Doubting the natural power of birth/my future plans for education/the current "system." - Mothering Forums

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#1 of 37 Old 07-12-2011, 06:27 PM - Thread Starter
 
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Hi all, 

 

A little background: I am 32 years old, the mother of one six year old son who was birthed at home with his father and three lovely midwives from the NHS in the UK. I have always been interested in pregnancy and birth, and recently made the decision to begin training for my birth doula certification (as well as breastfeeding counselor) with the eventual goal of becoming a midwife. I absolutely feel this is the right path for me -- I would love nothing more than to be surrounded by birthing women and their families for the rest of my life.

 

That said, the system here is completely different from the UK. Though I am American, I lived in Scotland for my pregnancy and birth, and am much more familiar with their maternity system than the one here. My original plan was to take the CNM route, but for various reasons, I feel this is not the way I want to go. So, I began to research direct-entry education plans, and though I haven't decided on any one program yet, I believe this is the how I will proceed with my education when the time comes.

 

Or I did. I encountered a thread on a birthing page on Facebook tonight that really made me stop and think. The original post was from a midwife who attends homebirths of those women some would consider high risk -- VBAC's, twins, breech, etc. -- who mentioned having come across what are essentially anti-homebirth and midwife sites. The resulting thread was very helpful and supportive up until the end, when two posters began to talk about how faulty the "system" is, how midwives would never tell their clients about the babies they've "killed", and how when a midwife is accused of negligence, the community rallies around her while crucifying OB's in similar cases. (I am paraphrasing because although I engaged them in respectful dialogue, their posts have since been deleted.)

 

This really got me thinking. IS direct-entry midwifery inherently dangerous? How much education and qualification is necessary to appease people who believe that? How many births? How many deaths are too many? I believe with all my heart that serving women and their families is what I am meant to do with my life, but this thread threw me for a loop. Am I kidding myself that this path can work for me, and work safely for my eventual clients? Deep down, I inherently trust birth as a natural process and women's abilities to do it successfully more often than not, but seeing such venom directed towards non-CNM midwives and the mothers who would choose them is a little bit horrifying to me. I even see it frequently on the board dedicated to homebirth here on MDC.

 

I don't know exactly what I'm asking for. Maybe reassurance that my goal is attainable? That it's reasonable? That distance education, self-education, and apprenticeship are valid paths to produce a well-rounded, safe, completely qualified midwife? If you don't feel that way, why or why not? This is troubling me on a pretty fundamental level, and I know it's something I need to work through -- and I will -- but I would very much appreciate feedback from women who are actually living my dream.

 

Thanks for reading this book and humoring me!

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#2 of 37 Old 07-14-2011, 10:16 PM
 
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Hi poetgoddess - I have never posted on this site before, but I found your message very articulate and compelling.

 

Obviously no one else can ultimately decide what is best for you in your life and profession. But just as important in your calling to serve birthing women is what is best for them and their needs - and I think you've already come across some different opinions on that.

 

I have some sympathy for you being deterred by the requirement in the US for a CNM to have a nurse qualification and then further study. I know it can seem like a huge and insurmountable challenge. I am a 36 year old mother of two (nearly three) who decided to become a psychologist three years ago. In my country that requires a Bachelor's degree and a Masters before you can even register to practice. It's hard and it feels like it's going to take forever but I love it. I love the rigour, I love using my life experience in inform the science I am learning and vice versa.

 

What I will say is that, to my knowledge, the US is the only maternity system in the western world that allows for direct-entry midwives. In other countries, like my own, where midwives attend homebirths they must legally be fully trained nurse midwives as qualified to practise in a hospital as in the home. I have many friends who have planned homebirths, and it would be unthinkable to them to have a midwife who was not medically trained.

 

I have never been afraid of birth, but nor do I believe it is totally safe. To me, in a world that is highly controlled and sanitised, birth felt like the one true, great visceral challenge I would face in my life. In the way I understand the world something cannot be that primal and that transcendent and still be safe. Like you, I do believe birth is a natural process and women can do it successfully more often than not - but if the 'not' happens I want someone at my side who knows *exactly* what to do.

 

You have my utmost respect for your calling and also for your willingness to reflect on the things that you learn. Best of luck to you.

 

 

 

 

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#3 of 37 Old 07-14-2011, 10:30 PM
 
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I do think that the process to become a CPM or lay midwife in the US is lacking. The standards set forth to become a CPM here would not allow you to practice legally as a midwife in other countries like the Netherlands, Canada, the UK, and Australia. There are only a few midwifery schools accredited by NARM, and only one, maybe two, offers an education that is in any way shape or form rigorous. The PEP path isn't any better -- do you really think that apprenticing with one or two midwives is going to give you the breadth of knowledge you need to practice safely? It's great to say that you "trust birth" -- most of the time, that's going to work fine! However, every once in a while, birth goes to hell quickly and it a life-threatening way. As a midwife, you are expected to know how to handle that! 

 

On the other side of the coin, I personally know two women who have lost a child in a home birth emergency with a negligent midwife, and it both cases, that midwife had prior deaths that they did not find out about until after the fact, even though they thought they had thoroughly checked the midwife out. Both those midwives are *still* practicing, even after having been found guilty of negligence by the governing body in their state. There was no way to punish them because the boards overseeing them are a joke (and in one case, there is no board), and no compensation for their victims, because they are not required to buy malpractice insurance. They are not telling potential clients about their past, either. And there is nothing to stop it.

 

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#4 of 37 Old 07-15-2011, 10:21 AM
 
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I completely respect those who want their provider to know exactly what to do in emergency situations - and in such emergency situations, many would need the help of an obstetrician.  With a good midwife (regardless of credential) she should be doing a lot of preventative counseling during pregnancy, and watching over the birth closely to ensure when transfer is necessary...etc. 

