For UNLV School of Nursing assistant professor Janice Enriquez, nursing is her calling … No, really, it called her.
Enriquez was in the middle of studying for a degree in sociology when her life took an unexpected turn. The call from a California nursing school was a surprise, but it was one that she was ready to answer.
“We need you to start in a week," the program representative said. "Can you do that?”
In the course of five minutes, she changed the trajectory of her career. Today, she educates students ready to answer their own call to nursing. She teaches them the details of obstetric care, and sometimes, students have the opportunity to “catch babies.”
“Pizzas are delivered; we catch babies,” she differentiates.
Her specialty in midwifery makes her one of about 60 certified midwives in the state of Nevada — a small number that she and her fellow advocates of the field are ready to change.
Once she entered the field of nursing, she said, she felt a sense of belonging and the need to do more. After obtaining associate's, bachelor's, master's degrees in nursing, she earned her Doctorate of Nursing Practice from UNLV in 2023.
How do midwives provide support through pregnancies?
We take care of women and people with uteruses who have low-risk factors or minimal comorbidities; typically, a normal and healthy pregnancy. If you are looking for a relationship with a health care provider who partners with you and works with you through your pregnancy, a nurse midwife might be an option for you.
We also provide wellness exams, help initiate or manage contraceptive choices, and manage minor gynecologic issues from abnormal bleeding to menopause support. We provide a holistic approach to care for pregnancy, childbirth, and gynecologic concerns. We escalate any complications or high-risk issues to physicians we work with because they are highly trained, educated, and knowledgeable in taking care of patients who are high-risk and in need of complex care.
What is the biggest misconception about midwifery?
I think many people assume that midwives and doulas are interchangeable and that midwives only attend home births. Midwives provide gynecologic, reproductive, and obstetrical care. Doulas are an amazing group of people who support people during pregnancy, birth, and the postpartum period. Some doulas also support people with end-of-life care. It is important to understand that [doulas] are not health care providers. However, midwives provide obstetrical and gynecological health care.
What is the difference between certified professional midwives and certified nurse midwives?
Certified professional midwives (CPMs) are certified through the North American Registry of Midwives. CPMs are educated and trained to participate in out-of-hospital settings, home births, or free-standing birth centers. In Nevada, CPMs are not licensed or regulated.
Certified nurse midwives (CNMs) or certified midwives (CMs) have received advanced education in midwifery and have taken their board examination through the American Midwifery Certification Board (AMCB). CMs are recognized to practice in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and D.C. Nevada does not recognize the CM credential.
CNMs are licensed and regulated in all 50 states. Therefore, our scope of practice has a wider reach. Not only can we provide care for birthing people in a home setting, but we can also provide care for people in birth centers and hospitals. We can offer a holistic approach to childbirth in a medical setting.
How can someone find a nurse-midwife?
You can start with the American College of Nurse-Midwives. There is a directory of CMs and CNMs in practice listed by state. Most often, CNMs in the Las Vegas area receive referrals by word of mouth. We're trying to work on having a directory of providers for our Nevada chapter of midwives, not just from Las Vegas but throughout the state. We want people to have an easier time finding us, and we are working hard at increasing our visibility.
What inspired you to get into your field?
I had a baby at 15. I had a labor and delivery nurse who was supportive of me and didn't judge me. The whole time, she was my biggest cheerleader. It changed me. I thought to myself, maybe this is something I want to do. This is where I want to be. And I knew that whatever this entails, I have to do well in school. I have to make this happen.
However, during my first encounter with my OB/GYN provider, they told me, ‘You’re 15, and you’re pregnant. By the time you get to 20 years old, you’re going to have four kids, and you’re not going to be able to contribute to society."
I told myself I wasn’t going to sit there and let them dictate what my future was going to look like. I want to do more than have four kids by the time I’m 20, I want to do better, and I want to be better. I want to be able to make a difference in the world.
What were your first steps?
I attended an alternative high school in California with an independent study program. I had my daughter when I barely started my junior year. I was fending for myself, but I was fortunate to have my mom, stepdad, dad, and stepmom's support. They were the ones who were there for me. I took parenting classes that taught you how to change diapers, feed them, and how to read cues. The students in my high school program were also like me. They were young, from 14 to 18 years old. Graduates of the program would come back to give us words of encouragement. They were always saying, "You just got to keep pushing. You can't let the noise of everybody else out there get to you."
But in my heart, because of my experience with that first provider, I knew I wanted to work with people like me — the people going through those situations of having to fight the stereotypes and the prejudgments. I want to make a young person like me, going through this, understand that, "Yes, it's rough, but you can do it if you have your mind set and you have enough support. Or if you can't find support, we can find you support.’
