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Midwifery

Midwifery

What is a midwife?

Midwife means, literally, "with woman." A midwife, traditionally, is a female birth attendant. She is a highly trained professional who assists a woman through labor and birth while preventing and/or treating any complications which may arise. A midwife can be either a nurse or a woman who has participated in an apprenticeship to earn her education. Either route has its advantages and disadvantages. Unlike a medical doctor, a midwife sees birth as a natural process for which a woman's body was designed. Pregnancy is not seen as a disease and birth is not viewed as an illness requiring medical intervention. A midwife is in spiritual kinship with the birthing mother and her goal is to make birth a joyous, empowering occasion for the mother and family.

How do I become a midwife?

There are two main routes to midwifery.

The first is to get a nursing degree (RN), along with a bachelor's degree which could be either in nursing (BSN) or any other subject, and then complete a master's program to attain the title CNM, certified nurse-midwife. CNM's work in hospitals, birth centers, or homebirth settings.

The second is a bit more variable, particularly from state-to-state. This is the apprenticeship route, the traditional path to midwifery. A woman learns as much as she can on her own about the basic issues of women's health and childbirth by reading as many books as she can get her hands on, particularly midwifery-specific textbooks such as Varney's Midwifery, Anne Frye's Holistic Midwifery, or Myles Textbook for Midwives. Then, she volunteers to help out a midwife in order to attain a working relationship with her and an apprenticeship. The apprenticeship is where the student observes, assists, and gains knowledge from an experienced midwife. Gradually, over the course of 2-5 years (approximately), the student acquires the skills and experience required to pursue midwifery on her own. She may then decide to get licensed by taking the NARM exam and becoming a CPM, certified professional midwife, or she may remain unlicensed (which does NOT mean incapable) and practice as a direct-entry midwife. Apprenticeship-trained midwives usually work in rural settings, homebirth practices, or birth centers.

A Direct-Entry Midwife may also earn her education by attending any of several schools dedicated to the training and licensure of non-nurse midwives. Such programs can last anywhere from 2-4 years, and include extensive training which includes about 750 clinical hours which includes attendance at approximately 100 supervised births, half of them where the student serves as the primary midwife. Such schools include the Oregon School of Midwifery and Seattle School of Midwifery. There are others, as well. Check out the Midwifery Page for links to some of these schools or go to the Midwives Alliance of North America (MANA) homepage to get more specific information.

What do all the different titles mean?

Midwives of different backgrounds may use different initials after their name, which may be very confusing, but they are all trained midwives, nonetheless.

CNM = Certified Nurse Midwife
CPM = Certified Professional Midwife
DEM = Direct-Entry Midwife
LM = Most appropriately used to denote Licensed Midwife (A midwife who has worked hard to earn licensure) or sometimes used to mean Lay Midwife (which some people use to denote a non-licensed DEM)


Other abbreviations which may be seen after a birth professional's name:

TBA = Traditional Birth Attendant (not necessarily a midwife, but also could be a labor support assistant or doula)
ICCE = International Childbirth Education Association Certified Childbirth Educator
IBCLC = Internationally Board Certified Lactation Consultant
ACCE = ASPO/Lamaze Certified Childbirth Educator
BCCE = Bradley Certified Childbirth Educator
CBE = Childbirth Educator
CCE = Certified Childbirth Educator
LC = Lactation Consultant
NP = Nurse Practitioner


Taskforce on Midwifery

Midwifery, one of the health care professions dedicated to caring for women before, during and after pregnancy, has had a unique history in America. Following their near monopoly as the attendant of choice for childbearing women for centuries, American midwives lost this position after the turn of the 20th century when organized medicine-and obstetrics as a specialty-entered the scene. Recent years have witnessed both an increase in number of practicing midwives and an increase in number of births attended by midwives, although the percentage of total births attended by midwives remains a fraction of the number delivered by physicians. What role has market-driven reform of health care delivery and reimbursement systems played in this re-emergence and how will managed care affect midwives in the future? The goal of the task force is to bring together experts in the field, identify the current and future issues facing the profession, and collectively recommend strategies to position the profession to take advantage of the opportunities afforded it by the changes as well as to raise the awareness of challenges likely to confront it. A national taskforce of eight experts is meeting to discuss the issues and to write a report by the Fall 1998/Winter 1999 that captures the group's concerns and recommendations. The Center will print and disseminate the final report through its communications division.. For further information, contact Catherine Dower at the Center. (Excerpt from http://futurehealth.ucsf.edu/taskforces.html.

