Midwifery Students Tribe 2009 - Page 5

[rebirth]

As a midwife I don't see myself *against* uc, but I certainly don't see myself as a UC fan/ supporter. I think there are many midwives that feel that way. It very much depends on what the birthing options/climate is where you are though.

I just think a trained and qualified birth attendant makes a huge difference in birth outcomes. I personally would prefer to give birth in the hospital then do a UC if homebirth wasn't an option.

[MamaRabbit]

I understand what you're saying rebirth. I support UC, I've done a UC, but a fan? Not really. A trained qualified provider can make a huge difference in outcomes, especially since most women don't choose to UC. I hope that my practice shows support to UC... I'd rather help a UCer with prenatal care, etc that is wanted than to not help at all. Even my own views on UC have changed over the last few months well after my twin UC.

As for InaMay, I know she's been vocal about it, and it seems maybe a thought process of women NEED/SHOULD have midwives.

Majikfaerie, not surprised that you love Ina May since you're the biggest treehugger I know LOL

[Om Girl]

I like Ina May, I think she's evolved as a midwife from the point of when her books were written and I think she's an amazing birth activist.
She has lately though taken a stance that all midwives need to become certified and is pushing in her birth activism for certification (CPM status) of all midwives. She claims this is needed for the future of midwifery in the nation.

[fairydoula]

Originally Posted by Om Girl

I like Ina May, I think she's evolved as a midwife from the point of when her books were written and I think she's an amazing birth activist.
She has lately though taken a stance that all midwives need to become certified and is pushing in her birth activism for certification (CPM status) of all midwives. She claims this is needed for the future of midwifery in the nation.

Do you not feel the same? I think inclusion in the mainstream care of pregnant and birthing women is vital to the continuation of midwifery in the US and to the improvement of maternity outcomes as well. If I've read her correctly, she sees the CPM or CNM certifications as needed so we can be "legitimized" in the mainstream consciousness, and participate in insurance reimbursement and collegial referrals/transfers/consults and truly provide CHOICE to women who are in the childbearing year, as well as being licensed state by state, providing more consumer and midwifery protection, viability, accountability and more liveable wages for hbmw's and truly including homebirth and fsbc midwives in the healthcare options for ALL women.
Personally, in states where women CAN get midwifery care and insurance reimburses or pays, where midwives are licensed and can interact more reasonably with the rest of the health care system, isn't that really the best of all worlds... states like Oregon, Washington, California, etc... I think it's awesome. What is the problem of delineating a baseline of competency for midwives in our country? It's done in lots of other countries with sucess. (hint, look north)
-Jen

[triscuitsmom]

Originally Posted by fairydoula

Do you not feel the same? I think inclusion in the mainstream care of pregnant and birthing women is vital to the continuation of midwifery in the US and to the improvement of maternity outcomes as well. If I've read her correctly, she sees the CPM or CNM certifications as needed so we can be "legitimized" in the mainstream consciousness, and participate in insurance reimbursement and collegial referrals/transfers/consults and truly provide CHOICE to women who are in the childbearing year, as well as being licensed state by state, providing more consumer and midwifery protection, viability, accountability and more liveable wages for hbmw's and truly including homebirth and fsbc midwives in the healthcare options for ALL women.
Personally, in states where women CAN get midwifery care and insurance reimburses or pays, where midwives are licensed and can interact more reasonably with the rest of the health care system, isn't that really the best of all worlds... states like Oregon, Washington, California, etc... I think it's awesome. What is the problem of delineating a baseline of competency for midwives in our country? It's done in lots of other countries with sucess. (hint, look north)
-Jen

I'm going to assume you are in the US (sorry I didn't check ) and that would make me North of you I can assure you it's not done with absolute success here... not even sort of close.

There are pros and cons for sure, but it's way to simple to say that licensure/regulation ensures the best of both worlds for midwives and the birthing women who want them. The part I highlighted above about choice really caught my eye. There are many birthing women who have far fewer choices here now then they did before regulation because of the restrictions that are placed on the midwives practicing here now. Breech births, VBACs, postdates... and there are others... standards are no longer set by the midwife/the midwifery practice but rather by an outside body and then on top of that even things that the College of Midwives says are OK are in some cases only OK if an OB says that they are OK so you end up with midwives who have their hands tied by OBs if you are (as I am) in a midwife unfriendly place. There is no chance for a vaginal breech birth here unless you UC, there is no chance for a VBAC homebirth here unless you UC, if you are GBS unknown and your membranes ruptured before labour you must go to the hospital if your water breaks and labour doesn't start and give up your homebirth... I could give many many more examples. Informed choice and consent it is certainly not.

