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Letter from "Midwife to Be" Attendee

I got this in my email shortly after posting "Midwife to Be 'Midwifery School'"... and yes, she gave me permission to print anything but her name...:

"A quick aside before I get into the incredibly incompetent 'Midwives to Be' program-- I have been a doula for several years. I had been accepted as an apprentice midwife in a birth center, and was very gung-ho about my CPM route. About 6 months before I was set to leave for the apprenticeship, a dear friend and local OB had me shadow him for four months at our local hospital. He treated me much like his other residents and PA students, and I learned an incredible amount in this extremely humbling experience and am now back in school for my CNM or OB, but we'll see how much chemistry I can handle. I'm now also being mentored by a CNM who provides homebirth services, and is very politically active and outspoken against the CPM credential (at least in it's current incarnation). Ideally, we would all be CM's educated much like the current CNM is, but with a board of midwifery that overseas our profession as opposed to the board of nursing. In any case that is another story....

"I am writing to you however, as someone who (gasp) attended the 'Midwives to Be' program, and just wanted to share my story/experience with you. I should preface this by saying that I have also worked in Africa as a volunteer, and I do think there is value in providing care and donations to these underserved areas of the world. The issue with this particular program is that works under the guise of serving women, but only so that the students may get their numbers up and practice skills they would never normally be allowed to do in the U.S. (with the exception of a place like Casa in El Paso, which also coincidentally serves Mexican immigrants wanting to birth over the border. Thus, it really isn't that different in its intentions than this program). I was introduced to the program by another doula. I had just finished my training a few months prior, and being a 23-year old college student, I wanted to travel and learn more about supporting women in labor. This was the only program that really offered this experience to doulas, so I applied. I want to drive home that though I learned how to take blood pressure, I was solely working as a labor support person. The 'midwives' there allowed me one assisted catch on my last day, but of course no more because they needed their catches.

We were brought to Boni to stay with the very religious, born-again Pastor Veronica who is friends with the woman who runs the program. They had stopped working with the hospital and housing organization that had been affiliated with 'Midwives to Be' up until this point, and decided that they were going to run everything together and split the profits. When we got to the hospital to be introduced to the staff we had no translator (which we had been assured there would be), and they didn't even know who we were because Veronica hadn't even told them we were coming. We basically just walked in and said, 'Okay, we're here. We're ready to start delivering!'. I mean, can you imagine? For some crazy reason, most likely the huge boxes of donations that came with us, they allowed us to stay and work with the doctors. So, basically bribery. Not to mention, transportation that CONSTANTLY broke down, constant reminders of how expensive everything was for Veronica to pay for (even though we had paid so much to attend the program), and guilt trips about attending her church despite the fact I am not a Christian myself. It was all very shady, uncomfortable, and unprofessional to say the least.

For two weeks, I stayed with three training CPM's from CA, one lead midwife from Texas, and one labor and delivery nurse from North Carolina. I should add here that even though this nurse had been in L&D for YEARS, she was criticized at every turn for working in hospital and constantly bombarded with homebirth statistics from these women who were doing a distance program for lay midwifery. At the hospital, the doctors would allow the students to suture, deliver, and even assist in surgery. I have never seen more nervous students in my life, but they were also clearly thrilled about getting their skills checked off. What was insane to me was how it was such a competition for who would get to deliver, depending on who was closest to having their numbers completed. I can't imagine in any medical or nursing programs, students saying things like 'Well I only need 3 more births! I didn't pay all this money just to go home with no numbers and have to wait another year to take my exam.' While I loved being able to be there for these mamas, support them, get them up and moving, and talk the doctors into allowing their mothers into the ward for the primips-- you got a definite feeling of us paying them to expose ourselves to things that would be illegal in the U.S. Ironic, though, how quickly these CPMs will work with OBs in OTHER countries to get their skills, but in our country denounce medical professionals.

"I loved the doctors, nurses and moms I worked with there, but I feel quite ashamed of participating in a program that exploits women the way this one does. I wish I had been more educated and less naive  than I was at the time (I think I was 23 when I was there-- still old enough to know better though). I think it is abysmal to go from one high volume birth center/hospital to another and 'get your numbers in,' and then go home and resume studies. Wouldn't every doctor/nurse love to be able to delegate their time like that in school? I am 26 (almost 27 now), and would love to get pregnant, start a family and have my midwifery education done, but it just doesn't and shouldn't work like that. Midwifery is a calling, and there is a value in education that is just lacking in the CPM credential. What's worse is that it is under the guise of 'trusting birth,' and not wanting to be indoctrinated into medical culture. Well, as a health care professional you work in medicine! I was just appalled at how on the one hand, these women treat the western medical culture in their own country and judge these Dominican doctors for how they practice, but then in front of them, act completely different and use these women and these hospital to get the  same skills they so adamantly preach against.