What was life like after high school?
I actually took a gap year and worked full time. I recognized that I really had to buck up and go to school and figure out how to get into a career where I could take care of my daughter, take care of myself, and experience a work-life balance. I just started taking a variety of classes at a community college in California, and I focused on what would transfer to a California university.
I started to find the subjects that I really liked such as anthropology, sociology, psychology, and child development. I started to feel like maybe social work might be more along the lines of what I wanted to do. I would be able to advocate for others and be doing what I said I wanted to do.
What changed?
I took anatomy and physiology classes because it was a requirement for the social work program. I thought to myself, these classes are hard, but they are kind of cool. As I was getting closer to finishing my prerequisites, I started looking at the program catalogs, and I noticed that nursing had the same requirements for social work. Both of them were impacted programs, which means they had waiting lists to be admitted into the program. The average wait time for both programs was two years. So, I said, "Okay, fine. I'm just going to put my name on the waitlist for nursing and see what happens."
In the meantime, I became pregnant with my second child and completed an associate's degree in sociology and liberal arts. When my son was 2 months old, I transferred to California State University, Long Beach, and majored in sociology. With just one semester left, I got the call from the nursing school.
What were your early experiences as a nurse like?
I chose oncology after I graduated from nursing school because I wanted to have experience with time management and caring for patients with high acuity. I really wanted to be good at being a nurse. My goal was to gain the skills I needed to be that nurse.
As an oncology nurse, I hung chemo, passed medications, and developed my assessment skills. I also learned to talk with patients and their families about their cancer diagnosis and dying. I learned how to hold the hand of a dying person and how to support their families in these sacred moments. It was hard, but it was rewarding.
What brought you to Las Vegas?
After a year of working in oncology, I started looking around for other job opportunities in nursing. I really wanted to try for a job working as a labor and delivery nurse. Sunrise Hospital in Las Vegas had an opening in its didactic labor and delivery nurse training program. I was pregnant with my third baby and decided to make the move to Las Vegas.
We grew up coming to Las Vegas often for mini vacations. My pops loved Las Vegas. He was a big basketball fan, too. Back then, because this was the 80s and 90s, we watched college basketball a lot. UNLV was all over the news. I always said, one of these days, I'm going to go to that school, and I'll get to be a Rebel.
How did you get into midwifery?
After I had baby No. 4, I transferred from Sunrise Hospital and started working at Southern Hills Hospital. After about a year of working at Southern Hills, I decided to complete my bachelor’s degree in nursing. I knew that this would be an important step in order to go on to become a women’s health nurse practitioner. I wish I could say I went into the program right after I finished my bachelor’s degree, but life happened.
ҳ| 鶹ýӳ six years after I finished my bachelor’s, it felt like it was time to make the move and pursue my master’s in nursing in order to become a women’s health nurse practitioner. So, at 37 years old and a single mom of four, it felt like the right time to keep working toward my goal. I applied and was accepted into the [Master of Science in Nursing] for women’s health program at Cal State Fullerton. I planned to attend the program full time and decided to cut back my hours at work and went part time. I still needed to make ends meet and could not afford to quit my nursing job altogether. This meant that I attended all my classes in California and worked part time in Las Vegas as a labor and delivery nurse.
In my first week of classes, I learned the practice differences between a women’s health nurse practitioner and a nurse midwife. I didn't really think midwifery was going to be it for me. Then my classmates told me, "You have 12 years of labor and delivery experience and 13 years in nursing. You really should just switch to the midwifery program." Even my professors encouraged me to go this route.
The Nurse-Midwifery program required 270 more clinical hours than the women’s health nurse practitioner program. It was hard. There were days when I would leave Las Vegas at 2 a.m. to make sure I arrived on time at my clinical site by 8 a.m. and would be turned away because family practice residents took priority over nurse-midwifery students. This meant I had to make up more clinical hours into the summer months or rearrange childcare schedules and co-parenting days for the accommodation. I didn’t complain, I was just too busy and made use of the extra hours to study. Even though I knew I had exponentially more opportunities to work as a certified nurse midwife in California, my goal was always to come back and practice in Las Vegas.
Tell us about an object in your office and how it represents you.
My favorite object, believe it or not, is the stuffy uterus. It was gifted to me by a student who just took her boards to become a women's health nurse practitioner and got a job at Optum. I love it because it's a uterus, and I work in the area where we deal with the uterus at different stages of ages, expansions, occupants, and whatnot. The smile on its face is significant to me because no matter how much it goes through, it's still smiling. So, I feel like it's really a good representation of me.
If your younger self could see you now, what do you think she would say?
What else can we do?
