Saturday, September 1, 2007

The Midwife Conundrum

I've known for a very long time (more than ten years) that I was meant to be on the path to become a midwife. I had always envisioned being a lay midwife and had gone so far as enrolling in Ancient Arts Midwifery Institute, an at-a-distance school when I found out I was pregnant with my son. After an empowering homebirth I felt the need to find a way to support us and so, after much encouragement from my family and despite my own personal misgivings I began to pursue my nursing degree. Along the way I became certified as a doula and childbirth educator, I took a course in prenatal and postpartum massage, and tried to stay "true" to my trust in birth and love of homebirth.

Fast forward to the winter of 2004 when I received my ASN, let's not forget that I was a single mom, struggling to pay the rent, I needed my degree but fast! I spent six months on a high risk L&D unit in a hospital in St Louis, horrified by the nearly 100% epidural rate, the lack of family centered care, and the laissez faire attitude of the docs towards their highly interventive births. It did however give me greater respect for the need for heroic medicine when it was really necessary. It opened my heart to the tragedy of fetal demise, and I found that I was actually really good at caring for families who had experienced the death of their babies.

After moving home to Minnesota, I took a position on a midwife unit in a large metro hospital, and here I sit, feeling that I'm spinning my wheels, disillusioned by what should be a closer-to-homebirth setting, and feeling burned out by demanding management, high needs (and sometime high risk)patients, and lack of staffing.

I need to move forward. The question is...which direction?

As a direct entry/lay/certified professional midwife I'd certainly go back to my first love:homebirth. The problem is, I can't leave my family or ask them to move so that I can attend a school like Birthingway or the Seattle School of Midwifery. And I don't feel that I'd learn as well from an at-a-distance course like AAMI. Additionally, it's difficult right now to part with my considerable income. I know that I'm very fortunate to make this kind of money, and parting with one half of our income is simply not possible.

On the other hand, I could easily attend the local University's Midwifery program (after obtaining my BSN of course) and I could continue to work part while I did it. I could also receive a dual degree as women's health Nurse Practitioner/Certified Nurse Midwife, which would be great because I love well woman care and I'd be able to do all sorts of neat things like insert IUDs (fyi I am a big IUD lover!). Problem is, I have NO desire to catch babies in hospitals. None whatsoever. And practicing as a CNM doing homebirths in Minnesota ain't easy. We used to have a few CNMs who did them, but the political climate either pushed them back into the hospital, or out of state all together.

So I'm at the crossroads, wishing someone would read my future and tell me what path to take. But of course, no one can. I've got to find my own (very convoluted) path, and will only know years from now if I chose right. Though, there may very well be no right, only right for me. Who knows? I'll keep you informed.


Laborpayne said...

Bless you, Child,
I know exactly the place you dwell in. As I search to find my own way, and claim my place in this struggle, I am confident the answer will come to you.

Karen said...

Whatever you choose will be the right choice. But I'd like to say that hospitals NEED cnms who trust birth. I would love to see a third way emerge in the US so that women who need or want to be in a hospital aren't all bullied down the same path.

Red Pomegranate said...

My concern, from my own experience, AND the experience of others, is that hospital protocol often ties the hands of the most compassionate, cruncy CNM. I heartily agree with you but I fear that change will take longer than even my lifetime! My single hope is to see more independent birth centers with both CNMs and direct direct entry midwives running them, maybe then we'll see some change in the hospitals.

AtYourCervix said...

I feel your pain and difficulty in making a decision. For now, I've decided on the distance learning path towards becoming a nurse-midwife. I'm not happy at the thought of doing my clinicals in a hospital setting where I work now (very interventional, cascade of interventions, seemingly everyone is high risk, even the low risk moms...etc). But, maybe I can help fight the system and become a low intervention hospital based (or at least trained) CNM.

I have also thought of the direct entry route - legal in my state, but ambiguous in many other states - and I still consider this route from time to time.