More on that Midwifery Madness and Stuff
If you have read the comments from the last post, you will find:
“It annoyed me that the two most prevalent trolls on all the homebirth blogs had to put their inane spin on it, but ehh, that’s what they’re here for, I guess.”
Yes, that is what they are there for and I am glad that they are over there. I have since left another comment on Sage Femme, which I am sure will be approved eventually, if not already. I guess I need to clarify and justify some of those things that I have said…not that I REALLY think that I need to, but see my brain is wired differently than most peoples’ brains.
First and foremost, I attack motivation by money, because that’s who I am. I don’t attack the need for a job for money to buy those things such as food and a life of health and safety. However, when you take something like midwifery or coming to the aide of birthing women and then bitch about not being able to make money from it, because of a lack in education or homogeneous education, credentialing, recognition or etc., you are then no better than what we all bitch about — doctors & insurance companies making bank from birth. Let’s face it, birth is HUGE business and why wouldn’t every ‘educator’, lactivist and birth aid want a piece of the pie? Because they should know better, that’s why. Women used to know the village midwife and cooked for her and gave her baskets and sewed blankets and she just did what came naturally to her.
Now let’s try to tackle education. I went to school K - 12, some college (some birth/midwifery related), apprenticeship and empirical knowledge. Do you want to know what prepared me the most and from where I have gained the most ‘knowledge’? From actually doing, seeing, observing, teaching and failing. I have learned by living life and sharing the experience with those whom I have served. That doesn’t mean that I found my way here through flailing and kicking and with an infant’s understanding of how ‘this all works’ (actually, that is sort of how I got my official start, but that’s another story all together). I was given more than a basic education in an odd sink or swim kind of way from an very kind and loving illegal Mexican granny midwife and then later from Jeannine Parvati Baker. I have been taught more and more as time has gone on from all the wonderful midwifes and sage women that I have encountered. But I have learned the most from the women and teenage girls whom I have had the pleasure of sharing their most intimate, powerful and vulnerable moments with. Have I continued to educate myself, yes (I’m passively seeking an ND degree) and will I continue, yes. Does that mean that I am better than some others, yes and there are a ’shit ton’ more who are better than me.
Do midwives NEED a unified/homogeneous education? If I say yes, then I probably wouldn’t have found myself where I am today and then I would be one of those who are perpetuating that lie that sage knowledge and heathen practices have no merit, are out of date and unscientific. We wouldn’t be here today if it wasn’t for a hell of a lot of unscientific practice — in all parts of life. If I say no, then I am now one of those heathen sages.
You can not truly measure what a person knows…you can see how many questions they can get right, you can see if a surgeon knows where to cut for a certain procedure (which is vitally important), but you can not measure what a person knows. There have been so many times that I have been moved to do certain things that I was never taught, but it turned out to be the right thing to do. There are certain things that I have been taught to do and could/would be taught to do (if I went to a formal educational institution) that I believe are truly unnecessary and usually dangerous when combined with pregnancy/childbirth. Some of my beliefs are backed by scientific studies and opinions, some by empirically learned and ‘obvious’ connections and then some are truly from the gut/heart and I might even go as far as to say from the Universe and it’s Great Architect (make of that what you will). Am I against those midwives wanting/seeking to become CNMs? No, I am not against them, but I am against much of their educational material, the rules and limits set on them by a patriarchal system of medicine and many of them continuing to perpetuate the practice of unnecessary and often dangerous interventions used against pregnant and birthing women. I am not saying that every one them wants to do these things, but is needing to be able to bill insurance companies and not losing your license because you stood up for something worth the damage/trauma/fear you might cause another human being(s)? Great, you can travel to rural settings and care for people who are far from hospitals and clinics, and you will in theory help less fortunate women, but all with the stipulation that your hands are truly tied from doing at times, what you KNOW is right. You might have a legal obligation to your license and to your overseeing hospital/physician, but you have a much stronger MORAL/ETHICAL OBLIGATION to honor a pregnant/birthing woman and her child(ren) with the rights and with the sanctity of living. Being right, being legal and begin safe are not always friends.
