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Wednesday
Mar192008

Midwifery Education (Lite)

I’m a Licensed and Certified Professional Midwife. I haven’t had a standardized, university-based education for midwifery. I would do almost anything to obtain one, though. I’ve even considered traveling to SUNY New York for a couple of years to become a Certified Midwife, but the license is worthless (legally) here in California. At almost 47 years old, do I want to devote more time to formal education that isn’t going to mean squat in my state? Probably not.

Twenty-one years ago, I met Mary Carole Akers, a Certified Nurse Midwife in the Army and talked to her about becoming a midwife during Sarah’s prenatal visits and my own postpartum visits. My biggest concern was if there was such a thing as a lesbian midwife and she laughingly (and lovingly) told me I had nothing to worry about, that there were plenty of lesbian midwives out there. (She’s right!) I whined about having to do all that nursing crap... geriatric care, tending to post-op patients, blah blah blah... B-O-R-I-N-G! Why did I have to listen to a thousand hearts and lungs that had nothing to do with listening to a newborn? Wisely, she looked at me and said, “When you listen to a thousand normal hearts, you quickly learn to distinguish the not-normal one.” Snap!

When thinking over my life, one huge regret that’s cropped up over and over is my not pursuing a degree in Nurse Midwifery. I adore homebirth and am proud I have a license and am a Certified Professional Midwife, but know I would be a wonderful CNM.

In the hospital, I could to be a midwife for Bradley clients, homebirth transports and transfers, for women who don’t even know how great birth can (and should) be in that location – with the right provider. I’d love to be able to take Medi-Cal/Medicaid and be a midwife for women for whom English is not their first language. Speaking Spanish, I crave the opportunity to use my skills with pregnant and birthing women.

I would love to be a midwife in a birth center. I always loved working clinic days and then being on-call to tend to whichever woman might come in during the night. I loved the surprise factors of the number of women that might deliver on my 12-hour shift. While I don’t mind call at all, even after all these years, it was really a different experience to have off-call days and come back to find your favorite client had had a marvelous birth experience with another midwife. I always thought it was great to be able to be with more than one woman in labor at a time, with each of them next door to each other, a mere few steps away. The births were still low-tech enough that I wasn’t sitting and watching a monitor in a remote location, but the option of being with more than one at a time was possible. In many ways, being a birth center midwife is my ideal.

I’d love to be a CNM and a homebirth midwife. I’d have to let go of the idea of insurance, but I would appeal to a wider audience. I’d have different experiences to draw from and would be able to stand toe to toe with the hospital personnel because I could be one of them if I wanted to be. Many women would love to have the option of a homebirth with a CNM, but there are so few CNMs doing homebirth, many women think there are none. CNMs in homebirth can take military insurance and even find their way into the Preferred Provider status with insurance companies. How great would that be? CNMs are reimbursed more often than a CPM.

I would be a wonderful Certified Nurse Midwife. After 25 years of working in birth, much of it in hospitals and birth centers next to amazing doctors, nurses and CNMs, I know I have what it takes to be a really wonderful CNM.

I know all the arguments against going to nursing school. I’d lose my heart, my homebirth mentality, my patience with women, patience with The System. I’d lose trust in birth. I’d see only the potential for complications every time I was with a laboring/birthing mom.

I believe that I have been around birthing women enough to be pretty set in my belief in the normalcy of birth while also acknowledging the possibilities for complications – and perhaps it has taken me so long to get to the place of really knowing I can do school as I wanted to be sure “they” can’t beat the wonder of birth out of me.

I like that nurses all go through the same courses. They don’t all have the same experiences, of course, but all have the concrete base. All that “boring” stuff I mentioned above lays a foundation of commonality that continues into the Master’s Program a nurse enters to get her midwifery degree.

LMs and CPMs come from a wide variety of backgrounds and that can be great and not-so-great. Some, like me, tried the apprenticeship route, but found working with many different midwives was a better fit. I also didn’t have the foundation of a MEAC-accredited school, something I think is imperative today ad something I definitely missed out on. I know there are non-MEAC schools and they might be phenomenal, but the way our society leans is towards accreditation and having the MEAC approval means the schools went through some pretty tight hoops to get where they are. I’ve considered going through one of the three-year schools even now, but know I want a different type of experience than what MEAC-schools have to offer.