There is a lot to consider, for both midwives and their clients. I am not saying there is a right or wrong answer, only that it's not black and white by any means.

I'm in Ontario. I could get trained here and get my pay straight from the government and not have to worry about a lot of things that unlicenced midwives worry about...

Instead I am a student midwife getting my bookwork done through the US, and then moving their to apprentice at some point. I am also a pregnant woman who has a midwife for her prenatal care but is also planning a UC because the care is so restricted here and the birth I want I am unlikely to get if I have them here... I don't have to pay to have a midwife sure, but I'd do it in a heartbeat to not feel forced into that choice.

[rebirth]

Originally Posted by MamaRabbit

I understand what you're saying rebirth. I support UC, I've done a UC, but a fan? Not really. A trained qualified provider can make a huge difference in outcomes, especially since most women don't choose to UC. I hope that my practice shows support to UC... I'd rather help a UCer with prenatal care, etc that is wanted than to not help at all. Even my own views on UC have changed over the last few months well after my twin UC.

As for InaMay, I know she's been vocal about it, and it seems maybe a thought process of women NEED/SHOULD have midwives.

Majikfaerie, not surprised that you love Ina May since you're the biggest treehugger I know LOL

I respect a midwife who would do prenatal (or even postpartum) support for a UC mom.... but I wouldn't do it if I knew.... b/c in my state liscensing and regulation of midwifery is strict enough, and liscenses can be taken away for really dumb things... so for me it'd be too much risk. And I would also feel really taken advantage of if I later found that a client was purposly decieving me to get her UC.

I don't necessarily think all women need a midwife, but I do think they should all have one (or some other care provider).

[BellaLuna Rayne]

I am now an official student of AAMI!

:

[636Jen]

Breech births, VBACs, postdates... and there are others... standards are no longer set by the midwife/the midwifery practice but rather by an outside body

SO TRUE...and so very unfortunate.

I have a lot of respect for UC. In my experience, these aren't women who are ignorant to any risks or are uneducated about birth. A friend of mine is planning a UC for her 7th child in March. The Amish also do it.

....And I would also feel really taken advantage of if I later found that a client was purposly decieving me to get her UC.

Or, you could feel confident that she had a UC with the best prenatal care you could provide.

[majikfaerie]

Originally Posted by MamaRabbit

Majikfaerie, not surprised that you love Ina May since you're the biggest treehugger I know LOL

[indignation] Hey!

oh. wait, yeah. i guess I am the treehugginest person most people know : [/indignation]
:

Originally Posted by BellaLuna Rayne

I am now an official student of AAMI!

:

congratulations!

Originally Posted by 636Jen

Or, you could feel confident that she had a UC with the best prenatal care you could provide.

:

I do provide a lot of support to UCing mamas; pre-natal and post-natal care, backup for labours, and loads of preparation work, for those that want it. and I'm happy to do so. I guess, I see the ideal birth as being with a midwife who has worked with the birthing parents in the lead up to the birth, to ensure that they are as prepared and informed as they can be, so they basically dont need the midwife around anymore. but she's still on call/ handy in case they need her for emotional support/ experience, or if there's a complication, she can jump in with knowledge and help out.
basically giving the exact level of care wanted/ needed by the mother.
that is the basis of how I run my practice.
but i'm an 'underground' lay midwife, in a place where I can 'fly under the radar' pretty easily.

[636Jen]

I love your philosophy Majik!

I guess, I see the ideal birth as being with a midwife who has worked with the birthing parents in the lead up to the birth, to ensure that they are as prepared and informed as they can be, so they basically dont need the midwife around anymore.

ITA! Especially with the moms who are informed, want minimal intervention and a very hands off approach to their birth. If there is a complication, we of course can be there to assist them. To me, just being present for a mom who is in that primal and powerful mindset is awesome.

[rebirth]

my issue would be with them lying to me though. I would have a big problem with them leading me to believe they wanted me to attend their birth when they don't. It is risking my liscense, which is a horrible position to be put in, and completely not fair to me. Were I underground or didn't live in a liscensed state I would be much more ok with it, but that won't be the case, so the personal risk is just far too much for me.

It also could mean that I would have to turn away another mom, who did want a midwife- and that is horribly unfair to both me and her. Not a huge deal, but it would come into play.

