Wanna Be A Midwife?

Everything you need to know to pick your path to midwifery
August 24th, 2017 by Mayri Sagady Leslie

Compassion and Fear: The Focus on Maternal Mortality

I am awed by the enormous media response to the rising maternal mortality rate in the U.S. Public awareness and compassion are important components of solution-making. This is an extremely serious situation we must improve. As a country, holding the highest maternal mortality rate among industrialized countries is nothing to be proud of. Under analysis, maternal mortality is a complex problem to unravel with multiple influencing factors. Some maternal deaths are unpredictable and inevitable. But many may have been prevented by earlier actions. This chart from the CDC paints a clear picture of where we stand.

Trends in Pregnancy-Related Mortality in the United States, 1987-2013. This line graph represents the number of pregnancy-related deaths per 100,000 live births per year: 1987, 7.2; 1988, 9.4; 1989, 9.8; 1990, 10.0; 1991, 10.3; 1992, 10.8; 1993, 11.1; 1994, 12.9; 1995, 11.3; 1996, 11.3; 1997, 12.9; 1998, 12.0; 1999, 13.2; 2000, 14.5; 2001, 14.7; 2002, 14.1; 2003, 16.8; 2004, 15.2; 2005, 15.4; 2006, 15.7; 2007, 14.5; 2008, 15.5; 2009, 17.8; 2010, 16.7; 2011, 17.8; 2012, 15.9; 2013, 17.3.

Excellent resources exist on what we can do and ways to improve outcomes. But this post is not about that. This post is about the unwanted impact of increasing public awareness on maternal mortality.

As I flip around to my various news apps, I see this effort to increase public awareness has begun to take on its own ‘personality’. Beyond the facts, beyond the evidence, a downstream effect is emerging and that is fear. Intended or not, those who read the media on this issue are hearing the horror stories of childbirth. Reporters are seeking out personal stories which are illustrative and compelling. But, depending on the quality of the news source, this has resulted in a collection of traumatic stories, which, taken together, paint a picture of pregnancy and childbirth as life-threatening events.

Propublica and NPR and other sources have responsibly brought the reality of losing a mother by storytelling of family members who have lost someone and by mothers who narrowly escaped death. I applaud this. But what I have noticed in the increasing number of news stories and personal testimony is the emerging dominant image of childbirth as a terrifying, mortal threat to the mother’s life. I worry that thousands of women seeing these stories will experience increased fear about having a child.

Let’s put this in perspective. In 2013 (above) the maternal mortality rate was 17.3 per 100,000 live births per year. This is saying that of every 100,000 live births, 0.017% of mothers died. This is less than two tenths of a percent. Turning this around, 99.083% do not die.

OF COURSE it matters that any mother dies as a result of childbirth and we should do everything we can to reduce its occurrence. But the vast majority of women do not die in childbirth. In fact, the vast majority of women have safe, healthy births.

We need storytelling about healthy and safe births. Where are the mothers who view their birth experience as powerful, significant and empowering? We need you to speak up as well. One very important solution to reducing maternal mortality is having mothers in good health receiving excellent care in pregnancy and birth. If you are one of these, please speak up.

Fear of giving birth will not reduce maternal mortality. Awareness, compassion and action will. But the awareness should include the perspective that more than 99% of women do not die in childbirth.

 

June 16th, 2016 by Mayri Sagady Leslie

My paper on Delayed Cord Clamping won an Award!!!!

For two reasons, I am excited to share that my paper “Perspectives on Implementing Delayed Cord Clamping“, published in Nursing for Women’s Health, the clinical nursing journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) was recognized with an Excellence in Writing Award presented at the convention in Grapevine, TX this week.

I appreciate the recognition (who wouldn’t!) But what really makes me happy is the attention Delayed Cord Clamping is getting.

Thanks AWHONN!  Thanks family for your patience and help while I work with others to bring attention to this issue!

 

 

June 18th, 2013 by Mayri Sagady Leslie

I’m a midwife. Boom.

The great thing about being a midwife is that it is a little like the Spanish Inquisition. I’ll be sitting in some public place looking pretty much like anybody else in the middle of a conversation, and then I say “I’m a midwife”. Boom. Petite silence. Nobody was expecting that.

Next comes a varying amount  of introductory information, depending on the company I am keeping – from explaining what a midwife is to describing what kind of midwife I am to where I work.  Then, beat-beat, the wait and see begins.