[ The following FAQ document was borrowed from http://www.internurse.com/ ]

The topics addressed in this document are: 1. WHAT IS MIDWIFERY? 2. WHAT DO MIDWIVES DO? 3. HOW DO I BECOME A MIDWIFE? 4. WHERE DO I FIND A MIDWIFE? 5. IS MIDWIFERY CARE SAFE?

1. WHAT IS MIDWIFERY? The simplest definition of midwifery is "with woman", but truly, midwifery means different things to different people. For many, the Midwifery Model is an attitude about women and how pregnancy and birth occur, and view that pregnancy and birth are normal events until proven otherwise. It is an attitude of giving and sharing information, of empowerment, and of respecting the right of a woman and her family to determine their own care. The attitude of midwifery, or the Midwifery Model can be contrasted with the Medical Model. In general, the Medical Model is an attitude that there is potential pathology in any given situation, and that medicine can assist to improve the situation. Medicine is also about teaching , informing, and prevention, but the power seems to be more with the provider rather than with the woman. Historically, midwives have always been around to help women give birth. Before physicians, midwives were the primary healers in their communities. They were the medicine women of their own cultures, and assisted families and women throughout their lives. In the Old Testament they were described as examples of the strength and faith in God. Midwives were once the nutritionists, herbalists, doctors, ministers, counselors all rolled into one 'profession'. Many feel they were the first holistic practitioners. Midwives were always available to help the poor, the women without medical care or the women who were the outcasts of their culture. Today, midwives take care of anyone who wishes to see them, but practice within the constraints of their medical and legal systems. Today midwives are as diverse as the populations they serve. Midwives are willing to take care of anyone who wishes to see them. Over 70% of births in the world are attended by midwives. In the Netherlands, midwives deliver a majority of the babies. Other countries do not utilize midwives to their fullest potential. Each country worldwide has a slightly different view of midwifery, and of how midwives work within their communities. In sci.med.midwifery, midwives will speak from these various perspectives and cultures. Midwives are encouraged to share their statistics and work situations within this newsgroup. The World Health Organization (WHO) presents us with the following definition of the midwife: A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. (WHO, FIGO, ICM Statement)

2. WHAT DO MIDWIVES DO? Midwives teach, educate and empower women to take control of their own health care. In most communities, they provide prenatal care, or supervision of the pregnancy, and then assist the mother to give birth. They manage the birth, and guard the woman and her newborn in the postpartum period. Most midwives encourage and monitor women throughout their labor with techniques to improve the labor and birth. Reassurance, positive imaging and suggestions to change positions and walk helps labors progress. Many midwives provide family planning services and routine women's health examinations such as pap smears and physical examinations. They teach women about sexually transmitted infections, and focus on prevention of the spread of infections. What specifically midwives do will depend upon: her training, her licensure, and what is allowed in the state, province, or country in which she practices. For example, in the United States some midwives can prescribe medications, provide women's health care throughout the menopause years. Midwives worldwide attend births in the home, hospital or birthing center, depending upon their education and licensure, and the rules governing their practice. Midwives believe it is especially important to provide time for questions, teaching, and time to listen to the concerns and needs of the women they care for. The WHO definition of the midwife gives us the following guidelines about what midwives do: She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counseling and education, not only for the woman, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions of in any other service. (WHO, FIGO, ICM Statement).

3. HOW DO I BECOME A MIDWIFE? There are many different paths to becoming a midwife. Which path you choose will depend on many factors: where you live, what the rules and regulations are in your state or country which govern midwives, your age and education, and what sorts of experiences you have had with birthing. The most important thing is that you need to look at your reasons for wanting to become a midwife are, both short term and long term. This will help you determine which path is best for you. The resource published by Midwifery Today Getting an Education: Paths to Becoming a Midwife gives good guidance and information about the various paths to becoming a midwife. In some areas women start as childbirth educators and/or doulas to become exposed to birth and working with pregnant women.

