Midwifery program at Montana State completes successful first year

BOZEMAN — In 2010, when Mariah Hill started exploring educational paths to become a Montana-based nurse-midwife, she quickly realized her options were limited. With no nurse-midwifery program in the state, she could pursue an online degree from an out-of-state school, or she could leave Montana to attend an in-person program elsewhere. 

She landed on the second route, earned her Doctor of Nursing Practice degree from the University of Washington, and returned to work as a nurse-midwife in Missoula. 

Until last year, Montanans who wanted to pursue nurse-midwifery had to leave the state for school or pursue distance learning through programs like Georgetown University in Washington, D.C. or Frontier Nursing University in Kentucky. That barrier turned many away from an already understaffed health care industry in a state that ranks significantly higher than others in maternal and infant mortality, Hill said — and where more than half of counties have no women’s health specialist at all, according to data from the Montana Department of Health and Human Services.  

Now, Hill leads the new Doctor of Nursing Practice nurse-midwifery program at Montana State University’s Mark and Robyn Jones College of Nursing, the first and only nurse-midwifery program in the state. Launched in fall of 2024, the program aims to help more Montanans become nurse-midwives and improve health outcomes across Montana. It was made possible by a historic $101 million donation from Mark and Robyn Jones to MSU in 2021 and support from Intermountain Health St. Vincent Regional Hospital in Billings.  

“This is a key step towards transforming maternal and infant health outcomes in Montana,” Hill said. “It’s been incredible seeing the widespread support there is for this program, and people who are not midwives saying what we need are more nurse-midwives in Montana.” 

The first group of seven students will graduate from the three-year program in spring 2027 with a DNP degree in nurse-midwifery. Another group of six students begins the program this fall, and a four-year part-time option is offered as well. The degree joins two other DNP options offered by the college: psychiatric mental health nurse practitioner and family nurse practitioner.  

After graduating with a DNP degree, students must pass a National Board Exam to become nurse-midwives. While there are many routes to becoming a practicing midwife who provides comprehensive care throughout pregnancy and birth, nurse-midwives are unique in that they can prescribe medication, provide primary care to women across the lifespan starting in adolescence, and work in hospitals or community-based birth settings. According to nursing officials, there are roughly four dozen nurse-midwives in Montana, with most practicing in urban areas.  

Starting in 2022, MSU leaders collaborated with seasoned nurse-midwives from across Montana and the nation to design the curriculum. Importantly, the degree is delivered via the web asynchronously to Montana residents. That means lecture content is pre-recorded and students complete all assignments online. For clinical coursework, students complete two intensive in-person skills weeks in Bozeman as well as a minimum of 765 clinical hours shadowing experienced nurse-midwives.  

“Our students are all over Montana, with many living in rural and tribal communities. It is really worth the extra challenge of figuring out how to accommodate students living in Montana’s most isolated communities to be able to build a maternal health workforce where we need it most,” Hill said. “I know at the end of the day how important it is to provide a program that meets students where they're at, and where they can keep being part of their families and communities.” 

Honey Newton, an instructor in the program and founder of Heart and Hands Midwifery and Family Healthcare in Kalispell, said the most common barriers to becoming a nurse-midwife include driving long distances to classes and clinical sites, finding willing clinical sites and teachers in an already overstressed health care system, the cost of education and travel, loss of income from current jobs, and the stress of having to move one’s family.  

“I think all of those factors are barriers that MSU is addressing well with their new nurse-midwifery program,” Newton said. “MSU should be very proud that they put this together and are pulling it off.”  

Newton said the program was specifically designed to attract students who already had the goal of staying in Montana, so that educated nurse-midwives can practice in their home communities. 

One of those students is Mariah Holdbrook, a resident of Roberts, population 299, who said she was drawn to furthering her education after hearing about the state’s high maternal and infant mortality rates. The reality that Montana ranks high in maternal mortality rates compared to other states was hard for her to shake, and she felt a calling to make a difference.  

Of the program, Holdbrook said remote learning is not difficult for her, as she received her bachelor’s degree in an asynchronous way as well. While sometimes not being physically together with her fellow students can be isolating, she acknowledges some people, herself included, would be unable to do an in-person program because of their family life and other jobs. 

After earning her DNP degree, Holdbrook hopes to start a mobile women’s health unit to go out and serve Montana’s rural populations who don’t have good access to health care, particularly specialty care for women.  

Her dream fits in well with the goals of the program and MSU’s land-grant mission. Hill stressed the impacts of nurse-midwives extend far beyond supporting the birth process. Nurse-midwives also provide prenatal care, which is essential for good maternal and infant health outcomes; postpartum maternal care and newborn care during the critical first month of life, and women’s long-term primary, mental health, and reproductive health needs including access to contraception.  

“We wear a lot of hats,” Hill said. “Having more nurse-midwives in more Montana counties will mean more than just attending births. Our graduates are going to increase women's access to basic primary care and reproductive health services.”  

Hill said the program’s first year went smoothly, and that the educators involved in teaching students have been fantastic partners. Students in the program take classes like pharmacology, primary and gynecological care, as well as pregnancy, birth, postpartum and newborn care.   

Thanks to Mark and Robyn Jones’ gift and a $3 million donation to endow the nurse-midwifery program from Intermountain St. Vincent Regional Hospital in Billings, the educational efforts will continue.  

Hill thanked the inaugural group of students for their trust in the first-of-its-kind DNP-Nurse Midwifery program at MSU.  

“We want our students to have a really excellent, high quality educational experience,” Hill said. “We really welcome student feedback, and it will play a huge role in helping us make the program even better for future students.  

Hill echoed a line often repeated by Sarah Shannon, dean of the College of Nursing, when discussing the new nurse-midwifery program.  

“Montana is a great place to raise a family,” she said. “We want to help ensure it is also a great place to start a family.”