Extremes
In the past few months I've been learning a lot about the politics of midwifery here in the States. Until recently I've naively thought that midwives were a pretty cohesive bunch. Obviously I was mistaken. I guess I should have figured out that something was afoot when I read the three pages in my school catalog devoted to clarifying the many types of midwife: Certified Nurse Midwife, Licenced Midwife, Certified Professional Midwife, Direct Entry Midwife, Traditional Midwife and Granny Midwife... Some of these terms now make some sense to me and others still remain a little vague. Some of the concepts overlap.
More recently I've become aware of a movement which seeks to remove midwives (to a greater or lesser extent) from birthspace altogether. Just as there are degrees of interventiveness within the medical model of birth it seems that there is also a spectrum of this within the midwifery model. Add to that a healthy (?) helping of internison warfare within the ranks of midwives as to who has the "best perspective" and you end up with a confusing mixture of a bunch of people who are all trying to improve the world.
I recently figured out that the Midwifery school I will be attending is known within certain midwifery circles for being far more 'medicalized' than others. It's certainly the most expensive and I think has the best chance of one day becoming the first midwifery school in the country to offer a degree in midwifery. This is huge in a country where only Certified Nurse Midwives -
who have a primary degree in nursing - are legally recognized in every state. I deliberately chose this program because I believe that I'll make a great midwife. In the same breath I can tell you that I'd make a crappy nurse. The two professions are discreet in my mind. Someone likened the concept to a ballerina-carpenter and while that's a little extreme I maintain that I can be a wonderful midwife without being a nurse.
And then a new site popped up extolling the virtues of "Autonomous Birth". I'm very into the sound of that but the more I read the more confused I get. Early on she wrote a pretty scathing review of what I immediately pegged was the birth story of the HBAC mama from Navelgazing Midwife's blog. I didn't get it. Here's a woman who chose not only to VBAC but to HBAC.* The emphasis added there is not because it's inherently more risky, just that it's pretty rare in the States. Her midwife had some concerns about the mama's chances (she had a handful of risk factors which would have "risked her out" of many a midwife's care) which she was careful to shield the mama from before her birth in favor of the "wait and see" approach. The mama had a lovely birth which she was very satisfied with. So what was the problem? I guess it was that the midwife was there.
I'm now aware of the concept of the "low profile midwife", and even midwives who remain in another room sometimes for the duration of a woman's labor and birth. Now I can definately see the need for a midwife to retreat into the background at points during a woman's labor and I think that minimizing interference is a noble goal. But I'm becoming a midwife because the vast majority of women in our culture (and most others) actually need trained, skilled attendants to walk with them on that journey.
I'm also reminded that I wouldn't be happy laboring alone or delivering my own baby in solitude. My first couple of births I wanted to limit the number of people in attendance, but my next birth I'd like to fill the room up with the women who love me. I don't want my midwife sitting outside. I want her there beside me. Not because I think that something might go wrong but because she's my guide and my companion in the process.
One one extreme you find the Britney Spears mamas who chose to forgo the experience of labor and vaginal birth altogether and on the other extreme you find those who seek to birth completely unassisted. In the middle though you find myriad low-risk women who are looking for different types of midwives to walk with them in the way they are comfortable. Yes, we need to work together to dispell the culture of needless fear which really does hamper the birth choices of normal, healthy women, but I find myself irritated by the almost evangelical positions of the hardcore of both extremes.
I tend to think that diversity of styles and beliefs in the midwifery community is a good thing. We don't practice in a vacuum after all. Each client will seek a different ideal for her birth. If we encourage different perspectives which are respectful of mothers and mindful of the larger profession surely we all benefit?
*VBAC - vaginal birth after caesarian
HBAC - home birth after caesarian
More recently I've become aware of a movement which seeks to remove midwives (to a greater or lesser extent) from birthspace altogether. Just as there are degrees of interventiveness within the medical model of birth it seems that there is also a spectrum of this within the midwifery model. Add to that a healthy (?) helping of internison warfare within the ranks of midwives as to who has the "best perspective" and you end up with a confusing mixture of a bunch of people who are all trying to improve the world.
I recently figured out that the Midwifery school I will be attending is known within certain midwifery circles for being far more 'medicalized' than others. It's certainly the most expensive and I think has the best chance of one day becoming the first midwifery school in the country to offer a degree in midwifery. This is huge in a country where only Certified Nurse Midwives -
who have a primary degree in nursing - are legally recognized in every state. I deliberately chose this program because I believe that I'll make a great midwife. In the same breath I can tell you that I'd make a crappy nurse. The two professions are discreet in my mind. Someone likened the concept to a ballerina-carpenter and while that's a little extreme I maintain that I can be a wonderful midwife without being a nurse.
