Log onto Squarespace
Archives

Entries in Licensed Midwife (4)

Monday
Aug082011

Dandy Commentary Continued

Continuing with what Birth a Miracle Services said in the post “Why state licensure is not the answer for midwifery,” the owners, Naomi Kilbreth and Haley Grant say: 

“A key componant (sic) of home birth is the mother taking responsibility for her birth. That means going to the hospital if she feels something is wrong, maintaining a healthy lifestyle, and being careful about which midwife she hires (ie. one that is well trained and experienced).” 

It is the woman’s responsibility to take care of herself and to hire the appropriate care provider, that’s certainly true. But once the provider is hired, the woman is depending on the provider, in this case, a midwife, to be her advisor, not her friend. 

Midwives do tend to be friendlier than many other providers. I stand first in line, guilty of this provider-as-friend attitude, both being one and applauding them. As time has passed, though, and through my own and others’ experiences, I see that a friendly provider isn’t nearly as important as a skilled one. I’m even guilty of encouraging women to choose a provider based on personality. 

“Most of us have very similar training, so I encourage you to picture yourself in a small room with the midwife –for 20 hours. If a quirk bugs you in the interview, it’s going to be greatly exaggerated when you’re in labor.” 

How’s that for advice on how to choose a midwife? groan of embarrassment 

While we had somewhat similar training, our levels of experience were vastly different. How is a newly pregnant woman supposed to gauge which experiences are great and which are useless in homebirth? While the birth junkie might learn about things like shoulder dystocia and hemorrhage and what a midwife should know when dealing with them, birth junkies are almost always born after their own babies’ births. It’s hard enough trying to teach women they have choices in childbirth; imagine the greater challenge of teaching them to be their own midwives! And that is exactly what BaMS is suggesting. 

“That means going to the hospital if she feels something is wrong….” 

Pardon?!? 

Do you women (BaMS) honestly believe women who hire midwives are supposed to “feel if something is wrong?” I know that most women hire midwives to let them know if something is wrong. Believing that women can “feel” a baby in trouble is cruel to the women whose babies died without their feeling one blip of concern. And it’s flat out wrong. Ask any midwife who’s overseeing a woman in labor, everything fine and then, during the next 15-minute fetal heart tone check, she finds the heart tones down in the 80’s. How long were they there? Sure, there are things to do to try and resolve the low heart tones, but seriously, shit happens in birth. And shit can happen fast. Having a midwife who knows what to do is crucial; her friendliness irrelevant. 

And it’s baffling to me how you think a woman in the middle of labor is supposed to take her contracting butt to the hospital. Drive? Call an ambulance? You make birth sound like a giant UC (unassisted childbirth). And terribly, terribly unappealing. 

(The great majority of) Women aren’t looking for a midwife to make every decision for her. They are not abdicating responsibility to a midwife who uses them like a marionette. Women look to midwives as counselors, as the experts in an area they don’t know much about. 

When hiring a plumber… or a car mechanic… most of us couldn’t care less how the job gets done, just that it gets done right. There are others who think the process is fascinating and learn, perhaps, to do it themselves. They might need help when learning… books, the Net or even talking to the technician. They might even go on to become the expert, inspiring other would-be plumbers as they snake the random toilet. 

Birth, in its crudest form, is like this. And a midwife knows more than the client. She is being hired to know more than the client! That isn’t the remotest commentary on her intelligence or the knowledge she does possess, but who wants to learn to be an expert in every trade or profession we utilize in our lives? I sure don’t! 

It’s great that women learn about the interventions and technology that might be (will be) used in their births. They can always learn more information… if that’s what they want to do. Homebirth women tend towards the information-heavy, that’s true. But should homebirth women have to learn everything in order to protect themselves from the midwife? Or shouldn’t there be a minimum standard they can count on so they’re able to relax during the pregnancy, labor, birth and postpartum period, trusting that the midwife really is looking out for her best interest (and that of her baby)? 

As many others have said, we go to all sorts of people assuming they have a certain level of competence… dentists, accountants, lawyers… even nurses, repair people and barbers… all carry with them the burden (if you will) of a minimum level of professionalism and knowledge. It should be the same for homebirth non-nurse midwives. 

