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Sunday
Oct162011

Droplets in the Ocean

I was asked:

"Barb, is there anything we could say to homebirth midwives to wake them up to the fact that their education and training is deficient? Is there any way we could convince them of the value of experience?"

This is my answer. 

Starting with my background, I had been attending births in the hospital, birth center and home for 21 years before I got my California midwifery license in 2005. I’d doula’d about 400 hospital births before I started assisting, then acting as primary midwife (under supervision) at three different birth centers, two with CNMs and one with LMs, getting another 300 births under my belt before I became licensed. At that point, with about 700 births of experience, I’d attended many, many more births than the average newly licensed (or certified professional) midwife. Since receiving my license, I’ve either presided over or assisted at another 80 or so births at home. I’ve doula’d my own transferred/transported clients as well as acted as a private monitrice or monitrice-doula for another 120+ women in hospitals. I’m now at about 900 births attended.

I’ve also witnessed a maternal death, in the hospital, from an amniotic fluid embolism. I’d been attending births a mere four years, but it affected me for decades, causing me to say things like, “After seeing that mom die, I knew I wasn’t emotionally or spiritually ready to hold two lives in my hands, so it took many more years before I was ready to pursue a license.” Even as I studied, that death loomed over my concerns about being a homebirth midwife, but I felt I had a lot of previous experience, so was comfortable with my forward movement. I had a pretty decent idea of what was normal and what stepping out of normal looked like. But, as I learned, there is a huge difference between seeing and presiding. A life’s breath of difference.

Those who have read through my blog for a number of years, see how I’ve spoken to deficiencies in homebirth midwifery along the way. I’ve written about the incestuousness of apprenticeship, about how some midwives don’t carry the appropriate tools or meds, even writing about my own lack of skills or knowledge in many areas, including suturing and starting IVs. It is in this writing that helped me be ostracized from my own midwifery community, culminating in the formal removal from Peer Review a year ago and told not to attend community functions. I wrote “Why I Left Homebirth Midwifery” in answer to the midwives’ despicable behavior towards one of their own.

I’ve tried to speak to midwives’ lack of education and skills training many times, but it seems to fall on deaf ears far too often. But, I am finding some hope among those choosing to head into midwifery nowadays. Amber Plyer of Midwife{ology} initially began her walk, seeing a CPM certificate as her goal, but after some introspection, which, she admits, had aspects of my commentary of CPMs involved, she has chosen to become a CNM instead. I couldn’t be prouder if she was my own child! Amber is but one of at least a dozen women who’ve come to me, thanking me for speaking about the different types of midwives there are and that they’ve shifted from CPM-goals to CNM-goals, several already in nursing school.

I’d love to be able to refer to a homebirth education program that serves mothers and babies adequately. I have named four I thought gave at least decent training (listed here), but the reality is none of the schools is standardized and the graduates’ knowledge and skill are dependent on which mentor-midwife the student-apprentice works with throughout the education process.

So, to answer Dr. Amy’s questions:

"Barb, is there anything we could say to homebirth midwives to wake them up to the fact that their education and training is deficient? Is there any way we could convince them of the value of experience?"

Amy, I’ve tried. And while I seem to be making some inroads, they are, in my opinion, minimal. I’ve had my experience discounted because so much has been in the hospital, but no matter how much I state that it isn’t medical intervention that causes the sudden emergencies, too many roll their eyes and think I’m full of shit anyway.

I guess I haven’t been graphic enough about the emergencies that have happened in the home, even with completely “hands-off” labors and births, how very lucky I feel I was that no mother or baby died during the harrowing complications that happen at home as well as in the hospital. I really do believe less technology than the hospital typically uses, mixed with more hands-on care than many homebirth midwives are wont to use, can make each of the scenarios more palatable (in hospitals) and safer (at home). I can’t help believing both are possible.

But, if I, a very experienced in birth (comparatively) non-nurse midwife is shoved aside because I’m not saying all the pretty, flowery and idealistic unrealities in birth, how are the masses of non-nurse midwives going to comprehend the risks they are taking until they end up like Lisa Barrett, losing baby after baby when their luck runs out? I wish I had a magic wand, but for now, that wand is my “pen” and all I can do is keep writing.