Credentials…again, what the fuck does a piece of paper mean? You can afford a license and it’s fees. You can pass a test that most people can if they prep well enough. You can answer to regulations — because, let’s face it, I don’t know of a credential (specifically a ‘medical’ one) that doesn’t come with it limits and regulations. I am sure we have all experienced a professional who was licensed and credentialed who didn’t know which way was up and we thought to ourselves, ‘ this guy went to school?’. I know to my mother, when she completed nursing school, her credentials meant that she had completed something and that she had accomplished a goal that took her far to many years to reach. I know that when my aunt passed the medical boards exam or when my uncle passed the bar exam that they were equally as proud at completing something. It has brought them joy and it has brought them pain. I am not trying to discredit a degree and credentials, but you have to be more than a piece of paper and a license fee. You have to BE what the people WANT.
If a group of people need something they will find a way to get it or to create it. That has been the case since man first sprung up on this green planet. If a community (be it a geographic community or a ideological community) wants a midwife and needs a midwife, it will make one. It will elect one. We’ve almost always done this, until we started seeing ‘all the possibilities’ in midwifery and then once again when we were practically buried for good. If Jane Doe decides that her calling is to be ‘with woman’ and she represents a need and presents the knowledge that the community seeks, then she will become a midwife. If she isn’t what they want or doesn’t answer their questions and leaves them uncertain, then she will either be a terrible midwife or not one at all. Mainstream mentality tends to discredit the average and ‘below-average’ person in its ability to both recognize what it needs and to see it when it presents itself. If, when or unless a woman ceases to have the right to choose when, where, why, how and with whom to be pregnant and birthing, then she should have just that right and it shouldn’t make a damn bit of difference whether the person she picks is certified, educated, recognized or approved by the government or one of it’s subsidiaries. If we are truly mindful of ourselves and those around us, we would see the injustice in a government or other such institution telling us what we can and can not do regarding our bodies…and as far as I am concerned, if and until a baby is birthed or extracted from our bodies, we hold the ultimate power over what is done do it or not done to it. We can debate things post birth later in another time, when I have calmed down from this fire some!
Am I selfish? Yes, you bet your ass I am. I am a self preservationist. That doesn’t mean that I don’t have a huge heart and desire to help out as many of my fellow Earth dwellers (both human and non), but if I can’t help myself, then I can’t help you. Could I go and sit through the NARM exam and become a CPM? Yes, with some strings pulled, letters of documentation and the usual hoops for alternate certification. Why then, have I not done it? I don’t want to. I haven’t NEEDED to — it hasn’t been a factor with my clients or where I lived when I started and it’s not a factor where I live now. If CPMs become legal here in PA, I still won’t get certified. It’s the very principle of getting certified that makes someone like me even more legally limited. If CPMs were legal, it would mean regulation and with regulation comes requirements. Midwives required to do this and to do that, whether or not they would do those things without regulation. It would limit certain skills and my abilities to serve clients authentically to their needs/culture/situation or other factors. It would leave a less diversified pool of midwives to pull from. I would have to phase a lot of things with, ‘I don’t require this, but the state makes me insist on such and such or else I can’t practice midwifery or you can’t birth at home with me’. While I am all for and a huge supporter of unassisted childbirth, I don’t think that a mother should be forced into birthing unassisted because the government and its sons have placed ultimatums on community midwives and how they can serve their community. I can not willingly place myself under state reign or campaign for others to be forced to abide by its politics and lobbyist schemes. Unfortunately, in our times, birth is as much political as it is physical and metaphysical.
