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

phathui5 · Jul 20, 2011

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.
 
 
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<div>How much education and qualification is necessary to appease people who believe that?</div>
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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.
 
 
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<div>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?</div>
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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

Bekka · Jul 20, 2011

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.

2littlebirds · Jul 20, 2011

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

MsBridget · Jul 20, 2011

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.

Bekka · Jul 20, 2011

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.

2littlebirds · Jul 20, 2011

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. 

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<div class="quote-block">Originally Posted by MsBridget <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system/20#post_16563756"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border-bottom:0px solid;border-left:0px solid;border-top:0px solid;border-right:0px solid;"></a> 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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olive&pimiento · Jul 22, 2011

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<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_16559941"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 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>
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Did you miss this part??
 
"Conclusions?
For a wide variety of reasons<a href="http://confutata.com/2009/07/29/midwives-mortality-rates/#footnote1" target="_blank">[1]</a> , 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.

MidwifeErika · Jul 22, 2011

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<div class="quote-block">Originally Posted by olive&pimiento <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system/20#post_16566112"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> 
Did you miss this part??
 
"Conclusions?
For a wide variety of reasons<a href="http://confutata.com/2009/07/29/midwives-mortality-rates/#footnote1" target="_blank">[1]</a> , 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.
 
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 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.

Alenushka · Jul 22, 2011

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
 
 
<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf#page=32" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf#page=32</a>

starrlamia · Jul 22, 2011

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.

Kanna · Aug 8, 2011

Hm...those midwives that you admire so much in the UK, which assisted you during YOUR birth, they had degrees equivalent to a CNM degree in the US.
(CPM's are not allowed anywhere in Europe....)
 
UK midwives undergo rigorous training ( see example here: <a href="http://www.uws.ac.uk/courses/ug-courseinfo.asp?courseid=579" target="_blank">http://www.uws.ac.uk/courses/ug-courseinfo.asp?courseid=579</a> ) in order to become truly competent in what they do.
 
I think it'd be really cool if you were able to offer your future clients the same level of care and competence which you received when you were giving birth <img alt="wink1.gif" id="user_yui_3_3_0_8_131277502700915" src="http://files.mothering.com/images/smilies/wink1.gif">

MidwifeErika · Aug 8, 2011

It is a bit different than the CNM process here in the US though. It appears that the UK requires only an undergraduate degree in midwifery. The CNM is a graduate program and the person must first go through a nursing program to gain an undergrad degree in nursing. Here, in the US, CNM programs are moving towards being doctorate programs rather than master degrees as well. So, the systems of education for this career path are just set up so differently. 

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<div class="quote-block">Originally Posted by Kanna <a href="/community/forum/thread/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system/20#post_16594236"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a> Hm...those midwives that you admire so much in the UK, which assisted you during YOUR birth, they had degrees equivalent to a CNM degree in the US.
(CPM's are not allowed anywhere in Europe....)
 
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Jane93 · Aug 10, 2011

OP -- I think your post is a very natural outcome of considering embarking on a career in which you hold the lives of women and babies in your hands. That is a tremendous responsibility and any provider who can take that on without experiencing serious anxiety and concern for being the "best she can be" is not a provider that should be in business. 
 
Have you checked out the Navel Gazing Midwife's blog? It might be of interest to you as the blog of a long time non-nurse midwife who decided to step back into a montrice-doula role primarily out of the same concerns you express.

MidwifeStephPDX · Aug 17, 2011

Wow, I first have to say how sad it makes me that this thread has included more of the same anti-CPM vitriol that is going on in this country. Everyone is entitled to there own opinions, but can we stick to actually responding to the OP's post, rather than using it as a soapbox for your own agendas?
 
In response to your actual question, I'm a CPM. I chose to go that route after exploring different CNM programs, and a reluctance to have two years of nursing education before beginning my midwifery education. I thought a lot about it, and attended a MEAC-accredited school that offers a Bachelor's Degree in Midwifery. For me, I wanted the three-plus years of midwifery education, to supplement the experiential training I got through my apprenticeship. In addition, I was lucky enough (after getting my CPM) to practice as a "junior" midwife for an additional 50 births and get more experience. I'm also lucky to live in a state that licenses midwives, and has strict guidelines for doing so. If one is licensed, there is oversight from the board and a means of complaint if necessary. They are also developing a peer review system similar to OBs where poor outcomes can be reviewed.
 
