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Becoming a midwife in WA - give me the scoop!

832 Views 10 Replies 7 Participants Last post by  mammalmama
Okay, so looking through the archives I get the feeling that for all our crunchiness up here, midwives are practicing in a semi-unfriendly environment. I have made the decision to become a midwife and I really want to stay in Washington state. In the name of full disclosure I would appreciate it if you all could tell me what the facts are and then what you perceive on a gut level or have "heard of". Specifically:

What pathways to midwifery are allowed in WA in order to become licensed? Do I HAVE to attend a MEAC school? Would AAMI's correspondence course meet the requirements? Is there any way to become licensed without attending school, such as full apprenticeship?

I know all insurance companies are required to cover licensed midwives and you are also able to accept medicaid/DSHS/medical coupons. What kind of restrictions are involved with that?

Obviously I'm highly considering Seattle Midwifery School (because of their proximity). What is the real deal there? Is the program thorough and will it provide me with the skills I need on an emotional as well as practical level?

Anything else you think I need to know... I really appreciate your input!!
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Anyone?? Also anybody have opinions about Birthwise Midwifery School in Maine?
I see MWs who are graduates of SMS pretty regularly (our hospital is the preferred transfer hospital for most home birth MWs) and have almost always been impressed. Their curriculum seems pretty thorough and Suzy and Marge are both incredible (most LMs stay to doula their patients in hospital and I've had the pleasure of having both of them do that for patients of mine).

I think it's not so much that the atmosphere in WA is "anti-midwifery" so much as it's a regulated state, with all that implies. WA doesn't regard its LMs any differently from other HCPs -- there are rules to follow for all licensed HCPs, and while there may be less freedom than in an alegal or illegal state, there is far more public and legal support (the insurance thing, especially medical coupon coverage, is HUGE). Both systems have their upsides and downsides.
I can help you out here as I am planning on becoming a midwife here as well.
In order to become a midwife in WA, you HAVE to attend either SMS, Birthingway in Portland, or Baster College (SP?). Thats it. Those are the ONLY approved school for licensure in Washington state. Baster is hard because you have to do another program too (I think naturopathy) and it takes like 6-8 years if I remember correctly. SMS is a wonderful school, I love it, but they are only counted as a part time school for financial aid, so I cant go there. So I am going to Birthway in Portland in the near future. They are counted as full time so I will be able to have my costs covered my fin aid. I love SMS though and have applied before (they didnt accept me cause I was preggo and due the day after school started, lol). Their campus is beautiful.
You cant apprentice to become a midwife here. Part of the reason is that midwives are given a lot of priveleges-they get to carry drugs, oxygen, do IV's, episiotomies, etc, and my midwives (the are CPM's, not CNMs) even had hospital rights at a hospital in Seattle (they closed their L&D ward though, cant remember which hospital). They are working on getting rights at Evergreen, right by their birth center....which I think was partly brought on by me and the horrid experience we all had after I hemorrhaged after my 3rd.
Although I know that medicaid is easy to get to cover birth center births, my midwives had to threaten to sue to get them to cover homebirth. They are covering them now though. I dont know much else about that.
Hope this helps!!
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I have also heard of the portfolio method being used in this state. The mw submits her education portfolio including all her documented clinical experience and is approved (if she meets all the requirements) to sit for the state license. My midwife was the first to do this in WA, and I think there has been about 10 others who have followed suit. So although they would like you to think that the only route to go it the neat and tidy SMS route....if you dig there are other ways. On another note...yes we are "regulated" but other states that are other "regulated" are much better at honoring the autonomy of Oregon and California. MAWS has been trying in the last year to make it even more regulated or I should say has been considering appeasing the medical law makers in Olympia who would like it even more regulated. I too am interested in becoming a MW and I am here in WA, but by default have a real issue with midwives who are trained to fear vbac, breech, twins, and any of the other "variations of normal". If you do want to go the SMS route and then step out and practice in a more traditional way it seems that you are on your own....I guess what I would suggest is really looking into the way that these midwives practice today. It is very interesting to read over the original policies/protocals of Suzy and Marge's from the Freemont Birth Collective when they were true to midwifery. In my opinion they have SOLD OUT.
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Originally Posted by little_monkeys
Part of the reason is that midwives are given a lot of priveleges-they get to carry drugs, oxygen, do IV's, episiotomies, etc, and my midwives (the are CPM's, not CNMs) even had hospital rights at a hospital in Seattle (they closed their L&D ward though, cant remember which hospital). They are working on getting rights at Evergreen, right by their birth center....
Providence. It was closed when Swedish bought it (closed in the middle of several labors, BTW -- the women were transferred to Swedish First Hill, which is not at ALL the same as the old Providence unit).