Either the conversation picks up where it left off, or someone begins to talk about birth. My guess is that more than half the time, the subject shifts to birth and I am not the one who takes it there. Plus, this phenomenon is not gender- specific. One of my favorite examples of this occurred when I reluctantly went to a business dinner with my then, new husband.

As far as I could see, the evening was doomed before it began. Not seeing myself as a trophy wife nor a socialite, I couldn’t imagine what I might have to contribute to a room full of ex-military, conservative business folks. As luck would have it, we were seated next to my honey’s boss. “Not good” I thought to myself. In his never failing supportive style, hubby explained that I was a nurse and a midwife and blah, blah, blah about all I had done. I was expecting deadpan awkward silence, instead Mr. Bossman launched into the most touching and endearing birth story about his grandson, leaving me with tears in my eyes.

True, usually it is women. They want to talk about their births or pregnancy. Maybe they had a midwife, maybe not. Maybe they had a great birth, but often not. Sometimes it’s about the incredible challenges they overcame. But somehow,  we are the vessels designated to receive the narrated sacred journey that stills lives inside them. I suspect this story-telling phenomenon happens with OB nurses and other providers too although I don’t know how much or if this has been studied. I just know that when I utter the word midwife, it is like hanging out a sign that says “tell me your story”.

But then I think about the other side of it. That means there are mothers walking around waiting for the right person to come along so that they can share their story. Do we just need to tell some stories over and over to the right kind of person as a way to heal, renew ourselves and be complete? I think so. I do.  I think I just did.

Maybe this is part of our work as midwives in the world. Maybe giving birth does not end at some point in time but lives on in mothers and as midwives part of what we do is continue to nurture and support the heart and soul of women whose pregnancy, labor and birth live on forever inside them.

June 10th, 2013 by Mayri Sagady Leslie

You Have a Call…

It’s no secret that a woman’s choice of provider (midwife or type pf physician) and place of birth (home, birth center, or hospital) are the two factors that most influence what kind of birth experience she is going to have. In fact, not just experience, but even outcomes for her and her baby. But if you had to choose between the two – provider and place of birth – which one element would you think is THE most influential?  Let’s assume a healthy mamatoto (motherbaby), a normal course of labor and a desire for minimal intervention. Now let’s picture a few different scenarios.

The first is an interventionist provider in a home birth or birth center setting. Not as likely I know, but possible. The number of interventions available are fewer, but one can still perform artificial rupture of membranes, do frequent vaginal exams, put time limits on the labor, restrict intake of food and water, and transfer when concerned things are not going well. In the next scenario, picture a non-interventionist provider in a hospital setting. All the interventions are available, but they are able to steer clear of many of them if not all, depending on the power dynamics of the hospital. So far, this discussion has focused on the labor and birth, consider also the impact of the provider on the antenatal period and the postpartum period when the birth setting has little influence.

My obvious point is that I believe choice of provider is the more critical of the two. I would hope that all women could make both choices freely, but sadly this is not true and we know it. Many women in today’s health system can’t make either choice. Their providers and places of birth are chosen for them – and in many settings midwifery is not available. That’s a problem and it is where you and I come in.

Stepping on the path to midwifery (and staying there) fulfills a critical need for our world. Mothers need midwives. The World Health Organization knows this, the international community knows this, and the research world knows this. Within a context of collaboration with the larger healthcare system, midwifery is the ideal form of maternity care for almost all mothers and babies. Yet in the US, nearly 9 out of 10 don’t have a midwife at their birth.

One of my concerns is that midwifery is sometimes associated only with homebirth, or birth centers, or drug-free birth. None of these things alone are midwifery. Midwifery is woman-centered. Caring for the mother and her choices. Some of the most beautiful, empowered, awesome births I have attended have not met any of those descriptions, yet I have also been at all of those types of birth. Most of the nearly 4 million births in this country are not at home, in a birth center nor drug free. Let’s meet women where they are, give them midwifery care and then go from there. Midwifery is for every woman.

So if you have been called. Answer that call. Don’t wait. Really. If you need support, ask for it. You are needed in every setting by every mother. We are here waiting to teach you, precept you, nurture you along, and welcome you to the midwifery community.

March 8th, 2013 by Mayri Sagady Leslie

Belly of The Beast

OK, I wannabeamidwife, but what kind of midwife should I be? A CNM, CPM, or a CM? What about the difference between being a nurse-midwife or a midwife that doesn’t become a nurse too?