[636Jen]

I agree that being lied to isn't very nice but I don't understand how that risks you losing your license. What if you don't get to a mom in time and she has an unplanned UC? Does that risk your license too?

[triscuitsmom]

I agree with Jen... having a Mom who UCs in the end shouldn't risk anyones license. It could happen by accident (and does happen!) to anyone, and UC isn't illegal anywhere as far as I now. In fact I'd think them not telling you would be the way to make sure you didn't get in trouble, since you might (not sure about laws/regulations in your area) be in trouble for knowingly going along with a UC plan.

My midwife doesn't know I don't plan on having her here. I do plan on calling her after the birth and having her come out. I am making a well thought out and researched decision for the well being of my child and I by protecting our space and planning a UC. I believe I'd be having a UC with this baby regardless of birthing climate, though I firmly stand by my statement I wish I didn't feel like there weren't good options for me besides a UC.

But why should the fact that I have made the best possible decision for my child and I mean that we get substandard prenatal care? The prenatal care lasts far longer than the birth does, and so I definitely don't feel like I stole a spot from someone else if I don't have the midwives actually at my birth. I had complete placenta previa that landed me with lots of bleeding and contractions earlier in my pregnancy. Around here you don't even have an OB until 27 weeks unless you are high risk, so instead of having to start care with someone I'd never met I had ultrasounds and met with one OB but the whole time had my midwives... people who knew my name and I knew them making sure that my baby and I were as well taken care of as we could be.

*shrugs* YMMV but I believe in midwifery care for all women. Every woman should have the one on one personalized care that midwifery can be. Someone who knows upon conception she is going to need a c-section obviously needs an OB for her delivery, but as far as I'm concerned should still have access to the best prenatal and postpartum care she can get, and if that is with a midwife then the delivery isn't what should matter...

[fairydoula]

Originally Posted by 636Jen

SO TRUE...and so very unfortunate.

I have a lot of respect for UC. In my experience, these aren't women who are ignorant to any risks or are uneducated about birth. A friend of mine is planning a UC for her 7th child in March. The Amish also do it.

Or, you could feel confident that she had a UC with the best prenatal care you could provide.

That's kind of a blanket statement that is not usually true. The Amish don't do it... SOME Amish may, just as some Amish use midwives all the way through, some go to FSBC and some go to the hospital.
There isn't just ONE way they do it, anymore than there is ONE way the English do it.

I've had two UC's myself and I am completely comfortable with them FOR ME. But I didn't deceive a care provider during my pregnancy. The first UC was a planned homebirth WITH a midwife, but with very poor communication between my two midwives, no one came to my house till 1 hour after the birth. This was FINE by me, as everything was fine and I knew what to do. The second was a planned UP/UC. Had I had a midwife for prenatal care I would have been very honest about planning to birth alone.
I think honesty is always the best policy. It may be uncomfortable, it may bring up issues or force someone to seek a different care provider or no care provider at all, but in the end, it's always best to be truthful and upfront.


quote*What is the problem of delineating a baseline of competency for midwives in our country? It's done in lots of other countries with sucess. (hint, look north)
*

When you look at what I said in context I was ONLY referring to the fact that Canada has established more clearly and with more sucess a BASELINE of COMPETENCY for midwives to be licensed and "legitimized" NOT that they have achieved perfection or even wonderful choices for SOME women. BUT the majority of women in Canada have more choice in their care provider and they have more access to homebirth across the range of incomes.
The majority of women are NOT dealing with vbac or breech. Absolutely, Canada still has a lot of improvements to make. Absolutely, choice still is a issue for women who are dealing with these issues.
I didn't mean to make it seem like Canada had it all figured out... I don't think there IS a country without healthcare issues and problems. What I meant was that Canada seems to have a more sensible way of dealing with healthcare and licensure of out of hospital births, providing that option to MORE women, regardless of income. From what I have read and learned, there is a more structured path to becoming licensed.
We're struggling here in the US to establish just what a competent midwife IS and how to "prove" that, through what type and path of education and through what type of licensing or not.
It is a frustration that not only do we have to deal with legislators, the public, the media, ACOG/AMA and more subgroups that all have different perceptions and opinions of what a midwife is, what is legitimate/legal/accepted etc, and what a midwife should be able to do in her practice, but we ALSO have to deal with widely differing opinions within our community about what constitutes a midwife and who, if anyone, should be able to regulate/control/licence that midwife.
Email/postings are sometimes such an incomplete way to communicate, but I think it's great to hear all the different views.
- Jen

[rebirth]

The reason it could be risky to my liscense is that my state has really strict regulations, and if something goes wrong- even if the midwife did everything by the book- it can and does risk the midwives liscense. So if something goes wrong and I were to not even be there at all, - I could lose my liscense. I am willing to take that chance for clients, but only with honesty going both ways, and knowing that they understand that a huge part of midwifery is about open communication and respect.