 

The important thing to remember is that no matter who attends the birth, the mother is paying for them - but the mother is ultimately responsible.  She needs to research and find a midwife who fits her birth philosophy, who she trusts, and who she believes to have the skill desired for the experience she desires.  Choosing a midwife because of their credential is the same concept as choosing an OB because you think you're getting better care from a surgeon.  A credential does nothing to prove the way someone practices - only experience, apprenticeship, birth philosophy, routines...etc.

 

A CNM studies in the hospital - if a CNM is attending home births, their skills in the hospital will count, but, their experience in home birth should be looked at separately from any years in a hospital.  Most births are medically managed in a hospital, no matter who the attendant is.  The problem is, many parents look for a credential and not experience.  They feel that if they go to a CNM who has had all this medical training, then they are safer than a direct-entry midwife.  That alone does not determine safety.  It isn't that CNM's can't be awesome - it is that we don't want to give someone false reassurance simply because we had some extra book work and passed a test.

 

We have to be responsible for our pregnancies and births.

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#5 of 37 Old 07-15-2011, 12:32 PM - Thread Starter
 
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I appreciate all yours responses and am taking what you say on board; however, I had hoped that by posting on this board, I would hear from actual professional midwives, whether CNM's or CPM's. It seems like no matter where I go, whether it is a "safe place" for discussing these issues or not, the same attitudes keep cropping up and eating away at me. Maybe that's something I need to really do some deep reflecting on. Maybe everything I thought I knew and trusted about women and birth is flawed, lacking in substance, and essentially a pipe dream. This is terribly depressing to me, but I guess it's something I am going to have to come to terms with and work with.

 

Pardon me if this comes across as petulant. I don't mean for it to. I am just saddened by what I feel is like the death of a dream to me. I know how dramatic that sounds, but when something you have always believed so deeply in is questioned at every turn, it feels a lot like starting from scratch, and who wants to have to go through all that building up again, you know? Thanks for listening to me ramble. This is very stream-of-consciousness!

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#6 of 37 Old 07-15-2011, 02:17 PM
 
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poetgoddess, I am also not a midwife so I'm sorry I can't give you the feedback you are looking for.  Is there anyone in your area that can mentor you?  Perhaps if you met some local CNMs and CPMs, ask them why they chose the path they did and what their philosophies on birth are, you could get a better feel for each model of care.

 

It sounds like you're afraid that taking a medical approach to your education means that you don't trust birth and trust in women's abilities to give birth?  I can see where you're coming from.  All I can do is offer my perspective.  I trust birth.  I trust my body.  I think childbirth is amazing and transformative and I think women can discover themselves in birth.  I also (more or less) trust medicine and the training of doctors and nurses.  I don't think the two are mutually exclusive.  I spent a long time finding the right person to be my care provider during pregnancy.  In the end, I went with an OB and it might surprise you to know that he is significantly more hands off and trusting of my body (and supportive of my decisions!) than several of the midwives (including CPMs and lay midwives) I spoke to.  

 

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#7 of 37 Old 07-15-2011, 06:01 PM
 
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I agree that most lay midwives/ CPM's need more traditional education. That said I am a traditional midwife and will be a CPM through the PEP route.  I think there needs to be a balance. I think most midwives should be required to take nursing level classes but I take issue with forcing midwife students who want to only work at home to drudge through all of the hospital crap and loop holes to become a nurse. They are different occupations. I have a BS degree in psychology with a minor in Biology and Women's Studies. I started out nursing/premed and did all of the requirements to be accepted to the nursing program biology, chem. anatomy, statistics etc. but nearly vomited in the one week I had to deal with the nurses and doctors in the nursing program. I really struggled about doing a MEAC school but in the end it came down to my personal circumstances. I looked at Frontier for my CNM but I didn't want to have to do rotations at a hospital. I am a great self learner and very motivated, I had a good basis of birth experience with 5 years as a busy doula and CBE, I come from a rich "medical " back ground (dad was a veterinarian, mom a nurse, I am a CNA and did all nursing pre reqs phlebotomy etc.), and I had a bachelors degree in a subject that is very applicable to midwifery (psych.) so in the end I decided to save the money and do an intensive apprenticeship with a couple of midwives. I have seen placental abruptions, previa, done twins and breeches all in my apprenticeship. Do I still have things to learn...yes of course. But I feel like I am competent and not dangerous. My preceptors trade off attending my clients births as a second midwife. I am a reasonable distance from a hospital. In the end babies and mothers die sometimes. If I practice long enough it may happen to me. It happens to doctors more frequently than any one likes.  I "trust birth" but not in the way that many people do. I trust that it can be dangerous and some times all we can do is our best.    I do think that NARM could become more strenuous. I think all the nursing prerequisites should be requires as well as phlebotomy, psychology, sociology and many more. May midwives lack basic writing and math skills. It is sad that only this year did NARM insist that midwives applying have a high school diploma. Seriously! That is a joke.


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#8 of 37 Old 07-16-2011, 04:11 AM
 
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I agree with you completebeginnings.  Sometimes things happen - sometimes people get hurt - sometimes people die.  Whether you did all you could, you can still have that hanging over you - but that is just one of those things that comes with the profession.  The thing to remember in the US maternity system is that most complications are iatrogenic, sadly.

 

All you can do is get educated and talk with the women you will be serving - and let them choose you just as much as you choose them.  It is a mutual relationship and doesn't have to work like other situations - you will be screening your clients.  If you feel they are not a fit for you for whatever reason, then that is your choice - and that is something you should stress to them as well - choosing you because they want you there.

 

You don't have to be like any other midwife you've heard of - it will be your choice to get as much education, apprenticeship..etc. as you like - and then those interested in what you offer will come to you.  There are soooo many people in th US, not everyone wants the same things.  If you feel this is your calling - go after it.  Regardless of how many years someone has of experience, they always have something to learn.  You simply just don't falsify your knowledge, and they will choose you at their comfort level.