I want women to trust midwives to act and react in their best interests… and the interests of their babies. I hate that I’m writing a “How to Interview a Homebirth Non-Nurse Midwife” piece. I shouldn’t have to!

Yet, with beliefs such as the one quoted at the top of the page, it’s more and more clear how critical that hand-out will be.

Friday
Jun202008

Response to ACOG’s & the AMA’s Homebirth Resolution

The resolution says, en toto:

Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or "lay midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM) recognize[1]; and

Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film [2]; and

Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery; therefore be it

RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers [3] (New HOD Policy); and be it further

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $1,929.

Received: 04/28/08

[1] http://www.acog.org/departments/stateleg/MidwiferyYearinReview2007.pdf, accessed March 18, 2008

[2] www.today.msnbc.msn.com/id/22592397, accessed March 18, 2008

[3] www.acog.org/from_home/publications press_releases/nr02-06-06-2.cfm, accessed March 18, 2008

I respond:

It’s true. Hospitals are a safer place for mothers and babies to be during labor, delivery and postpartum. If unexpected emergencies appear, as they sometimes do, hospitals have more personnel, more medications and more opportunities to save a mother’s and baby’s life (cesarean deliveries, hysterectomies, ICU, etc.). Simply by virtue of being in the hospital, women have every medical, surgical or practical tool at their disposal; this spectrum of options cannot possibly be offered in the home.

When women having homebirths have complications, where do they run? To hospitals.

I can understand the thought process of doctors:

How come hospitals are so sucky as a rule, yet they are the gleaming white knights in an emergency? Why do we have to “clean up” the mess made at their beloved homebirths? Why do we legally risk ourselves when too many midwives don’t even have malpractice insurance? Why are we expected to accept patients whom we know nothing about in the middle of a life-threatening crisis and the midwife is able to release accountability and become the woman’s doula? Why, when a homebirth transport comes in, do the women still think they have a right to force us to adhere to an unrealistic and sometimes absurd birth plan? (I know you all certainly wonder) Why do women listen to midwives – women with far less education and experience than we have? How can women implicitly trust a woman with no license or a license that isn’t even nationally recognized or accepted? What do they say to get women to be so militant against doctors, hospitals and medicine?

The answer?

Nothing.

Hospitals and doctors make their own beds with their actions and words.

I understand there is very little to be gained on the economic front and that is not your motivation. I understand your heart-felt concern is for the life and health of the mother and baby. I understand that you feel any inconvenience should be tolerated and the “birth experience” is ancillary to the final outcome.

But, you see, the hospital “experience” is abhorrent to many women. When the experience includes procedures, medications and a dismissal of a woman’s individuality, the risk of being at home doesn’t seem so great after all. When women describe their hospital birth experiences in terms of “birth trauma,” “birth abuse,” and “birthrape,” something is terribly wrong with the system.

It is the hospital system itself that writes the homebirth script. If you want women to stop having homebirths, you are going to have to make some major changes in how you operate. I firmly believe if the hospital and physician care weren’t so egregiously offensive, cruel and inhumane, the Unassisted Childbirth (UC) movement wouldn’t be accelerating.

It is in the typical birthing experience in our country that sends women away from medical care and into the hands of homebirth midwives or planning UCs.

If I were on the committee to re-vamp the hospital system, being blunt with ACOG and the AMA, these would be my recommendations:

1. Stop de-personalizing women by putting them all in hideous hospital gowns.

I know you are probably rolling your eyes, but women HATE those gowns and understand that whatever they wear (of their own clothes) will be tossed into the garbage after the birth. Removing personal articles from women is tantamount to institutionalizing her. It’s vulgar.

2. Stop calling women “Momma,” “Mom,” “Mother,” and use her name.

It is rude at best to diminish a woman to a universally used word instead of acknowledging her individuality by remembering her name, not just the vagina, in front of you.

3. Since birth plans are so similar, perhaps listening to what the majority of them ask for would be prudent.

You know the drill… no continuous monitoring, encouraged (not just “allowed”) to ambulate in labor, encouraged to eat and drink in labor (and not assume every woman is headed to the operating room), no routine IV (most women are cool with a saline lock)… and how about bringing in birth balls, huge tubs and the accoutrements that homebirths and even in-hospital birth centers provide. If LMs, CPMs, CNMs and CMs can learn to maneuver around water labors, ambulating women and women on hands and knees, then surely educated physicians such as yourselves can.