I'm also not a UC supporter. I think birth should be attended by a trained care provider, so that certainly influences my feelings on the subject. If I were pro UC I would feel differently about giving care to UC moms.

[MidwifeErika]

I am actually against the CPM being required by anyone to practice midwifery. I am also against licensure being mandatory. I am thrilled there is licensure available in many states, I only wish more states had it optional rather than mandatory. I feel that it being optional gives more choices to families. I feel that if I want to pay the woman across the street to come and catch my baby, it should be my right to do so. When spending quite a bit of time a few years back reading books on the history of midwifery I really came to this opinion. I would hate to see the push to be accepted by the medical community erase where we came from and what midwifery stood for. Just my opinion.

[triscuitsmom]

Originally Posted by hotwings640

I am actually against the CPM being required by anyone to practice midwifery. I am also against licensure being mandatory. I am thrilled there is licensure available in many states, I only wish more states had it optional rather than mandatory. I feel that it being optional gives more choices to families. I feel that if I want to pay the woman across the street to come and catch my baby, it should be my right to do so. When spending quite a bit of time a few years back reading books on the history of midwifery I really came to this opinion. I would hate to see the push to be accepted by the medical community to erase where we came from and what midwifery stood for. Just my opinion.

I totally agree. I'm not against licensure at all. I am against it being the only option though.

As far as I'm concerned I agree with those who have said that birth doesn't belong to doctors or midwives, it belongs to women... and I trust women to make the choices she needs for her body and her baby. I think the best way to ensure good outcomes with that is for all options to be informed and avaliable, even those we might not readily agree with.

I would never choose an elective cesarean. I also wouldn't choose a hospital vaginal birth with no medical reason. I would choose a homebirth with a midwife or an unassisted childbirth. I feel as a midwife however it's not my job to make those kinds of calls for other women, but rather provide the information and support that they do need from me (whatever that is for that woman) to make their own informed choice and have appropriate care doing so to ensure the best possible outcome for Mom and baby in the end.

[fairydoula]

Originally Posted by hotwings640

I am actually against the CPM being required by anyone to practice midwifery. I am also against licensure being mandatory. I am thrilled there is licensure available in many states, I only wish more states had it optional rather than mandatory. I feel that it being optional gives more choices to families. I feel that if I want to pay the woman across the street to come and catch my baby, it should be my right to do so. When spending quite a bit of time a few years back reading books on the history of midwifery I really came to this opinion. I would hate to see the push to be accepted by the medical community erase where we came from and what midwifery stood for. Just my opinion.

Erika, is it mandatory in your state? I mean, is it illegal to be a CPM or a lay midwife catching babies without a state license? Just curious. I realized I don't know if it is in my homestate or not. I "think" it is illegal, but I'm not sure. My current state does not have regulations in any way so, so far, it's not relevant.
- Jen

[MidwifeErika]

Originally Posted by fairydoula

Erika, is it mandatory in your state? I mean, is it illegal to be a CPM or a lay midwife catching babies without a state license? Just curious. I realized I don't know if it is in my homestate or not. I "think" it is illegal, but I'm not sure. My current state does not have regulations in any way so, so far, it's not relevant.
- Jen

Yes, it is mandatory here. You have to have a license to practice and you have to be a CPM to get the license.

[636Jen]

Originally Posted by hotwings640

I am actually against the CPM being required by anyone to practice midwifery. I am also against licensure being mandatory. I am thrilled there is licensure available in many states, I only wish more states had it optional rather than mandatory.

As always, I agree with you.

Fairydoula, I didn't say ALL AMISH had UC. I said Amish do it. I am very aware that there isn't a certain way ALL cultures birth.

triscuitsmom, ITA. You do deserve the best prenatal care. I also don't see how you're taking someone else's "spot" either. If you don't plan on your midwife being there, it seems to me that you opened a spot! YES, birth belongs to WOMEN!! And it should be women who make the choices on where and how they give birth!!


I know we went through the licensure issues in the past thread. I hope it doesn't get regurgitated again. I think we are all aware of where each other stands.