"I know I'm ranting here, but I just had to say it. One training midwife actually said, 'If I was your age I'd get my CNM, but I just can't because I have 3 kids and I'm almost 50.' Well, if you can't or won't put in the time to do things right, should you really be doing it? You're just going to take the path of least resistance, because that is most convenient for YOU-- never mind the women you deliver!"

Thank you for speaking up. There are many, many women who will never know to thank you, so I will do it for them. You have, most assuredly, saved plenty of prospective midwives money and wasted time... and possibly even saved some mothers or babies their lives.

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Reader Comments (12)

Bless you. I to was in the Midwife To Be program before realizing what a horrible "education" the program was. I did 8 months worth of the "units" and realized I was completely blinded and this was *not* a good thing. I also heard through the grapevine some really, really bad things about these clinical trips to the DR.

I loved this last part -

"I know I'm ranting here, but I just had to say it. One training midwife actually said, 'If I was your age I'd get my CNM, but I just can't because I have 3 kids and I'm almost 50.' Well, if you can't or won't put in the time to do things right, should you really be doing it? You're just going to take the path of least resistance, because that is most convenient for YOU-- never mind the women you deliver!"

You are 110% right. I ashamedly admit that I was scared to death to go back to school (I'm only 24, but I have a husband of nearly 5 years and two children under two). I didn't think I could do it - heck - I didn't *want* to do it! So I took "the easy way out" because I knew I wanted to be a midwife, and that suited me more. A distance education program with no real tests - or anything really... It wasn't the only reason, but it played a part no doubt. I also was indoctrinated with a "trust birth" mentality and had picked up on the "fear hospitals, and all OBs are out to cut you open" way of thinking. This just is not true. We must respect birth, but not fully trust it. And along my journey as a doula, I've met some amazing obstetricians and nurse-midwifes. Absolutely wonderful providers who try their very best to give mom the birth she wants while keeping both her and her baby safe. I am going to be responsible for a mother and child pair - for their lives - I can't get by on minimal standards! They deserve the best, and that is what I intend to give as a CNM. I'm now working on my gen ed and pre-req's for nursing school and am hoping to begin clincals in August of next year. From there, I plan on pursuing my masters in nurse midwifery. Is it tough? Absolutely! But it is necessary to ensure a safe, confident, well trained care provider.

Good luck to you on your journey into midwifery or obstetrics - the *real* way. From your writing - I already know you have a huge heart for mothers and babies and will be a wonderful care provider. If you ever need any support or encouragement along the way - feel free to contact me. amber.babiesinbloom@gmail.com or through my blog - Midwife{ology} - http://midwifeology.blogspot.com/ Barb is also an absolute angel and such a strong supporter. She is wonderful.

October 19, 2011 | Unregistered Commentermidwife{ology}

I've been following all of these posts on midwifery education with fascination, and I wanted to thank you for posting your personal experience. I am an aspiring midwife who has been putting a lot of thought and research into which educational path I want to take to becoming a midwife; as strongly as I support home birth as a safe option for many families, and as much as I respect the obviously well-educated and competent CPMs I have met, I am coming to the same conclusion that I sense many other prospective midwives are coming to--to become a competent, well-rounded midwife in the US today, the CNM route is currently our best option. This is a tough choice for me because I am hesitant to be subject to the very real possibility that as a CNM I may not be able to attend home births if I so choose, both due to educational preparation and legislation; in the state I currently live in, CNM practice is still quite restrictive thanks to mandatory physician agreements, so there are no CNMs attending home births as far as I am aware.

I really wish there were a good middle ground here in the US--a challenging, well rounded direct-entry midwifery program that would prepare midwives to work in all settings (hospital, birth center, home), with training appropriate to each location. I wish that the CM option were more feasible than it currently is, because I would seriously consider it if I planned to live in any of the states that currently recognize/regulate CMs, and perhaps in the future this will change. I am not afraid of school--in fact, my background in science and my love of academics is part of why I am becoming more and more convinced that even attending a MEAC-accredited program will not be rigorous enough for me to feel fully prepared to be a competent midwife.