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#9 of 37 Old 07-16-2011, 06:27 AM
 
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Poetgoddess, there are many different routes to going about being a midwife. CNM and CPM are only two ways. I know a number of women, myself included who would not want a CNM at the birth. I would (have done) a UC and had a birth with a direct-entry midwife who was very, very hands off because that's what I wanted. I trust birth and my body and for my births I do NOT want any vaginal checks, heart tone monitoring and I wanted to catch my own baby, no management of 3rd stage ect. I am not the only women like this. UNfortunately many liscensed midwifes are not allowed by their guidelines to provide such hands off care or they cannot do homebirths for breeches ect whose mamas may want a homebirth. Most places where there are licensed midwives there are also practicing "underground" unliscensed midwives who many times are direct-entry.

Also I am a practicing midwife (I greatly prefer the term private birth attendant. I support women who want a UC and am present at birth whose mamas want someone there. I am just educating myself through many various means and until just recently attended all births with another more experienced midwife. After a LOT of research and thought I have decided I would never go the liscencing route for midwifery. It limits mamas choice for homebirth. I trust birth while realizing that things do happen. Just like driving- car acidents happen but that does not keep me from driving. The more births I do the more I trust birth but the more I realize I need to learn. I think it is a life-long process.

I guess my point is that there are many ways to look and approach this. I would encourage you to research your options.

For starters you could check out Carla Hartley. She articulates some very good reasons not to go the lisencing route.

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#10 of 37 Old 07-17-2011, 05:56 PM
 
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I was curious about whether my preceptor thought the NARM requirements were minimal, and she agreed with that statement.  I was interested in that.  I am certain, especially after experiencing a sick baby at my 7th birth with her, that I really feel like I need more like 75 or 80 births before going "on my own."  I'm planning to apprentice with my local midwives (have started) and I'm planning at least 2 away programs for training opportunities, trying to see birth in different settings and countries.

 

The question about whether birth is safe is a discussion about what you mean by safe.  I believe that by respecting physiologic birth, a mom has the safEST chance at birth; certainly much safer than the routine stuff that happens in many hospitals that causes iatrogenic complications.  But birth is only as safe as life, and life isn't safe.  Riding in a car is "unsafe," having relationships is "unsafe," etc.  But the sick baby I helped at the birth with was safER because she got to keep her cord for longer, etc.  And then we needed EMS to help her for the long term.  But if the mom had had a highly medicated birth, who knows if there had been more complications with the baby that would have made it harder for her earthside.

 

I respect your concerns; remember that you need to assess where you're at for yourself.  There certainly has been any number of times that I have reassessed what I thought about something like birth, as I have been working through my education.  My education, both my background and my current process, sounds really simlar to completedbeginnings.  So I won't describe that again.  But I believe that both theoretical knowledge as well as wisdom is important in becoming a midwife.  And learning to rely on intuition.  This is an interesting thread to me.

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#11 of 37 Old 07-18-2011, 10:13 AM
 
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Quote:
Originally Posted by poetgoddess813 View Post


 

This really got me thinking. IS direct-entry midwifery inherently dangerous? How much education and qualification is necessary to appease people who believe that? How many births? How many deaths are too many? I believe with all my heart that serving women and their families is what I am meant to do with my life, but this thread threw me for a loop. Am I kidding myself that this path can work for me, and work safely for my eventual clients? Deep down, I inherently trust birth as a natural process and women's abilities to do it successfully more often than not, but seeing such venom directed towards non-CNM midwives and the mothers who would choose them is a little bit horrifying to me. I even see it frequently on the board dedicated to homebirth here on MDC.

 

I don't know exactly what I'm asking for. Maybe reassurance that my goal is attainable? That it's reasonable? That distance education, self-education, and apprenticeship are valid paths to produce a well-rounded, safe, completely qualified midwife? If you don't feel that way, why or why not? This is troubling me on a pretty fundamental level, and I know it's something I need to work through -- and I will -- but I would very much appreciate feedback from women who are actually living my dream.

 

Thanks for reading this book and humoring me!



I don't believe direct-entry midwifery is inherently dangerous. I wouldn't do it if I felt it was. No matter what kind of care provider you become (CNM, CPM, OB, etc) you must always work to learn more and constantly improve your skills. There will always be more to learn once school is over. It the the drive of an individual to continue to learn and improve that brings up their level of safety.

 

I know the sort of comments you are speaking of about non-CNMs. However, there are plenty of women who feel good about hiring a CPM or traditional midwife. I am very clear with women who interview with me as to what kind of midwife I am, what my training involved, and the fact that I do NOT have malpractice insurance. They sign a 9 page document outlining all of this if they are interested in my care. I am transparent and there are women who are completely comfortable with me based on that level of honesty. And to be honest, that is what I look for in a provider as well rather than credentials. I am currently seeing a midwife for my pregnancy who does not have any credentials behind her name, but I have worked with her at births and I trust her honesty and experience.

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#12 of 37 Old 07-18-2011, 11:44 AM
 
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I disagree that mother is resposibale . If I am paying a professional, it is their responsibility to provide the best service and care. I do not research car repair when I hire mechanic. I do not go to laws school myself when I hire an attorney.  If I am hiring and OB or midwife,  it is their professional resposibility to follow standard of care and proved me with care that will keep me and the baby alive.

 

I can;t control my body of physiological process 100% of the time. Bad things happen. I need a professional  who will know how to deal with bad things.

 

Otherwise, why do I need a doctor or midwife?

