Tell me about midwifery/nurse midwifery

In My Humble Opinion
1

Just one of those “if I were to go off the deep end and find another career” sort of daydreams. Which is surely an insane one, because I’m really not ever planning on relocating, and as far as I know we don’t have any midwifery schools locally and how many midwives and certified nurse midwives can Columbia really need? One assumes we are probably well supplied. I believe MUSC does have a nurse midwife program, but that’s in Charleston, unless they have some kind of mostly online thing. And anyway, I have a career already and I very rarely get bodily fluids on me.

At the same time, it’s something I’m really interested in (although God knows I don’t have the personality for it. I am no WhyNot.)

What, exactly, would becoming a midwife entail? What’s the difference between “midwife” and “certified nurse midwife”? I gather a certified nurse midwife is an RN? How much school is involved? How hard is it for somebody with a degree but without a science background? Is it hard to get in? Hard to find a job? (These days?) How’s the pay? Is the malpractice insurance like the situation OB-GYNs are in now? Is there an internship sort of thing? A residency? Is it hard to stay in one place? I dunno, just tell me about it. I’d also like to hear experiences and opinions (thus this forum.)

2

Or, you know, don’t. Whichever.

3

I don’t have anything useful to contribute, except that I LOVED the CNMs who delivered my son. It seems to me (completely anecdotally) that CNMs are a little more integrated into the “Mainstream Medical” world than plain 'ol Midwives are. That was perfect for me - I didn’t want a homebirth, but I also don’t think a low-risk pregnancy/delivery should be treated like an illness. I got exactly the (intervention-free) birth I wanted, and I feel I got excellent care in the process.

There’s a midwifery school here in Seattle, should you ever want to move here: http://www.seattlemidwifery.org/index.html I’m going to take their Lactation Educator course next year, as a first step toward becoming a Lactation Consultant.

4

CNMs do have to be RNs. There must be considerable extra training, of course, but I don’t know the details. They can write prescriptions, I know.

My impression is that midwifery is growing, in a way. It seems to me that standard OB practices are increasingly taking on a few midwives, so they can pay lip service to the natural birth option. But I also get the impression that many of these practices have midwives who practice in the classic OB model (rescuing the baby from labor, intervention=control=good, etc.) rather than what Henci Goer calls the midwifery model (most labors are best left to progress, it’s a natural process that doesn’t automatically require intervention). Of course, that isn’t true across the board, but it is my general impression.

If you want to practice outside the OB model, it can be difficult. NC only has one free standing birth center, and it is next to impossible to practice as a midwife outside an OB practice. I don’t know what SC’s laws are, but I wouldn’t be surprised if they are equally anti-midwife.

Still, I so greatly appreciated my midwives. I shudder to think what my experience would have been had I been in the hospital. I have a friend who said she’d rather give birth alone in a ditch than go to the hospital again, and similar stories are prevalent among people who want natural birth. It’s an important calling. I imagine it isn’t boring, and is very rewarding.

5

http://www.scschoolofmidwifery.com/

Just a link to help you if you decide to do this.

On a conversational note, I think midwives are exceptionally important. Especially Nurse Midwives, to tell the whole story. Midwives are surprisingly hard to find, generally, as well. Midwives and CNMs (Certified Nurse Midwives) offer a completely different prenatal experience as compared to physicians. The whole process (at least for me so far) is far less invasive and far more compassionate and understanding. My nurse-midwife has taken the time to talk about why certain tests are needed, and whether certain tests are needed. She has discussed risk vs. reward in regards to tests, and my appointments are as long as necessary. The tests are all still available, and some are recommended over others, but I got the information on WHY, which I never got with my boys.

From what I understand, one can become a midwife in many locations through a process called “direct-entry”, which is basically the apprentice program. Nurse-midwives are nurses who then attend midwifery training. The requirements, restrictions, rules, and regulations vary by state, as there is no national certification in place. The pay is less than an obstetrician, but I don’t know the numbers. Most midwives do stay where they are certified, because they have to recertify if they move between states. My midwife’s (a CNM) malpractice insurance is completely handled by the hospital she works out of. (Yes, she does homebirth, but she works with a particular physician group and a particular hospital.) I would suggest that you ask local midwives how things work in your state, and see if it’s right for you.

6

Philadelphia University has a distance-learning program. You have to come to campus three times (for orientation, and for two “hands-on” training periods), but most of the program is done online and with clinical work done under the supervision of a midwife in your home community.

Check your state for licensing requirements, which vary from state to state. Not all require that you be an RN.

