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Tuesday
May102011

I Believe...

I've been asked a few times why I left homebirth midwifery for monitrice-doula service and I thought I'd clarify for those that think I left because I no longer support out-of-hospital birth. Nothing could be further from the truth. And while "truth" is typically black or white, for me, life includes grey, which often comes across as contradictions. "I know; life's complicated," as Annette Bening's character in The Women says. I concur.

And, as is a woman's prerogative, I reserve the right to change my mind at any time, without notice.

Therefore, TODAY:

- I believe in out-of-hospital birth.

- I believe in homebirth.

- I (grudgingly) believe in a woman's right to birth where and how she chooses, whether that is an Unassisted Birth or a scheduled woman-requested primary (or otherwise) cesarean. 

- I believe certified nurse midwives have a great education and skills foundation by the time they call themselves CNMs and are practicing independently. I believe CNMs are blessed/lucky to have a collaborative relationship with OBs and are able to write prescriptions. That doesn't mean I don't acknowledge the limitations of CNMs, especially with regards to supervisory relationships with OBs. And having to pay malpractice insurance. And having a harder time doing homebirths if that is their desire.

- I believe there are some really great non-nurse midwives, but believe those women have learned through extraordinary means, the least of which is school and the standard one or two year apprenticeship. Experience cannot be underestimated when choosing a midwife. Choosing the least expensive midwife might not be the best way to choose the person you're hiring to keep you and your baby safe and, quite possibly, alive. And yes, there are always exceptions.

- I believe non-nurse midwives could use some increased education and skills requirements before they go out on their own.

- I believe pre-admission education for Certified Professional Midwives needs to be added.

- I believe there are a handful of MEAC-accredited schools that adequately educate student midwives... going above and beyond the basic NARM requirements :Nizhoni (points off for mis-formatted website), Florida School of Traditional Midwifery, Birthingway College of Midwifery and Bastyr University... schools that cost $20,000 or more and require more than the standard three-year committment. 

- I believe the "minimum standards" either need to be higher or eliminated altogether, leaving the expectation of a fully-trained midwife who, once she has a license in her hands, is not a danger to others. (I am not alone in this as the latest information from NARM demonstrates.)

- I believe women wanting to be a midwife should not choose a program because of it's low cost and speed of graduation, but should have a goal of more school and more experience in order to serve their clients better and more safely.

- I believe Continuing Education requirements should be more stringent, the cost be damned; the added education should be invaluable and worth every cent.

If I've forgotten anything, I'm sure you'll let me know.

So, there you have it. What I believe today... did yesterday... and probably will tomorrow. We'll have to wait and see about the day after that.

Reader Comments (38)

Dearest Barb,
You are an amazing and inspiring woman. Life has so many shades of grey but birth is one of these areas where people like to qualify things in a dual way that does not allow for perspective. I was recently reading a book written in the 70s by a woman who trained as a doctor but became a herbalist and lived in a remote mountain area in BC, When time came for her to choose where to give birth it was hard, she leaned towards the "safety" of a hospital setting but felt patronized by her OB. She ended up giving birth at home with a lay midwife. It was a life-changing experience but she has a subtle way to talking about the challenges of her situation as a former doctor, a feminist, a believer in the power of women and their bodies. She talks about her doubts and how people around her misinterpret her questioning the safety of a homebirth. You would love her really I'm sure. When I work as a doula, I feel that I help mothers more in the hospital setting than when they birth at home. I cannot turn those mothers down. Some really need the medical assistance and despite all the interventions, some manage to have truly beautiful births. We need to help each other as women, whatever way our sisters choose to go. The more we fight amongst ourselves about "who is right", the less we are able to really make a difference in maternal health. So THANK YOU for being who you are, a true, honnest and whole person.

May 12, 2011 | Unregistered CommenterElodie

Ooooh, I was hoping you'd include Certified Midwives, since they lie between lay-midwives and nurse-midwives. I was just accepted into a CM program at Philadelphia University. I will receive the exact same education as those in the nurse-midwife program, I just won't have a nursing background. And, at least in NJ, won't be able to prescribe meds (can administer meds, though). Of course, I will be working on changing the law so that we can prescribe. I am really interested in your thoughts on the CM pathway! :)

May 12, 2011 | Unregistered CommenterJen B

This is one thing that Dr. Whatsherface got me thinking about and it's something I feel pretty strongly about. The school I've chosen, I did because it is accredited, has a long history of an exemplary, well rounded education by not only midwives but lots of other practitioners as well. I'll spend two years doing pre-requisites before I can even enroll, and I *like* that. I am actually proud that I need to have what almost amounts to an AA before I can start this program.

For years I've been hearing from aspiring midwives who look for the lowest cost first, length of time second and quality seems to fall somewhere in there near the end. How cheap can I do it, how fast can I do it, and can I live with the philosophy?

Two human beings' lives are going to be in MY hands. The midwife I assist had a rare emergency arise and without pause, she jumped right in and took care of business and kept the client alive AND stable. (Being alive is not good enough!) Because of her education I have full confidence in her ability to deal with what arises when we are in vigil with a laboring woman, or newly postpartum family. I can't say that other programs give me this level of confidence, at least not the ones I'm most commonly hearing about.

Maybe I am biased, and I am not saying that my program is the best there is, but I know it's one of them.

May 12, 2011 | Unregistered CommenterKristina

ACK! Forgot the CMs! How could I?!

I *love* the CM programs... really, really wanted to go through one, but finally accepted I just wasn't going to be a CNM/CM and to figure out what to do as an LM/CPM.

I'm so sorry I forgot to add them. Let me consider adding CMs in the piece. Thanks for the reminder!

And congratulations! I can't wait to hear about it as you go along.

May 12, 2011 | Registered CommenterNavelgazing Midwife

Barb, thanks for remembering! I swear, it feels like CMs are the red-headed stepchild of midwifery! LOL So many people don't even know they exist. Like you're either a CNM or lay (CPM/LM/DEM/etc.).

So, do you consider us lay midwives? We don't have a nursing background, but damn if they don't make us make up for it in all the prereqs (its almost a page long at our school, and they are picky about the quality of the credits they accept, I went round and round trying to find classes that would meet their standards).

Can't wait to hear from you on this!!!

Jen

May 12, 2011 | Unregistered CommenterJen B

I know you said you support out of hospital birth, but do you believe it is just as safe with a proper attendant? Do you think there's a difference between home and a birth center? Where I'm going to have my next baby, there are many CNMs that do births anywhere and everywhere and I'm having a hard time deciding if I want home, bc, or hospital.

May 12, 2011 | Unregistered CommenterBrie

Hi there Navelgazing Midwife! Enjoying your thoughts all all things birthy. I did notice, however, that you did not include Maternidad La Luz on your list of great MEAC schools. Is there a reason why? I am thinking about that program. It is super intense, but I think give great experience also with women with diverse health and social needs (from Mexico mostly). Thoughts?

May 13, 2011 | Unregistered CommenterLookingForward

It does make me wonder sometimes why there aren't more stringent academic requirements for CPMs. I really do understand that there are women for whom traditional education is burdensome and impossible, either because of upbringing or learning style. Then again, there are a lot of things that can't be learned in any other way that midwives need to know! I'm experiencing this right now at Nizhoni as we tackle microbiology and genetics. I have undergraduate degrees in biology and chemistry - I was bound for medical school when I realized that becoming that OB was not actually as woman-friendly as I had previously thought - and I will admit that I struggle a bit with maintaining a connection in classes that I've already taken at the university level.