I don't know that Evergreen will actually give the LMs privileges. They've been trying for years and Evergreen's not been the most LM-friendly atmosphere (there can be quite a bit of attitude about HB/BC transfers).
Thank you all for your input. I had to transfer to Evergreen during labor last June and it was a fairly good experience (apparently much better than it usually is).

littlemonkeys: how do you like Birthingway? what are the major differences as compared to SMS?
in order to be qualified to receive medicaid funds you need to have malpractice insurance--

as for portfolio evaluation they stopped doing that and I do thing that they closed the option of challenge

inquire at the schools and see- the biggest obstacle is going to be finding a preceptor and getting enough clinical experience- most midwives have to leave the state or even the country in order to meet the # requirements in a fairly timely manner--
the problem with Washington is they have no money for anything other than policing midwifery so nearly every lm in the state has an open investigation going on - even if the midwife doesn't know it she has probably been scrutinized- they have disbanded the advisory committee because of lack of funding and have steadily raised the price of getting a license. The have no protocols but the state will attempt to pull your license of prosecute you as a way of making regulations and protocols-- very costly way to do it a functioning advisory committee would be cheaper all the way around and more useful--- I am sorry but I just don't have much good to say about the State of WAshington as it relates to midwifery- I use to live there and practiced allegally and for 20+ years they had a challenge mechanism that they said there was no money for when the state found out that it was illegal for them to do that - it was their responsibility to find a way to make the law true or else get rid of the law - so after reluctantly letting in some midwives via challenge they closed that avenue off. They require more clinical experience than CNMs do and only 2 schools have ever been open and running SMS and the naturopathic college has a midwifery component- but you have to become a naturopath in order to use that route.. Right now the state is on a mission to stop midwives from attending VBAC- they lost on their gamble to stop breech births.
What else I would say is got to CNM school- maybe go to some home births with an LM but if you become a CNM you have a bigger scope a degree that actually transfers to other states-and when you get tired or too old or just too poor you can suppliment your income with a nursing job and not have to work your bottom off doing some other kind of "joe job" just to stay afloat.
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Originally Posted by maxmama
I don't know that Evergreen will actually give the LMs privileges. They've been trying for years and Evergreen's not been the most LM-friendly atmosphere (there can be quite a bit of attitude about HB/BC transfers).
I totally agree. A few years ago, an OB at Evergreen was trying to get PSBC shut down. They are not friendly at all, and most non-emergent transfers from the Eastside will go to the UW or even Swedish if time permits.

mwherbs, I think they just passed a law which will keep the licensure cost down. Not cheap, but lower anyways.

You can get licensed here with a MEAC education and I believe the challenge process is still valid; I was just talking with someone today who is going that route.

SMS is a good school, but buyer beware. They are teaching towards the medical model and like nurnur said, there are a lot of sell outs there. You have to be able to take what you learn with a grain of salt. My midwife is a graduate of SMS, but you wouldn't know it unless you questioned her. She is a true renegade. When I was pregnant with my 2 year old, I interviewed almost every midwife in the area. The biggest thing that I did not like about most (SMS graduates, Bastyr grads were a little better) is that they had rehearsed, cookie cutter answers to my questions. The answers clearly indicated that they were practicing out of fear rather than practicing midwifery.

I am planning to go out of state to a MEAC accredited school, but I do not know if I will be returning to WA when I finish. There is a true witch hunt going on here.
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what they did with the licensure costs was roll them back to the legal limit- they are only allowed to raise them so much every year or so if the requested raise is passed- and the department basically defrauded midwives and broke the law and over charged in order to support the nurse investigators-- they eventually got caught doing that but and had to go back to the legal allowed limit - there is not the proper checks and balances in the government office that regulates midwifery in Washington state- you folks up there need to be calling for an investigation of the entire department and probably an audit while you are at it so you know the true cost of these investigations....
I think the question for you is, what kind of a midwife do you want to be?????????
You do not have to attend SMS or Bastyr, but it means it will be a bit more of a challenge for you. Personally, I think that prepares you better for the challenges of being a midwife in this witch hunty state, where, frankly, most of the midwives are selling out and not practicing by the hallmarks of midwifery. It is very interesting to look at their original "protocols" and also to look at their original transfer rates from the lists provided by CEAS, and compare them to now, even factoring in for size of practice. I also agree with the "cookie cut" answers so many of them put forth to your questions, and the cookie cut phrases in their brochures. Few of them seem willing to truly give clients choices. They are too afraid, because the climate here is very hostile towards midwives. The current schools here teach from a perspective that we need to get along with OBS, which might be true, but how we go about it gets very interesting, and who loses out? Birthingway seems less inclined to teach "just in case," fearful midwifery, but notice I say LESS inclined, rather than that's not how they teach.
So, it just depends on what kind of midwife you want to be. Wether or not you truly want to serve women and their families. How committed you are. How hard you are willing to fight. Where your beliefs about birth, medicine, politics are. I think any of us have to look at that before making the best decisions to further our educations. The schools here might be right for you, but they are NOT the only option.
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