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

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

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.

“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.