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    - Navelgazing Midwife Blog - Droplets in the Ocean

Reader Comments (32)

Barb, I don't think they want to believe you. They do not want reality to ruin this beautiful construct they have built. I have entered many discussions with NCB advocates and they always respond in the most volatile way. I think there is nothing to say to them at all, they are stuck in their ideology and can't be swayed. Sometimes some of them come to it in their own time, like Amber, and I have come to it this way too. I used to be quite the believer in the NCB ideology. I have come to the conclusion that trying to convince them isn't the way to go, at least not for me. I don't have your years of experience to draw on. I haven't seen enough, and I haven't been personally hurt by homebirth (thank God) What I can do is swarm the leaders of our states and country with emails and letters, to try to persuade them that laws need to be passed. There are a few of us doing this and more would be even better. This is something all of us can do, we don't have to be nurses, midwives or doctors. We are just concerned citizens. Maybe a few of your readers would be glad to do this as well. I have some email addresses to start with.

October 16, 2011 | Unregistered Commentertara

I agree that Bastyr's program looks better than average, but I would seriously reconsider recommending that anyone attend Birthingway. It is a driving force behind the reckless sort of midwifery rampant in Oregon--most of our younger midwives attended there, most of our older midwives teach there and/or take on apprentices from there. I have a side-by-side comparison of what Birthingway requires with what nurse midwifery programs nearby require here: http://oregonmidwifereviews.blogspot.com/2011/09/birthingway-is-rip-off-and-bad.html

And on my tag for Birthingway college you can see many upsetting examples of bizarre religious beliefs being taught in place of evidence based practice, 19th century homeopathic manuals that advocate methods for homebirth with placenta previa being used as textbooks, and of course the elective courses in astrology: http://oregonmidwifereviews.blogspot.com/search/label/birthingway%20college

October 16, 2011 | Unregistered CommenterAnonoregonian

Thank you so much, Barb, for answering this question. I couldn't agree with you more, especially when you say, "I really do believe less technology than the hospital typically uses, mixed with more hands-on care than many homebirth midwives are wont to use, can make each of the scenarios more palatable (in hospitals) and safer (at home). I can’t help believing both are possible." I think this is only possible, though, if NCB advocates stop telling women who have no business giving birth at home that they will be safer if they do, and that c-sections are the worst thing possible, even worse than the death of a child or permanent injury to a mother. Just this afternoon a prominent NCB facebooker is encouraging a woman who posted asking whether or not she should have a vaginal birth when she has a rectal prolapse to ignore all common sense and medical advice and rather listen to one case study and one anecdote where a woman had a vaginal birth with with a rectal prolapse. And that is no isolated incident. But I digress.

Anyway. I, too, have evolved in my thoughts on this issue quite a bit over the last few years. I never was squarely in the "trust birth" crowd for myself, but it wasn't until fairly recently that I began to see the potential danger in the attitude overall.

I admire you for your willingness to speak out candidly, even in the face of persecution from your "sisters" and the loss of your midwifery career because of your integrity and self-examination. Thank you for being one of those drops.

October 16, 2011 | Unregistered CommenterHeather

Barb thank you so much for your honest look at the issues, sharing your experience, and your commitment to the truth as you understand it in any given moment. I truly believe this kind of discussion will, in the end, help avoid tragedies like my daughter's loss.

It is so hard to know what we don't know, so those who know it need to speak up.

October 16, 2011 | Unregistered CommenterJenn

Thanks for this insightful essay, NGM.

I was particularly struck by this statement:
"there is a huge difference between seeing and presiding. A life’s breath of difference." A thousand times YES. Professionalism is all about making responsible decisions, AND considering yourself accountable for the outcomes.

October 16, 2011 | Unregistered CommenterSue

CNM here who stayed on the nurse-midwifery path when the training seemed so much uglier than the CPM apprenticeship model, with the help of Barb's kind, blunt, and honest words. The training was brutal but I would not trade the knowledge and skills I learned for anything. Thank you, Barb, and you ARE making a difference.

October 16, 2011 | Unregistered CommenterKatie

Barb, If you were Queen of the Universe, and could fashion the perfect midwifery education program, what would it entail? What kind of education, experience, etc., required for admission? Graduation?

Is the answer to the "CPM problem" the Certified Midwife?

Also, FWIW, ACNM doesn't require any set number of births to sit for the exam. Each program and preceptor is responsible for determining and certifying that the student is a safe beginning midwife. (According to my professor, anyway.)

Your thoughts?

