retired husband. For now, she is “midwifing” her elderly mother. As the mother of five and grandmother of 12, family will continue to be a major part of her life. Marsha is currently contracting with BirthCare, filling in some scheduling gaps and is far from retiring from midwifery.
She is serving as an advisor for a study funded by the Robert Wood Johnson Foundation entitled, Black Birthing Futures (BBF). The principal investigator is Kaytura Felix, MD, a Distinguished Scholar with the Johns Hopkins School of Public Health since January 2023. BBF specifically is an asset-based narrative analysis study that seeks to:
1. Describe the unique aspects of the care that Black midwives provide to Black birthing people outside the hospital
2. Identify the environmental conditions that support or hinder that type of practice
3. Describe the impact of this type of practice on families and communities
BBF was developed based on the findings of community activists and health equity experts that suggest that the care provided by the Black community midwives to Black clients is an important strategy to address the Black perinatal crisis. The goal of BBF is to increase community birthing options for Black birthing people.