However, there are other women in my class who know so much more about birth than I do! I've never given birth, and many of my classmates are mothers. They have been there in labor land, and come back to tell the tale. In many ways I often feel that I am the least qualified of my classmates, as I have been trained (and my personality tends this way anyhow) to approach everything as a scientific question that can be solved through rigorous observation and problem-solving. It's an interesting dilemma, since several of the women in my class have stated that they categorically hated formal schooling and did not thrive in that sort of environment, but now they are getting that background education that I, coming from an academically-minded family with the intention of being a doctor, learned in high school.

I don't know the answer to this, but it's an interesting thought-debate: If women deserve to have midwives who are capable, intelligent, and deeply caring, then can we really afford to be closing doors rather than opening them?

(I also wonder how I would react to this post if I weren't sitting pretty with my magna cum laude science degree and high MCAT scores. Yet another interesting thought to ponder.)

May 13, 2011 | Unregistered CommenterEmily D.

I know, it's a dilemma. My observations aren't to make anyone feel good OR bad, but what I believe after being in the birth community for almost 30 years. Even those who don't have ten tons of book learning can apprentice with a variety of midwives to learn that way. Learning from one midwife creates black holes of knowledge... and learning from midwives who learned from the same "family tree," perpetuate those black holes. I've said this for years and years... *knowing* I also had black holes of knowledge, mostly from the learning I did with docs, nurses and CNMs, sometimes the most basic of midwifery knowledge missing (suturing, for example). I also had black holes from not learning/reading about the tough subjects like A&P or biology... things that didn't remotely interest me, but that, as time passed, I realized, "Holy shit! I really need to learn this stuff!" and either studied on my own, tried to pick other midwives' brains or prayed I didn't need the information in the moment (if I did, I wouldn't have "guessed," but would have called in another midwife).

However, there comes a place without formal education that says, "How do I know if I don't know I don't know?" A formal education by a reputable school *covers* those bases in a way apprenticeship might miss.

Re: not birthing yet, you have distinct advantages the others don't (no childcare issues, etc.), but I will admit, if/when you have kids, dollars to donuts, your practice will be transformed. I've seen it over and over again. Even in our own community! Doesn't mean you plow forward in despair, but that you stay in the moment and embrace who and where you are today. You're doing great!

May 13, 2011 | Registered CommenterNavelgazing Midwife

Barb,

As a student midwife I agree with a great deal of what you propose.

I was enrolled in an online program and found the pace to be so fast that it was not possible for me to absorb foundational information key to midwifery . Though this wasn't the reason I ended my relationship with the school, it was a huge concern as I am the sort that wants to get my money's worth when making a considerable investment in my education. There is a great deal of work to be done in establishing MEAC accredited schools, and accelerated programs for aspiring midwives does not seem to be the most responsible way to educate.

My greatest disagreement with your proposal is the comparison between the qualifications for entry level CPM's and CNM's. I am surprised that you feel that CNM's have such an understanding of labor and birth upon graduation that their education process should be viewed as a model for CPM's.

As a disclaimer: I am a newby, having viewed fewer than 50 births most of which were clinic/homebirths under 5 different well-seasoned midwives.

I have seen a small number of hospital births under nurse midwives and find their understanding of the birth process to be limited to the administration of drugs and a narrow view of what is "allowed" during birth. I watched a nurse midwife slap the hand of a mother away from her child's crowning head in the name of "protecting a sterile field". What kind of program graduated such ignorance on such a small matter? Most education programs, whether accountants or teachers, graduate people with entry level skills. Experience is what makes a true craftsman. Is it not enough to recognize that CPM's are scrutinized in a way that no other trade on the face of the planet is, and hold fast to the apprenticeship model of training new midwives?

"Black holes" in the education system also exist in the modern college classroom. People get out of their education what they put into it.

I do not want to be a CNM. I will not fit in a hospital system. It is difficult for me to doula my mommas when they are brutalized, demoralized and generally condescended during their birth process. Why then would I want to be educated through methods that produce caregivers who practice in this manner?

Do I have strong feelings towards the hospital system and those who operate therein? Absolutely, and with good reason according to my experiences in such a short time. Do I think we can co-exist and move towards a unified goal? Absolutely not. Things that are different are not the same. I saw previously your post about "med-wives". While I support civility, it is impossible to compromise the care of mother's in the name of getting along. A "med-wife" is not defined by the action of intervention, for intervention can be necessary and quite merited. A "med-wife" is defined by a perspective, an attitude towards birth. The inherent fear of birth, the need to control, the lack of confidence in and for women.

Your posts about CPM's have bothered me lately, not because I don't want quality education with high standards, but because it seems (to me) that you would prefer that future midwives take the mainstream path of the nurse midwives. This tone (and I realize this may not be your intent, but the filter of my perspective) is terribly discouraging to me as I look up to you and endeavor to get through my studies.

What have you experienced that directly influences your beliefs about midwifery education? Post a link if you have already written about this. I try to keep up, but may have missed it.

Acckkk! Baby is crying, gotta go. Hope this is coherent with heavy editing.

Thanks!

May 14, 2011 | Unregistered CommenterElly

I come from an interesting perspective. I have been studying midwifery since the age of 13, and really enjoy studying. I've given birth to two children at home with CPMs. I have gone to the border to learn skills. I've started two didactic midwifery programs and realized they really didn't help me along, so went the PEP route. I had two primary births left to be "done" before taking the NARM, and had apprenticed with various midwives of different backgrounds, before a family crisis forced me to quit. Several years after, the prerequisites to the nursing program completed, I enrolled in an RN program. I just graduated, and am waiting to take the NCLEX. I've learned that although nursing education covers a lot of stuff you *don't* need for OOH midwifery, more often then not I feel like everything I have learned is applicable. I have a deeper respect for charting and record keeping. I have a deeper knowledge of the pathophys of disease processes and normal functions - this is especially relevant with complications of pregnancy. Medications and IV therapy - I don't fear how to use these *when needed*. Even if I don't have to dig in my toolbag for these for the majority of the women I would serve OOH, I get it. I have a better basis of interaction with medical staff, doctors, etc. Even caring for the dying old man with alzheimer's helps me integrate the needs of the whole person, the whole family, the whole continuum. Most of all, I feel like every person that graduated with me I trust to have the knowledge and skills to be an entry-level nurse. Do I feel that level of confidence with traditional midwifery education? No. It's only after going through more education that I truly realized how much I didn't know - and how incredibly close I was to being legally able to serve women on my own (now, I had planned on working with an experienced mw for all births, as I think this is the safest route, but this is an aside). There is definitely value in a structured, educationally sound program and a solid basis in A&P and patho, combined with an appropriate and progressive amount of practical skills (clinical).

May 14, 2011 | Unregistered Commenteralmost-rn

Well-said. And I concur (obviously). Congratulations on your hard work! I know your vantage point will serve you well. And I agree that *everything* in nursing school is applicable to midwifery. E-ver-y-thing.

And no, I do *not* think every midwife should necessarily be a CNM. If I were the Queen of Midwifery, I *might* make it so, but I'm not, so having another type of non-nurse midwife seems to be going to hang around. I *really* like the CM program and *that* is the model I'd love to see become the standard education process.

