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

poetgoddess813 · Jul 13, 2011

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!

greenbreather · Jul 15, 2011

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.

areawoman · Jul 15, 2011

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.

esali · Jul 15, 2011

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.

poetgoddess813 · Jul 15, 2011

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!

cwill · Jul 15, 2011

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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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completebeginnings · Jul 16, 2011

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.

esali · Jul 16, 2011

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.

Spirit Dancer · Jul 16, 2011

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.

Bekka · Jul 18, 2011

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.

MidwifeErika · Jul 18, 2011

<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by poetgoddess813 <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system#post_16550840"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 
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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 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.

Alenushka · Jul 18, 2011

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?
 
 
<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by esali <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system#post_16555458"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 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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Alenushka · Jul 18, 2011

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
 
 
<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by Bekka <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system#post_16558635"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 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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Bekka · Jul 18, 2011

<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by Alenushka <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system#post_16559819"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 
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.
 
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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.

MsBridget · Jul 18, 2011

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

Alenushka · Jul 18, 2011

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.
 
<a href="http://confutata.com/2009/07/29/midwives-mortality-rates/" target="_blank">http://confutata.com/2009/07/29/midwives-mortality-rates/</a>

crimsonandclover · Jul 19, 2011

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.

cinderella08 · Jul 19, 2011

I just wanted to hug you. <img alt="hug2.gif" src="http://files.mothering.com/images/smilies/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. <a href="http://midwifeology.blogspot.com/2011/07/be-change-you-want-to-see-in-world.html" target="_blank">http://midwifeology.blogspot.com/2011/07/be-change-you-want-to-see-in-world.html</a>
 
 
I wish you luck in your choice

Alenushka · Jul 19, 2011

I enjoyed reading your blog. Good luck in you professional path. I met some totally amazing CNMs in the hospital.
<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by crimsonandclover <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system#post_16560473"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 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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summer776 · Jul 20, 2011

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.

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

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