October 16, 2011 | Unregistered CommenterJen B

Dearest Barbara. I hopefully will be completing a degree in midwifery. For the last two years i thought i was not quite sure that i wanted to complete the course as my ideals had taken quite a knock as some had questioned my motives and had been called a med wife. I understand now that ther needs to be the ones who stand in the gap between the extremes. The watch women to ensure that the good we have gained is not lost due to the questionable actions of those who proclaim trust alone will do. Thank you for helping me find the balance. Blessings.

October 17, 2011 | Unregistered Commenteranew

Barb what do you think of the program we have here in the UK? The qualification is a 3 year Bachelor of Science degree which involved 50% theory, 50% working on delivery floor, antenatal ward, postnatal ward, community midwifery, clinics, fetal medicine, NICU, birth centre etc etc. We learn to cannulate, start IV's, to suture & to deal with emergencies - 9 of which we are intensively tested on. Before we can qualify we must also attend 40 births in which we personally catch the baby & deliver the placenta. We must also complete the 3 year program within 5 years of starting it (so cannot have lots of time off sick or fit in more than one pregnancy in the program). Once we qualify we must register with the Nursing & Midwifery Council who oversee our fitness to practice.

A UK midwifery degree is recognised in most countries as the gold standard.

Your thoughts?

October 17, 2011 | Unregistered CommenterLiz

One thing that stood out in your reply to Dr. Amy Tuteur, and is a constant with ALL homebirth midwives without CNM credentials is just how few births one can amass in an average career, as compared to a CNM on hospital staff.

For most of the 40 years I've been a midwife I have been working in mid-size hospitals with a monthly delivery rate of between 350 and 400 births per month. Although the maximum number of births where I have either been the primary or secondary HCP has been 14 per 8 hour shift, and there has been the occasional shift when no one was in labor, this works out roughly to there being 10-12 deliveries per day, on an average, or 3 to 4 per shift. Since a full-time staff nurse or CNM would work for 25 days a month, this means that I can expect to be involved with as many as 75 deliveries a month, or slightly more than 800 a year [allowing for a month of vacation]. Even if I want to subtract 160 of those for C/Ss [using 20% as a C/S rate], it is obvious that ANY hospital-based maternity worker is going to see and do vastly more deliveries than a midwife who is self-employed and working in the homebirth arena. It is extremely difficult to do more than 2 deliveries a week on one's own, since one is expected to attend the woman for the entire duration of labor, which almost always will take longer than 8 hours, even if the demand exists, which is not always the case. Homebirth midwives I know can go weeks, indeed months, between clients. When I hear that an "experienced" homebirth midwife can have several hundred births under her belt, I simply am not impressed.

Also, as Barb notes, being hospital-based means the midwife has a much wider knowledge of emergency situations and procedures, which is nothing to be sneezed at. If you constantly don't use a skill, you lose it.

October 17, 2011 | Unregistered CommenterAntigonos

Dear Mrs. Herrera, (NgM's note: MS... not Mrs!)

I would love to see a blog post listing specifically what you believe are the insufficiencies of the CPM certification. For example, “The current CPM requirement is attendance at X number of births, while I believe it should be Y number of births” or “The current required CPM skill set includes skills A, B and C, while I believe it should also include skills D, E, and F.” I ask this because I am puzzled at what points you find the CPM insufficient. We have a great community of CPM midwives out here in Arizona, and I have not yet met one to whom I would not cheerfully entrust my safety (and my baby's safety) during a pregnancy/birth, nor have I ever heard of any bad homebirth outcomes.

Love the blog, I learn a ton every time you write. Please keep it coming!

Diana

October 17, 2011 | Unregistered CommenterDiana

That's a great question, Diana... and one I'm trying to figure out myself. The thing is, I've never developed an education system before, just looked at the variety of those out there and their curricula. I'm being asked this more and more, so let me ponder how to best answer. (The obvious one is to compare it to a CNM and acknowledge *that* as the Gold Standard in midwifery education.)

October 18, 2011 | Registered CommenterNavelgazing Midwife

Oh, and DIana, I *do* know of bad outcomes and crappy midwifery service/skills in AZ. Just because consumers don't learn about it doesn't mean others of us don't.

October 18, 2011 | Registered CommenterNavelgazing Midwife

This is clearly not central to your post, but it irks the hell out of me nonetheless.

I hate when writers use the broad term "homebirth midwife" to refer specifically to non-nurse midwives, CPMs, & direct-entry/lay midwives.

Like this: Those who have read through my blog for a number of years, see how I’ve spoken to deficiencies in homebirth midwifery along the way.