To reiterate, I chose the schools I did because they went above and beyond the NARM requirements for their students to 1) get in 2) to graduate. They don't offer an accelerated program... something that is like an induction, speeding things along that are probably best left to unfold in their own time.

To Elly in particular:
You have hardly seen anything, so making such huge judgements at this point is rather... unfortunate? Unfair? Incorrect? Demonstrative of your intense bias? Possibly all of the above and more. I *highly* encourage you to shove those biases away and walk into birth completely clear and open to the experience. By setting yourself up for anger and disappointment, you serve no one... least of all your clients. The negative things you have seen were not the result of education, but of personality; be clear what is what before judging. That you think there will never be a place of cooperation not only saddens me, but really makes me feel sorry for your negative viewpoint... your cynicism so freakin' early in the game. Very sad.

You ask what I've seen that makes me make these comments, have these beliefs. The answer is: enough.

May 14, 2011 | Registered CommenterNavelgazing Midwife

Oh, and Elly... you said, "Most education programs, whether accountants or teachers, graduate people with entry level skills. Experience is what makes a true craftsman. Is it not enough to recognize that CPM's are scrutinized in a way that no other trade on the face of the planet is, and hold fast to the apprenticeship model of training new midwives?"

It is a WHOLE lot different having an accountant with entry-level skills and a midwife with entry-level skills... she is being hired to keep two HUMANS alive, not someone's stupid IRS form. Entry-level for midwives shouldn't be the meager number of observes, assists and catches there are now. In fact, there aren't even "observes" as part of the requirements!! Did you read the link I put to the NARM questionnaire? In there, you will see how many others also think the education is severely lacking and *must* be improved if we are going to be taken seriously.

Please do not *ever* compare a midwife to a lay occupation again. If you want to compare us to someone that isn't in the medical field, choose a cop. Do you want a cop with "entry-level" skills? Or do you want someone who can save your life on the first day of his/her shift. THAT is the comparison to make.

May 14, 2011 | Registered CommenterNavelgazing Midwife

Though I agree with you that many CPM programs are currently lacking in vital education to be truly safe birth providers, I wonder if you think only -nurses- should be come midwives, or only women with -nurses educations- who apprentice under midwives should become midwives?

The CNM's at the Ob practice and then hospital that I delivered were not evidence based, they were burnt out and practiced like burnt out nurses. They were never "with me" during 99% of my pregnancy or labor. They were not with women, they were lazy and were actually more intervention-minded and listened to me less than --the OB's-- did! I found myself questioning whether I should've just gone with creepy OB. He at least respected my wishes for a vaginal birth and didn't assault me at any point, however innappropriate some of the comments he made were. I think I honestly would've taken the auto-episiotomy over what was done.

I am thinking, you think CPM's should have something closer to an RN's education, but I think their apprenticeships should be differing. To become experienced.. many a CNM ends up compromising her views to fit into the OB and hospital world.. which is full of restriction of mind and of practice and eventually makes some of them hardened beyond a pale.. and judgment clouded by over-zealous interpretation of "data" and of "hospital rules".. they lose their midwifery base and fall into burnt-out land.

I mean. It was CNM's that offered me an induction at 38 weeks (FOR NO REASON), CNM's that told me I "needed to do something if I hadn't delivered by mid-week" at 39 weeks 4 days pregnant, a CNM that played the dead baby card at 41 weeks (when NOTHING WAS WRONG), CNM's that couldn't figure out my child was posterior in labor, CNM's that freaked out and thought I needed a c/s when I did not, a CNM that ignored the crap out of all of my requests during the birthing process and violated me, a CNM who made incredibly insensitive comments about my child ending up in the NICU due a "hospital-acquired infection" (which I've recently discovered may have been a sham, because of the way the lab testing reads) and in my opinion hospital-caused electrolyte imbalance and breathing trouble (he was breathing fine until this one nurse deep-suctioned him for pooping all over my vagina.. AFTER he'd slid out according to my medical record), CNM's that missed severe PPD and PSTD. Hell, the CNM's never even did any check-ups after besides my 6 week. I never saw a bleeping one of them in my room after my unnecessarily brutal (brutal because of all that pit and being restricted to positioning they wanted and all the crap they did to my vagina) posterior delivery. I saw the OB, that I had requested I not see, because he made innappropriate comments to me during an exam. He also made innappropriate comments about my breasts during my post-natal exam. CNM /=/ good birth care provider. I feel like I would've been better off in a ditch.. and they are who .. if I were to go back to school and finish the RN program (I was half done with it when I quit because of philosophical reasons, I had a 4.0) and then go onto further education in midwifery , they are who I am supposed to try to emulate and look up to?! No. I'd rather not. I'd rather poke myself in the eye with a stick a million times than answer to one of those women. And, I pity anyone who eats the knowledge of out their hands like it is candy.. simply because they've caught a lot of babies and likely ruined just as many births. I'm not saying there aren't CNM's out there that are just .. awesome.. but I would not sit in awe at someone capable of getting a CNM and necessarily scoff at someone who chose CPM over it. There may be very good reasons and intelligence and level of knowledge doesn't HAVE to be those reasons at all!!

If CM is some sort of crossroads between the two, then, I agree that is ideal. I definitely don't see CNM's as necessarily ideal.. as it seems too easily rife with burn-out.

May 15, 2011 | Unregistered CommenterElElRi

I'm finding the last couple of threads' comments interesting in how they criss cross each other. The CNMs are evil. RNs are the devil's work. CPMs suck royally. OBs are horrible people. It's been quite a study watching and reading the reactions to the posts.

If anyone thinks I think ANY kind of obstetric provider is perfect, you've misunderstood. Just like in life, there are good and bad with every profession. We can *always* pick out the shit, using them as the example to our story, but when (as Bette Midler sings) we look at things "From a Distance," what do we see then?

I am also not so ignorant to know that a person's vantage point has a great deal to do with what things look like, how a certain profession looks to them.

And experiences... for ourselves, our sisters, our neighbors, in the news... it goes on and on. I acknowledge that.

I think the easiest way to say it (and I thought I did) is to say more education isn't a bad thing and is probably a very *good* thing.

Being burnt out isn't a CNM problem. It's a *staffing* problem. Being rushed isn't something that's taught in midwifery school like how to measure the diagonal conjugate. Real, everyday issues creep into every aspect of our lives. I know that I do my best to serve women without allowing the extraneous stuff affect the service. I *know* it has in the past and all I can do is try my heart out to not let it happen again.

May 15, 2011 | Registered CommenterNavelgazing Midwife

I was on the ACNM website today and noticed there is a motion to change the name to American College of Midwives. I am excited about that! CMs are certified by ACNM, but the name implies that we aren't.

And judging by the comments on here (and I have noticed on Midwifery Today facebook page too!) it is sorely needed.

I think CM's deserve their own post! LOL Too many people just don't even know that is out there!

May 15, 2011 | Unregistered CommenterJen B

I personally don't think that a midwife needs to be an RN, but I do think that a broad base of A&P/Patho/Microbiology and a structured educational process with progressive clinical experience should be mandatory - and perhaps modeling all direct-entry midwifery programs after successful ADN programs in length, clinical hours & prerequisites might be a good idea. This does become difficult in getting midwives trained and practicing in their home communities, but this is the same problem with physician training. I also believe that a broad family practice/public health knowledge could be helpful, as traditionally most midwives weren't just birth attendants but community healers and you will find in your practice that your clients will ask you about their sick mom or kid or heck, their dog.

