2024 Washington State Nurses Hall of Fame — Q&A with Katherine Camacho Carr

Why did you choose nursing?

I initially wanted to be a physician, but when I started college in the late ’60s, it was a very patriarchal system, and I was encouraged to major in nursing. However, I liked the challenging nursing curriculum, so I completed my BSN. So, in a way, nursing chose me!

What was your first experience as a midwife?

I worked as a student at the Cook County Hospital in Chicago. This was an eye-opening experience for me, since I had not worked in a large hospital in labor and delivery. The hospital had 12 labor beds separated only by curtains. If one woman started screaming, it would spread through the unit. It was crazy. There were not enough nurses or student midwives to be with the laboring women.

I started midwifery school in 1972, when abortion was still illegal. We had a gynecology ward where there were a number of women recovering from surgery, including some who had been injured as a result of illegal abortions. Some of these women lost their uterus and had various perforations of the bladder or bowel. Some women died from complications of these injuries, including one I recalled that died from gangrene of the bowel. I knew then that I couldn’t make a decision about abortion for anyone else. That experience is something I will never forget. On the other hand, each and every birth was a miracle as far as I was concerned. I was committed to be with women for a lifetime!

What did you do after graduating from midwifery?

I started a practice with another experienced CNM, linking Chicago Board of Health pregnant patients with the Illinois Masonic Medical Center (now Illinois Advocate Medical Center) in Chicago for labor and birth. We soon hired more CNMs. I am forever grateful for the support of the physicians and nurses that helped us get started, since this was a new idea at the time! We will be celebrating 50 years of this midwifery practice this summer.

How many nurse-midwives are there in Washington state?

Currently, there are over 500 CNMs in Washington state.

What would you like to see happen in this field?

I would go national and have midwives nationally recognized by every state licensing agency. I would also get graduate education dollars for midwives so we can obtain more clinical rotations in hospitals. Graduate education dollars pay $100,000 plus for each resident physician in training. Midwives don’t have access to much funding for clinical placements, so hospitals choose doctors. This change in funding is something that Congress would have to approve. We also need a more diverse workforce. And we need midwives who can address the inequities in the healthcare system, especially for African Americans and other persons of color. The high rate of maternal and infant mortality and morbidity, especially among birthing persons of color, is of great concern to our profession. In 2020, the American College of Nurse-Midwives developed the Addressing Racism and Advancing Equity in Midwifery Education: A Program Content Toolkit for Action. The toolkits provide faculty with resources for addressing the historical racism in U.S. midwifery and prepare faculty and future midwives to be aware of racism and bias in themselves, institutions, and the healthcare system.

How would you describe your impact on the field?

I have always known that I had to do more than clinical care. Advocacy for change in the policy and political arena to improve healthcare has always been a part of my work. I can only hope that I have helped make some positive change.

Do you have advice for young nurses and midwives?

The principles that have guided me were related to me by a midwife mentor, Dr. Ruth Lubic. I would tell young nurses and midwives to do the following:

• Treat people with dignity and respect, and it will be returned.
• Take care of all people, especially the underserved or those experiencing inequity.
• Be aware of the limits of the medical model (care that is organ-based, denigrating, excessively profit-oriented, or inequitable).
• Tolerate uncertainty. Evaluate the evidence when making clinical decisions, and build alliances with other healthcare providers. Value their wisdom but verify.
• Trust your caring instincts, and be emotionally open. Don’t be afraid to be human. Read body language.
• Avoid anger and bitterness. Negotiate conflict and strengthen your sense of humor—it can neutralize opposition and brighten the darkest days.
• Overcome the fear associated with leadership.
• Choose your colleagues for their philosophical and caring stance.
• Listen to the people you serve, and they will become your strength.

Note: Ruth Watson Lubic, CNM, EdD, FAAN, FACNM (born Jan. 18, 1927), is an American nurse-midwife and applied anthropologist who pioneered the role of nurse-midwives as primary care providers for women, particularly in maternity care. Lubic is considered to be one of the leaders of the nurse-midwifery movement in the United States.

What’s next?

I am continuing to enjoy occasional teaching and working part-time as an educational consultant with Grow Midwives, a company focused primarily on the business aspects of midwifery practice (see https://www.youtube.com/@growmidwives). Grow Midwives also consults with academic institutions regarding accreditation of nurse-midwifery education programs. This is where I come in to help! Of course, I also plan to travel, read more books, continue to do yoga and garden, spend more time with my husband, and visit our two sons, and especially the two grandchildren.