I'm just showing a personal bias here as I had a CNM-attended homebirth, am currently planning my second, and now work for my midwife, but ugh.

When people run around hollering about how "homebirth midwives" are all uneducated quacks, it discredits those out there working who DO have training, who DO have standards and are licensed with the state medical boards, who DO have advanced degrees, legal medications, and the skills to handle most of what comes at them.

Instead, I'm left explaining myself over and over because people equate "homebirth midwife" with "crazy hippie who shows up to catch the baby carrying a bag of alfalfa and lighting incense."

October 18, 2011 | Unregistered CommenterJo

More often than not, I say "non-nurse, homebirth midwife"... should have done that in here. Sorry, you're right.

October 18, 2011 | Registered CommenterNavelgazing Midwife

Ms., not Mrs. - you got it!! :)

October 18, 2011 | Unregistered CommenterDiana

Dr. Amy wrote the following in her post (question) to you, " In fact, she has come to believe that the experience required for certification or licensing as a homebirth midwife is so deficient that homebirth midwives are not safe practitioner. She has put her money where her mouth is, suspending her practice as a homebirth midwife until such time as she has greater education and experience."

I have read much of your blog and wanted to ask if her assessment of you and your opinions and reasons for stepping back from homebirth midwifery is correct. It seems about half-correct from what I have read of your writings.

Specifically, is it your opinon that homebirth is not safe with a CPM here in San Diego? Are there no CPM's - locally - that you could recommend? You write about the lack of standards and licensing guidelines in other states, but do you feel that there are competent midwives who are not nurses. Is homebirth "safe" with them?

Secondly, is the reason that you stopped attending homebirths as a midwife because you thought that your skills (or lack of skills) made homebirth too risky for women who wanted to hire you? I did not get that AT ALL from your post about why you left homebirth midwifery.

I'm consistantly irritated by Dr. Amy's vitriol of homebirth. The message I get loud and clear from her is all homebirth is unsafe - even with CNM's, Family Practice MD's and OB's attending. Is this the way you are beginning to lean?

Please say it isn't so. I respect your self-reflection and desire to bring to light the inadequacy of some (many) CPM's, LM's, etc, but never would have lumped you in with Dr. Amy.

Alyssa McPherson

October 18, 2011 | Unregistered CommenterAlllyssa

Alllyssa: I wondered when that question would come... and from where. And here it is.

I believe you've read me better than Dr. Amy on this one.

There are less than a handful of LMs I'd trust with my baby (or grandbaby) here in San Diego.

I did *not* leave because I felt inadequate, but do believe I did not have enough training or education.

I *do* believe I had (or assisted at) too many close-calls that would better have been served in the hospital.

I *do* believe many midwives are living on luck more than their education or training.

I *absolutely* support and believe in homebirth... with educated and trained midwives... and with low-risk women. I believe many/most midwives are far too liberal in who they take on as clients and that will be the downfall of homebirth midwifery. I believe if we could agree on the level of risk of women, keeping it extremely low and risking out when it steps outside the boundaries, I believe homebirth will continue to be seen as a viable option. But, I see more and more complicated cases being done at home (not necessarily here in SD)... took too many on myself!... and that endangers moms and babies as well as casts an eerie darkness on homebirth in general.

I *want* homebirth to be a valid choice for women, but I want to see the choice be a safe one.

Does that help?

October 18, 2011 | Registered CommenterNavelgazing Midwife

@ Antigonos
How true! And apart from those labours/births that hospital midwives are involved in on a daily basis, there is also the oodles of other women that one has contact with, who aren't in labour. Midwives who work in continuity of care models such as hospital caseload or homebirth practice may get to know each woman well, but they miss out on that constant contact with lots of women. I have seen colleagues working in these models lose there skills, which becomes obvious, when theyre confronted with something a little hairy or something requiring more than just standard support. With the emphasis on good midwifery being through continuity of care (which is pushed and supported here in Australia); our profession is becoming less skilled in my opinion.

October 18, 2011 | Unregistered CommenterAussie hospital midwife

I have done homebirths. It was within a framework of strict vetting procedures for both the pregnant woman and her home [ !] to determine if the woman was really a candidate for home delivery, an excellent emergency backup and transfer system, and where all the midwives were CNMs, nationally licensed after completing a nationally supervised midwifery program. Even so, there were occasional unpredictable complications. Fortunately, none resulted in permanent damage to mother or baby, but the potential for catastrophe was always there.