Something that I've also mulled about is making a requirement to plan on attending all births with an experienced midwife for some amount of time (although, as stated before, I think this is a safe practice all.of.the.time, you never know when a baby is going to need resusc and a mom is going to bleed, and two pairs of skilled hands are essential in this rare situation).

Also, it bears repeating, I've worked with wonderfully caring and progressive OBs, forceful & interventionist CPMs, and every range of in between. It's not the title after your name that makes you the care provider/person you are. I did find that nursing school has made my charting and clinical interactions much more succinct and professional. This is vital for midwives as a profession if we ever want to be treated seriously.

May 15, 2011 | Unregistered Commenteralmost-rn

Barb,

Didn't you suppose that I had legitimate reasons for the way I felt? It seemed a little weird that you jumped all over me for being

"unfortunate? Unfair? Incorrect? Demonstrative of your intense bias? Possibly all of the above and more."

instead seeing through the emotion to the person/experiences behind the words? I thought talking to you would be a great way to work out kinks as a new doula and student midwife (I am part of the "us" too) but instead you tried to rip me a new one. My heart desires to learn, so I can take the truth in your harshness and weed out the rest. I guess you just thought I was on the mindless bandwagon of stupid homebirth hippies and I should just fall in line with the program. That's o.k., I get that a lot in the hospital. I still love you and I'll always read your blog :)

So here is my rebuttal:

You are right that I have hardly seen anything but what I have seen, including the experience that I had with the birth of my first child, has been a very scary and hard thing for me. Where once I didn't have a fear of the hospital, I now do.

My first baby was born in FL, I was transferred to the care of a perinatologist (friend of the LM) for pre-eclampsia at 41w6d. Labor was actually rather quiet and uneventful, the nurses only laughed at me twice for not accepting meds. Pushing for that labor was spontaneous, the lovely overbearing urge that feels good. I asked the OB if I should "blow through" the stinging I felt and she shrugged her shoulders. Even in the midst of pushing, her response hurt my heart. Long story short, I didn't want a lot of the traditional odds n ends, and it irritated a pediatrician. If she would have asked my reasoning, I would have explained it. My son was jaundiced (and he was pretty yellow) but I found it pretty understandable as he had a whopping cephalahematoma (posterior asynclitic) (and I asked for Vitamin K). His cord was cut super fast too, which may have contributed?? Anyways, they did do a blood type to rule out blood incompatibility, and that wasn't the problem and I wanted to go home. Baby was well, eating, peeing pooping...acting like a newborn. I volunteered to bring my boy in to have the jaundice checked, but said "we will nurse like crazy and it'll be gone in a week. I had been at the hospital 24 hours and wanted to leave. The pediatrician told me no and said she would call OCS if I left. That threat stayed with me in my head for the next 6 months, it haunted me that a medical person could threaten to have the state step into my home, for no good reason.

After speaking with administration at the Baptist hospital they let me go home, with the agreement that I would have his heel stuck to check his bili levels, for the next 3 days. I reluctantly agreed and was urged to follow through with the reminder about OCS. I told the nurse liaison that I thought being a parent meant being prepared to make decision for your little baby; I made educated decisions and was being punished for them less than 24 hours after the birth of my son. She apologized and said she wished they had more moms like me (I don't think the nurses and MD's agreed!).

The worst part of the whole nightmare was that my little Noah Michael had something terribly wrong with his leg. The pediatrician shut me out of the nursery when she did the newborn check and missed hip dysplasia while she was focused on controlling me. My baby spent 2 weeks with a dislocated hip and it was hell on earth. THEN I tried to advocate for him at the pediatricians office and the pediatrician told me I was "too overbearing" that I just needed to "stretch his leg out because newborns hold their legs in close often" and proceeded to stretch my baby's leg flat. The man proceeded with the move and Noah screamed and turned purple. It was a sound that I will never forget.

2 weeks later my hubby and I were desperate because there was obviously something wrong so we tried again with the pediatrician. He took x-rays and lo and behold there was a dislocated hip and a broken femur...and he tried to blame us for it.

In the end my son got healed up and now sees Shriners once a year, but he deserved better than that. It took years for us to be o.k...our hearts are still healing.

On the contrast, my baby girl Isabelle was born in front of my bedroom window on a beautiful July night in AK last year. On her birth announcement for her midwife, all I could write was "No regrets, only peace". I almost caught her, but got an overwhelming sense of "stuckness" so I rested my legs on the wall of the tub and told my midwife "I need help" . Isabelle had nuchal hands, both fist were by her shoulders. A little nudging from the midwife, pushing from me, and rotation from Isabelle and she was home. That transition was mind blowing and pushing hurt, especially when the midwife wiggled her :)

I have seen an emergency rupture of a placenta previa and watched the staff let my SIL sit for 2 hours while she drenched sheets every time she coughed. I have seen an ER doctor tear into a midwife for a situation that she had no fault in. I have seen doctor's and nurses criticize women for their choices, comment on their attractive bodies during contractions, refer to their babies as "ours", hound women for not wanting Hep B shots, completely ignore a miso induction that was uterine hyperstimulation (it was like watching 3 hours of transition...and I suggested the epidural), and watched a nurse hold a mother in a triangle for an epidural while she was in transitioning. There was nothing I could do to stop or intervene or support the women..I could only be there for the fallout.

In all honesty, I haven't seen any of this stuff happen outside of the hospital (and most of what I have seen has been homebirth). The closest it ever came was when a student midwife chattered at a mom through intense contractions and I finally asked her to please wait a minute.

My experience pales in comparison to yours, but if this is what I have seen and experienced in 4 short years, what else is out there? Becoming a CNM was a huge possibility for me before my son was born, I was a pretty clean slate as far as birth politics at that point. I didn't form my opinions of the hospital from distant stories, I lived them. I had a good bit of book learning at that point, but that was simply because I bought medical textbooks and devoured them.

I concede your point about comparing trades. That obviously offended you and wasn't my intent. It was a poor comparison to make my point that there always has to be a beginning place and mistakes will be made, even with higher academic/clinical standards. Don't be mad at me (gosh I don't want to raise your BP!) I felt a little like target practice there :(.

It stinks that the laws are the way they are, and there is such a bummer attitude towards natural birth. My utopia would be training under OB's, CNM's and CPM's and gleaning their different perspectives while learning foundational didactic work and getting plenty of births in all 3 birth scenes. I don't see it happening anytime soon.

One thing I cannot agree with is that there will be a unity. There are OB's in my town who will always condescend and oppose the midwives and there are those who will support them (there are 2 and one amazing pediatrician) because that is what is in their heart. All the logic in the world won't convince the first group (Marsden Wagner can't convince most of his contemporaries).

I'll plug away on my path and earn it just as the writer you congratulated, and you'll continue on your well-worn, hard earned path.

When I asked about what shaped your views I only meant was there specific bad circumstances that happened with midwives that impacted your direction or was it just your general gleanings from 30 years of doing this...apparently it was answer 2.

Thanks for letting me be in your comments.

May 16, 2011 | Unregistered CommenterElly

Elly, of course I knew you had legitimate reasons... I didn't doubt that for a second. And I really am sorry for your sucky/awful/negligent experiences... your own are bad enough, but you at least were able to speak for your child (even as no one listened). I *know* what it's like to stand by and watch birth abuse/birthrape and, as you might know, know the guilt and horror of being a perpetrator of such birth abuse.