 

 

Quote:
Originally Posted by esali View Post

I completely respect those who want their provider to know exactly what to do in emergency situations - and in such emergency situations, many would need the help of an obstetrician.  With a good midwife (regardless of credential) she should be doing a lot of preventative counseling during pregnancy, and watching over the birth closely to ensure when transfer is necessary...etc. 

 

The important thing to remember is that no matter who attends the birth, the mother is paying for them - but the mother is ultimately responsible.  She needs to research and find a midwife who fits her birth philosophy, who she trusts, and who she believes to have the skill desired for the experience she desires.  Choosing a midwife because of their credential is the same concept as choosing an OB because you think you're getting better care from a surgeon.  A credential does nothing to prove the way someone practices - only experience, apprenticeship, birth philosophy, routines...etc.

 

A CNM studies in the hospital - if a CNM is attending home births, their skills in the hospital will count, but, their experience in home birth should be looked at separately from any years in a hospital.  Most births are medically managed in a hospital, no matter who the attendant is.  The problem is, many parents look for a credential and not experience.  They feel that if they go to a CNM who has had all this medical training, then they are safer than a direct-entry midwife.  That alone does not determine safety.  It isn't that CNM's can't be awesome - it is that we don't want to give someone false reassurance simply because we had some extra book work and passed a test.

 

We have to be responsible for our pregnancies and births.



 

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#13 of 37 Old 07-18-2011, 11:48 AM
 
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This is why I went with OB. 75-100 births is not enough see ll possible variation of all possible complication.

 

OB residents sees thousand of birth by the time she is done with her residency program.  Their professional intuition comes from practice.

 

I

 

 

Quote:
Originally Posted by Bekka View Post

I was curious about whether my preceptor thought the NARM requirements were minimal, and she agreed with that statement.  I was interested in that.  I am certain, especially after experiencing a sick baby at my 7th birth with her, that I really feel like I need more like 75 or 80 births before going "on my own."  I'm planning to apprentice with my local midwives (have started) and I'm planning at least 2 away programs for training opportunities, trying to see birth in different settings and countries.

 

The question about whether birth is safe is a discussion about what you mean by safe.  I believe that by respecting physiologic birth, a mom has the safEST chance at birth; certainly much safer than the routine stuff that happens in many hospitals that causes iatrogenic complications.  But birth is only as safe as life, and life isn't safe.  Riding in a car is "unsafe," having relationships is "unsafe," etc.  But the sick baby I helped at the birth with was safER because she got to keep her cord for longer, etc.  And then we needed EMS to help her for the long term.  But if the mom had had a highly medicated birth, who knows if there had been more complications with the baby that would have made it harder for her earthside.

 

I respect your concerns; remember that you need to assess where you're at for yourself.  There certainly has been any number of times that I have reassessed what I thought about something like birth, as I have been working through my education.  My education, both my background and my current process, sounds really simlar to completedbeginnings.  So I won't describe that again.  But I believe that both theoretical knowledge as well as wisdom is important in becoming a midwife.  And learning to rely on intuition.  This is an interesting thread to me.



 

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#14 of 37 Old 07-18-2011, 12:30 PM
 
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Quote:
Originally Posted by Alenushka View Post


This is why I went with OB. 75-100 births is not enough see ll possible variation of all possible complication.

 

OB residents sees thousand of birth by the time she is done with her residency program.  Their professional intuition comes from practice.

 

With all due respect, in many residency programs, OB residents gain a fear-based professional intuition, not a respect for how the process is supposed to work most of the time.  The OB that I interviewed for my second birth used the excuse that they used interventions to "keep from getting behind the 8 ball."  The OB residents seldom are exposed to a birth in which "the process" is allowed to progress physiologically, without being augmented, water broken, induction, etc. is few and far between. So if that resident has seen 10 physiologic births out of the 1000 births by the time she has finished her residency program, she may have seen lots of complications, often caused by intervention, but she has not seen the 40/60/80/300 births that a midwifery student has seen which have progressed well, easily, and without the fear instilled.  I would rather have someone who has experience with *normal* so that she can get help when the experience moves outside of the *normal* that she has experience with.  This is what I consider *responsible* both as I consider how I will practice, as well as what I would choose in a midwife with another pregnancy.

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#15 of 37 Old 07-18-2011, 12:44 PM
 
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All CPMs are different. If you go to an OB, you're basically guaranteed to get accepted.

 

If you come see me, you're not. (I'm a LM for VA and CPM - I went to a non-MEAC school though do a very rigorous studying on my own. I *still* spend hours per week researching/studying/etc.  I've been to hundreds of births due to a great apprenticeship and etc..).

 

Along with the regular risk factors I also have attitude - a bad attitude is a risk factor and I've seen my preceptors "risk out" moms for that. I encourage moms to interview other midwives in my area and I am also VERY transparent. I have an informed consent documents that read like a textbook of all that can go wrong, complications I've experienced, etc.

 

I won't do breech births at this time. I won't do twins.. possibly ever. I would assist another midwife who has experience in these areas though. 

 

You must be willing to exercise and be honest with me about diet. I do insist on checking hearttones and listening through contractions, I check ever 30 minutes during active labor and after -every- pushing contraction during second stage. This is my comfort. I want to hear what your baby is thinking about labor and birth.. I will use a fetoscope when possible, but also let moms know that during labor I often use the doppler. I think I'm more "medical" than some clients would want, but again, this is my comfort level. I want the full labor picture so that I'm aware of what's going on and can be responsible if changes need made.

 

I don't feel as if becoming a nurse first would improve my skills as a midwife.  I'm a specialist in this area -- low risk birth. 

 

Just a few thoughts.

 

I've had a homebirth and felt comfortable with the care my CPM gave me. I also knew that she would have transported at any time if she had doubts and not worried about her "stats". I don't care about my "stats" either. If we need to go in, we go in. (And I stay as a doula) 

 

Bridget

 

 


Happy single mom of six amazing children ~ Charlotte 15, Bethany 13, James 11, Joseph 7, Noah 6, and Naomi 4.