As a nurse, I will plod through the rigors of the basic skills of care-taking for a human being, regardless of gender, age, ability or language. Doing something by rote will imbed the information into my hands, eyes, ears and brain. Taking 10,000 blood pressures on normal arms will guide me when I hear the “sound” of Pregnancy-Induced Hypertension. Being able to change wound dressings after surgery will afford me the information I need when I am presented with a client’s abdominal incision or an oozing perineal repair. Working with patients on the orthopedic floor will allow me to observe, first-hand, what a broken clavicle or dislocated hip might look, feel and sound like.

Once I’m in a midwifery program, depending on the location, neighborhood or hospital I work in and the preceptors I might have, I might see loads of easy-going births. If I go through the Frontier Nursing School’s program, one of the preceptor sites here in San Diego is a free-standing birth center. I would love the opportunity to work there.

However, if I chose to work in another location such as Grady Memorial in Atlanta, I would see and work with (what most homebirth midwives would consider) high-risk clients. This type of environment would be phenomenal training for me! The midwives I know that trained at Grady speak of the majority of clients having some complicating factor like PIH, Gestational Diabetes, asthma, drug addiction, being very young, having a diagnosed mental disorder or you-fill-in-the-blank. Most homebirth midwives would rarely, if ever, see or accept this type of client. For me, seeing such a wide variety of differences brings home the fact that what seems so rare most of the time might not really be so rare after all.

I have known CNMs who saw so many HIV+ women they weren’t considered high risk either! Can you imagine the amazing amount of information I’d have to know to take care of a “normal” HIV+ woman? It astounds – and excites – me.

Birth in a homebirth setting is slower-paced and it is different focusing on one woman at a time, but as a doula, I only had one client at a time and was usually with her for many hours at a time, so I understand the one-on-one aspect of homebirth midwifery. At home, we also don’t have the same resources available compared to a hospital, but the equipment and resources are very similar to what is available in the birth center setting.

Where birth occurs can affect the actions of the family, the woman and even the midwife. The location can mean more or different equipment. There is no doubt there is more equipment and more medication and more personnel in the hospital. If a woman were having a complication or a complicated pregnancy and/or delivery or if the baby needed help, the location can make a huge difference, but that is why we offer Informed Consent to our clients. They weigh the pros and cons of where to deliver and, since my clients are homebirth clients, they definitely lean towards avoiding the rollercoaster ride of the hospital while believing/knowing what I offer is as safe as an out-of-hospital birth can be as well as the good sense to call for help if necessary.

I have two apprentices right now. One has been with me for two years and is in a school that is close to being MEAC-accredited. The other is just beginning and wants to start school in the next few months. I want them both to have a plethora of hospital experiences so they can see more and more births there. Both are hired out as doulas, but one of their main jobs while in the hospital is to soak up every nuance they can – learn those machines, learn the lingo, learn what a fetal monitor strip looks like, watch IVs put in, ask questions of helpful practitioners, examine the suturing that goes on, listen to the other women in labor, guesstimate where they might be and how they might be better supported without an epidural. Her first responsibility, of course, is to her client in front of her, but part of being a homebirth midwife (a midwife in general?) is to absorb the nuances of the surroundings and use them in your on-going/final judgment calls. If I could get them onto the CNM track, I would, but neither wants that, so I do the best I can with what I have available.

I want my apprentices to learn to be graceful in the hospital, to learn the language of nurses and doctors and to know what all the equipment is and what it’s used for. It can be very uncomfortable transporting a woman and then not being able to explain thoroughly what exactly is going to happen next.

Why do homebirth midwives have to learn so much about the hospitals? Even if we have a very low transfer/transport rate, some of our women are going to find themselves in the hospital and it helps them so much if we are able to offer them information along with our support.

Through the years, I’ve heard others say there is no need for formal education for midwives, but it is my belief that some sort of organized education is a must. I definitely missed out not having one. Even though I got my license through the challenge mechanism (I challenged the exam through testing and hands-on examinations), I know I would have greatly benefited from a more organized book learning. I know it can be hard when states require 3 years of school before being able to sit for the midwifery exam, but I believe it really lays a wonderful foundation for the educated midwife.