Hmmm... don't think I was trying to "rip you a new one," but was merely being emphatic. It does make me a tad... erg... annoyed? impatient? when newer doulas or student midwives cement negative attitudes early in their education, closing out the value of learning/seeing such common examples of hospital procedures. It doesn't negate the disgust at all, but *trying* to see the good side offers more fuel for your passion than hardening of the heart for what 99% of women *might* see/have in the hospital. I'd *love* to see newer doulas/students peek through the cracks and design ways to make moms' experiences positive, blessed and one they find empowering. It doesn't mean ifnoring the shit *at all*, but it does mean not seeing *everything* through the veil of previous crappy/cruel births they've seen.

That said... I am *not* saying YOU *are* doing that, but that I *hope* you are not doing that... and what I wrote to you was imploring you not to.

Oh, and my BP is fine; no worries there. This type of discussion is pretty common in my emailbox and even here/on FB. I don't want to discount/negate your (and other doulas'/students') experiences AT ALL. I am merely reminding you there *are* other ways of looking at things and to please, please keep an open mind about the lessons... spiritually/universally and technically... that are unfolding in front of you.

You may *never* see another <fill in the blank> again; pay attention to what the staff is saying and doing to and for the mom. Pay attention to WHY they were ignoring a woman who you see is having a medical problem. *Listen* to what they are saying so you can 1) research more about it later 2) ask other more experienced midwives/nurses/docs WHY this or that happened 3) meditate on how you supported mom and how you might have done things differently (at all) 4) and this is crucial for student midwives, *think* about how YOU would handle <this situation> in a homebirth.

And Elly, while I was totally speaking directly to you, I was also seeing the many doulas/student midwives that will one day read the same words I was writing and that it might cause them pause to consider the variety of angles from which to see a particular birth. You were a great foil for my message... emphatic as it was.

And I *really* REALLY want to thank you for continuing the conversation and not slamming the door and huffing away. That means a *lot*. Really, really.

Re: what I have seen personally, I have written about these things through the years...

http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2004/7/8/birth-rape-and-otherwise.html

http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2005/12/12/postpartum-abandonment-by-midwives.html

... are two examples. There are *many* more and I have to gather my strength (of character/of not giving a shit what others say) before I can disclose things. That's why I'm talking about Sarah posting things after I die. I'll be totally brave then.

May 16, 2011 | Registered CommenterNavelgazing Midwife

Barb,

The birth of my boy left some pretty serious scars on the two of us, and it affected my work in a way that I wasn't willing to admit because it was too emotionally painful to see up to this point. Here is the conclusion of our discussion that I had to admit to my hubby as I helped him load his truck this morning:

When we had our first baby, I stood up for us the best way that I could and it wasn't good enough. I was articulate, educated and persistent about my views. In spite of my efforts my baby spent his first month in agony and our little family suffered. It is terrifying for me to open my mouth at births now and I have all but lost my ability to articulate and converse with hospital staff because I can't handle the thought that my intervention would cause a caregiver to lash out and inflict wounds on an innocent infant. I am essentially paralyzed and I have to either get over it or quit. *enter sobbing wife and poor husband trying to hug it all away*

So I have some decisions to make....

The miso induction produced a college-quality research paper from me on the subject. What astounded me about that particular situation was that upon summoning the nurse from the station to discuss the epidural, I casually mentioned that those were "killer contractions" and she flippantly said "oh yeah, that is pretty common of miso". I couldn't even find a response to that. My client, a tough and dedicated woman, was enduring 60-90 second contractions, barely getting a minute break between them, for 2.5 hours. How is this safe, how is it humane? Miso is powerful stuff and is leaving a trail of destruction as it becomes more powerful. There are several good reports from the Cochrane Review that reflect some serious concerns about its veracity as a method of labor induction. There have been enough * reported * maternal deaths associated to miso in the last 10 years that researchers are for once considering the "anecdotal evidence" that supports discontinuing usage for inductions. Many of these deaths fall into that 28 day window following birth and are related to hemorrhage, embolism and internal damage. Wicked potent drug. I still have no idea how to have supported her better. She was in the shower trying to cling to the tile walls when I asked her what she was thinking (in order to not put ideas in her head but let her choose her path) and she simply said "epidural" I was down the hall in a split-second getting her nurse :)

I am 110% for better education standards. The development of the CPM has come so very far, which thrills me, but I am not blind to the downfalls. I am very concerned about midwifery becoming the business that Obstetrics is, as well loosing the apprenticeship model of training. Midwifery is too precious. Preserving the right start for families is too precious.

Stomping away is for toddlers :) real women talk it out, no?

Blessings,

elly

May 16, 2011 | Unregistered CommenterElly

Contractions, in transition (7-10cm or so) are *supposed* to be 60-90 seconds long, sometimes with 90 seconds between them. Cytotec contractions can totally suck and your lady's might have been too much (I wasn't there) and I swear, as I am sitting here, if I had to be induced, I would ask for an epidural first. I had a pit induction with Tristan and it was HORRIBLE. Epidural wasn't an option in the olden days; I had 2 shots of Demerol that did nothing but make me mute outside; my inside screamed bloody murder. I admire women who can endure inductions w/o meds. I'm just not one of them.

One thing you might say in a similar situation with the Cytotec client is, "My client seems to be having a hard time coping. Can you offer any ideas to help her?" She'll certainly say "epidural" and you can say, "We talked about that, but she says she's not ready for that yet. Anything else?"

And I don't think I would *ever* say anything like "My client's having killer contractions." 1st, the word "killer" is a REALLY poor choice of words in an L&D ward/a litigious situation and 2nd is you are making a clinical judgement about the intensity of her contractions. If mom was on the monitor, they were watching what was happening and could see for themselves how close they were and how intense they were. If the contraction monitor wasn't showing the huge spikes (because of poor placement or the monitor wasn't zero'd out), *that* can be a great time to say to the nurse about your client not coping well with the contractions and could she please check on her to see if you're missing something about helping her. By putting ALL the "fault" on yourself as a doula, the nurses feel they are helping... the reason they got into the profession. You quickly learn if you're a PITA, but almost always, the nurses don't mind helping a mom who isn't too needy.

You did GREAT in going to the nurse for your client... that was a tender and compassionate thing to do. Next time, you might try a different tact. You weren't "wrong," just the wording could have been a tad different.

Hope it's okay to critique/offer alternate ideas to your situations. If you were cool with it, I'd LOVE to take that exact comment and explain WHY to say what I would say (just like I just did) as a doula. I think doulas would totally learn from it. And I soooooo love to teach! Thanks for that. :)

May 16, 2011 | Registered CommenterNavelgazing Midwife

Barb,

I think that is a great idea, use whatever you would like.

Here is the problem in that paticular situation: Mom wasn't on a monitor she was doing intermittent (every hour) which I didn't think was allowed with the miso/cytotec induction because of the wild varieties of results that it creates.

The nurse obviously recognized the potential of the drug, and that is what threw me by her response. I didn't recognize the wording of my statement and litigious connotation as incorrect, but that makes a lot of sense. Your point about the "judging" statements is also right and I need to adjust accordingly (although my statement was more about the drug than the woman, but you'd have to be inside my head to get that. Unfortunately I am the only one who has that honor). I have been to 2 classes that covered healthcare communication and this is not new to me...Boo for me.