4. Stop offering medications when women ask for them not to be mentioned.

We all know medications and epidurals are an inch away; we don’t need to be asked, “Where is your pain on a scale of 1 to 10?”. Women who want a natural birth work hard to not think of labor as pain. Again, if women in the hospital want something for pain, they darn well know they can ask for it. It is extremely disrespectful to a woman’s desire to re-frame her perception of pain in labor, all this Pain Scale stuff.

5. Educate nurses and yourselves about the importance of reverence in labor and birth.

Speak softly, knock before entering the room, look in a woman’s eyes, SLOW DOWN, listen when she speaks and THINK before you do; stop when she asks you to stop (touching her, the vaginal exam, lying to her, etc.). While this might be the 20th baby you’ve “delivered” today, it is that woman’s ONLY birth that day… perhaps the only baby she will ever have.

On the same note, when you are the surgeons during cesareans, SHUT UP about day-to-day topics and remember where you are – standing at the birth of a human being. Imagine the doctors and nurses yacking about the best sushi restaurant of the moment while your daughter (or spouse or mother) is taking her last breaths on earth. That is exactly what it feels like to many women when you act like you are cutting on an anesthetized woman. This woman lying there feels – perhaps not the skin incision; her heart and spirit are not numbed. The same respect and consideration are due humans joining the earth as humans leaving the earth.

6. Stop using your status as a means to manipulate or lie to women when they ask you questions.

Educated women are so tired of “the dead baby card.” There are times when life and death occur, but there is an enormous leap between, “We need to rupture your membranes so we can put an electrode on the baby or your baby might die,” and an abruption. Your exaggerations and attempts at –or out and out manifestations of- risks must stop. I believe the manipulations are one of the major reasons women ignore what obstetricians (and many nurses) say. If you always spoke the truth, your word would stand stronger. Crying wolf takes on a whole new meaning with physicians in the baby business. Nowhere else in medicine can you find this level of untruth streaming towards patients.

Just today a woman told me about her two mild decelerations in an eight-hour period that caused a doctor to take the husband outside and say the over-used phrase, “If she were my wife….” The doctor insisted on an “emergency cesarean,” yet the woman didn’t find herself in the operating room for another 4.5 hours. Interestingly, her surgery was at 5:00 pm. Coincidence? We are sure not. How can you wonder why she wants an out-of-hospital birth this time? Such absurd scenarios pepper your medical records; we see it all the time. Stop it.

7. Find a way to open your hearts to the pain and sadness in women whose births don’t go the way they expected.

Of course women “shouldn’t” have a cement-set vision of their births, but many women do have desires and wishes and it is deeply sad for them when things turn out differently. Try and talk to her like a human being in pain, not just a physical body that can be repaired with staples and numbed with Vicodin.

I understand your belief in the impossibility of seeing each woman as a human being. I understand you think if you hear every woman’s fears, pains and concerns you will surely commit suicide from all the pain foisted upon you. I understand that you think you just don’t have the time for all that emotional stuff. I understand that you believe listening is for a therapist, not a technician like a doctor. I understand you are busy, busy and just can’t possibly have any more time to offer women so they can whine and cry about this or that.

But, you are wrong.

The best and most beloved of doctors touch their clients… if not physically (although many do this as well), then emotionally. They take a few extra moments to listen to women, not just hear them. Re-frame your own perceptions of women speaking about sad, painful or difficult topics. It isn’t whining; she is speaking from her heart.

The great part of all of this, though, is that when you open yourself to a woman’s pain, you also have given her the space to share her joys, laughter and triumphs. It isn’t all negative “energy” that comes from pregnant, birthing and postpartum women. It is a mix of emotions, just as life is a mix of joy and sadness.

Through exquisite sadness comes exquisite joy.

