‘Wherever you put a nurse-midwife, things get better’

Elizabeth Hill-Karbowski loaded all her belongings into a white panel van in January 1993 and drove south from Oshkosh to Milwaukee. Just eight months after completing her bachelor's degree in nursing, Hill-Karbowski had set her sights on becoming a nurse-midwife ever since she saw a live birth during her obstetrics clinical rotation.

Marquette was starting a midwifery program, and Hill-Karbowski was accepted to the first class.

"I never really thought that I would ever have an opportunity to go to a school like Marquette," Hill-Karbowski says. "They took a big chance on me, and I remain grateful for it."

Now, with decades of nurse-midwifery experience, Hill-Karbowski is the director of perinatal services at UnityPoint Health - Meriter in Madison. It's one of dozens of success stories from Marquette's nurse-midwifery program. Ranked 20th by U.S. News and World Report, the program draws on a deep well of faculty experience and institutional connections to health care providers to train nurse-midwives.

Even 33 years removed from its founding, there are still strong links to that first class of six students who walked into Emory T. Clark Hall in 1993. Hill-Karbowski was one of them. Kathleen Kett, another certified nurse-midwife, was too.

"At the time, there were barely any nurse-midwives really practicing in Wisconsin, and Marquette certainly had a big role in changing that," Kett says. "Marquette puts out quality people who approached setting up their practices the right way. That went a long way toward promoting the acceptance of nurse-midwives in the state."

Dr. Lisa Hanson, Klein Endowed Professor and associate director of the nurse-midwifery program, has been there for all of it. She co-founded the program along with Associate Professor Emerita Dr. Leona VandeVusse and Dr. Kathryn Harrod. Harrod still practices as a nurse-midwife at Aurora Elkorn and serves as a clinical preceptor for Marquette midwifery students.

"I was younger than some of the students at the time, and many of them had waited their whole careers to have the chance to be a midwife," Hanson says.

"Wherever a nurse-midwife's philosophy of care is present, health outcomes improve."

The nurse-midwifery program is rigorous for anybody at any point in history, but the first students did it without any of today's technological conveniences. Hill-Karbowski remembers taking notes on a Brother word processor, a 30-pound electronic typewriter. Every article for class was copied on a Xerox machine. Although the program would become an early adopter of distance learning; widespread internet use did not exist at the time of its founding, leaving some students to travel long distances for classes and clinicals.

The program's rigor created a bond among the original students that persists to this day. The students still exchange Christmas cards with Hanson. In 2020, the students reunited to celebrate the 25th anniversary of their Marquette graduation. This close kinship was forged despite the students coming to the program at different phases of their life and with very different levels of experience.

"We ran the gamut from very experienced nurses to someone like Beth who was just out of her undergraduate nursing school," Hanson says. "They were all very passionate about what they wanted to do, and that was exciting for me."

"Our group was so cohesive because we were all in it together and we all wanted very badly for each other to be successful," Hill-Karbowski says.

The nurse-midwifery program's rise came at the right time for Wisconsin's patients, who desperately needed more women's health care providers. A 2021 estimate by UW Health puts the number of Wisconsin counties with no OBGYN provider at 27 of 72, placing even more strain on an already stretched-thin midwifery workforce to fill the gap.

Despite the number of nurse-midwives in Wisconsin increasing by nearly 20 percent over the last five years, there are still fewer than 300 active in the state as of August 2025. Minnesota, which is estimated to have roughly 200,000 fewer people than Wisconsin, has more than 440 licensed nurse-midwives.

Kett sees the need for nurse-midwives firsthand. Her current practice, Footprints in Time Midwifery and Family Clinic, is in Greenwood, a small town in the western part of the state. Many of them are thankful that there's a nurse-midwife nearby.

"I'm so proud of what Kathy has done with her practice," Hanson says. "She saw people who were going without care, and she saw a way to fill that gap. That's what we do."

"Wherever a nurse-midwife's philosophy of care is present, health outcomes improve," Hill-Karbowski says.