7

For those of you who have gone through midwife births - were your midwives mothers themselves? Would it have been weird to you if they weren’t?

It seems that South Carolina does indeed license midwives who aren’t RNs through an apprenticeship. I hope all the websites don’t look like that awful one, though. Ugh. :slight_smile:

8

I haven’t gone through a midwife birth yet (8 more weeks), but my midwife is a mother. I don’t know if I’d find a non-mom midwife weird, though. I don’t think so. We don’t really talk about her kids or anything.

9

I went to a midwifery practice that had 3 CNMs at the time - 2 of them had kids and one didn’t. The one I really clicked with - and the one who was on call when I went into labor - had her first baby when my son was 16 months old. And I think she’s right about my age, too. It wasn’t weird at all; I knew she was experienced and had good training, and I just really liked her.

10

Well, I was thinking, you know, the woman’s all “Push! It isn’t that bad!” and you’re like “How the fuck do you know, bitch?” So, you know, wasn’t an issue?

11

Actually, my midwife said that a woman should only push when she has the urge, not because some idiot is shouting instructions at her. I think you just hit on one of the big differences between the average OB and the average CNM. Not doing things your body isn’t ready for keeps things like tearing and interventions down.

12

Well, yeah, but my point was that I don’t know that I’d get a tattoo from somebody who doesn’t have any.

13

You know, it never occurred to me to ask whether they had kids. I don’t know.

I don’t think it matters much in the context of birth. In the arena of breastfeeding, I can understand why LLL requires leaders to have nursed a baby - that empathy and experience can really help. But for me, being in labor is a time when you’re suspended from reality so much, I can’t see how the direct experience would translate very well into helping other women. The event is so immediate and personal, it’s just not very transferable.

The thing that mattered most to me was having someone knowledgeable who had a similar philosophy about birth - it could even have been a man, if he was truly committed to the midwifery model.

My memories of the midwives during my labor are dominated by their calm yet authoritative presence. When I was on the verge of panic, they led me back with placid mastery of the situation. When my daughter’s heartbeat slowed down incredibly, I got scared, but the midwife just said, “OK, she doesn’t like this position - let’s flip you over to your other side.” And it worked instantly. I suspect in a hospital the attendants would have been more likely to panic along with me and start prepping for a c-section.

14

What’s really surprising to me is how religious all the local alternative birth stuff seems to be. I was thinking, you know, crunchy granola placenta eatin’ cord bitin’ folks. I wasn’t expecting so much Jesus, although in retrospect it makes sense. I was looking at websites last night, and the birth center that looks really awesome and amazing looked great right up until I found that one link to that awful fundamentalist child rearing philosophy, you know, the one where that three month old infant needs to get punished for crying so damned much? Yeah.

I honestly think this might be something I might really want to do. I couldn’t do it now, though - my boyfriend would have to be able to support us the way I do now for me to quit my good job and take what I’m sure is a pretty good pay cut, at least in the beginning. I could fit in distance classes, but not practical work. Unless everybody can agree not to have any babies between 9 and 5:30 except on my night to work and on every third weekend.

15

I’m going to hell if they’re right, but “I wasn’t expecting so much Jesus” made me laugh.

Just because you can’t “do” it now, doesn’t mean you can’t start studying. Both hitting the books and learning about being a Doula or other means of birth support.

From this site:

My midwives were interesting. The younger ones had birthed within the last five years, the older ones not so much (obviously) but they all shined with their earnestness and their listening was fantastic.

But I tripped the circuits at one point in the pregnancy and had to go back to a regular OB in a hospital instead of a midwife-attended birth center birth; I applaud their caution and understand their position and concerns in doing so, even if I disagree :P.

Other fascinating reads on my reading list:

**TOP IMAGE IS NSWF :frowning: image of a topless woman in labor. **


http://navelgazingmidwife.squarespace.com/

I understand LLL’s desire to have lactated moms as nursing support, but at the same time, that does not guarantee that they are sympathetic or helpful. I got less support from my local LLL leader and more from fellow attendees of meetings.

16

Do you mind me asking what happened to make you ineligible for a non-hospital birth? (And since you disagreed, was it something that turned out to actually be a problem?)

17

My primary midwife wasn’t a mother. CNMs are covered under Ontario health care- you can have a midwife, a GP, or an OB. The midwifery centre I went to gives you a primary and a secondary midwife, in hopes one of them will be awake and available for your birth. I loved both of mine, and have just re-registered with the same centre for my second kid (due in March), and requested my primary midwife again. In Ontario midwives have hospital privileges, and even though my birth went medical my midwife was in charge of my care until I was prepped for my C-section, stayed as support, and resumed care post-op.