I should probably have told that story with more start to finish detail, as I fill you in hindsight. The problem with the timing, length, intensity of the aforementioned contractions was that, just before the epidural, momma was on the toilet and I saw her transition (and told her as much) I saw the demeanor, the shakes, the change in sound and knew that she was completing. I was a smidge confused up to that point because here cxts were transition like for the previous 2.5 hours, but the rush of staff never appeared :). My biggest regret in the whole thing was failing to ask the nurse to check her again before the epidural (1 hour had elapsed between the request and the initiation of the process). How that woman climbed on the table and was able to allow the nurse to hold her down for the epidural while in transition is beyond me. Of course, they checked her about 10 minutes after the epidural and was pronounced complete. When then sat there for another hour so 1 more round of antibiotics could be administered for GBS.

Momma has PCOS and seems to be one that needs induction, but stated she will never again go the miso route. This was baby #2 and miso did nothing the first time so she had a pit induction...who knows what happened there.

May 16, 2011 | Unregistered CommenterElly

I wasn't at this particular birth start to finish, when I showed up she was already in the land of crazy contractions. She later told me that she got the miso around 8, fell asleep, woke up an few hours later in the middle of a very hard contraction and called me. Here I thought she had just gone to her regular prenatal the afternoon before :)

May 16, 2011 | Unregistered CommenterElly

One of the things that I love about this blog is that I feel like everyone here is willing to listen and learn. I myself made a rash comment a few weeks ago that I quickly regretted, but never for a second did I feel unwelcome and I still follow NgM religiously. As a student midwife and a newbie doula, I can learn so much from the discourse of like-minded individuals here. I can learn even more from the (fairly minor) disagreements that arise, and I drink it all in!

I don't suppose this reply is adding very much, but I just wanted to thank NgM and her dedicated readers for holding this space as a place to read and think and talk about birth; REAL birth, the kind that's always messy and unique and never quite goes according to plan. :)

May 16, 2011 | Unregistered CommenterEmily D.

Thank you, Emily. :) That means the world to me.

May 16, 2011 | Registered CommenterNavelgazing Midwife

Hello there! I usually read your blog in my feed reader, but with this post, I'd really like to ask your advice.

First, a little background. I'm figuring my options for becoming a midwife, and figuring out my desired path and particularly deciding on CNM/ CM/ CPM has been one of the more frustrating decisions I've had to make in my life.

I don't desire to work in a hospital, but if I found a hospital that truly implemented the Midwifery Model of Care, I would. I don't have an ideological opposition to them. I'd be happy in a birth center, happy attending home birth. I don't want to practice routine interventions, but I want to be able to provide them or help my clients get them should the need arise. I'm not an extremist. I would like the best of both worlds.

I just want to end up with an education that REALLY prepares me. I don't think that I can judge a school by its graduates--everyone hears stories about the mini-ob CNMs and the incompetent CPMs, which seem to exist on both sides of the spectrum.

If I go to nursing school (I already have a B.S. and would easily qualify for an accelerated BSN with my science background) and then to a masters program, I'm very concerned that I won't get the understanding of "normal" birth. If I go the CPM route, I'm concerned I won't be prepared if a client transfers to a hospital. Or what if she also needs family planning services? Wouldn't it be great to provide true continuity of care?

Yes, I'm aware of the CM credential. I live in NYS at the moment, so it is an option for me. I don't know if I'm going to stay in NYS, though, so that's not particularly helpful.

I'm so sorry that this comment is all over the place. It reflects my total frustration and confusion on the best way to get my education, the best way to get solid experience. I've been beating my head against a wall since January, trying to figure this out, and I've finally gotten to the point where I'm just going to drop it until something becomes clear. I so strongly dislike this disconnect between the two approaches.

Ok, let me get to the point. Do you really think that Bastyr and Birthingway give $65,000/ $50,000 worth of education? I was told that, should I desire to transfer into a nursing program after becoming a CPM, much of my credits taken at MEAC schools won't transfer. After finally paying off my Ivy League education (which I don't think very highly of, to tell you the truth), I would seriously like to know what students get for their tuition dollars.

One more thing. I've almost completely decided on going the CNM route. I DO want the most preparation I can get. I DO want formal schooling (fine, it's not for everyone, but I'm an egghead and it works for me), and I want it to kick my butt. I'm NOT going to cut corners. BUT. I have yet to find a CNM program that can convince me that they provide their graduates with sufficient experience with normal birth. Let's face it: the majority of CNM grads work in hospitals, and that's how they're trained to work. Normal birth CAN exist in a hospital, but it's not the rule. I've also yet to find a CNM grad school that provides sufficient experience with home birth (Frontier being the one exception). THIS issue is what leads me to consider a program like MLL... in addition to a nursing bachelors and masters degrees.

My question: how would you recommend a aspiring CNM structure her education and experience to get enough experience in out-of-hospital, "normal" birth?

I'll stop now; this is long and incoherent. I'm sorry for that, and I'll gratefully read and appreciate any comments or advice you may have. Best wishes,
Nico
an avid reader of your blog

May 17, 2011 | Unregistered CommenterNico

Of course I just read this post:
http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2010/11/2/when-im-asked-a-question.html

I'll try to make my comments and questions more pointed and succinct. ;-)

(1) In reference to continuing education, you write, "The added education should be invaluable and worth every cent." I agree. But quite frankly, II can't afford Birthingway and Bastyr, unless I take out some serious loans AND that's the only training I do for YEARS, if not a decade. Can you comment on whether you really believe that these $60k+ programs are "worth" the cost (yes, this is a value judgement)? When you get a bachelor's/ master's from one of these schools, is that an equivalent to a bachelor's/ master's in nursing, e.g. will credits taken at an MEAC school transfer to a nursing school (I don't expect you'd know this)? Are you able to comment on other three-year CPM programs, like Birthwise in Maine?

(2a) Do you know of any CNM programs that actually support natural birth and/or provide sufficient experience in out-of-hospital birth?

(2b) I am concerned that if I become a CNM, my definition of "normal" will be skewed by the environment in which I learn. Do you think that concern is valid? If so, how can I insulate my heart from the attitude of fear while still getting didactic and experiential learning?

(3) I'd like to point out that this black-and-white discussion of CNM v. CPM, hospital v. non-hospital is INCREDIBLY frustrating to me, and I believe to many other aspiring midwives AND women needing our care. I'm willing to invest serious time and money in my education if I knew it prepared me, not just adequately, but exceptionally. I would LOVE to see a convergence of the academic rigor of becoming a CNM with the holistic focus of the CPM. So far, I haven't found a single educational path that's met my (admittedly stringent) academic, experiential, and financial requirements.

That's all for now. Thanks for reading and for any insight you might have. Best wishes to you!

May 17, 2011 | Unregistered CommenterNico

You've hit on one of the most maddening parts of this "process" -if we want to call it that. It borders on stupid that there isn't *A* way to become a midwife. I remember being baffled about the CPM process even as I prepared for the NARM exam! Where *are* the step-by-step instructions? None of "if-this-then-that" here and there crap, but a #1, #2, #3, etc. path to get where you want to go.

But that isn't what we have right now, so you're stuck with the system that's available... stupid as it is.

Your education is what you make it. Only YOU can learn about normal birth outside your education if you feel you aren't getting what you need out of midwifery school. It is fairly easy to acquire "natural birth" experience, MLL being one, sort of, but also with homebirth midwives; most would be more than willing to have you tag along for 6 months or so.