I do think that the lack of oversight for some CPMs in this country can led to a situation where negligent or unskilled midwives can fall through the cracks. So I do think it is the consumer's job to research any health care provider before hiring and trusting them. I also think that while CPMs are pushing for autonomy, and in this climate it is terrifying to think about oversight from a medical community that thinks we are uneducated and unsafe) I can't help but wonder if a system of oversight, and working within the medical community as opposed to on the outside of it, would change how midwives were perceived and create a uniformity of education, etc. There's a great old documentary online called All My Babies <a href="http://www.snagfilms.com/films/title/all_my_babies_a_midwifes_own_story/" target="_blank">http://www.snagfilms.com/films/title/all_my_babies_a_midwifes_own_story/</a> that shows midwifery in the southern US in the early 50s. It's a beautiful old film, and in the system they had set up at the time, traditional midwives were seeing patients, and the patient had to see their back-up doctor 1-2 times to verify they were safe candidates for homebirth. That is so appealing to me -in theory. Unfortunately, even here where we have a fantastic relationship with a local hospital; when I call to consult about something they preface their responses with "well, I don't think anyone is safe to give birth at home, but this particular risk factor doesn't concern me."
 
All that being said; I do have occasional regrets about not choosing to take the CNM route. It has nothing to do with my education and training, and in fact I work closely with CNMs (who, for the record, actually attend fewer births than midwives before certification). It's more about my personal struggle in being on-call all the time. Sometimes I wonder if it would be nice to have the option of taking a hospital job to earn more money, or get to take turns on call and have a different kind of family life. On the other hand, I struggle with births where I haven't connected well to the clients. If I'm getting called in the night for someone I barely know, or don't know at all because I'm covering for someone, it's harder for me to love my job. So, for me, the CPM route and this type of practiec is the right choice right now.
 
Good luck with this decision! I hope you follow your heart wherever it leads you! Feel free to PM me if you have any other questions.
 
 
**And so the flamers know in advance, I won't be responding to posts that debate the safety of home birth.

midwife2mama · Aug 19, 2011

I am also saddened by this thread. I think pitting CNM's against CPM is destructive to both professions and women who choose midwives. I am a CPM and have been for 12 years. I have worked with wonderful CPMs, CNMs and even a few good docs. The most important thing you can do regarding your education is follow your heart. I started with the CNM and realized it was not for me. I love being a CPM. My training was wonderful and when I finished I was a competent entry level midwife and I practiced like one which means I called for advice and always took more experienced midwives with me to births. Now I am the one attending births with newer midwives so we can keep birth safe and accessible to all.
Your education will be what you make it. No matter what path you choose and if you ever meet a midwife or doc who has 'seen it all' or 'done it all' ---
RUN the other way.
take care and good luck

Beccadoula · Aug 27, 2011

Wow...I haven't read the whole thread, but I just want to encourage you that this is a worthy cause. Maybe you aren't ready to bite off the midwife part of birth - maybe you should just start as a doula and see what you witness. As a doula I have nearly given up on hospital birth - it is not only dangerous at times, but emotionally extremely traumatic for me as I take the brunt of the medical manipulation for my client. I have nearly quit more than once because I too began to doubt that birth was at all safe. Every home birth I've done has reassured me that birth can be great...and usually should be. I've had to redefine my personal goals and to rehash my own reasons for attending births at all. And at the end of the day I come back to the same fact - women bond better with their babies and have less medical interventions when they are well supported. I stand in the gap and help women discover just how amazing and powerful they are. It isn't for everyone, but it is a worthy endeavor. I am now the mother of 4 boys who's first mother experienced postpartum psychosis...and I believe they would still have her had she been in the loving hands of a doula or midwife. Just some thoughts. Follow your heart...what do you want to do? If you will be a midwife - do it to the best of your ability. Blessings on your journey!

starrlamia · Aug 27, 2011

their training is and isnt rigorous, it actually isnt a whole lot different from the training here. They do 2-3 years of university, they have to catch 40 babies, they do in class and in placement portions of their training. CNM degree is a lot more comprehensive and includes nursing, which UK midwifery does not. UK midwifery is not the same as CNM, they are more akin to CPM as they are direct entry midwives. 

<div class="quote-container">Quote:
<div class="quote-block">Originally Posted by Kanna <a href="/community/t/1321368/doubting-the-natural-power-of-birth-my-future-plans-for-education-the-current-system/20#post_16594236"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border-bottom:0px solid;border-left:0px solid;border-top:0px solid;border-right:0px solid;"></a> Hm...those midwives that you admire so much in the UK, which assisted you during YOUR birth, they had degrees equivalent to a CNM degree in the US.
(CPM's are not allowed anywhere in Europe....)
 
UK midwives undergo rigorous training ( see example here: <a href="http://www.uws.ac.uk/courses/ug-courseinfo.asp?courseid=579" target="_blank">http://www.uws.ac.uk/courses/ug-courseinfo.asp?courseid=579</a> ) in order to become truly competent in what they do.
 
I think it'd be really cool if you were able to offer your future clients the same level of care and competence which you received when you were giving birth <img alt="wink1.gif" id="user_yui_3_3_0_8_131277502700915" src="http://files.mothering.com/images/smilies/wink1.gif">
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Doubting the natural power of birth/my future plans for education/the current "system."

phathui5

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