It does seem to me that although the CM credential isn't taking off as fast as perhaps it could/should, an alternative option may be becoming more widely available--that of the direct-to-MSN accelerated programs that allow students with a non-nursing Bachelor's degree to become advanced practice nurses (including CNMs) in about three years, with a one-year accelerated nursing program, then two years of the Master's specialty. I haven't decided whether this is the route I will take, but it is a great option for many of us who want to build on our undergraduate education but not necessarily get a separate nursing degree (Yale, for example, does not grant a BSN but only the MSN when following this pathway).

I would also welcome more rigorous programs for CPMs; I don't think the credential should be thrown out, and I see value in a wide variety of educational pathways to midwifery. That said, I do think that there are other women like me who value many aspects of the CPM approach but don't feel comfortable with the level of education that so many schools offer, especially as they interface with modern technology (which, like it or not, is here to stay and does save lives when used appropriately--NOT routinely).

I don't know what the answer is; I just hope that together, we can all work toward a better, safer, healthier future for mothers and babies.

October 19, 2011 | Unregistered Commentertrauerweidchen

Who verifies the "numbers", if the student is in deepest Africa or somewhere else? What is there to prevent a bit of "creative register-keeping" or downright fraud, with everything else being rather shady and unprofessional?

This is one of the areas where the lack of a national midwifery governing body [such as the Central Midwives Board in the UK when I was there], under the aegis of the Federal government, is crucial. If students MUST attend an accredited medical institution in order to obtain their experience, then there is SOME means of determining just what experience they are getting.

October 19, 2011 | Unregistered CommenterAntigonos

I live in a state that certifies CMs, and I am in a CM program. I had applied to get my RN initially, then decided to go straight into the CM program instead. I also looked at the 1 year accelerated BSN at UMDNJ, but you basically can't work at all while you are doing it, so it was a non-starter for me. I have a family to provide for!
Sometimes, I wonder if I am making a mistake going to school for the CM rather than accepting admission into nursing school. CMs are legal here, and can work in hospitals, but its rare. I just wonder what kind of reception I will get, who will hire me (I don't want to work as a solo midwife right out the door!), and if my life would be easier with a CNM cert.
Don't get me wrong, I like the program so far (I;m in the first semester). And I know I can get my RN license after my CM and then I will be considered a CNM. But with everyone saying DEMs are bad, and CNMs are the bees' knees, sometimes I wonder if being a CM is even worth it!

October 24, 2011 | Unregistered CommenterJen B

Interesting. It clearly states on the MTB program that nothing that happens on the trips to DR "counts" towards NARM totals. So I have no idea why they would be doing that other than competing with each other in some way. She is also very clear that doulas go as labor support and do not catch babies. They are doulas only. I haven't gone myself, but I have read all the literature that is available about the DR trips. You are contradicting a bunch of the information provided about the program. I don't know what the answer is. My babies have all been delivered by CNMs, but here in my state they do not do homebirths. So the only option for a homebirth is a lay midwife, DEM, or CPM.

November 3, 2011 | Unregistered Commenternaturalmom

You and I have agency, and we are all free to choose the path to midwifery, or choose another path. I am grateful for the varied methods and free-enterprise behind midwifery. It keeps us accountable for the method we subscribe to. It is a CAREER, it is a MISSION, and it is a GIFT to be involved with labor work.

I personally would have loved to get the CNM, but I know in my heart I do not feel it is the best service to the women I serve. Our hands are bound to the credential, and if we choose CPM or CM it may be for the simple fact that we are NOT bound by the medical jurisdiction/control .

I chose CPM because I felt it was closet in line with my personal beliefs and my natural approach to ALL HEALTh. Not simply midwifery .

November 4, 2011 | Unregistered CommenterDee

I have had six babies at home. Three with a CPM and three with just a Licensed Midwife. I have talked with the Licensed Midwife about being an apprentice. It seems that what is misunderstood about CPM's is that the book knowledge is only part of the issue. The Midwife to Be program is the book knowledge, but if you don't have a preceptor to work under for a few years and get your certified NARM catches then all the book knowledge is useless.