In the US today there isn't [1] a national curriculum, [2] a national licensing system, [3] no way of removing rogue birth attendants who call themselves "midwives" from advertising themselves or their services, [4] no dedicated emergency rescue or transfer system that can equal the speed of reaction in a hospital when a life-threatening complication unexpectedly presents itself, [5] no national standards of practice for midwives, including restrictions on who precisely can be delivered at home, [5] no mandated insurance coverage for midwives, and [6] no legal requirement for medical records to be kept by midwives. As far as I am concerned, this makes homebirth a kind of lottery where you might well be lucky should you opt for a birth at home, but you are really traveling blind. The "CPM" credential, like ALL the other "alphabet soup" credentials apart from CNM can mean various things in various states, and the client really has little way of accurately determining just how competent her chosen midwife is.

I too dislike the blanket term "midwife" for everybody from CNM to a totally untrained birth junkie, but I don't know another term to substitute for it. In my experience, so few CNMs do home deliveries that when one is referring to a "homebirth midwife" one is almost inevitably talking about a midwife with some form of direct-entry qualification, if she has a qualification at all. Alas.

October 19, 2011 | Unregistered CommenterAntigonos

A Lottery is the *perfect* way to describe the crap shoot it is for finding a skilled midwife. I wish I'd thought of that.

October 19, 2011 | Registered CommenterNavelgazing Midwife

I am torn.

I think that all midwives should have the knowledge that a good hospital based CNM have, but I simply hate the way many of my clients have been treated by the hospital care system. One of my last births that ended up in a cesarean I was there a total of 9 hours with the clients. They saw their midwife for maybe a total of 30 minutes the entire birth. There was no help with positioning, no help with trying to help the baby move down. She was in and out as soon as the exams were over and to tell my client she needed a cesarean.

Maybe the midwife had more the one client at that time, (I am sure she did,) but I would not call this midwifery care. She spent no more time than a doctor would, and in some cases, less. It was the complete opposite of the "hands on" and respectful care women expect from a midwife. This is not the exception around me, this is the norm.

October 19, 2011 | Unregistered CommenterCrowbabies

Yes, you're response clears things up a lot - Thank you. I also just came across your post titled, "I Believe . . ." which spells things out pretty clearly. I think Dr. Amy must have missed that one too :)

October 19, 2011 | Unregistered CommenterAlllyssa

To Barb and her readers who are dealing with those who would call them ‘medwives’ and mean it as an insult – please don’t lose heart. As far as I am concerned the ‘medwives’ your detractors speak of are the real midwives: the ones who will use any knowledge or expertise at their disposal to improve outcomes for mothers and babies.

My third son was born on Monday in hospital under the care of a medically trained midwife, who also conducted my prenatal care (and is in the middle of my postnatal care). She did not eschew tests or the greater medical knowledge of the obstetricians – she took charge of them and used them to keep my baby and I safe.

When my waters broke at 37 weeks and 1 day and my hospital’s protocol said I would need to be induced within 24 hours she didn’t get me extra time by trusting birth with all her heart and sticking it to the man. She did what was necessary to make extra time an acceptable risk – she confirmed my GBS negative status, had me go in once a day for a CTG and obs and stayed in regular contact with me. Because of this – and their confidence in my midwife as a medical professional – the registrar of the hospital was comfortable for me to wait for 48 hours after my waters broke. Labour never started and at that point I was induced.

The expertise of my midwife was what made it possible for me to labour and deliver without an obstetrician or paediatrician – although she consulted the ob about my syntocin levels when she was unsure.

Luck, my midwife’s expertise and the fact that she’ll be visiting me at home every day for three days are what made it possible for me to go home less than 24 hours after my son’s birth with no tearing, no need for relief, basically no welling, and bleeding already less than my usual period.

I guess basically what I’m trying to say is that I had a woman-centred, midwife-led birth without compromising a single element of the health and safety of myself or my baby. That’s what a real midwife does and I offer my heartfelt encouragement and gratitude to everyone of you who is willing to work harder and longer to offer women more.

October 19, 2011 | Unregistered CommenterMJ

Congrats, MJ! Sounds like a lovely birth experience. Congrats to your whole family. :)

October 19, 2011 | Registered CommenterNavelgazing Midwife

I currently live in a state where CPMs are legally recognized, and before I was pregnant, I was gung-ho about going the freestanding birth center route with one. But when I got that positive test, my gut told me to stick with the CNM group I had been seeing for my health care, and deliver in a hospital. And I have felt good about my decision.

