At 9 years old, UNLV Nursing alumna April Clyde witnessed the birth of her little sister at an Idaho hospital. She wasn’t grossed out. In that moment, the seed was planted for a health care career that would eventually make history in Nevada.

Clyde, a certified nurse midwife, runs Serenity Birth Center in Las Vegas. 

In 2021, Serenity became the first free-standing birth center in Southern Nevada, the result of a lengthy process to stake a claim not just for Clyde but for other nurse midwives. Now one year in, she looks back on what it took to get this far to help raise more awareness for her specialty.

Finding Her Calling in Health Care

Clyde grew up with a pharmacist father but notes that the hospital room where her sister was born seemed to make a lasting impact. First, she saw what it meant to be a nurse. “The nurses were wonderful with me,” Clyde said.

“They let me help with her first bath, and I think that was probably my first experience with nurses. They were lovely.”

But in retrospect, she said this also introduced her to the midwifery experience. “My mom didn't have any medication,” she recalled. “It was a very natural experience.” Clyde added, “It instilled in me that for most women, birth is normal, and it's a family event rather than a medical event.”

Certified midwives and nurse midwives offer health care services for women like primary care, but are largely known for their work during pregnancy, childbirth, and postpartum. Midwives can assess, diagnose, and treat like many health professionals.

Clyde received her bachelor’s in nursing from UNLV in 2000 and became a labor and delivery nurse. During her clinical rotations, she met her first nurse midwife and became more intrigued about the field. But there were no nurse-midwifery schools in Nevada, so she enrolled at Frontier School of Nurse-Midwifery in Hyden, Kentucky, where she was introduced to birth centers.

She said, “I was interested in more natural childbirth. That’s why I was drawn to that as a labor and delivery nurse. I started researching birth centers and knew I wanted to work at one.”

Lobbying for Change on a Statewide Level

In 2008, Clyde started her first business, Baby’s First Day, the home side of her natural birth services. But she had her sights on something bigger, a birth center not housed in a hospital. It took years for Clyde to officially launch Serenity Birth Center, and included pursuading the Nevada Legislature.

In 2012, she and other nurse practitioners reached out to state lawmakers to allow nurse practitioners to operate autonomously, without supervising physicians. Until that point, birth centers were all physician-owned.

Clyde and another nurse practitioner built a case for birthing centers in Nevada. “It took us three legislative sessions and our Legislature only meets every other year,” she said. “So, it took six years, and they finally changed where nurse practitioners could own birth centers in 2018.”

This ultimately became known as Assembly Bill 287: Providing for the licensing and regulating of freestanding birth centers.

Clyde admits there was a learning curve when opening up her own company, not from the clinical side, but the entrepreneurial side. “It forced me to learn things I hadn't learned,” she said. “I learned how to use (accounting software). I read a lot of books about practice management. It took a couple of years before I felt comfortable with that end of things.”

Defining a “Maxi-Home”

Birth centers are health care facilities that specialize in midwifery practice and natural birthing with licensed staff and management autonomy. Clyde refers to a birth center as more of a “maxi-home” than a “mini-hospital,” with the goal to have an unmedicated birth.

“We know for mom and baby, there are risks that come with an epidural and IV pain medication,” she explained. “Epidurals are known to slow labor. They're also known to decrease mom's blood pressure, so it's not completely risk-free.”

Patients at Serenity do not have IVs nor are they hooked up to continuous monitoring. Clyde’s team does intermittent monitoring with a handheld Doppler to give the expectant mother more freedom to move around. But birth centers come with normal medical equipment specifically suited for birthing, including tubs and queen-sized beds with head and foot inclines. Birthing is supervised by a midwife, nurse practitioner, and registered nurse.

Like many birth centers, Serenity only accepts low-risk patients. For potential emergency situations, Serenity is only minutes away from University Medical Center of Southern Nevada, with which it has a transfer protocol. Clyde and her staff also work with Kirk Kerkorian School of Medicine for patients who develop higher risks during pregnancy or during labor. Moreover, Clyde runs drills with the nearby fire department to stay prepared.

“We've never had an ambulance transfer. It's why we run drills,” she said. “These things happen so infrequently that it's how to keep our staff skills sharp for transfers.”

Changing the Perception of Midwives

Part of the challenge for Clyde and other nurse-midwives to advocate their services is midwifery as a health profession is often misunderstood or underutilized.

UNLV nursing professor and certified nurse midwife Jennifer Vanderlaan cites access as a major obstacle. Nevada is 44th in the nation for births attended by nurse-midwives, she noted, despite slight increases in the number of nurse-midwives.

“Inconsistent rules at hospitals mean some nurse-midwives admit patients independently, and some are required to admit patients under the name of a collaborating physician,” she said, which can lead to delays in care while waiting for a physician’s signature.

Vanderlaan hopes to see nurse-midwifery in Nevada expand with more hospital support. “Expanding access to nurse-midwives makes sense for Nevada because, for women at low risk, midwives provide high-quality care with lower costs than obstetricians,” Vanderlaan said.  “Over half of all births in Nevada are covered by Medicaid, so this cost-savings will benefit all Nevada residents.”