So, what about low-income, minority and other under served clients? I’m not sure, because that’s who I am serving. I ask a fee for services, but it’s more of a suggestion. My husband would like for it to be a contract! Here’s what I feel I should receive for my time and resources in a perfect world…not what I think they are worth, because at certain times they are priceless. Have I ever been paid the full amount, yes. Have I ever been paid nothing at all, not even something material in exchange, yes — but I knew that this would be the case before I ever agreed to anything. Do I usually receive money, yes; or other compensation, yes. Have clients tried to claim for reimbursement, yes - some have won and others haven’t. Would I get paid more if I could bill insurance companies? No, or maybe a little here and there, but insurance companies expect me to actually DO something in order to get money from them. I can’t just sit on my hands in another room and bill for my time. I would have to DO things and gasp be more ‘doctor-ly’ or ‘nurse-ish’. Both things that I don’t want to be nor do my clients want me to be. So, I continue to be passionate about something that I love and pass on the knowledge that I have to other women, so that they can ‘bill themselves’.
Exactly who do you serve, Michele (I get a kick out of me in third person!)? Right now, mainly young radical Anarchist or as well educated, white, middle class women (who everyone else is serving apparently) might refer to them as ‘punks’, ‘outcasts’ or even a few other as ‘hippies’. I am a radical and I tend to stick with ‘my kind’…not because I couldn’t serve anyone else (I have had clients of all walks and with all degrees of bulging and empty wallets), but because they are under served, discredited, unappreciated and very much aware of what they need and want. I come from a completely different mind set than most midwives…I didn’t start out serving ‘posh’ women and ‘trend mongers’. I started out with poor illegal Mexicans, very low/no income white and black families, but mainly single and teen mothers. There have been the religiously fundamental (of various stripes) and those who were simply afraid of doctors and hospitals and fearful of what they might do to them or their child. I have seen some desperate souls, but they were more full of light and understanding then all of these policy pushers crammed together.
Who knows, maybe one day, I will grow up and realize that this isn’t about life, beauty, autonomy and freedom, but it’s really all about who is ‘with money’, who is privileged and what they think is better for the rest of us. Maybe I won’t always be so radical…maybe I’ll stop caring one day. But right now, all I see are the rights of so many women being trampled on and many of the women who serve them are being trampled on even harder. Midwifery is not Nursing; midwifery is not Allopathic or medical. Midwifery is (w)holistic; midwifery is ‘with woman wisdom’ - you could say it’s the wisdom one gains from being ‘with woman’.
Jah Love and Peace
“Being right, being legal and being safe are not always friends.”
That’s it, in a nutshell.
Comment by Stu — March 4, 2008 @ 11:26 pm
Hey there!
Here’s what I think of the other side to the whole standardized, accredited midwifery education issue. You said it: communities will make/elect midwives. Obviously, it doesn’t take nationwide lobbying to have what I (cheerfully and affectionately, after my own first midwife) call ‘outlaw midwives’. You know, uncredentialed, self/apprenticeship taught, lay, traditional, whatever? I absolutely respect what you do and there will always be a niche for it. There will always be the moms like me who won’t birth breeches or twins or postdates in hospital, moms who want a knowlegable friend along at their UC, etc. We ALREADY have that. And I believe we already have those informal networks in place to the fullest extent possible. But I disagree that we reach everyone who could benefit from one-on-one, compassionate, affordable, accessible, humanistic care. I disagree that everyone who could benefit from midwifery knows to seek it out or even knows what it is! Just as you question motivation by money because it’s your nature, it is my nature to see whole countries as communities. I’m just not an anarchist, respectfully — so this nation, as a community, does need more ‘legit’ midwives yes, and I see these musings as first efforts of this community to create midwives for itself. Not because this kind of midwife would be better, but because that’s how the socioeconomics of health care works for the vast majority of women on the ground. Grassroots lay midwives can and will and already do coexist with an institutional midwifery system; I don’t see how working to overhaul that system could hurt your cause.
I hope I’m making sense!
Judit,
just a home birth mom
Comment by Judit — March 5, 2008 @ 10:14 am
Stu: thanks! I think that pretty much sums it up too.