8. Demand more (compassionately-trained) nursing staff in Labor & Delivery units.

Women know one reason they are encouraged to have epidurals is to keep them immobilized and quiet. (Did you know that?) It is much easier to staff a unit with women who don’t wander the halls or moan with each contraction. We know it can be disconcerting to watch women give birth without medication, especially when you believe women are suffering needlessly. But, one reason women choose midwives is we are able to BE with women in their transitory state of labor towards becoming a mother (or mother again). Being able to not just tolerate, but embrace an unmedicated woman’s labor is a wonderful gift of understanding and kindness to women. It’s okay if she’s loud. If she “scares the other women,” take the lead and explain the wonder of an unmedicated labor and birth to the frightened patient. People reflect the emotion you express, so express goodness instead of disgust or dismay when speaking to other patients regarding unmedicated laboring women. And really, if it’s so distressing to everyone, sound-proof the rooms; technology abounds.

Have nursing staff attend doula trainings to develop the compassion necessary for work in L&D units. Seeing birth from another angle can do nothing but expand her capabilities with unmedicated and medicated women alike.

9. Institute doulas in all L&Ds.

When the above goals are met, doulas become the physical and emotional augmentation for nurses in the unit. If the woman no longer has to hire a doula to fend off the medical interventions, she becomes what she was designed to be… the loving support person for the laboring couple.

10. Remember that birth is unpredictable.

You chose to be obstetricians. Birth happens during the entire 24 hour day and night. If you are one of the many that “nudges” women to birth during the daylight hours, whether with pitocin or cesareans, shame on you! If you are tired, either suck it up or find more help in your practice. If you are on-call, sit yourself at the hospital for your call time. Coming and going, wooshing in at the last second of birth, discussing a woman’s care via telephone and forcing women to stop pushing until you arrive are incredibly insensitive and sometimes cruel ways to treat a woman birthing a human being. Probably the number one complaint I hear about obstetricians is their absence in birth. Women are shocked at how little they see their doctor – any doctor - once in labor. A major reason women hire midwives is because they are physically present for labor, birth and postpartum. A nurse is not a replacement for your care. If you feel labor sitting is beneath your skills and a waste of your time, perhaps losing the OB portion of your title is called for. Women pay for your care. Isn’t it time you care?

11. Accept that as long as the System remains the way it is, women will continue having home and unassisted births.

There will always be a segment of society that desires homebirths and it behooves the medical world to do what it can to make the emergency transition from home to hospital palatable. While hearing “We want you to see we aren’t monsters in the hospital” when a woman moves from home to your L&D units is less than comforting, the sentiment behind it offers a moment of understanding in why some people choose homebirths in the first place. If all of you really want us homebirth advocates to not see you as monsters, quit acting like ones!

None of the above requests include anything about the prenatal and postpartum period. Often, your prenatal demeanor belittles a woman’s questions and concerns. It isn’t uncommon for your appointments to last mere moments after the multi-hour’d waits in the waiting and exam rooms. Calling a woman by her name and looking her in the eyes as you speak goes miles towards building trust and goodwill. Women who trust sue less. If there is no other motivation to humanize your demeanor, consider that studied fact; women who know their doctor well typically do not take them to court.

One reason midwives are rarely sued by the client, much to your bafflement, is exactly because communication between midwife and client is so extensive. Communication builds trust and trust allows the care provider to say, “We really need to do a cesarean,” and the client/patient saying, “Okay.” I know it sounds simplistic… and it is really that simple.

Risk is a part of life and those that choose homebirth are accepting that risk. Women don’t just want an “experience,” they want compassion, respect, some semblance of autonomy and the knowledge they are being seen as an individual, obtaining individualized care. It might seem selfish or bizarre that someone would take that risk, but it seems a risk to step into the hospital and be put on the production line that includes unwanted (and often unneeded) medications that are used to speed up the production line, being pressured to immobilize and be silenced and strong-arming that all too often ends in a cesarean.

While it seems I am only focusing on what you all need to do, I also know homebirth midwives could always use more education. The schools work hard, and are working harder, to include the vital information that keeps a woman safe at home and to know when a transfer/transport are necessary long before it gets to the critical stage. Midwives don’t wait until the last second; we understand the time element that can be crucial in life and death.