When I pondered these questions in the late 80’s, it was easier to sort out my decision because there were fewer choices. National certification only existed for nurse-midwives and state licensed midwifery was rare. Since I wanted to be both certified and licensed, it was a pretty obvious choice for me – become a certified nurse-midwife. But now, national certification and state licenses exists for those who do not choose to becomes nurses first. Both the North American Registry of Midwives (NARM) and the American College of Nurse-Midwives have a certification process for midwives who do not go through a nursing-school process. (See blog “Alphabet Soup” for more details on how this works.) As for state practice, according to The National Association of Certified Professional Midwives (NACPM) “twenty six states now recognize direct-entry midwives in statute, 24 through licensure”.

This is much more consistent with the rest of the world where nursing and midwifery are not the same profession. I always say,” we don’t require physicians to become nurses first do we?” But then, nursing is it’s own, deeply honored profession rooted in strong values and ethics and there are those who find that nurse-midwifery is a rich blend of these two professions. But for me, I am clear it is two professions. I am happy people today can choose.

Having said that, I am a nurse-midwife and in the U.S. it can have advantages in terms of access to jobs, insurance reimbursement, and on a more philosophical level – access to birth settings and to women. Hence – the belly of the beast.

When a wannabemidwife talks to me about pathways to midwifery and what might be right for them, I ask them where they want to be practicing 5, 10 years from now? Homebirth? Birth center? Hospital? Different certifications may affect where they can most easily practice. I ask them to think about how important their compensation from their work as a midwife will be to their family. I also ask them to think about the costs of their education. Different routes to midwifery have different potential costs. What about the regulations in the state where they want to work? Do they know about that? I try to help them gather data. In the end, I talk about the “belly of the beast”.

Around 98% of the mothers in this country give birth in hospitals. Some by conscious choice, many because it is the only option they know, and still more because they have no choice. To the wannabemidwife – do you want to work with these women in “the belly of the beast’ where intervention-based birth is the norm and midwifery-led care is not? It will be tough. Or do you want to work outside the system in out-of-hospital birth where the locus of control is much more in the hands of the mother and the midwife? This shift of power usually has its price tag in terms of potential compensation and insurance reimbursement for your work. There are many factors to consider in deciding what is right for you.

Windmill

As midwives, I think we all have a bit of Don Quixote in us and are fond of the battle. While I have worked in all settings, I am happy to to do mine within the belly of the beast. I feel these women deserve midwifery care and the option to have physiological birth if they choose (and yes it can be done in a hospital).  But I know my sisters and brothers who take on the rights of mothers and families outside the hospital work just as hard.  In choosing the right pathway for you to become a midwife, start to consider where the windmills are that call to you.

 

March 5th, 2013 by Mayri Sagady Leslie

Alphabet Soup: Professional Midwifery Organizations in the U.S. and What They Do

So I don’t know about you, but it took me a while to sort out all the different organizations that  represent and work with professional  midwifery in the U.S. If I wannabeamidwife, it really helps to understand not only what my options are but who is out there to support me.

Professional Organizations

Sometimes called “trade organizations” (a name I personally dislike), these are the representative organizations. Often there is a membership involved (usually with a membership fee). Membership may have defined parameters but in other organizations it is more open. Professional organizations “go to bat” for you, provide resources, publish information and even practice guidelines. The bigger ones have public relations and public policy staff and/or committees working to improve the status of the profession.

Accrediting Organizations

Accrediting Organizations are concerned with the accreditation of educational programs. Standards are set which define what is required for a student to graduate with the didactic knowledge and clinical  competencies to be a particular type of midwife. In addition, for a program to be accredited it must meet many other standards in terms of the quality of the faculty, curriculum, clinical sites and preceptors. The accrediting organizations are affiliated with the specific professional association of a type of midwifery.

Certifying Organizations

These are the certifying ‘bodies’ that establish the process for certification of the profession. In the context I am speaking of here, national certification is the most common example. Students graduate their programs and then “sit” for the national exams. When they are successful, they become certified. It is these “bodies” which are responsible for the exams and the certification process.

The diagram below gives you an idea of the current organizations serving these functions. Note however that there are midwives in the US not represented here. Not all midwives choose to be certified, but this gives you an idea of the organizations associated with the types of midwives that are. Also, see the links below the diagram from MANA and ACNM which provide good information on the different types and definitions of midwives in the US.