Otoh, if you were a CPM, learning the hospital stuff is a *lot* harder. Being admitted into ORs, learning how to rx and give medications and an endless number of other skills and knowledge will not be accessible to you.

Everything you say says you want to be a CNM. Your only concern is being brainwashed into not thinking birth is normal. Well, here in this country, one doesn't necessarily get brainwashed without our consent. And if you go on to be a CNM and don't see birth as a pretty experienced wrapped in a bow, as far as I'm concerned, you've only then begun to see birth as it REALLY is, not that you've been brainwashed.

We are ALL a product of our experience. Whether that means we only know homebirth or hospital birth. And if we want other experiences, WE have to create them, or create the opportunity for them.

If you stand at the fork and to the left is CNM, you'll see it filled with pretty houses and gardens and stores and schools, whereas to the right, there are a couple of pretty houses and then vacant, but sweet looking fields. There are *so* many more options being a CNM, but the options as a CPM outside homebirth are very few and far between. And why is that? Because the CNM education is standardized, clear-cut and a socially accepted path to being a professional. The CPM education is barely acknowledged and, imo, *totally* misunderstood by the masses. For goodness sake, if *I* couldn't figure out the path while I was ON the path, how do we expect those who don't even know midwifery to "get" what and who we are?

You want me/someone to tell you what to do, but I'm not going to do that. I *will* tell you to lay out the proverbial Pro and Con list and head on down the lists, looking at them once you've finished to see where your logic takes you.

Stay in your Power. Believe in your ability to see birth normally; I do! You are, of course, ultimately the one who controls what's in your brain (& heart!); find happiness in wherever you choose.

May 17, 2011 | Registered CommenterNavelgazing Midwife

Nico, I so feel your frustration. I'm coming from the same place you are, with an education that my parents (one a professor at Stanford Law School and the other the first female Rhodes' Scholar) are proud of. I was happily on my way to medical school to be an OB/GYN, which I'd wanted to do for ages because I wanted to care for women. And then I discovered that if I wanted to care for women, really care for them, medical school wasn't where I wanted to be. So I foundered for a few years and now I'm in school to become a CPM.

I chose this route in part because it's forcing me to let go of some of my prejudices. See, my sister is about to graduate from Harvard Law School near the top of her class and my brother has just nabbed an incredibly prestigious undergraduate internship. I'm the scientist in a family of thinkers, the doer in a family of thinkers. They were already skeptical about my being a doctor, and they are totally unsure of what to think of my being a midwife.

My family knows what a nurse is, though, and although they would be supportive and proud, etc, in reality they would wonder why I wasn't "good" enough to be a doctor. Becoming a CPM allows me to be something away from the prejudices of the people I love most in the world. It's also a choice I made because I don't think I'd be very successful getting through the pre-midwife nursing school and training. I like to be my own boss, and I'd think I'd be bitter and resentful as a nurse. I've already done nursing-level A&P, patho, and micro (I took them in college with undergrad nursing students as part of my pre-med preparation) and I don't feel any special need to take them again.

I'm rambling now, but I just wanted to say that sometimes the math doesn't add up and you just have to follow your gut. Everything about me says that I should have been a nurse midwife, and it's possible that I would be happier as a CNM than as a CPM . . . but I've learned for myself that I have to live in the journey, and the CPM journey holds more for me as a person, a woman, and a scientist than that of the CNM.

My hope is to get a Master's degree in midwifery down the road. The medical board here in CA is very supportive of the CPM credential and is exploring some ways of giving it more clout and providing a greater depth and breadth of education to those who are interested in pursuing it.

I should add that if I lived in NY or another state that recognized the CM credential, I would totally be pursuing it because I think it's a great middle ground. However, my understanding of the CM is that instead of being a middle ground, the ACNM tried to replace the CPM with the CM, and it only caught on in a few states depending on the legislative environment and the strength of the lobby. Because of this, I don't think that most defenders of the CPM credential will ever get behind or support the CM as a middle ground. The history just isn't there. It's unfortunate, but supporting the CM would be like "giving in" to some of the die-hard CPM supporters and founders.

May 17, 2011 | Unregistered CommenterEmily D.

@Nico, can I make a suggestion? It sounds as though we have the same thought processes about deciding which school and which degree to get. This is what I learned, and what I chose....take from it what you will and leave the rest!

I have a BS in psych. I decided I wanted to go into nursing and midwifery, so I applied to the local county college's RN program, and began working on the prereqs while I waited for a decision. Out of curiosity, I contacted Philadelphia University's Institute of Midwifery, just to find out what the program was like, what the requirements were, etc. they have both CM and CNM programs, its online and you get to choose your own preceptor. The benefit of this being that you interview CM/CNM preceptor candidates and find one that fits your philosophy. If you find more than one (maybe a hospital CNM and a homebirth CNM), you can use both. There's a lot of flexibility. As for the coursework, it is what you amke of it. Put your whole self into it and get the most out of it. Its also not that expensive at about $45K for the whole program, including books. Also, if you become a CNM, you can work for a Federally Qualified Health Center and get loan forgiveness (in NJ, up to $50K for 2 years of work, more if you work for them longer). The National Health Services Corps also offers loan forgiveness programs and also nursing scholarships, but they are tough to get and need based. What I found out in NJ is that I can become a CM, first, and then later, if I want to, I can get my RN license, and I can become a CNM. Here in NJ CM's don't prescribe, and although we CAN work in hospitals, none do. If I find that too limiting, or decide I need to enter a loan forgiveness program, I can get my RN. So I have decided to go into the CM program at PhilaU, since I don't want to be a nurse for nursing's sake. I wanted to go straight into a midwifery program anyway. But I know I still have the option open to me later. I hope that in the time that it takes me to finish my CM, that NJ will allow CM's to prescribe, bill insurance, and work in hospitals.

I hope this helps give you a little different perspective and some new information. And you might want to look into Philadelphia University. They host online open houses about once a month. They are also on facebook.

Good Luck!
Jen

May 17, 2011 | Unregistered CommenterJen B

Emily says: "However, my understanding of the CM is that instead of being a middle ground, the ACNM tried to replace the CPM with the CM, and it only caught on in a few states depending on the legislative environment and the strength of the lobby. Because of this, I don't think that most defenders of the CPM credential will ever get behind or support the CM as a middle ground. The history just isn't there. It's unfortunate, but supporting the CM would be like "giving in" to some of the die-hard CPM supporters and founders."

ACNM did not try to replace CPM with CMs, but answered a call from women who wanted to be a highly qualified midwife that could work in hospitals, shoulder to shoulder with CNMs, but not have to go through the nursing aspect of school. As other CM-students have said, there *are* stringent pre-reqs before beginning (CM) midwifery school, so it isn't like you can grab your high school diploma and start (CM) midwifery school. However, as a CPM, you can skip off *without* a HS diploma and begin CPM training if you pay the right amount of $$.

Also, CMs started in New York and then moved to Rhode Island and then New Jersey; they are expanding, not being limited to.

And of course die-hard CPMers don't want to back CMs!! They don't want to go to more school! Anything to do with ACNM has to be evil, right? I mean, they stress education and skill... don't teach homeopathy or aromatherapy... and, *gasp* are accepted in hospitals. Who would want to be a part of *that* establishment?