 

Blessed to be a CPM/LM in Virginia and doing work that I love.. as well as blessed to have worked with talented midwives who shared their knowledge with me. 

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#16 of 37 Old 07-18-2011, 12:50 PM
 
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I do not actually need an OB, or midwife for a birth that goes well. I do not need a seat belt if I do not get into the accident. I do not need a fire alarm if I do never have a fire.

 

Thing is, when I start driving, I do not know if I get into an accident . When I go to bed, I do not know my electrical writing goes wrong and when i start laboring I do not know if I will end up with PPH.

 

Ambulance is not good back up plan in US. It can take forever.

 

Actually, CDC stat show that the safest birth for a baby is in the hospital with CNM

 

We can't compare England of Netherlands to US. We have totally different training standards. In other countries midwives are integrated partner in healthcare and will not take on high risk birth. They have years of training starting with 3-4 year university degree. I want my birth professional to know exactly what to do when things go wrong.

 

http://confutata.com/2009/07/29/midwives-mortality-rates/

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#17 of 37 Old 07-18-2011, 05:52 PM
 
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I am also not a midwife, but I have been struggling with the same issues as you and just wanted to share what I am currently doing - taking my nursing pre-reqs part-time and also studying to be a CPM through an online course.  Meanwhile, I am observing as many births as I can as a volunteer doula.  I always thought I would be a CNM, but now I wonder if it is really for me.  I am leaning towards becoming a CPM because when it boils down to it, I want to give women the best birth they can have, and I don't think the majority of those births ideally would be in a hospital.  I feel by trying to look at both certifications as possible, I am slowly becoming more confident in my choices.

 

I also think the midwife who mentioned she wanted her clients to be as upfront as possible with their diet is right on the money.  I believe there are things you can do as a CPM to ensure a client will have a safer birth, and nutrition is one that I strongly believe.  My drug-free CNM birth was only made possible by a lot of research and nudging from my own doula.  Otherwise I feel certain that I would have been induced at 41 weeks, albeit in a natural birth friendly hospital with CNMs.  (As it was, I delivered at 41 weeks 3 days.)  The hospital midwives did not mention anything about protein or the Brewer's diet to me, just a caveat not to go over 30 pounds in pregnancy weight.  (As I gained 67 pounds and lost it all in 6 months, that also would have been a mistake, I feel.)

I think the flaw is in the system, not you.  The US seems to have a huge chasm in bridging traditional midwifery and clinical care.

 

I share this with you because I wonder if it would be possible for you to  take a couple of steps both with your college education AND your experience at births?  There are so many other "acronyms" on the resumes of some of the midwives I admire.  How about becoming a childbirth educator, or a lactation consultant, or an EMT, or a post-partum doula? I really do think that we are moving towards a more natural birthing movement in this country.  Whether this manifests itself in better standardized training for direct-entry midwives, or more hands-off hospital care remains to be seen.  However, even by questioning this, you are moving forward in your journey, whatever it may be!  I wish you the best of luck.

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#18 of 37 Old 07-18-2011, 10:01 PM
 
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I just wanted to hug you.  hug2.gif  

 

I've been in combat with myself for months now regarding this very thing.  I was the opposite however.  I knew midwifery was my calling but had planned to take the DEM/CPM route.  I even started a DEM/CPM program.  Now, six months later I made a life changing choice and am pursuing midwifery as a CNM.  Not sure if it will help, but you can read my blog about how and why I came to that choice. http://midwifeology.blogspot.com/2011/07/be-change-you-want-to-see-in-world.html

 

 

I wish you luck in your choice


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#19 of 37 Old 07-18-2011, 10:26 PM
 
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I enjoyed reading your blog. Good luck in you professional path. I met some totally amazing CNMs in the hospital.

Quote:
Originally Posted by crimsonandclover View Post

I am also not a midwife, but I have been struggling with the same issues as you and just wanted to share what I am currently doing - taking my nursing pre-reqs part-time and also studying to be a CPM through an online course.  Meanwhile, I am observing as many births as I can as a volunteer doula.  I always thought I would be a CNM, but now I wonder if it is really for me.  I am leaning towards becoming a CPM because when it boils down to it, I want to give women the best birth they can have, and I don't think the majority of those births ideally would be in a hospital.  I feel by trying to look at both certifications as possible, I am slowly becoming more confident in my choices.

 

I also think the midwife who mentioned she wanted her clients to be as upfront as possible with their diet is right on the money.  I believe there are things you can do as a CPM to ensure a client will have a safer birth, and nutrition is one that I strongly believe.  My drug-free CNM birth was only made possible by a lot of research and nudging from my own doula.  Otherwise I feel certain that I would have been induced at 41 weeks, albeit in a natural birth friendly hospital with CNMs.  (As it was, I delivered at 41 weeks 3 days.)  The hospital midwives did not mention anything about protein or the Brewer's diet to me, just a caveat not to go over 30 pounds in pregnancy weight.  (As I gained 67 pounds and lost it all in 6 months, that also would have been a mistake, I feel.)

I think the flaw is in the system, not you.  The US seems to have a huge chasm in bridging traditional midwifery and clinical care.

 

I share this with you because I wonder if it would be possible for you to  take a couple of steps both with your college education AND your experience at births?  There are so many other "acronyms" on the resumes of some of the midwives I admire.  How about becoming a childbirth educator, or a lactation consultant, or an EMT, or a post-partum doula? I really do think that we are moving towards a more natural birthing movement in this country.  Whether this manifests itself in better standardized training for direct-entry midwives, or more hands-off hospital care remains to be seen.  However, even by questioning this, you are moving forward in your journey, whatever it may be!  I wish you the best of luck.