An apprenticeship is only as good as the preceptor. I want to be a wonderful preceptor! Even as I go through school, I will be able to teach my apprentices, neither of whom wants to go through nursing school, great pearls of wisdom. They will surely benefit from my nursing school experience.

I also am a firm believer in getting as much experience from as many places as possible. I love when I hear about midwives (or student midwives) going to Casa de Nacimiento or Maternidad la Luz in El Paso, Texas. If they go to Jamaica, India, Africa, Indonesia, Mexico or any other location that will accept students and midwives into their maternity systems, they most certainly learn skills that aren’t typically taught (or experienced) in the United States. I think once a midwife steps out of her comfort zone, she begins to see how much she really still needs to learn. The higher risk the women she can see and care for the better. My apprentices know they will be going to other locations for experience and tutelage from other midwives. I absolutely do not know all the things they need to know! I want them exposed to a wide variety of midwives, settings and experiences.

I believe that midwifery education doesn’t end with the license or certificate. Along with CEUs, if midwives are able to advance their knowledge with experiences, all the better. When I got my license, I became a midwife with entry-level skills. I know that, even with all my previous experiences, I had a lot to learn. I still do!

I’ve wished, for over two decades, I had become a CNM. Their numbers have grown (even if not always in power or control). I have no illusions of fixing a system that is ingrained and seemingly immobile, but I do want to learn more of their world. I’ve let math and science stand in my way, but now, the fear of not going to school is greater than the fear of the subjects that give me a distinct challenge.

It’s time for me to shine the light on the fears I’ve harbored for all these many years. I often use the analogy of a fear looking so, so large standing over there in the corner... its shadow giant against the wall. But, when we take a flashlight and shine it on the shadow, it so often becomes a mouse of a thing we were once so frightened of. I’m living my own analogy.

I’ve enrolled in school.

I’m almost 47 years old and it might take me another several years to get through Nursing School before I even catch a whiff of Midwifery School, but I am going to walk towards that CNM – or die trying. I’ve danced around becoming a CNM for 20 years, learning great amounts of information that I wouldn’t otherwise have had as I am heading into nursing school, but I want still more!

I know being a CNM isn’t for everyone. I acknowledge the challenges ahead of me. I don’t have (m)any idealistic thoughts about the ease or simplicity of nursing and midwifery school. I know I will have to contend with egotistical teachers, long-time nurses and doctors, but I also look forward to learning from the kind-hearted in each profession… those jewels in the sea of the salty ocean of difficulties. I am on the look-out for knowledge; I know I can find it.

Imagine the things I’ll be able to write from the other side of this wish!

I can hardly wait to get started.

Reader Comments (13)

You know I considered med school for a long time, so I know the desire to have information and experience on all sides. I say go for it and blessings upon you as you go into it. Don't forget to write... ;)

March 19, 2008 | Unregistered CommenterRedspiral

Both of my sons births were attended by CNMs, one in a freestanding birth center, and the other at home. They were both perfect, beautiful births, and I've never understood some women who are "anti-"CNM for homebirths. (One of the apprentices at my second son's birth was going to be a midwife without the nursing school - DEM maybe? And I would feel perfectly comfortable with her attending a birth, too.)

Congratulations!!! Good for you.

And thank you for inspiring me. As I approach 30 and have no plans for the future - except of course for the whole wife/mom/homeschooling thing - I sometimes wonder if this is all there is (not that it's not enough now). If you are going back to school at 47, I can remember that I have plenty of time to figure out what I want to do when I grow up!

March 19, 2008 | Unregistered CommenterJudy

I am in my first semester of the BSN clinical portion of nursing school- will gratudate Dec of 2009. I am already a CPM and registered in my state. I am 45 years old and much of what you have written resonates within me now.

For those who have wondered why I am abandoning the cause, I tell them that I see it as an expansion of what I know, and not as a flight from what I have already done.

I am ready for this step NOW, when I wasn't back when I took the first step to CPM.

Onward!

March 19, 2008 | Unregistered CommenterTFJ

I'm a long time lurker, commenting for the first time to say that I'm so proud of you!!
I'm 32 and completed most of the CPM process( I never took the written exam due to a number of strange circumstances) a few years ago.
I often think about going to CNM school, but fear by the time my kids are old enough for me to be in school I'll be too old to start such an ambitious program.
This post has inspired me and given me hope for my own future as a midwife.