* Both ACNM and MANA welcome membership of all types of midwives

LINKS TO PROFESSIONAL ORGANIZATIONS:

American College of Nurse-Midwives, Accreditation Commission for Midwifery Education and American Midwifery Certification Board

Midwives Alliance of North America, National Association of Certified Professional Midwives, Midwifery Education Accreditation Council, and North American Registry of Midwives

Definitions of Midwifery from MANA Website

ACNM’s “What is a Midwife?”

Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives

 

 

March 1st, 2013 by Cheryl

Birth of a Midwife

My first post is on the long side, but I couldn’t bear to break it up. I wanted to start by telling my wannabeamidwife story. My path wasn’t straight or easy, and I tell you that not out of nostalgia but because I think there is probably someone out there who can relate. Someone who did not start out to be a midwife, who like me did not even start out in healthcare, but heard the call and in the end – answered.

The conception of my being a midwife began with the pregnancy of my first child in 1979. In my 7th month of pregnancy, I attended a midwife appointment with a friend who was planning a homebirth. I was getting care from an obstetrician I liked very much and was planning a hospital birth. I really had no complaints. Yet, I was impressed with the length of my friend’s appointment and the depth of education and personal attention she received from the midwife. After reading Ina May Gaskin’s book “Spiritual Midwifery” and considering my options, I switched to midwifery care and my son was born at home without complications into my arms with his dad at my side and a group of close friends there for support.

I was so moved by this first experience of being a consumer of midwifery care that I though – maybe I should become a midwife. My career at that time was in the arts and entertainment field. I worked as a producer and writer in regional theater and in production in the television industry. Friends actually made fund of this idea. The further I got away from my birth experience, the less real it became that I should or more accurately that I could become a midwife.

Nine years late in 1988 with the pregnancy of my daughter, the staying power of that notion to become a midwife was much, much stronger. I had had  a miscarriage between the two pregnancies and some early bleeding in this one. This – and the fact that the midwife that had been with me for my first birth was unavailable – led me to choose to return to my original obstetrician and a hospital birth. On March 3rd, 1988 in a labor pretty much identical to my first, I brought my daughter into the world in yet another amazing event. I had the striking experience of two healthy, well supported births with two excellent care providers – one at home and one in the hospital – both with excellent outcomes. I will forever be grateful for having had those personal journeys with both the medical mode and midwifery model. I believe it gave me the opportunity to “walk in both worlds”.

Now, I could not stop thinking about becoming a midwife. So I went to my guru midwife friend, Mary Jackson (midwife of my son). She gave me brochures and told me to attend some conferences (which I did). The first conference I went to, I ended up being housed with Penny Simkin at a private home and sat in amazement listening to her speak around the kitchen table late into the night. The other conferences were filled with inspiring leaders in maternal child health and I drank their wisdom in.

At the same time, I was still working in the entertainment industry at this time, on a documentary called “Childbirth at a Turning Point” featuring Michel Odent and was also helping my former pregnancy workout teacher produce a prenatal exercise video.

By Fall of 1988 it was evident I was meant to be a midwife. I decided I would “set my foot on the pathway to midwifery” and that I would stay on the path until something or someone showed me I should not be there. Nothing and no one ever has. I think there is a moment like this for all of us and it is our moment of birth as a midwife. It is a moment of demarcation before which we weren’t sure and after which we were. In January of 1989 I went back to school and began to earn my Associate Degree in Nursing (ADN) as the first step toward becoming a Nurse-Midwife. At that time in California, there was no option for direct certification or state licensing of non-nurse midwifery – and I wanted to be certified and legal.

I graduated in 1994 with my ADN and in May of 1997 completed both my Certificate in Nurse-Midwifery from the Frontier School of Family Nursing and Nurse-Midwifery and my Masters of Science in Nursing from Case Western Reserve University. I passed the national boards that summer, making me a Certified Nurse-Midwife.

Epilogue: In January 1989 when I said I would “set my foot on the pathway to midwifery” and stay there, I did not know how soon that path might be challenged. On April 20th of that year I was involved in a 5-car crash caused by a drunk driver coming down the wrong side of a wet highway at 5:00 AM. I was closer to death than life coming out of the accident. One thought I remember having was thinking about what was really important to me if I lived. Obviously my children and husband were the first things on my mind, but the other thing that was crystal clear to me was that I was going to be a midwife.