Wanna Be A Midwife?

Everything you need to know to pick your path to midwifery
June 18th, 2013

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

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 5th, 2013

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


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