Judit: Thanks so much for the comment and your perspective. I am not implying that I don’t want every woman to have a midwife if that’s what she wants or that every woman expecting shouldn’t know of the option of having a midwife or homebirth. However, midwives such as myself are legal in only a couple states and barely legal or ‘alegal’ in only a couple more. Us and the women that we serve are in dire need of being left alone. When CPMs become legally recognized/regulated/approved in more and more states and more and more CPMs and aspiring midwives decide to go the CNM route, we shut the door on so many wonderfully vital midwives and their clients.
The very system that doctors want and that so many CPMs/CNMs want (whether all of them know it or not) would completely stump out ‘grassroots lay midwifery’. The very people that so many of them learned from, observed and apprenticed under, would become absolutely illegal everywhere and completely dismissed. What’s more is that for many of them (doctors and midwives alike), this is EXACTLY what they want to have happen. ‘I am dying as we speak’.
When they win, because they will, all of the wisdom, subtle nuances seen only from observation, valuable herbal knowledge and empirically gained knowledge will be lost. When midwives are predominately learning from books, high-risk or busy learning hospitals and doctors, they won’t have the chance to just ’sit on their hands’ and witness how the planet stops and holds its breath as a woman becomes a mother with nothing to aide her, but her inner animal instincts. Most people don’t understand this, because they haven’t been witness to it and I’m afraid that even fewer will understand or experience this themselves or as witnesses if we continue to rely on a system of ‘health care’ that only values ‘ends justifying the means’ and ‘insurance money’.
I want every woman to be her own or have access to a midwife, but at what cost; the loss of compassion, ancient wisdom, respect for the natural order? If we could somehow concede to a socialized form of health care, where ALL DEM MIDWIVES were valued and respected and paid — where in the private sector (because there will always be privatized health care, regardless of how socialized we become), CNMs and physicians are available or in the case of high-risk needs. But I don’t see us throwing out the kludged together under serving systems that are currently in place unless and until there is either a real revolution (scary civil war) or absolute economic collapse and we have to build from the bottom up. Hopefully the few of us ‘grassroots lay midwives’ will still be alive and kicking and can start this all over again.
Comment by michele james-parham — March 5, 2008 @ 1:42 pm
Heh heh, you take the approach to a midwifery license the same way some of my friends look at marriage: “it’s just a piece of paper.” Which, ultimately, it is.
And to be perfectly honest? I’ll take the midwife with the generations of wisdom handed down, hundreds of beautiful births under her belt, and the happy recommendations of many women than the one with the diploma on the wall who was taught in a school. That’s just how I am, and that’s what I want, perhaps because I tend to shun and shy away from allopathic medicine as a whole. And to me, a diploma screams allopathic just as much as a white coat does. Would I turn down a licensed midwife because I’m terrified of that diploma? Of course not. But neither would I turn down a midwife who DIDN’T have one.
Some people will say that there is no way to tell who is skilled enough without proper standardized training, and they’ve got a point. But like you said in this post, how many times have we seen a “professional” make a horrible, inexcusable error despite his years of training and the title behind his name? Yet we all point fingers at the midwives who make mistakes, lambast and attack them, while we just roll our eyes at the silly docs with their silly goof-ups. That’s not fair.
You said it perfectly: BE what the people WANT. Some WANT, and feel more secure, with a caregiver who went to school for X number of years and is licensed in this and that. Some WANT the more homeopathic approach that doesn’t necessarily have to be accredited by an organization that hands out those pieces of paper in order to be damn good. Homogenizing a profession that has so many different facets to suit so many different types of people and their desires is not going to make things better, it’s going to make them much worse.
Comment by Jill — March 5, 2008 @ 7:56 pm
I just read Judit’s comment and I have to say I agree with her to an extent. The “outlaw midwives” need to be more accessible, both in publicity and in affordability (I’m going to have to pray my way into paying my midwife as it is). These women should NOT be outlaws. Their work should NOT be illegal. They should NOT have to work in some kind of underground system where only those “in the know” are aware of them and the rest of the general public winds up stuck with an uncaring OB or a CNM who’s an OB in sheep’s clothing.