And looking at it, most of the CPMs in my area do not have any kind of OB backup, so if I ended up needing to transfer during labor, I would get whoever is on call, someone I have never met in my life, and frankly, that scares me. I want to at least have met the person at least ONCE before letting them deliver my baby!

Now don't get me wrong, I am not against women having out-of-hospital births. Not at all. But I feel like the way out-of-hospital midwifery is handled in this country is deeply flawed. If we could have all medical professionals work together and consulting each other, instead of this "us against them" attitude I keep seeing.

October 19, 2011 | Unregistered CommenterLaura--The Sushi Snob

I think you need to be careful about the way that you flippantly attack Lisa Barrett and suggest that she has lost baby after baby. Unless you have spoken with her directly, I don't think you have any right to tell the world that she 'loses babies'. Given the current climate world wide and the general negativity towards midwifery, particularly homebirth midwives, I think it would be prudent to be cautious when believing all that has been written in the newspapers and online by other bloggers.

October 21, 2011 | Unregistered CommenterJane

Nothing "flippant" about fetal deaths.

October 22, 2011 | Registered CommenterNavelgazing Midwife

I am not suggesting for a second that there is anything flippant about fetal deaths. As a mother of five and 9 months pregnant with my sixth and as a doula I am very aware of the potential for awful outcomes. They are sometimes preventable and sometimes not no matter where the birth occurs. I am just saying that I think we need to be careful about jumping to conclusions, particularly given the current anti-homebirth climate that exists in Australia. We have seen a number of amazing midwives driven out of the profession across Australia over the past few years and I see the potential for that to be happening again.

October 22, 2011 | Unregistered CommenterJane

This is a very pertinent post for me. At our last ICAN meeting, we had 3 homebirth MWs speak - mostly re: HBAC, but also on homebirth in general. The 3 were, a 30 year CPM, a doula who is an lay midwife in training and a RN who went through her CPM training but declined to certify.

One of the questions was "what medical supplies do you bring?" Only one brings oxygen, none of them suture, none of them carry anti-hemorrhagic drugs... all in all, they carry very limited medical supplies due to their scope of practice. All of them use herbal, homeopathic drugs, however. The RN says she is cautious about the homeopathy, the other two use homeopathy regularly.

When another meeting attendee asked about verifying a MW's credentials - "How do you know that the MW is telling you the truth? How do you know how much experience she has? Her education? Her continuing education? etc" The doula/MW in training gets very angry in her response of "experience is much more important than training" she goes on to say that how dare anyone try to control how she practices, she gives women references for other clients and that should be enough. She is very much on the defense.

I piped up in support of the querrent and said that any pregnant woman should ask the same questions of an OB as they would a MW. It's called due diligence. From a client's perspective - most moms I know didn't even know there were multiple types of MWs, let alone how they got their qualifications. I told her that these questions weren't meant to criticize, but to be informative.

Honestly, if a MW is going to get that defensive, I wouldn't want her to attend my birth, or any other births. That tells me she's not confident in her skills.

We need to have some sort of standardization and oversight for homebirth MWs. We run serious risks if MWs have inadequate training and spew outdated, useless or dangerous information (Brewer's diet anyone???).

The big question for me is how do we push for an oversight program and yet keep the integrity and autonomy of the homebirth MW? Without that, you won't have a whole lot of buy-in from the community...

Deena: Did anyone else notice what was going on? How did the other mw's act/respond?

I am quite aware that what I've written about how to interview a midwife isn't going to go over so well with too many midwives, especially the skills training part. But, I think even that reaction speaks volumes about a mw and her knowledge and skill in birth.

Ohhhhhh, how I wish *I* was at that meeting!

What do you mean by autonomy? A midwife's choice to choose any client she wants?

October 23, 2011 | Registered CommenterNavelgazing Midwife

Hi Barb,

As a student of midwifery apprenticing to one of the best midwives here in my home town, I have to say that I definitely agree with you on the fact that students should definitely be taking more time to learn and worry much less about the costs and numbers...my own mother died in the hospital of an amniotic embolism when I was 3, so I really feel that years and years of learning before licensure is really key to learning all the fine details of the profession.

Thanks for all your admonishments to the students who would love nothing more than to rush out and get their numbers so they can begin their own practices! I personally feel so blessed to be studying with a team who is enjoying the journey and really doesn't mind how long it takes!

Blessings,
Stephanie

November 1, 2011 | Unregistered CommenterStephanie

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