4. WHERE DO I FIND A MIDWIFE? Seek midwives in your community, state and country of province. Speak with local childbirth educators about midwives they know, and of course, talk with your friends about their birth experiences and their particular choice of provider. Watch for health fairs in your area, check with herb and health food stores and ask questions of other types of health providers such as massage therapists. Sometimes a call to the local hospital or health center will give you information about midwives, childbirth educators and doulas. Some systems have referral systems for midwives in place, and you can easily locate a midwife. In other areas you may need to ask lots of questions. Locate your La Leche League or other groups that work with mothers and infants, and ask for names of midwives they know. There might be a listing within your phone book for midwives, but some midwives are not listed there due to finances or legalities. For example, in the US, sometimes only CNMs are found in the yellow pages and it might be more difficult to find the names of midwives who attend homebirths. Contact nurse practitioners in your area, your local Health Department and Planned Parenthood. They will usually tell you their favorite providers first

5. IS MIDWIFERY CARE SAFE? As mentioned before, midwifery is probably the oldest profession known to humankind. Certain mammals (whales for example) have been seen assisting their sisters births, and helping new whales reach the surface of the water, and are called midwives. The more the scientific method is used to analyze birth and the use of technology, the more the midwifery model stands out at a model for normal pregnancy and birth. Two recently published works support non- intervention and midwifery care as being safe and cost effective. A Guide to Effective Care in Pregnancy and Childbirth is a collaborative effort to prepare, maintain and disseminate reviews of randomized trials of health care using the Cochrane Database. This is an international effort, and a very readable resource. The Database is based on a decade- long study of controlled trials in obstetric care concerning different aspects of care and treatment. It also describes the approaches and decisions that have been demonstrated effective and those for which the evidence in inconclusive or negative. "As technical advances became more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. Direct comparisons of care given by a qualified midwife with medical back-up with medical or shared care show that midwifery care was associated with a reduction in a range of adverse psycho- social outcomes in pregnancy, and with reductions in the use of acceleration of labor, regional analgesia/anesthesia, operative vaginal delivery, and episiotomy. (p 15, ) . BIRTH: Issues in Perinatal Care Vol:22, No 2: June 1995 summarizes this resource. A second excellent resource is Obstetric Myths Versus Research Realities. This lists many recent abstracts from medical research in an organized and systematic fashion. It would be impossible to quote them, and one needs to review this text to appreciate its value. Women seeking assistance for her pregnancy and birth will find providers at all points along the spectrum: physicians that are highly interventive, physicians that behave similarly to midwives that are non-interventive, trusting herbs and other modalities, and midwives that practice like physicians. The onus is on the woman and her family to question the available providers and find the match that best suits her individual needs.

This FAQ was prepared by Pat Sonnenstuhl, ARNP, CNM with the supportive assistance and contributions of the following individuals. Suggestions for topics to add to the FAQ are always welcome. Ms. Sabrina Cuddy Childbirth Educator, Nursing Mother's Council volunteer, USA Ms. Elizabeth Couch DEM, USA. Ms. Marjorie A. Dacko DEM, birthcenter practice, USA Ms. Sharon K. Evans writer and and licensed DEM, birth center practice. Co-chair for the NARM Qualified Evalator Committee Ms. Cheri Van Hoover CNM, hospital practice, USA. Mr. Patrick Hublou Midwife, Flanders, Belgium Ms. Deirdre E.E.A. Joukes Consumers-viewpoint, The Netherlands Ms. Debbie Pulley MANA Legislative Chair CPM, homebirth practice, USA

SHAMANIC MIDWIFERY:  HANDS THAT HEAL BIRTH
by Jeannine Parvati Baker

I am a spiritual midwife, called by the God-Us to heal the Earth by healing birth. I first heard my call to assist women becoming mothers, to realize birth as a spiritual as well as a natural rite-of-passage, by birthing my own babies consciously. My initiation in giving natural birth was in January of 1970. It was the first time an obstetrician had seen a woman squat on the delivery table to give birth. Post-partum, when I wouldn't be separated from my newborn Loi Caitlin, (as they had no rooming-in arrangement) they put me back in the labor room with my baby. A laboring mother in the next bed was screaming, "Ah Dios, Dios!" How she suffered: My heart went out to her and I soothed her from my bed, my first experience as a spiritual midwife.