The question is, is there another way to get there beyond standardizing all midwifery education, which to me is a very unsavory option? At the moment I can’t see one, but I’m sure it must exist.
Comment by Jill — March 5, 2008 @ 8:02 pm
“The question is, is there another way to get there beyond standardizing all midwifery education, which to me is a very unsavory option? At the moment I can’t see one, but I’m sure it must exist.”
Yes. You take it all away. You don’t require anything. You make all midwives legal in all birth settings. You treat the midwifery model of care as though it were an egalitarian society.
I lived in Oklahoma City, OK before I came to Pittsburgh, PA. In OK, there is no licensing process for DEMs (of any kind or certification), there is no ‘official’ registration (implied or voluntary), there are no wishy-washy laws in the books, there is no witch hunt. You just can’t say that you are a NURSE-MIDWIFE, unless you are and have your license. There is no mandatory peer review group you have to attend and there is no board of midwifery that regulates midwives and decides for them what their protocol is or what their scope of practice allows. In fact, in many ways we are actually protected by the ‘healing arts’ code, as long as there is no over-stepping our ‘healing rights’ bounds.
This means that anyone could in theory wake up and decide to be ‘open for business’, even without ever seeing a birth, let alone having any education or experience…but this just doesn’t happen. People don’t want to do that, mainly I guess, because there isn’t any ‘real’ money in it and you won’t get very far before someone calls you and your lack of knowledge out! Ha! But, at the same time, we can self regulate and be regulated by our clientèle. There have been a couple attempts by a certain group of midwives to lobby for a ‘midwifery practice act’, but they haven’t succeeded and I don’t see them ever doing so — the birthing community doesn’t really want there to be a monopoly on who can do what and the state knows that it would make for a HUGE mess concerning all the Anti-Baptist and other Christian sects that depend solely and completely on Lay Midwives for their care. I have to say that it was one of the best experiences for me and an awesome way to start my career.
In the free & community clinics and planned parenthood clinics, the aides and nurses know who the midwives are and refer women to them. Most of the time there was good luck getting insurance companies to reimburse clients or pay up front even. The state never bats an eye when homebirth parents file for birth certificates other than asking why their homebirth midwife didn’t do it for them. True freedom without fear and it works. This doesn’t mean that every now and then there isn’t a poor or bad outcome, a death or emergency; these will happen eventually in any practice anywhere as it is the nature of birth to not always be all ‘love & light’.
Could midwifery be an option for every woman if this were the state of midwifery everywhere? Yes, because advertising of and education of the option wouldn’t have to be done on the cheap or the ‘down low’. More midwives would be able to practice, so there would be more midwives to shop around for and more midwives who could serve more people. Midwives would be able to tailor their practices to their clients and not to state mandated protocols. It would be fantastic for everyone involved.
Is this how I think it should be everywhere, yes!! Can we make it happen? Gosh, it might be foolish to hold my breath, but I can’t help but hope that some day we can get there — for the sake of mama-babies.
Comment by michele james-parham — March 5, 2008 @ 9:50 pm
Wow, what a great discussion.
I’m sorry you feel like you (your kind) are dying as we speak. Do you have/have you had apprentices to pass your experience on to? Are there CNMs/OBs in your community who are aggressively pursuing your client base or attacking your practice?
I just want to clarify two points:
one: (Hi Jill!) I’m not advocating for CPMs or DEMs to get licensing, state or national. What I do want to see is more licensed midwives to serve the women whom the grassroots lay midwives don’t, won’t, can’t reach. I do not see that turf wars are inevitable. Call me naive or uninformed… no DEM ever had to compete with a CNM for my business because I’m personally not attached to being served by someone with legal licensing. AND I do think the N in CNM is absolutely superfluous so I wish there existed a CM license over the U.S.; I’m convinced it would make a difference in how hospital midwives practice (more autonomously, for starts).