 

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#20 of 37 Old 07-19-2011, 10:26 PM
 
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As far as education, in my experience as a birthing mom with both types of midwives (my first birth was with CNMs, the 2nd with a CPM), I have to say it's the NURSE MIDWIVES that seem to be lacking a rather significant body of knowledge regarding natural birth and pregnancy care.  I would almost rather go unassisted than ever go back to CNM care.  I feel that strongly about it.  The CNMs gave me no useful advice about how to deal with any of the issues I was having, and simply just said everything was fine while looking for excuses to risk me out.  Low iron - they gave me supplements that didn't help, significant weight gain - just said 'hmm', killer hip pain - told me to use pillows, posterior baby - said nothing, polyhydramnios and suspected large large baby at 41w1d - bullied me into an induction, which failed and led to c-section.  To add insult to injury, they then dismissed me when I called in tears on postpartum day 3, crying, shaking, no appetite, unable to rest, unable to move off my couch, begging for help. They never mentioned PPD or anemia.  They were done with me since they don't do VBACs.

 

2 years later, pregnant again, I got the courage to get a CPM and my medical records.  I was angry when I found out the CNM practice pretty much knew my induction would fail (first time mom with a 9.5 lb posterior baby, polyhydramnios and a Bishop score of zero!), but lied to me anyway because the supervising OB had insisted it was either induction or c-section (um, how about refusal as an option?).  My CPM knew I wanted a homebirth VBAC and she didn't just sit there quietly - she told me exactly how to get it.  She helped me find out I had gestational diabetes (how I passed the glucola test defies logic) and suggested I monitor my diet with a glucometer.  She made dietary and supplement recommendations that were extremely helpful.  For low iron, she suggested liquid cholorphyll (worked like a charm!), and a gifted chiropractor for my hip pain.  She ensured the baby was not OP, but just in case, knew how to use rebozo and other turning techniques.  When I went into labor 1 week eary, the birth went so fast and easy that it was almost unassisted.  My healthy and beautiful second son was born into the bathtub at my home, a full 2 lbs smaller than my first son!  Because of her training in homeopathy, she was able to give me a remedy for bruising and one to the baby for wet lungs which  worked perfectly.

 

There is no doubt in my mind that had I gone with an OB or CNMs at the hospital, I would be sitting here with 2 c-section scars.  I was prepared to travel to The Farm to see Ina May to attend my second birth, but I am so glad that I found an amazing CPM right here in my area!  The doula who also attended my birth was just starting CNM training - I hope that my birth (her first home birth and first VBAC) inspired her to persue CPM training instead.

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#21 of 37 Old 07-20-2011, 02:59 AM
 
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I am currently a student in a CPM program, the National Midwifery Institute. Like you, I got the birth doula certification done and attended some births before taking the leap into midwifery education.

 

Obviously, I don't think that direct-entry midwifery is inherently dangerous or I wouldn't be pursuing it. I am completely comfortable with the CPM credential and believe that for someone who loves learning and will pursue knowledge on their own, those midwives will be better educated than an OB or a hospital based CNM.

 

 

Quote:
How much education and qualification is necessary to appease people who believe that?

I don't think any level of education short of a Doctorate, would be enough. For those people, thinking that doctors are better than midwives or that hospital births are safer than home births is their philosophy. For them, you can't measure up. As a midwife, you'll be able to help educate those people about midwifery care, but don't make it your job to change their minds.

 

 

Quote:
Maybe reassurance that my goal is attainable? That it's reasonable? That distance education, self-education, and apprenticeship are valid paths to produce a well-rounded, safe, completely qualified midwife?

I think your goal is attainable. Heck, I didn't think that I would be able to do what I'm doing now; working as a doula, working 40 hours a week at night to pay for school, taking care of my kids and being a student midwife, but I am. (Thanks to an amazing husband!).

 

And I definitely think that a combination of the methods you mentioned can produce a qualified midwife. I don't personally believe that any of those things alone are enough, but I think that you can piece together a program for yourself that will make you the kind of midwife your clients will need.

 

For me, what that looks like so far has been:

 

- working at WIC as a Breastfeeding Counselor

- training and attending births as a doula

- taking the neonatal resuscitation training

- attending the Midwifery Today conference

- attending La Leche League conferences

- taking the BirthWorks childbirth educator training

- enrolling in the National Midwifery Institute and starting to look for a preceptor

 

It will include:

 

- years of study

- apprenticeship with several midwives

- renewing my neonatal resus. card every other year, hopefully with Karen Strange again

 

And possibly:

 

- training as an EMT or LPN

 


Midwife (CPM, LDM) and homeschooling mama to:
13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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#22 of 37 Old 07-20-2011, 09:01 AM
 
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I like phatui's technique here.  I have a science background and have worked in hospital in cardiology as a tech.

 

My road to midwifery has been:

 

participating in a grassroots breastfeeding organization helping moms

working toward becoming a BirthWorks CBE, including the workshop training

neonatal resuscitation with Karen Strange

Waterbirth workshop with Barbara Harper

Midwifery Today conference

CPR certification

working toward completion of modules as part of the first class in Virginia School of Traditional Midwifery (non-MEAC accr. at this time)

Other local seminars, including a medical billing seminar as applies to out of hospital midwifery

choosing CPM over CNM after carefully considering all my options locally and what I valued in midwifery.

 

I'm hoping to sit for the NARM exam in about 2015.

 

I am sure that you can get more training in areas of interest to you where you feel like you need to "beef up" your skills.  Since I've been aware of these things the last 2 years, I am amazed at all the options for womens health training within 2 hours of where I lived.  If I did all the things available, I would be much further along my journey; but I have children and family activities, etc. also to fit into my life.

