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Entries in Lack of Education for Midwives (3)


Interviewing a Homebirth Midwife: Skills Training

Too often, when the discussion of a homebirth complication comes up, the ineptness of the midwife’s actions comes into play. How would a potential client know if her chosen midwife is up-to-date and practiced with her skills? I’m going to propose something completely unique to anything I’ve ever heard before, an addition to the interview process that might actually have a hand in 1) helping women choose the most competent midwife 2) help midwives practice their skills until they are body memories and can be done in their sleep… or during an acute emergency. 

Ask to attend a skills training session with the midwives so you can see who is the most adept handling the fake emergencies. You don’t need to know how she is supposed to handle a shoulder dystocia or a surprise breech because they will be discussing that in the session. You’ll get an idea of who the “leaders” are as far as teaching the skills (usually the midwife with the most experience in that skill) and who has the least knowledge about a certain skill. I believe just asking to attend this type of session would give you an enormous amount of information about the level of transparency and disclosure the midwives in your area offer. If you’re refused entry, that speaks volumes. If you’re permitted in, that also speaks volumes. 

Skills that should be observed:

  • Starting an IV
  • Suturing
  • Neonatal resuscitation
  • Adult CPR
  • Shoulder Dystocia resolution
  • Surprise Breech
  • Surprise Twins
  • Cord Prolapse
  • Postpartum Hemorrhage
  • Calling 911

It's unlikely you'll be seeing all those in one session, but that a group of midwives even putting on a public session says great things about their willingness to display their knowledge and skill.

I do agree midwives deserve to have a safe space in which to learn and grow their skills, but if holding a public skills session forces the wary midwives to practice their heads off for the event, everyone wins… especially the mom and baby. 

I look forward to feedback from moms about how this request works in your community.


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.


Midwife to Be "Midwifery School"

I just learned about a school for women (people) who want to be midwives called Midwife to Be. It’s based in South Carolina, but students can take the “classes” anywhere in the world. (I’ll stop using quotes, but know they are there throughout the post.)

Just skimming the website, I am horrified anyone would pay for this incredibly inferior education (boy, do I want those quotes!).

Starting with typos, if someone can’t spell, use apostrophes, commas, dashes or know when to capitalize… or use Spell/GrammarCheck… or, as a last resort, hire an editor… how can you trust they know how to teach life-saving skills? I mean, if a midwife doesn’t know how to spell HIPAA or Chux pads correctly, she hasn’t been paying attention.

And checking off pages in the Practical Skills Guide is, not only subjective depending on the preceptor, but also completely independent of any oversight.

I won’t even begin to address the arrogance of going to other countries, scouting out high-volume hospitals to practice on women… because it makes me nauseous.

I’m embarrassed this school uses the name midwife.