two: The book-learnin’ vs. apprenticeship dichotomy is false. Everyone learns by doing and by example; and not all books advocate the medical model. Why did I want completely hands off births? Had I personally witnessed beautiful births where as you say above the attendants “just ’sit on their hands’ and witness how the planet stops and holds its breath as a woman becomes a mother with nothing to aide her, but her inner animal instincts”? Of course not. But I had read all about it, and it was incredibly inspiring. My first child’s birth was the first birth I saw; by my second I had seen a half dozen more or less managed hospy births but not even a single UC video. Still I’m a firm believer of mother-led birthing and I practice it (as a mother; I’m not a midwife). The ideas are out there. Midwifery students can read about it. It can be on the syllabus, or they can do it in their free time and come back to challenge their professors. They can question their preceptors’ level of involvement at births. Obviously, they will have preceptors. Obviously, they will attend home births during their apprenticeships. But wouldn’t it be nice for the next generation of midwives to be able to take college credit and federal financial aid while working their butt off learning midwifery at those home births? Maybe I’m self centered, but the only way I could become a midwife given my family’s financial situation is if I could study it ‘officially’, and then get a salaried job doing it so I can pay off the costs of that education. Why wouldn’t I sit on my hands just as good as my own midwives did just because I have a license that says I know how to intervene? Assuming hands off is what the mother wants of course.
Okay, this is too wordy already. I hope I’m making sense…
Comment by Judit — March 6, 2008 @ 9:31 am
Hi Judit!
I think my main beef with licensure or no licensure is that depending on what system gives you that license, you may be forced to perform a certain way at births because it’s THEIR protocol even though YOURS would be totally different. Hospital births especially. Here, CNMs don’t attend homebirths, and I know there are other states where they do both. I imagine it must be difficult to attend a lovely autonomous homebirth one night, and then a few nights later attend a woman who chose hospital birth and have to comply with hospital birth procedure even when their regulations are unnecessary. And I know for sure there are plenty of women who are like I was with my first birth, who weren’t too schooled on the idea of homebirth or were too afraid to do it with their first birth, but thought, “hey, I have a midwife, I’ll still get a good birth at the hospital, right?” Only to find out that the midwife is under the hospital’s thumb because of those three letters behind her name, and as much as she’d love to let her client do X or Y, her license is at stake if she “breaks the rules.” Bye-bye, happy hospital birth!
All this is hypothetical and probably isn’t even making much sense because I just woke up not long ago. But I’ve heard of situations like this, and to me, they seem to make sense. If you let The Man dictate your ability to learn how to do your job, he’s going to continue to dictate how you do your job unless you buck him off your back.
Oh good grief, listen to me, I’m ranting about The Man now. I think that’s my cue to STFU.
Comment by Jill — March 6, 2008 @ 2:27 pm
Jill: Don’t worry about all the ‘The Man’ talk around me! ‘The Man’ and I aren’t friends! The point that you make about ‘The Man’ dictating your education to be approved, ‘He’ will then dictate how you practice, is exactly one of the main points I have against a proposed ‘universal’ DEM education/credential.
Judit: “I’m sorry you feel like you (your kind) are dying as we speak. Do you have/have you had apprentices to pass your experience on to? Are there CNMs/OBs in your community who are aggressively pursuing your client base or attacking your practice?”
I wouldn’t say that there are CNMs/OBs ‘aggressively pursing’ ‘my clients’, but there are few physicians who are not actively hostile towards DEMs and there are only a couple CNMs who attend homebirths near the central part of the state where most of the Anti-Baptist (Amish/Mennonite) live. The birthing climate in general here in PA, especially in and around Pittsburgh, isn’t very pro DEM or homebirth — as far as other professionals go and hospitals. There are several DEMs who are and have been negatively effected in a legal sense because of ‘The Man’.
And I agree that yes, you don’t have to become a carbon copy of what you read while attaining an education, but you walk a fine line when you start considering ‘challenging’ a doctor or senior midwife in a hospital setting.
I want to say more, but my head is all blah today…it’s been a long and busy day for me.