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#23 of 37 Old 07-20-2011, 12:35 PM
 
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I have struggled with those thoughts and fears a lot since starting this journey. I definitely think the CPM system can lack, but for me I think the quality of your education comes down to your clinical training and how it plays into where and with who you will be serving. I have taken on a trial apprenticeship and I honestly don't know that it is capable of preparing me for what I want to do. I love the idea of trusting birth and all that and I definitely feel inspired when I read Carla Hartley's views....but I think sometimes we might put so much faith in "trusting birth" that we forget how vital is is to have as much knowledge and skill as we possibly can.  At least I know I have done that sometimes. I live in an area that isn't heavily populated, and the majority of the women who homebirth here are sturdy, healthy midwesterners, and many of them Mennonite/Amish. It hit me recently that training in this environment might not be able to prepare me very well because complications are rare and the lifestyles, health, and beliefs of the mamas tend to be the same, resulting in similar births. My preceptors trained in birth centers in Texas where they regularly saw complications, STD's, all that kind of stuff...but how can they teach me to deal with that when none of the clients have those issues? My main reason for becoming a midwife is because I want to be able to serve women in developing nations, women who are malnourished, disease ridden, etc. I am realizing that for my goals, CPM training in my area is not going to be adequate. I am strongly considering switching over to CNM. On top of the education issues, my other reason for wanting to switch is because I want to promote change in the medical world. I hate that people have bad, medicalized experiences with CNM's. I want to be a good CNM who helps women achieve the most satisfying and safe birth possible. If we had more holistic CNM's, I think the hospital birthing world would be a much better place.

 

I think ideal training would be an apprenticeship that is with midwives who work with a variety of people and a large enough client base so that the apprentice gets well rounded experience. I think that training programs like Casa, Maternidad la Luz, the school in the Phillipines are wonderful resources for getting that kind of training. If I didn't have a family to take care of, I think my apprenticeship here paired with some internships at the schools like I just mentioned would be an excellent training.  

 

So anyway...my point is, I think apprenticeship/self study/distance learning can be a very valid path to midwifery. But from my experience so far, it all just depends on your apprenticeship and where and with who you want to work with. If I wanted to stay here forever and serve healthy Kansas women, I believe that my apprenticeship and self study would prepare me fully. Hope that all makes sense...I'm a little tired :)


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#24 of 37 Old 07-20-2011, 01:12 PM
 
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Personally, I'm for there being a large variety of choices. OB, CNM, CPM, LM, lay-midwife (unlicensed), unassisted, etc. If I want my choices respected I believe I need to respect the choices of others. 

 

There are a lot of ways to give birth and there's a "right way" for each individual woman. She needs to be educated and determine that "right way" for herself. 

 

I became a CPM because I like the idea of being a Village Midwife. Many times I get paid -and- barter for services.. my clients due soon are paying me partially via chicken tractor/chicken and mechanical work as well as cash. It's not something I could do as a CNM or OB. 

 

I am prepared for emergencies. I have seen EMS work in home settings as well as homebirth. I do not accept every client that comes my way. I'm not a cowboy midwife who just assumes it'll all go well. I'm a professional and spent many years training to become a midwife. 

 

Being a midwife is my calling, it's not my crusade. If someone wishes for facts I provide them, but I never try to talk someone into a homebirth or convince them it's best. Nor do I run around judging my sister midwives. I practice a certain way and hold true to what I feel is best. Others practice very differently and the moms that are drawn to that are the ones that hire them. It works beautifully and doesn't have to be a negative competition. 

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Blessed to be a CPM/LM in Virginia and doing work that I love.. as well as blessed to have worked with talented midwives who shared their knowledge with me. 

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#25 of 37 Old 07-20-2011, 02:00 PM
 
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It's not like FB where you can just "like" the comment!  LOL!

 

I forgot to say that I am considering the Mercy-in-Action program in the Phillippines for a month or so, but not for a couple of years until my toddler gets about KG age.  I feel like this will be a really different perspective I will appreciate.

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#26 of 37 Old 07-20-2011, 02:59 PM
 
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You sound like a wonderful midwife. If I were to do CPM, I would want to be the same way. I think the village midwife thing would be an amazing role. If I planned on practicing in one location I would love to do what you are doing, I think the bartering thing is so fun! Have you ever read The Birth House? That was my first exposure to midwifery and I wanted to be just like the girl in the book! And I agree that there should be a variety of choices. We all have different beliefs and desires for our births, and it is amazing to be able to choose a care provider to fit your specific needs and desires.
 

Quote:
Originally Posted by MsBridget View Post

Personally, I'm for there being a large variety of choices. OB, CNM, CPM, LM, lay-midwife (unlicensed), unassisted, etc. If I want my choices respected I believe I need to respect the choices of others. 

 

There are a lot of ways to give birth and there's a "right way" for each individual woman. She needs to be educated and determine that "right way" for herself. 

 

I became a CPM because I like the idea of being a Village Midwife. Many times I get paid -and- barter for services.. my clients due soon are paying me partially via chicken tractor/chicken and mechanical work as well as cash. It's not something I could do as a CNM or OB. 

 

I am prepared for emergencies. I have seen EMS work in home settings as well as homebirth. I do not accept every client that comes my way. I'm not a cowboy midwife who just assumes it'll all go well. I'm a professional and spent many years training to become a midwife. 

 

Being a midwife is my calling, it's not my crusade. If someone wishes for facts I provide them, but I never try to talk someone into a homebirth or convince them it's best. Nor do I run around judging my sister midwives. I practice a certain way and hold true to what I feel is best. Others practice very differently and the moms that are drawn to that are the ones that hire them. It works beautifully and doesn't have to be a negative competition. 



 


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#27 of 37 Old 07-21-2011, 08:14 PM
 
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Quote:
Originally Posted by Alenushka View Post

I do not actually need an OB, or midwife for a birth that goes well. I do not need a seat belt if I do not get into the accident. I do not need a fire alarm if I do never have a fire.

