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Delivering New Life and Hopeful Beginnings: A Midwife’s Role in Providing Health Care for Migrant Women

Megan Danielson CNM
As long as the struggles for migrant health exist, I will stay in the field, to work to try to overcome those barriers.
Delivering New Life and Hopeful Beginnings: A Midwife’s Role in Providing Health Care for Migrant Women

Megan Danielson, CNM is not your typical nurse-midwife, because her patients are not the typical patients. They are mostly migrant farmworkers. In addition to facing many barriers to care while migrating, pregnant migrant workers, once at their destination, may also encounter occupational hazards, like pesticides and chemicals, that are common to industries where migrant workers find jobs, like in the agricultural and service sectors. But Danielson is up to the task as a certified nurse-midwife at InterCare Community Health Network.  

EARLY INSPIRATION

From a young age, Danielson understood the challenges facing migrant workers and their families. Growing up in rural Southwest Michigan, Danielson witnessed her mother’s concern as a fourth grade teacher of migrant students who drifted in and out of the school system with each move. While Danielson would later dedicate her career to overcoming the barriers that migration presents to continuity of health care, the first barrier she encountered was continuity of education for migrant children. One summer, Danielson worked at a school for children of migrant workers. The goal of the program was to help the kids get caught up on the education they missed during the school year. At the intersection of poverty and migration, education is interrupted not only because migrant parents are moving in search of work, but also because migrant children frequently have to miss school to help their parents in the field, she said.

Danielson was further inspired by her high school Spanish teacher who volunteered as an interpreter at a local hospital. The teacher shared her stories and experiences with her students, which added a new dimension to Danielson’s understanding of the unique struggles confronting migrants.  

As a result of these early experiences, Danielson was moved to pursue Spanish in the Residential College at the University of Michigan. There, while taking a class on women’s health, she was introduced to midwifery and to one of her role models, Joanne Motiño Bailey, CNM. Bailey teaches women’s health in the women’s studies department at the University of Michigan and is also the director of the Nurse Midwifery Service for the University of Michigan Health System. Additionally, Bailey has worked as a health care volunteer throughout Central America, with a special focus on Honduras.  Bailey’s passion motivated Danielson to change her focus to Women’s Studies, with the end goal of becoming a Spanish-speaking certified nurse-midwife. Danielson became a volunteer doula, offering pregnancy and labor support for low-income women who otherwise could not afford the services of a doula. She worked as the outreach nurse’s assistant at a migrant health center for a summer, which further solidified her commitment to working with migrant women and families. After finishing her undergraduate degree, Danielson attended Yale University School of Nursing to receive her master’s degree and become a certified nurse-midwife. Danielson’s thesis, entitled “Models for Improving Accessibility of Prenatal Care for Migrant Farmworker Women,” outlined models that can be used to ensure access to prenatal care for migrant women.  

While attending the annual meeting of the American College of Nurse-Midwives, Danielson met MCN’s Candace Kugel, FNP, CNM. Danielson had read a number of Kugel’s published articles while researching for her master’s research paper and was further inspired by her work after attending her presentation. (This year, Danielson co-presented with Kugel on one of MCN’s national webinars titled “Health Care for Migrant Women: Taking it to the Next Level,” which is archived on our website.)

RETURN TO MICHIGAN

Though her studies took her away from home, Danielson knew she wanted to focus her career on helping migrant women and their families in Southwest Michigan. As Danielson began her work in a rural hospital near her hometown, the relevance of her thesis became clearer each day. Her hospital was the only one in the county providing obstetric care. Danielson’s pregnant farmworker patients struggled to find the time and transportation needed to receive care, so her patients were often well into their pregnancy by the time they came in for their first prenatal visit, she said. Other barriers for her patients included lack of health insurance and the ever-present fear of entering the health system for women who are undocumented. Danielson was frustrated by the lack of outreach in her rural area to address these barriers, she said.   

Despite these challenges, Danielson’s patients motivated and inspired her to continue her work. Her genuine commitment to this population fostered trusting and gratifying relationships with her patients. One of her patients who was experiencing domestic violence confided in Danielson about her situation. Her patient felt demoralized, especially because she had served as a police officer in Mexico before coming to the US. Danielson helped her find a more secure environment so she could safely deliver her baby in the US before returning to Mexico.

Another one of Danielson’s patients, 16-year-old Marta, did not realize she was pregnant until she was 16 weeks into her pregnancy and was not able to have her first prenatal appointment until 18 weeks’ gestation. At her first appointment, a bedside ultrasound showed she was pregnant with twins. Marta expressed concern over the health of her babies, because she had limited access to food and was underweight pre-pregnancy with less than expected weight gain at that point in pregnancy. She had also seen “Lo que bien empieza… bien acaba,” the fotonovela by MCN that discusses pesticide exposure during pregnancy. Although Marta was now using proper protective measures to minimize pesticide exposure, she had not been doing so for the first months of her pregnancy. Danielson and the obstetrics team helped link Marta with Women, Infant and Children (WIC), a government nutrition program to assist new mothers, and the local food bank. The hospital’s nutritionist spent time talking with her about healthy foods and the recommended weight gain in a twin pregnancy. Danielson and hospital staff reviewed proper pesticide protection techniques and reassured Marta that she was doing everything she could to protect herself and her babies at that time. Marta gave birth to healthy twin girls at 36 weeks’ gestation, and she and her twins did well during and after the delivery, she said.

This is the work and dedication of a migrant clinician. Their patients work tirelessly, in and out of the fields, to overcome great adversity. Clinicians also work tirelessly, in and out of the exam room, to improve more than just the health of their patients.  In Danielson’s words, “as long as the struggles for migrant health exist, I will stay in the field, to work to try to overcome those barriers.”

From her childhood in rural Michigan to her work as a certified nurse-midwife, Danielson’s close work with the migrant population and the dedicated clinicians who serve them fostered a genuine commitment to health justice for the rural and mobile underserved. When asked what she finds personally gratifying about her work, Danielson responded, “Everything: after a woman has a healthy baby and is so happy and grateful;  seeing the outcomes and seeing the joy of my patients; [and] having patients who are immensely thankful to have received care regardless of their insurance or documentation status.” Migrant women share their stories of suffering, resilience, and success with Danielson and the many other clinicians who care for them. Danielson will continue to play her role in their stories by delivering new life and hopeful beginnings.

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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