May 17, 2011 | Registered CommenterNavelgazing Midwife

Hahaha, I know. The thing is, I think not being taught aromatherapy and homeopathy is a serious lack in a midwife's education, don't you? I don't understand why we can't all learn all of it.

@ Jen B: I really wish we had that option here, but to me it isn't worth living on the east coast just to be a CM. ;) And I think it would be amazing if you could start as a CPM, get your RN and then be certified as a CNM. As far as I know that isn't the case and isn't being considered, even. (Right?)

I don't want to be a CNM because I don't want to be a nurse. I wish people didn't feel the need to make me feel guilty about that decision. I am going to be a skilled midwife and I have a very solid background in biology and chemistry, and I've chosen one of the programs on Barb's "good" list, lol. I don't mean here, for the guilt thing, just in general I feel like a lot of people want to guilt me into going to nursing school, which I just don't want to do. If I could be a midwife first and THEN a nurse, I would seriously consider that.

What are people's opinions of a master's program? That requires a high school degree and frequently a bachelor's as well. Could that provide an alternative that people would be happy with? What are your thoughts?

May 17, 2011 | Unregistered CommenterEmily D.

Emily, it sounds like you've found a good middle ground, and it's heartening to read your story. Jen, the model you describe (choosing your own preceptor, distance learning, flexibility, etc) is what I've found in most Masters (nursing) programs (particularly Stonybrook and Frontier, the two that I'm considering). I can tell that you're very excited about it, and I hope it goes well for you! For me, I'd rather spend an extra year or two, become a nurse, and then go on to midwifery and have the ability to practice in all 50 states, plus be able to provide a wider range of services.

Navel-gazing midwife... my logic is simple: I am an aspiring midwife because I work for women. I need to be where women are, not where I want them to be. I want to be able to give them what they need as well as what they ask for, whether it's walking in the woods as they labor or following them into the OR for a c/s.

I appreciate your insights, and (unsurprisingly?), they're in line with other midwives have shared. I've now been told by several midwives who I trust (CNMs and CPMs alike) that formal education helps to develop, but will not DEFINE, one's underlying philosophy of care. I recognize that I tend to be wary and critical of "The Establishment" in whatever form it takes. I'd like to believe that this makes me a critical thinker, able and willing to evaluate what is presented to me as "fact" in light of evidence, but I do need to be aware that it can lead to cynicism and an "us versus them" mentality, as you've so nicely pointed out in your second comment to Jen RE: CMs & CPM opposition to them. Though I might go through nursing school, I'll still cheer on the women who are called to continue developing the CPM and CM credentials and hope for the day when all paths to the midwifery are equally respected and equally able to produce quality midwives.

Thanks for letting me sound off and listening to me. I loved this post, and I hope you update it with what you believe the day after tomorrow!

Also, I nearly missed both of your comments; I got email responses from Jen's & Emily's comments but not from yours. A quirk in your blogging platform? Just wanted to let you know.
Best wishes,
Nico

May 18, 2011 | Unregistered CommenterNico

RE: becoming a nurse, Emily, I don't want to be a nurse either. I'll never "be a nurse." Yeah, I'm going to go to nursing school, and I'll hold a nursing license. Still, for some of the same reasons you mentioned earlier (bitterness and resentment, desire for collaboration instead of hierarchy (which probably comes from working in a hospital, not from being a nurse)), I don't see myself as "being a nurse." We're all (student) midwives, period.

Regarding Master's programs... I live in New York State, and the requirement here is that midwives have Master's degrees. There are some midwives grandfathered in who certainly don't, but to enter the field, you must either have a Master's in Nursing or the equivalent Master's for a CM.

At first, I thought this was ridiculous and overkill, and that I should just move to a state (Oregon, Washington, Texas, whatever) where I could do a one-year program like MLL and start catching babies. (!!!) Thankfully, I talked to several homebirth CNMs in my state and they've universally said that the climate for midwifery in NYS is good, that the educational requirements are great. That's helped me to see the Master's requirement in a different light.

I applied for and got a nomination for the Peace Corps. The hoops that the government makes you jump through to get into that program ARE ridiculous, especially considering it's a "volunteer" program. Why? Because they're preparing you for the frustrations you will face and the persistence you will need once you start working in a developing country. Quite frankly, if you can't make it through the application process, you're not going to make it 6 months abroad.

I see midwifery education in a similar light. Education, whether via Master's degree or long-term apprenticeship, discourages students from joining on a whim, graduating from a program with the NARM minimums, and thinking that they're totally prepared and know everything. In other words, a higher (but not very high) barrier to entry acts like a speed bump (not a road block) to make sure that students are committed going into the process AND come out of the process with the didactic AND experiential learning they and their clients need.

This doesn't discount the apprenticeship model. A commitment to apprenticeship for many years is, well, a commitment, and my gut tells me that the apprenticeship model can and does train excellent midwives.

One more thought. From what I understand, there are two types of accreditation: national and regional. Strangely, the national accreditation holds less "clout." If you don't plan on pursuing additional education after attending a nationally accredited school, then it probably doesn't matter. But if you want to get a bachelor's degree through a nationally accredited school (MEAC is a national accreditor), and then you want to go to a Master's program at your state university (regionally accredited), there is no guarantee that the credits you took as an undergrad will transfer. So it might not be as simple as "adding on" a nursing degree later, not without some backtracking, repeating A&P for the third time. This was also a factor in my decision to go to nursing school first to "get it out of the way."

Bastyr seems to have a good model, they graduate CPMs with Master's degrees. I spoke with one alumna from Bastyr and she raved about it, and she seemed really prepared to go right into her own practice (she also seemed like an exceptional student/ midwife). Unfortunately, it's $65k in an expensive city. Still, if the CPM credential were recognized in NYS, I would seriously consider taking on the loans (again, blargh) and going there.

BTW, Emily/ whoever else, I'd love to chat more about education and all things midwifery... I put my blog address in the URL, you can find my email address on my blog, feel free to email me. Then Navelgazing Midwife doesn't have to keep approving our off-topic comments on her blog. :-D

May 19, 2011 | Unregistered CommenterNico

Oh, PLEASE keep talking! I'm actually considering taking the thread and making it its own post! It's really, really, REALLY great. Keep talking!

May 19, 2011 | Registered CommenterNavelgazing Midwife

i agree. as a homebirth-loss mother, i cannot say strongly enough that the bar needs to be set much higher for CPMs. it is scary when gross under-training is paired with a large ego. thank you for stepping out on a limb to say this.

May 19, 2011 | Unregistered Commenterliz p

Hi Barb-

I'm a periodic reader/lurker and have been reading some of your recent stuff about the CPM credential. In light of that, I'm just curious about your thoughts taking a glance at this program being offered by a community college in Wisconsin (where I live): http://www.swtc.edu/gray_career.aspx?id=2238

I'm a big supporter of out of hospital birth, and of non-nurse midwifery (like the CM credential), but in looking at the requirements of this program, I'm not convinced I'd be comfortable with a graduate of this program caring for me during birth ... I'd love to hear your thoughts, since you are both educated as a CPM and supporter of more stringent educational requirements, and I think you'd be able to provide me with a better perspective. Thank you!

June 8, 2011 | Unregistered Commenterjohanna

What are your thoughts on Maternidad La Luz's one-year program?

October 19, 2011 | Unregistered Commenteraspiring midwife

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