My sister who is a nurse went to school for four years but would tell you that until she started her clinicals and then started working as a nurse she really did not know very much even though she had gotten a BA in Nursing. The same thing go for CNM's and CPM's. You have to be under a preceptor whether in a hospital setting in the case of a CNM or a Home Birth setting in the case of a CPM in order to get the practical skills to be a midwife. For either one, if you have a bad preceptor then you are going to be behind the curve. At the same time a good preceptor will take your book knowledge and expand it into the practical.

So, no matter what path you take CNM or CPM, the goal is to find someone to take you into their practice and teach you hands on what to do.

FYI...a few years ago, the catches that people made in the Dominican Republic did count towards NARM numbers but not any more. Also, it says that if you are not well into the Midwife to Be Program that you will only do labor support. I have never gone, but know about the program.

November 6, 2011 | Unregistered CommenterTAL

TAL: See, the deal is, an apprenticeship IS only as good as the preceptor/mentor and ANY homebirth midwife will get a fraction of the births any hospital student midwife will get. If a homebirth apprentice gets 30 births, that's a lot... and it can take a couple of years to work up to 20 a year. Compare that to hospital-trained midwives who can assist at (not just witness) 50 births a month.

There simply is no comparison.

November 6, 2011 | Registered CommenterNavelgazing Midwife

I disagree that a hospital trained midwife will be better than a homebirth trained midwife just because they get to be at more births a month.

The CPM's and licensed midwives that I know who train student midwives have those students with them at most if not all prenatal visits for a given mother. Since the goal of a good homebirth midwife is to learn how to risk out high risk pregnancies, this is very important since it starts in the prenatal period. The student midwife is greatly involved with the prenatal visits, asking questions, spending time with the mother, doing fetal tones, measurements etc. It isn't about just being at the birth and witnessing the birth. The licensed midwife that is local does between 3-5 births a month which is between 36-65 births a year. Is it really the number of actual births that are attended that makes a midwife good or bad? As a student midwife during labor and delivery they do fetal heart tones, get things for the mother, do assessments on the mother etc. Though they may not actually "catch" the baby every time, they are not just sitting back and observing. Yes, I agree that the more births one is able to witness and attend will increase that student's knowledge whether in a hospital or in a homebirth setting. But that doesn't mean that the CNM student will be better than the CPM student or vise versa.

A person could be involved in 50 births a month but if the preceptor doesn't teach well as to why things happen that student may not have the experience as a student in a homebirth situation that has a good preceptor that talks to them about what is going on and how to deal with things that came up during the birth.

Bottom line: It still comes down to the preceptors teaching and the students ability and willingness to learn NOT the number of births that are ultimately attended. I do believe there are times that a hospital birth is best. It must also be understood that the hospital and medical fields philosophy of birth is much different than the Homebirth midwifes view and philosophy of birth, thus a person should choose the education based on what they believe about birth and which philosophy best agrees with what they believe. And then find the best education available in their course of choice. I do not believe either type of training is best for everyone.

November 8, 2011 | Unregistered CommenterTAL

You offer a good argument, but I'll go on to say that the hospital/CNM-trained midwife still learns more because they go through more preceptors/teachers than homebirth/non-nurse-trained midwives do. Homebirth preceptor-ships that don't swap apprentices around tend to become quite incestuous practices, each woman having the same blind spots and strengths. In the hospital, there is cross-pollination that simply cannot happen in the homebirth setting.

And it's rather myopic to think that CNMs don't also attend to women throughout the pregnancy. Many, many more than CPMs.

I do feel there is room for a homebirth midwifery education, but it isn't in the system we have now.

November 8, 2011 | Registered CommenterNavelgazing Midwife

I do believe you have a good point in that it would profit a midwife student to attend births under multiple midwives. I can see how only being under one midwife could cause blind spots. And you are right that in a hospital there is more cross pollination as you call it.

I am sorry that I misspoke. I know that CNM's do prenatal care. I was referring more to the students, because it sounded like in the post that the main training for a CNM student is when they attend lots of births at the hospital not the prenatal care that goes into the mother before hand. So please forgive my misspeak on that point.

I am not in formal midwife training currently. However, I do feel called to be a midwife at some point in my life. I personally will not be going through a CNM program, though I think you have raised some valid points and ones that I will consider once I start looking into a CPM program. Thank you for the dialogue and hearing me out.

November 8, 2011 | Unregistered CommenterTAL

Love talking, TAL. Anytime.

November 8, 2011 | Registered CommenterNavelgazing Midwife

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