 

Thing is, when I start driving, I do not know if I get into an accident . When I go to bed, I do not know my electrical writing goes wrong and when i start laboring I do not know if I will end up with PPH.

 

Ambulance is not good back up plan in US. It can take forever.

 

Actually, CDC stat show that the safest birth for a baby is in the hospital with CNM

 

We can't compare England of Netherlands to US. We have totally different training standards. In other countries midwives are integrated partner in healthcare and will not take on high risk birth. They have years of training starting with 3-4 year university degree. I want my birth professional to know exactly what to do when things go wrong.

 

http://confutata.com/2009/07/29/midwives-mortality-rates/


Did you miss this part??

 

"Conclusions?

For a wide variety of reasons[1] , this data cannot be used to draw valid conclusions about the competence of any group of providers.

One particularly important caveat is that the numbers for the “other midwife” category are so small that a single death can disproportionately influence the mortality rate."

 

It is ridiculous to say that ambulance is not a good back up plan in the US.  It is not the ambulance system that is the problem, it is the transfer of care.  We are a nation with a huge wealth of resources.  There is no reason that home birth cannot be as safe here as it is in Europe.  We need to set up a better system for quickly taking care of clients who are transferred in.  And we need for midwives to transfer clients in a timely matter.  This means that midwives cannot be afraid of being arrested or harassed, and that their prenatal and intrapartum records should be accepted.

 

Then there is the issue that we don't like to talk about.  Every time I read a tragic birth story, I feel so very sad and frustrated because there always seems to be obvious signs that something was going wrong.  Why were these mothers not transferred.  Is it because their midwives didn't know what was happening or because they were afraid to transfer for? I know hind sight is 20/20 and that we don't have both sides of the story, etc, but I also think that there is this "trust birth" veil that blinds people sometimes.  It seems like the last generation of midwives had a healthy respect for birth as the force of nature that it is.  Home birth is safe for low risk women.

 


Wife to Joe and Mama to Rosie, 6/28/06, Jack, 10/25/08 and JoJo 3/18/10.
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#28 of 37 Old 07-22-2011, 06:20 AM
 
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Quote:
Originally Posted by olive&pimiento View Post




Did you miss this part??

 

"Conclusions?

For a wide variety of reasons[1] , this data cannot be used to draw valid conclusions about the competence of any group of providers.

One particularly important caveat is that the numbers for the “other midwife” category are so small that a single death can disproportionately influence the mortality rate."

 

It is ridiculous to say that ambulance is not a good back up plan in the US.  It is not the ambulance system that is the problem, it is the transfer of care.  We are a nation with a huge wealth of resources.  There is no reason that home birth cannot be as safe here as it is in Europe.  We need to set up a better system for quickly taking care of clients who are transferred in.  And we need for midwives to transfer clients in a timely matter.  This means that midwives cannot be afraid of being arrested or harassed, and that their prenatal and intrapartum records should be accepted.


 



So, so, so true. Some hospitals are wonderful to transport to and will allow for the women to go directly to L&D and there will be an OB waiting..... others make you go to the ER and triage through there.... regardless of the reason you are coming in. Precious time can be lost. And then there are those yucky situations where you call ahead to let them know you are coming in and they call you back and tell you to not come to their facility (in a rural area where the next hospital that does births may be an additional hour away) as they have no interest in treating someone who was planning a homebirth..... and I am practicing in a completely legal state with a license. There are some hospitals that will report every single transport to the state, regardless of the reason for transport or what kind of shape the mom/baby is in when the transport occurs.... this is for political reasons. I can't imagine how core shaking that could be if I wasn't practicing legally and had to be worried about being charged with a felony.

 

There is so much with the system that we could all work on to improve (on both sides of the fence) that would make it all more safe. Being a CNM would not help me in the situations where transports don't go smoothly as the issue that has been brought up was that we were trying to do a homebirth and had nothing to do with my educational background. I would love to see our system turn into one that can better serve women.


Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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#29 of 37 Old 07-22-2011, 01:55 PM
 
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Hee is in interesting reports (See chapter 13, page 150) from Englad. I think it is clearmore education is good idea and MW's GPs and OB, all need to know signg of danger and not just picture perfect healthy births

 

 

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf#page=32

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#30 of 37 Old 07-22-2011, 03:24 PM
 
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Some CPM training is definately lacking and some is very amazing. And just to clarify, CPM training is not Lacking in comparison to Canada (for good courses), Canada requires any foreign trained midwife to go through a bridging program regardless of where they trained, it's a way to ensure the midwife is up to snuff with regulations and training requirements for the province they are going too. There have been many Canadian Midwives trained in the US, Seattle school of Midwifery is one of the schools many on the West coast attend because of how incredibly hard it is to get midwifery education here.

 

That being said, numerous studies have shown that home birth is as safe as hospital birth for low risk women. it is the individual midwife's duty to ensure that they are only taking on home births for low risk women and should a concern arise transfer care. Some studies have also shown an increase in hospitals in regards to "high risk" situations, the whole snowballing effect of intervention etc.

 

As for breech, vbac, twins etc, these are not neccessarily high risk situations. Breech for example is not neccessarily high risk and depending on the baby's presentation can be very safely delivered at home, the issue is that many doctors and even midwives are not trained on delivering breech birth, because of this many doctors do not feel comfortable vaginally delivering breech babies, and hence the guidelines against it were drawn up. You have to remember that what ACOG deems as "high-risk" may or may not fit that definition, they are a self serving organization and you need to read between the lines in regards to their policies (not saying they are all bad but you cant take everything they say as the highest authority). There are also studies showing VBAC is safer then repeat cesarian and that risks are fairly low for most women.


Aspiring Midwife applying to University for fall 2011!
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