About this time in my life, I began to teach childbirth education and prenatal yoga classes. My goal was to help more babies be born consciously -- thus, creating a sustainable future for my own child -- and future grandchildren. I had a significant dream during these years -- In my dream two brilliant white doves flew to me. I watched them land on my hands, and when they walked from my hands, now tingling with energy, up my arms, to my heart, I was filled with radiant light. I understood at that time that my hands and heart were agents of the healing light.

It was awhile later that I met this archetype in the Greek myth of the two midwives who flew to the birth of the twins Artemis and Apollo in the form of doves. By then I was well known as the "baby lady" of my community and preparing for my next challenge in reclaiming birth.

My second and third births were twins and when I was in the hospital, they x-rayed me and announced that my pelvis may be too small and I would need a cesarean section. I checked myself out of the hospital and went home to give ecstatic birth to my footling breech baby, Oceana Violet and her head first twin, Cheyenne Coral. From that point on, 1974, I have only birthed and midwifed at home. I clearly saw what a distraction hospitals can be when giving birth.

After my third birth, I understood that I needn't hire anyone to be paranoid for me when laboring to bring forth my young. In 1975 I became a spiritual midwife whose main tools are my faith in the naturalness of birth, my healing hands and word medicine.

My community made me a midwife by asking me to attend births. Rather than getting trained by an institution, and learning a medical set of rituals to take women through birth, I apprenticed directly to birth itself. My promise as spiritual midwife is to honor the journey, be attentive to what presents itself, and remind a mother by my presence that she already knows how to give birth. I trust that if a woman consciously conceives her baby without the help of experts, she is able to give birth unassisted by the medical experts. My "back-up is whatever God-Us is "on call" that night -- in over a generation of attending births, every woman I have midwifed has given spontaneous birth.

Once I was called to a birth and forgot to bring my birthing kit. Then I realised that I am my midwifery kit -- I had my ears through which I could hear the baby's heart, I had my hands through which I could feel the baby, and I had my heart -- which loves the baby earthside. After that experience in 1980, I founded HYGIEIA COLLEGE, a mystery school in womancraft and lay midwifery I teach the "inward skills" -- how to cultivate intuition and know our embodied perception is the medicine bundle, or midwifery kit par excellence.

At this writing, mid-90's, there are over 600 students currently enrolled in Hygieia College, studying an essential midwifery which locates the power to give birth in the God-Us -- a divine life-force which brings our babies to the light. It is an international mystery school which, I am proud to say, graduates midwives who practice differently than I. Each midwife serves her own community, and is responsive to what is best-for-life in the moment. Rather than a method, or a training course, Hygieia College is a journey to the sources of healing and an un-training of erroneous beliefs and actions which interfere with spontaneous childbirth. I see this un-training process akin to removing the mind swaddling of the prevailing technocratic culture.

From attending birth mindfully, I recognized that there is a lot of work to be done to heal fertility, specifically the abortion epidemic and on the other extreme, infertility. Women who had abortions as well as women who had difficulty conceiving, are more likely to have difficulties surrendering to the power of the birth-force. In 1986, my partner Frederick Baker and I published the tome CONSCIOUS CONCEPTION: ELEMENTAL JOURNEY THROUGH THE LABYRINTH OF SEXUALITY. In this book we articulate the practice of fertility awareness as an opportunity for Self-realization, in the specific focus of fertility. My work in spiritual midwifery includes conscious conception and I often connect with a family before they conceive their baby in capacity of midwife. What I notice is that a baby who is consciously conceived, who is desired by both mother and father, already has the foundation for health, wholeness and holiness in place. A baby who is not wanted, on the other hand, is spiritually handicapped in that their Source, the earthly mother and father, are disconnected. Children who are not wanted are more likely to be abused, and "act out" for negative attention -- for it is better to be wanted by the police than not at all.