Good luck!!!!

March 19, 2008 | Unregistered CommenterMegan

Barb - I think you will be wonderful no matter what you do! I'm pleased you speak so kindly of midwives who trained at Grady. I will soon be among those ranks.

March 19, 2008 | Unregistered CommenterStudent Nurse Midwife

I'm so glad you've decided to pursue this dream... Lord willing, I will join you in your pursuit sometime in the future. I currently have an RN but hope to get my CNM in the future, as God leads. Right now I hope to raise and increase my family (just one babe now who is almost 2, wondering when we might be blessed with another). I have to agree that I think you'll make an awesome CNM.

Nursing school is at the same time intensely interesting, challenging, and difficult. Having just finished last year myself I say this without hesitation. I pray that you will find it more interesting and challenging than you do difficult. I, like yourself, at first, wanted only to do the things that would really pertain to what I ultimately wanted to do - work with women and infants - but again and again realized the importance of the other skills that are available if I was willing to learn... and now I see how important these skills can and will be as I pursue working with women and children. In fact, I felt that I still had so much more to learn that I've chosen (my first year out of school) to work on an acute care floor.

So much of what you have written resonates with me that even though I've not been a midwife.

Congrats on your decision and blessings to you on your journey.

Sincerely,
Cindy

March 19, 2008 | Unregistered CommenterQuantmlife

Good luck to you!

Also, I'm curious about this:

"having a diagnosed mental disorder. . . Most homebirth midwives would rarely, if ever, see or accept this type of client."

What do you mean by "mental disorder" and what services are CNMs/Obs providing that direct entry midwives cannot or will not?

March 22, 2008 | Unregistered Commentersuperlagirl

As you know, some of us can't choose homebirth even when our hearts desire it. It's wondreful to think that someone with your caring and understanding could be there to help women like me.

March 24, 2008 | Unregistered Commentercq

I have just started nursing school, on my way to CNM, although DEAR GOD so much school!!! I thought that the majority of nursing school would be BORING as well, but it hasn't turned out to be that way at all. I realize now, much like you have, the more you know about a normal/abnormal situation, regardless of age or gender, the more it will help when you are in a similar situation with no one to ask if you're correct.

I feel that this will make me a better midwife when all is said and done. But, four more years of school, GEESH!!

March 26, 2008 | Unregistered CommenterSamantha

This was an absolutly inspiring post. Thank you.

April 2, 2008 | Unregistered CommenterMollie

Congratulations! Long time lurker, putting in her 2 cents.

I'm an RN, I work pediatric inpatient. Since having my 2 babies, I've decided I want to become a CNM. The thought of going to all the school scares me, you don't become a nurse if you like to sit in a desk all day. Anyways, good luck and I'm sure you'll keep us posted.

April 10, 2008 | Unregistered CommenterMäria

Have you thought about doing a graduate entry advanced care nursing programs. There's a program at Yale where you can become a nurse in one year and then the last two years are dedicated to certain tracks (midwifery, nurse practitioner, nurse anesthesiologist, etc.). There are programs like that in California as well. I think the university of san diego has one? Do a search for graduate entry nursing programs and you might be able to find something that would work for you in California or nearby.

April 12, 2008 | Unregistered CommenterNoelene

Bravo for you. Both my children were delivered by CNMs. While I have known many wonderful CPMs and lay midwives, I needed the insurance coverage and did not have the option to use their services.

I also understand the desire for more information, access, and choice. I went back to school 18 months ago to pursue nurse-midwifery. While I've yet to set foot on the labor and delivery ward, I have been pleasantly surprised by how personal and compassionate nursing can be, and I think the education I have will be valuable to me when I am at last able to practice.

My CNMs were my advocates and my priestesses, and their status gave me the assurance that they would be allowed to support me even if my birth didn't go according to plan. I experienced a long labor and fetal distress with my first son and had to be transferred to the hospital. It meant everything for my midwife to be there. She fought for me when I was in no shape to do it for myself, and I had a healthy vaginal birth. My second son's birth was simple, and my midwife let it be so.

I wish you strength on your path.

April 28, 2008 | Unregistered CommenterKathleen

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