And then a new site popped up extolling the virtues of "Autonomous Birth". I'm very into the sound of that but the more I read the more confused I get. Early on she wrote a pretty scathing review of what I immediately pegged was the birth story of the HBAC mama from Navelgazing Midwife's blog. I didn't get it. Here's a woman who chose not only to VBAC but to HBAC.* The emphasis added there is not because it's inherently more risky, just that it's pretty rare in the States. Her midwife had some concerns about the mama's chances (she had a handful of risk factors which would have "risked her out" of many a midwife's care) which she was careful to shield the mama from before her birth in favor of the "wait and see" approach. The mama had a lovely birth which she was very satisfied with. So what was the problem? I guess it was that the midwife was there.
I'm now aware of the concept of the "low profile midwife", and even midwives who remain in another room sometimes for the duration of a woman's labor and birth. Now I can definately see the need for a midwife to retreat into the background at points during a woman's labor and I think that minimizing interference is a noble goal. But I'm becoming a midwife because the vast majority of women in our culture (and most others) actually need trained, skilled attendants to walk with them on that journey.
I'm also reminded that I wouldn't be happy laboring alone or delivering my own baby in solitude. My first couple of births I wanted to limit the number of people in attendance, but my next birth I'd like to fill the room up with the women who love me. I don't want my midwife sitting outside. I want her there beside me. Not because I think that something might go wrong but because she's my guide and my companion in the process.
One one extreme you find the Britney Spears mamas who chose to forgo the experience of labor and vaginal birth altogether and on the other extreme you find those who seek to birth completely unassisted. In the middle though you find myriad low-risk women who are looking for different types of midwives to walk with them in the way they are comfortable. Yes, we need to work together to dispell the culture of needless fear which really does hamper the birth choices of normal, healthy women, but I find myself irritated by the almost evangelical positions of the hardcore of both extremes.
I tend to think that diversity of styles and beliefs in the midwifery community is a good thing. We don't practice in a vacuum after all. Each client will seek a different ideal for her birth. If we encourage different perspectives which are respectful of mothers and mindful of the larger profession surely we all benefit?
*VBAC - vaginal birth after caesarian
HBAC - home birth after caesarian
posted by Louisa at 8:47 AM
5 Comments:
In my small city there are four midwives. Two are Certified Nurse Midwives and Two are Certified Professional.
They work in teams of two. The team I had were the CNM's. I was very happy with my care during my pregnancy as well as my birth and the care and support I was given afterwards.
I am a hairstylist and several of my clients work on the maternity floor. From what they have told me the CNM's are much easier to work with than the CPM's and are more respected by all staff and physicians. Maybe that sucks but that's how it is.
I had no idea there were so many types of midwives. And I'm sure there is a lot of controversy between all of them as well.
Not that I know you at all, but from what I do know I also think you'll make a FANTASTIC midwife!
I also was very naive about the divisions between midwives. It exists not just between the different "kinds" but also within the CPMs or CNMs etc with allegations and name-calling (dangerous, medwife, etc) being flung on both sides.
I have no dog in this fight. There are women who want medicalized birth, even at home. I'm glad they can get that. There are women who want unassisted or unhindered births. I'm glad they can get that.
I just want to help women have babies. I want to be a non-interventive midwife with the skills to intervene if necessary, the strength of character to hold back when it's not and the wisdom to know the difference.
Thought I'd barge in here... as a Canadian, we have all those types too. BUT, they are all lumped together once they pass their Previous Learning and Education Assessments. Or if they graduate from one of the universities they can just register straight away and are given the title of RM (Registered Midwife). So we have all the "types" you mention, but they all have the same core competencies and are held to the same standards. I'm not saying there aren't problems and trust me there are with all the rules and regulations! But for the most part the biggest is the lack of midwives for the number of women who want care!
end of novel. sorry =)
Well said hot mama. When I was pursuing midwifery, I felt like a child caught in an ugly divorce. I belonged to both the CNM professional group and the direct entry/CPM midwife group. I'd come home from both meetings despondent over how they talked about one another, when really their goals were the same.
On another facet of this posting...
I contemplated UC for my third birth. I am a very private person in this kind of way. I made not a single noise in the entire birth of my second (I believe I made a few quiet orgasm-sigh type sounds with my third) and really, didn't want to interact with anyone during my labors and births. Now, I still felt vastly reassured to have a midwife present (she sat on the couch for the majority of the labor and birth, checked me once, pretty much just made sure things were going smoothly). But I understand those who don't want a midwife there at all.
Judging someone else's birth story on these grounds is just MEAN though. It brings up a HOW DARE THEY feeling for me. I don't know about anyone else, but I haven't put up my birth stories so that they can be picked apart (I know some people actually DO do this). I know that we all take that risk when we put the stories out in such an impersonal place as the internet, but still...a birth story is so deeply connected with the personhood of the mother, that it is simply...out of bounds...to insult it in this way.
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