According to research reports, babies who are born in violence (standard obstetrical management of birth in hospital) are more likely to be involved in violent crimes as youths and adults. (See the Jonn Vascocellos congressional report from California.) My work in conscious conception, toward making every baby a wanted baby (rather than a mistake in a contraceptive method), contributes to a more peaceful society.

My firstborn son, and fourth baby, Gannon Hamilton, was our first freebirth. We didn't pay anyone to be responsible for our baby's birth and in 1980, my partner, the baby's father, and I experienced a most powerful spiritual initiation. There were no other adults present to distract us from the immense sexual bonding of the original lovers greeting their newborn together. The Holy Trinity has new meaning for us since Gannon's birth -- Mother/Father/Baby. And we honored the Son as he is -- already enlightened, whole, perfect. Needless to say, no circumcision.

When I conceived and birthed my fifth baby, Quinn Ambriel, in 1985-86, I prepared for these experiences as a vision quest. I was given a vision which has sustained me spiritually ever since. When I ecstatically gave birth underwater to my fifth baby Quinn, I saw every mother on this earth giving birth with her lover between her legs -- in a unique, and creative expression of love. No masked man, no paid paranoid in attendance -- only the original lovers who first invited the new one to join them in holy family.

I see this as central to what will bring peace and an authentic self-sufficiency to the world. Once parents birth their own babies, in a balanced partnership, they know they can also take care of this baby. The trust that is established in a freebirth, a delivery free of MANipulation and medical control, lasts a lifetime.

The fear-based imprint of hospital birth is "the institution will take care of me". The consequence is socialized welfare -- the institution of government taking care of our own responsibilities. Again the experience of being my own midwife has made me freer ever since and the sequel of homebirth naturally follows: natural healing at home (no pediatricians), home school (no teachers), and the living experience of spirit (no churches). We do not rely on institutions to mediate or make safe life for us. Birth is as safe as life gets.

As a spiritual midwife, my primary responsibility is to empower the mother to give birth spontaneously. The tendency is to enroll in the cult of experts who say, "I know more about your body than you do." My responsibility as a healer is to return any projections of power upon me to the family I am serving. The truth is that I am not medically nor surgically skilled -- I cannot deliver a mother's baby for her. Rather, I remind the mother that she is the only one able to give birth (her other option is to be delivered) -- and I support her every way I can. In this way I am able to respond to my original calling -- to be the guardian at the gate.

To aspiring healers who are called to attend childbirth, I advise the following; first, midwife, heal thyself, Next, do no harm. Remember your own birth and forgive any trespasses upon your soul. And always, listen to the still, small voice within -- and the voices of countless mothers before who gave birth with dignity and as a natural expression of sexuality. Last, realize that mothers who give freebirth can connect with the Source of all creation and be the God-Us in action.

It is an honor to see the original face of any new one. Each baby born holds the light very purely and as a spiritual midwife, I greet the new one with celebration and gratitude for the ordinary miracle of birth.

Humility, patience, trust, integrity -- these qualities are essential to a spiritual midwifery practice. I was called as a young woman myself, yet traditionally it is the grandmothers who are asked by Spirit to be midwives. Now that I am a grandmother, I see the wisdom in first being seasoned by life before answering the call. However, as a young midwife, I would take my children to births with me, considering this the best part of their home school experience. Therefore I encourage young midwives to be who we really are -- if we have children, to give a living model to the families we serve by being real mothers and taking care of our own children. Hygieia College was founded, in part, to meet the needs of mothers desiring to increase the upward mobility of their minds as mothers. Our college holds all gatherings and workshops with children not only invited, but honored.