Comment by michele james-parham — March 6, 2008 @ 7:20 pm
Oh, good. I always feel silly when I catch myself talking about “The Man,” like I should be taking a big drag off my joint and muttering, “it’s the corporations, man, they’re out to GET US.” Which, is sometimes exactly what I mean, but it’s hard to say it without sounding like a cliche.
Comment by Jill — March 7, 2008 @ 1:06 am
Oh Jill! You crack me up! Thanks for coming here and commenting. Also, somehow I missed it the other day but, “Heh heh, you take the approach to a midwifery license the same way some of my friends look at marriage: “it’s just a piece of paper.” Which, ultimately, it is”
I had to laugh, because most of my friends feel that same way…but they are almost all Anarchists! The hubby and I were married via common-law, but not because we are ‘anti-marriage’, just lazy and wanting a ‘champaign wedding on a beer budget’, I suppose!
Comment by michele james-parham — March 7, 2008 @ 1:43 am
Just wanted to let you know that they are anabaptists not anti-baptists. They believe in believers baptism not infant baptism so back in the 16th century when the movement started they re-baptized people who were baptized as infants because they said the first baptism ‘didn’t count’ and that is where the ‘ana’ prefix comes from.
Comment by Monika — March 7, 2008 @ 1:52 pm
Yes and thank you Monika. I know that, but at times, ‘ana’ and ‘anti-’ often swirl around in my head at the same time — similar I am sure to ‘there’, ‘their’ and ‘they’re’, but I guess on a much more important level. Unfortunately, many people actually think that they are in fact ‘Anti-Baptists’ and not Anabaptists. But, I am glad that you pointed out my typographical error, for those who might not know anything about the Amish and similar religious groups.
Comment by michele james-parham — March 7, 2008 @ 11:03 pm
Good post. You make some great points that most people do not fully understand.
“First and foremost, I attack motivation by money, because that’s who I am. I don’t attack the need for a job for money to buy those things such as food and a life of health and safety. However, when you take something like midwifery or coming to the aide of birthing women and then bitch about not being able to make money from it, because of a lack in education or homogeneous education, credentialing, recognition or etc., you are then no better than what we all bitch about — doctors & insurance companies making bank from birth. Let’s face it, birth is HUGE business and why wouldn’t every ‘educator’, lactivist and birth aid want a piece of the pie? Because they should know better, that’s why. Women used to know the village midwife and cooked for her and gave her baskets and sewed blankets and she just did what came naturally to her.”
I like how you explained that. Very helpful. Thanks.
Comment by chiz — March 17, 2008 @ 10:13 am
hello
I would like to link this discussion on a post at midwives to be yahoo group is that ok.
Emily
Comment by Emily buchanan — March 21, 2008 @ 9:23 pm
Emily - that’s fine with me. If I don’t get around to it by Saturday afternoon, feel free to post it yourself. The post before this one can be linked to as well.
Comment by michele james-parham — March 22, 2008 @ 1:29 am
“The very system that doctors want and that so many CPMs/CNMs want (whether all of them know it or not) would completely stump out ‘grassroots lay midwifery’.”
We’re seeing this now in Oregon, which has long been recognized as one of the best places to practice midwifery in the U.S. They are trying like hell to make licensure mandatory.
Comment by Linda — March 28, 2008 @ 1:26 am
It’s going to happen and it will happen all around. Women will wake up one day and find that they really can’t get the care that they want because they were fooled into helping this nation wide lobbying effort to credential/legalize every tom, dick and harry…not because mums and babes need it, but because tom, dick and harry need it. This is the main reason I am not behind the “big push for midwives” or whatever the pre-witch-hunt is calling itself today.
Comment by michele james-parham — March 28, 2008 @ 2:12 am
I like what you are saying in this post.
Comment by Matthew C — March 29, 2008 @ 9:41 am
Hey, thanks Matthew!
