Madness...
is what happens when Husband takes off to the far reaches of Alberta for a week, both children get sick, one twice on two separate occasions. I have a senate hearing which I try (and subsequently fail) to get to, I do manage the logistics involved with attending a conference (all 13hrs factoring in the travel time, and childcare arrangements), a full day of clinic, three assignments, an elementary school non-contract day (my kid is like, never at school I swear), late paperwork (Sorry, school), two women in dates and a bloody partridge in a pear tree.
Indeed where the 'madness' comes in.
After my finely crafted fit of bravado the other day (I'm good under pressure) I find myself 100% outed to what feels like every midwife in the state. That being said, I'm feeling a little inhibited (while I know that this was possibly what was intended it's hard not to feel a little um, maybe cautious is the word I'm looking for?). It's one thing to write like no one's reading, and another to keep writing when you know lots of folks are.
After last weeks ACOG statement I have felt the need to variously, bellow obscenities, laugh out loud, and write a rebuttal. All of the above I've done, and yet, despite it's almost comical ultrablogfodder potential I find myself at the end of this process less irritated with ACOG (it is wasted effort at any rate) and much more inclined to direct my ennui toward the ACNM who seem happy to sit back and bask in their 'favored daughter' status. It all struck me as more than a little paternalistic. I should note that if I were one of the few CNM's with OOH (but especially homebirth) practices I'd be more than a little irked at the deafening silence which now appears to echo from the powers that be at the ACNM. Does the ACNM not represent those midwives too??
I've long had the feeling that if midwifery in the United States is to truly flourish, to really count in a system so dominated by a medical paradigm which is clearly not working as it should be, nurse midwives and direct entry midwives should quit this "us and them" business just as midwives in all countries where midwifery has successfully taken it's rightful place in national maternity care infrastructure - the UK, Australia, New Zealand... We are all midwives. Neither group benefits at the expense of the other, this only serves to divide what could be, in my opinion, one of the most powerful single groups for change in women's health in the world, but certainly here in America. I'm fortunate I think here in this leafy corner to be able to observe DEM's (here mostly Licensed Midwives/CPM's) and CNM's working really well together, as they have done for decades. I'm fortunate, and very grateful to count some CNM's among my school's faculty. So it baffles me when CNM's teach at my DEM school, when I can observe CNM's and LM's milling about in conferences together, and when I hear about them practicing beautifully along side one another and collaboratively together, when I watch CNM's mentor DEM students and yet the two organizations which represent midwives nationally in this country apparently cannot seem to work together for the common good of our shared mission: midwifery and women's health!
The ACNM has fought long and hard for the position which they now hold on the (largely hospital) stage among the nations obstetricians. I can't help feeling as though, by allowing ACOG, midwifery's most strident critic, to take last week's unbridled swipe at midwifery - for that is what they have done in challenging a woman's most basic choice to have their baby at home with a midwife, instead of inside a hospital (and don't get me started on the birth center rhetoric) - that all midwives, CNM's and DEM's alike, midwifery has taken a beating. And the ACNM looks like it's standing back and is letting it happen.
I don't get it.
And for my Dad who doesn't speak midwifery acronyms, and anyone else who may be in the same basket: ACNM - American College of Nurse Midwives.
ACOG - American College of Obstetricians and Gynecologists.
CNM - Certified Nurse Midwife.
DEM - Direct Entry Midwife/Midwifery.
LM - Licenced Midwife.
CPM- Certified Professional Midwife (National DEM credential).
Indeed where the 'madness' comes in.
After my finely crafted fit of bravado the other day (I'm good under pressure) I find myself 100% outed to what feels like every midwife in the state. That being said, I'm feeling a little inhibited (while I know that this was possibly what was intended it's hard not to feel a little um, maybe cautious is the word I'm looking for?). It's one thing to write like no one's reading, and another to keep writing when you know lots of folks are.
After last weeks ACOG statement I have felt the need to variously, bellow obscenities, laugh out loud, and write a rebuttal. All of the above I've done, and yet, despite it's almost comical ultrablogfodder potential I find myself at the end of this process less irritated with ACOG (it is wasted effort at any rate) and much more inclined to direct my ennui toward the ACNM who seem happy to sit back and bask in their 'favored daughter' status. It all struck me as more than a little paternalistic. I should note that if I were one of the few CNM's with OOH (but especially homebirth) practices I'd be more than a little irked at the deafening silence which now appears to echo from the powers that be at the ACNM. Does the ACNM not represent those midwives too??
I've long had the feeling that if midwifery in the United States is to truly flourish, to really count in a system so dominated by a medical paradigm which is clearly not working as it should be, nurse midwives and direct entry midwives should quit this "us and them" business just as midwives in all countries where midwifery has successfully taken it's rightful place in national maternity care infrastructure - the UK, Australia, New Zealand... We are all midwives. Neither group benefits at the expense of the other, this only serves to divide what could be, in my opinion, one of the most powerful single groups for change in women's health in the world, but certainly here in America. I'm fortunate I think here in this leafy corner to be able to observe DEM's (here mostly Licensed Midwives/CPM's) and CNM's working really well together, as they have done for decades. I'm fortunate, and very grateful to count some CNM's among my school's faculty. So it baffles me when CNM's teach at my DEM school, when I can observe CNM's and LM's milling about in conferences together, and when I hear about them practicing beautifully along side one another and collaboratively together, when I watch CNM's mentor DEM students and yet the two organizations which represent midwives nationally in this country apparently cannot seem to work together for the common good of our shared mission: midwifery and women's health!
The ACNM has fought long and hard for the position which they now hold on the (largely hospital) stage among the nations obstetricians. I can't help feeling as though, by allowing ACOG, midwifery's most strident critic, to take last week's unbridled swipe at midwifery - for that is what they have done in challenging a woman's most basic choice to have their baby at home with a midwife, instead of inside a hospital (and don't get me started on the birth center rhetoric) - that all midwives, CNM's and DEM's alike, midwifery has taken a beating. And the ACNM looks like it's standing back and is letting it happen.
I don't get it.
And for my Dad who doesn't speak midwifery acronyms, and anyone else who may be in the same basket: ACNM - American College of Nurse Midwives.
ACOG - American College of Obstetricians and Gynecologists.
CNM - Certified Nurse Midwife.
DEM - Direct Entry Midwife/Midwifery.
LM - Licenced Midwife.
CPM- Certified Professional Midwife (National DEM credential).
posted by Louisa at 8:17 PM
3 Comments:
I spoke to my state rep yesterday to encourage him to vote for a Midwife licensing bill here in IL.
hey, I totally appreciate your skipping the ranting and raving and going straight to the actual point of interest in the ACOG statement! Yes, what *is* up with that endorsement of freestanding birth centers?! My guess is ACNM is silent because that was part of their understanding with ACOG to get FSBCs ok'd. (Sound paranoid? I welcome the chance to concoct conspiracy theories as a birth advocate.)
It makes me wonder if we're doing this the wrong way, midwifery licensing I mean. Midwives are midwives, that's right -- but might it not be strategically better for the long run to take the N out of CNM, instead of putting CPM into all the laws?
I must admit your system in America does confuse me sometimes and its a shame you cant all be 'midwives'.
We have our problems here in New Zealand as well. There is still some conflict between nurse/midwives and direct-entry trained midwives but that is minimal these days. If anything, the tension is between hospital midwives and community (LMC) midwives who bring women into the hospital to birth. But we keep working on it. We have enough problems sorting things out with the medical profession without fighting amongst ourselves. best wishes Sarah
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