At the edge of the millennium, more midwives are being ordained by the God-Us to heal birth without being indoctrinated nor controlled by medical licensure. In that one legal definition of a license is permission to do what society considers "dangerous or immoral, we are choosing to be midwives based on authentic need. Homebirth is not dangerous or immoral" --actually the converse is true -- hospital birth is dangerous and immoral. The U.S. is 20th in the World Health Organization's statistics on perinatal mortality and morbidity. In other words, there are 20 other countries in the world where it is safer to give than birth than in an American hospital. The other countries with better statistics almost exclusively use midwives rather than doctors. But what about the "consumer" or "patient" -- do they not need protection? Let me clarify that I am not suggesting a "buyer beware" attitude toward midwifery. If a midwife is capable, she will stay in practice. If a midwife is not serving her community, she will eventually not be asked to attend anymore. We do not need the State in our bedroom for indeed, birth is a woman's expression of sexuality -- and in my practice, not under legal or medical jurisdiction.

Traditionally midwives are the wise women, the herbalists and psychologists of their communities. They knew who was sleeping in whose lodge -- and being attentive to the sexual dynamics of their communities, could facilitate the sexual energy of birth. A major eradication of wise women took place in the dark ages and most midwives were destroyed as "witches". It has taken a long time for a renaissance in birth to occur. Midwives today must be courageous to practice in our constrictive and litigatious climate. Sometimes the most courageous amongst us, are targets of litigation. Midwives need the support of the entire healing community to face the challenges ahead.

In 1986 I gave birth underwater to my last baby, Halley Sophia. As in our last three births, we hired no expert to attend "just in case". All my work is devoted to making every mother a midwife -- so I practice what I preach. I live in a state where parents have the right to chose where and with whom they give birth so we broke no law. Yet, in my neighborhood there was an unease which, in my pregnant, intuitive condition, I sensed. I went to my neighbor's church on a fast and testimony meeting day and addressed the congregation all at once. I said, "I have prayed about this birth and have been told that being home is our sacred place. However I have one fear and that is, if something goes wrong in this birth, I'm concerned what you would think. So, I now ask that you pray for a perfect delivery at home." After the meeting, the very ones who had been in the most fear about our upcoming unattended birth, now were enrolled as allies for they soothed me with stories of their own relation's various births at home and promised to pray for us.

With all these prayers, during Halleys ecstatic birth, I had a vision where I had eyes all over my body and could "see" multi-dimensionally. I realized that I was like the White Hole in astrophysics -- that source point where something new comes into material existence, the opposite of a Black Hole. My uterus is the universe -- I am the stargate. As mother, I am the means by which life creatively expresses itself and giving freebirth is akin to the origin of stars. In other words, I know how God-Us must've felt giving birth to the universe.

How can my personal experiences in birth serve the world now? One idea of how evolution works, is the morphogenetic field theory of Rupert Sheldrake. It has been popularized by Ken Keyes in his book, THE HUNDREDTH MONKEY. What this idea states is that there are leaps of evolution for an entire species which occur simultaneously amongst all members regardless of geographic location. In regards to childbirth, I observe the phenomenon of morphic resonance in this way -- more and more families are choosing to freebirth, all over the world. When a critical mass is reached of ecstatic rather than suffering birth, there just may be a leap of faith. All mothers may remember that we are co- creators of life and have totally within each of us the capacity to show the world what our love looks like in the form of a baby. Whenever I give a talk or workshop, I imagine that the one mother who is the "critical mass" for freebirth may be attending and inspired by my word medicine to reclaim birth. Indeed, each mother I speak with, in my mind, is the hundredth monkey, a change agent for evolution, as well as the God-Us incarnate. For as the canon of Hygieia College states, Healing One Mother is Healing the Earth. Blessed Be the Babies!!

 

More Information about Midwifery:

Midwives Alliance of North America
http://mana.org/

Women of Spirit: The International College of Spiritual Midwifery
http://www.womenofspirit.asn.au/

American College of Nurse-Midwives
http://acnm.org/

Midwifery Today: The Heart and Science of Birth
http://midwiferytoday.com

Find A Midwife
http://www.findamidwifetoday.com/birthmarket/search.asp

Citizens for Midwifery
http://www.cfmidwifery.org/

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