A glaring error in your Resolution says that CPMs are “lay midwives.” That is incorrect. A lay midwife has no formal education in midwifery, but only learns through apprenticeship or even on her own, rarely studies birth as is done now. It is rare to find a lay midwife, even in states where there is no licensing. In California, the National Association of Registered Midwives (NARM) exam (which, if passed, creates a CPM credential) is accepted by the Medical Board of California as the bar women must leap over in order to be licensed in the state. The same can be said for other states that have adopted the NARM exam as acceptable for licensing. Licensed and Certified Professional Midwives are not lay midwives. Using that sort of inflammatory language leaves the homebirth/natural birth advocates shaking their heads knowing you still don’t understand even the basics of what women want or need. I am the first to say licensed and CPM midwives’ education doesn’t equal a certified nurse midwives’, but we do have book learning, CPMs now graduating from accredited schools. We also have experience in natural birth and in knowing normal birth, we are hyper-aware of when birth deviates from the norm.

Another issue I have with your Resolution is your acceptance of out-of-hospital births with CNMs. Do you not know we carry the same equipment and medications (except for sedatives and an isolette) as what sits inside a free-standing birth center? Once again, having all the correct information before writing public pronouncements would help your image amongst those that have issues with you.

Instead of bashing midwives, wanting to outlaw homebirth and perpetuate half-(or un-) truths, understand we aren’t going anywhere and it might better serve women and babies if you supervised us (as CA law requires) or at least collaborated with us. Talk to your insurance carrier, create a resolution that you cannot be sued when patients transfer care from a midwife without taking that fact into account, find a way to tolerate (at least!) midwives so the relationship doesn’t have to be so antagonistic. We’ll also do our part in continuing to educate ourselves, create increased opportunities to practice vital skills and work towards licensing in all 50 states.

I know this is long, but I hope it’s been at least somewhat enlightening. Please consider the requests above. They will fast forward the goals you desire - to have more women birth in the hospital; the location we all know is the absolute physically safest place to have a baby. Physiologically, probably not. Interpreting the difference is paramount.

Thursday
May012008

When Gossip Becomes Slander/Libel

Gossip: a person who habitually reveals personal or sensational facts about others

Legal Definition of Slander: A type of defamation. Slander is an untruthful oral (spoken) statement about a person that harms the person's reputation or standing in the community. Because slander is a tort (a civil wrong), the injured person can bring a lawsuit against the person who made the false statement. If the statement is made via broadcast media -- for example, over the radio or on TV -- it is considered libel, rather than slander, because the statement has the potential to reach a very wide audience.

Definition of Libel: An untruthful statement about a person, published in writing or through broadcast media, that injures the person's reputation or standing in the community. Because libel is a tort (a civil wrong), the injured person can bring a lawsuit against the person who made the false statement. Libel is a form of defamation, as is slander (an untruthful statement that is spoken, but not published in writing or broadcast through the media).

It seems I have become a topic of conversation at the local California Association of Midwives’ meetings.

Two months in a row, a piece I wrote – and pulled – has been discussed. (Although now I am really tempted to put it back up!) The latest meeting’s public minutes had this statement. I didn’t edit it; this is how it was written.

Barbara’s blog….neg piece about LM’s …a physician is now using her statements in their state to ban LM’s in his state..navelgazingmidwife..

Now, the blog piece I wrote was seen as negative by some, but not by all Licensed Midwives. Sure, plenty commented their anger or frustration that I wrote that I felt LMs needed more education, but for goodness’ sake, it is my OPINION. And I am allowed my opinion.

One person who commented to the PULLED piece said a legislator had mentioned my blog during discussions of something or other, but, first of all, there is NO proof of that at all and second of all, my words did not help to “ban LM’s in his state” (whoever "he" is).

I am LIVID that a group of LMs, CPMs, students and supporters have gathered together TWICE discussing my piece (once again, a PULLED and then revised piece) and are putting out, in email and words, the implication that I am single-handedly destroying licensed midwifery.

Have they ever invited me to come speak about what I wrote? No.

And people wonder why I have issues with professionalism in Licensed and Certified Professional Midwifery; see Example A above.

Because it is apparent that my local community is reading my blog, I hereby demand that the California Association of Midwives and the local licensed midwives that have begun and perpetuated this libel cease and desist or I will bring charges against the lot of you.

And I have PROOF of who started this slander in a vile (and amusing) email by a local Licensed Midwife. She even said she was going to spread the word about my "true self."

Any emails or comments will be used in court. Keep your thoughts to yourselves, oh, local women who are yacking about me.

Wednesday
Mar192008

Midwifery Education (Lite)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’ve enrolled in school.

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

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

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

I can hardly wait to get started.