Here, the midwifery centres are non-religious, at least the ones I’ve heard of.

I love midwives- they spend time with you, ask your opinion about all aspects of pregnancy and birth, and offer all testing and procedures as a choice. Mine stayed with me for about 40 hours with a 5-hour sleeping gap somewhere in the middle.

The ones I’ve encountered (I chatted with most of the ones at the clinic) all gave off this great calm. Calm and encouragement and empathy.

Lord, I love them.

18

A number of factors; some health-related, some support-personnel related, some baby related. Separately on another person probably not a problem, but together, pushed me out of everyone’s safety zone (including all my support persons, who had been out of their comfort zones for quite a while).

I think the main reason was simple: VBAC attempt.

Everything else just said to them “and here’s another health reason not to VBAC” - nothing like bleeding or pain or fetal movement or size. Some edema, some blood pressure concerns.

No way to tell that it might have gotten worse. The “cure” for most of the problems is “have the damn baby”.

I was sent to an inner city hospital (though they’d shudder to hear me call it that, but it was pretty bad) to a doctor the MW had called to take me “as a favor to her” when I should have just said, “Screw you all, I’ll go to a hospital I like”. My shattering support system had me doubting all of options offered by people not in white coats, including self.

I consented to an internal, had my membranes “disturbed”, and went into labor a few hours later. I was not allowed to leave the labor bed, eat, or drink, even when my surgery was backed up several hours, and everyone but the attending agreed that my water had broken. Per the attending, therefore, it had not. :smack:

I was knocked out completely and my support team was left out in the hall, literally, waiting to be let in and never let in - there for over an hour until the baby was moved to the nursery. I was knocked out because of the position of the baby (hello, had been in labor for four hours, hard and fast like last time). I think this could have been potentially avoided had I gone to surgery earlier, but no way to tell. I awoke in recovery without the support system (as requested - they were to stay with the baby, period).

As had happened previously, and I probably blindly expected, I was back to “normal” in no time, but since I was just a bit high on normal for blood pressure, and edema, and fat, and a big baby, and a VBAC and and and and … I risked out or “risked” out.

Obviously, there is no way to know for certain if a VBAC would have gone well or badly, but I had no post-surgical indications that there were any issues with my scar, placenta, or child (other than size which was just under 10 pounds). I’ve had unrelated uterine “work” done since then (and am sterile and in a sort of menopausal state before the age of 35) and was told my uterus “looks” fine. It’s easy to Monday-Morning QuarterBack.

When you’ve got a VBAC, there’s no crystal-ball way to tell if it will rupture or not (there has been some research on ultrasounds of the scar, but nothing definitive). But real rupture is quite rare; but I can’t make that decision for people, and I was a bit miffed that I couldn’t make it for myself, but I’m over it.

Read Navelgazing midwife, she’s got an important post about a survey the ACOG is running to lay the foundation, IMO, to completely criminalize midwifery and homebirths, as is being done in Australia.

The more willing and trained midwives, the better, IMO. Being all-cesarean, I would be unlikely to be able to take on that role, though if I were better motivated I wouldn’t let that stop me.

19

Heh. My son’s birthday was a couple of weeks ago, and a lot of friends are having babies soon, so I’ve been thinking about my labor & delivery a lot lately. And I said to my husband last week that I don’t recall anyone telling me to push, at all, ever. My midwife told me to put my chin to my chest to push most effectively, but I pushed when I felt the need. And that was part of why I wanted midwives in the first place - I wanted people who believed as I do that my body knew what to do. One of the books I read (The Big Book of Birth by Erica Lyon - if you’re at all interested in the process of birth, you should check it out! It’s GREAT.) talked about how someone else telling you when to push would be a lot like someone else telling you when to bear down while having a bowel movement. It’s a little gross to think about, but it’s totally true - in both situations, pushing when your internal systems aren’t ready is going to be much less effective, and will only make you feel like you’re incapable of understanding what your body is telling you. (I realize that the whole thing is different if the woman has had an epidural and is still to numb to know when to push.)

Also, anyone who says “it ain’t that bad” to a laboring woman deserves to be shot. It’s completely not helpful, and just because my experience wasn’t that bad doesn’t mean that your experience will be the same.

20

One thing I’ve always like about midwifes (midwives??)…

They always “help people out” !!!