Comment by michele james-parham — March 29, 2008 @ 12:13 pm
Great discussion. I don’t think registration makes a midwife at all. Mainly it makes them more afriad. I have a licence in the UK and here in Australia. In Australia it’s almost a burden. It makes life very difficult and can be a stick to beat us with.
The best way to learn midwifery is on the job with an experienced practitioner over a period of years. I trained in the UK over 20 years ago and although it was hospital based we attended homebirths and just worked with the midwife all the time. Breeches, twins were classed as normal and there was no high risk clinic. Everyone saw a midwife and at the hospital I trained at more than 80% of the births happened with a midwife.
In the State of South Australia they have direct entry midwifery. They peddle the course as women centred yet as homebirth isn’t government funded in this state students are not allowed to work with independents like myself. How can a student midwife learn to be woman centred if they have to follow the sheeple and how can they learn midwifery without attending homebirth?
Lisa Barrett
Comment by lisa Barrett — April 20, 2008 @ 10:34 am
Lisa-
“…how can they learn midwifery without attending homebirth?”
I feel the same way. My mum who is a nurse (gerontological, so she’s a bit tired of midwifing people out of this world!) thought that she might be interested in going back to school to become a nurse-midwife several years back…but like she and so many others have said, “I’d just be a glorified labor and delivery nurse with more time to spend with my patient and be allowed to catch babies.” My mum wanted to be around normal spontaneous birth (and learn its trade) and she wasn’t going to get that by going back to college and doing clinicals at a hospital.
Yes, you can make a difference in a hospital or birthing centre by being a nurse-midwife and we need lots of fantastic CNMs in hospitals who really care and see birth as a physiological process. I don’t think doctors should touch birth unless it’s surgical and even then, they should be required to have a nurse-midwife present. But, you can not learn and efficiently practice midwifery as it is in context with homebirth, if your main hands-on learning comes from a hospital.
I guess the real difference that I see and here is that the divide is more in how to deal with the spontaneous and how to leave things alone. A non-nurse homebirth midwife usually learns to do nothing first and then to apply what some might consider ‘traditional folk medicine’ or in some instances what I like to call ‘common sense’. Whereas, obstetricians and more and more nurse-midwives are taught to ‘actively manage’ a pregnancy/labor. ‘Actively manage’ implies much more than sitting on hands, trusting birth, pointing out that mum hasn’t peed in 4 hours, having mum eat a small piece of placenta if she’s bleeding more than necessary. ‘Active’ means to be in the middle of it and monitor every last step of the process and to move it along if it’s ‘dragging’ so that you can go home and get some sleep before your big golf game this weekend.
If you never get the chance to witness spontaneous and physiological birth, then you won’t ever learn how to ‘deal’ with it or how to let it happen — it doesn’t need you. When you view birth this way, you can see the ‘not normal’ cases a mile away. In a hospital where you are waiting around for something to happen so that you can fix it, you haven’t a clue what normal is and when nothing wrong is happening, you’ll be more inclined to run tests and monitor so that you can find something to do to justify your time.
“…families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition.”*
We have a choice. Some women want or think they need more specialized care and care that can only come from a hospital or birthing centre at best. They need nurse-midwives.
Some women trust birth and enjoy the companionship they receive from their midwives and appreciate their midwives ability to help out when they are needed. They want non-nurse midwives at home.
Some women completely trust birth, their bodies and babies and do not want or need a birth professional present and only think that if one were to be there it might cause problems. They don’t want or need any midwife.
I fully believe there is a need for nurse-midwives, but their place is not in the home and a homebirth midwife can not truly believe that by going to college and becoming a nurse-midwife, she will better serve her homebirth clients. Could she make a difference in the hospital world because of her homebirth training, you bet your ass! But it doesn’t translate the other way around unless you are willing to abandon all those years of hospital and college indoctrination before you step foot into a laboring mum’s home.
*Valerie French, “Midwives and Maternity Care in the Roman World” (Helios, New Series 12(2), 1986), pp. 69-84
Comment by michele james-parham — April 20, 2008 @ 1:11 pm