I love CNMs as much as CPMs. My post last week was written with a broken heart because I tend to be quite Type-A and have very high expectations of people in my life. Sometimes, my tendencies toward perfectionism leave little room for mistakes committed by others. Just ask my husband! I understand why NCACNM wanted to pass their bill this session – last year, almost all of the home birth CNMs in our state lost their backing physician leaving hundreds of families scrambling to find a care provider. If they can get rid of the physician’s signature requirement, the CNMs practicing home birth can continue serving their families. This is hugely important to our organization as well – read more about our attempts to help this situation here.
But I also want to explain a bit about why I chose a CPM and why I feel particularly passionate about obtaining licensure for them in our state.
When I got pregnant in 2004, I did not know about home birth. I just knew I was pregnant and uninsured and new to my community. I had not found an OB/GYN for my well-woman care (did not know about midwives!), so had to start making phone calls to find someone to care for me and my tiny, growing baby. Each of the practices I called informed me they were not accepting new patients, except one. The secretary at this practice said they would be happy to see me, until she found out I was uninsured. ”We require 10% of the doctor’s fee at your first visit. His fee is $6000, so you will need to bring $600.” Now at the time, our rent was $700 and my husband was unemployed. Where were we going to come up with that kind of money? I was distraught and beginning to feel that we had made a huge mistake, trying to start a family when we couldn’t afford to pay for a physician. I began looking up any and everything I could on-line about birth. And that’s when I discovered something that changed my life – pictures and a blog about a woman giving birth under a tree in California. With midwives. Whoa. Wasn’t that unsanitary? Dangerous? But the story this woman wrote was so beautiful and compelling, I began looking up the now new term “home birth.” I found a site called nchomebirth.com and discovered that in order to find a midwife practicing home birth in N.C. I had to enter my personal information and wait for a phone call from some stranger.
Once I got a phone call, I found out that this particular midwife lived almost 2 hours away but came to Wilmington to do pre-natal visits once a month to help assist families have the type of birth they wanted. No one else was helping families choosing home birth on the eastern side of the state. She explained that she had no license in our state, but at the time I did not understand the implications. I just knew I did not want to have my baby in a hospital. And did I mention how affordable she was? She was charging $2200 for all of my prenatal care (each visit lasted an hour), and the birth and several post-partum visits. And her apprentice would teach us the Bradley method as a bonus. Wow. If I had chosen the physician, my visits would have lasted about 5 to 10 minutes and his fee would not have covered the birth or post-partum care. Not to mention all of the hospital facility fees and incidental charges.
After 25 hours of labor, we saw meconium in my amniotic fluid so I decided it was time to head to the hospital. That was when I understood why not having a license was not okay – my midwife had to pretend to by my doula. When the hospital staff asked if I had received any prenatal care, my husband said, “Yes.” But when they asked for our records, we could not provide any. Everything worked out – Katherine was born about 30 minutes after we arrived (20 minutes of pushing). But it became quite clear to me why we needed to have licensed midwives in our state. We need continuity of care. My midwife needed to be able to hand my chart to the physician so my husband and I could have continued laboring together. Instead, he was busy filling out paperwork and getting the third degree from the hospital staff.
My second daughter was born at home with the midwife’s apprentice from my first birth. She had passed her CPM certification and opened her own practice. Rose was born after a quick 4 hour labor, just in time for lunch! It was perfect, peaceful and I could not have imagined a more beautiful birth. I became fascinated by the kind of care she was providing, and by the fact that she was willing to risk being arrested in order to continue practicing. She agreed to let me follow her to births to film a documentary.
At each of the three births I had the honor to attend, I documented something that I had not noticed during my own birth. While the woman was laboring, my midwife and her apprentice sat patiently watching – encouraging the woman, offering suggestions, checking heart tones – doing all of the kinds of things one would expect a birth attendant to do. But there was something else going on, something much more subtle. Several times throughout the labor, my midwife would look across the room at her apprentice and make eye contact. No words were exchanged, but the apprentice would leave and return with something that the midwife clearly needed at that moment. This is the art and craft of midwifery, and what I fear is going to disappear from maternity care if we fail to ‘legitimize’ the CPM credential in our state.
There is a type of knowing that cannot be quantified. I have read many books about it – In a Different Voice by Carol Gilligan; Women’s Ways of Knowing by Belenky, Clinchy, Goldberger and Tarule; Sacred Pleasure by Rianne Eisler. Pregnancy and birth are uniquely feminine experiences, and therefore belong largely to women. Midwives are, and have been since the beginning of time, Wise Women. Here is Psychology Today’s definition of ‘wisdom’:
It can be difficult to define Wisdom, but people generally recognize it when they encounter it. Psychologists pretty much agree it involves an integration of knowledge, experience, and deep understanding that incorporates tolerance for the uncertainties of life as well as its ups and downs. There’s an awareness of how things play out over time, and it confers a sense of balance.
Wise people generally share an optimism that life’s problems can be solved and experience a certain amount of calm in facing difficult decisions. Intelligence—if only anyone could figure out exactly what it is—may be necessary for wisdom, but it definitely isn’t sufficient; an ability to see the big picture, a sense of proportion, and considerable introspection also contribute to its development.
I believe that midwives who are free to practice the Midwives Model of Care “experience a certain amount of calm in facing difficult” situations. This allows them to have a “tolerance for the uncertainties” of birth. When midwives truly sit with woman, they are able to sense what is happening with her and her baby. They do not need to see a machine in order to know when a woman is experiencing a contraction – they feel it. I know because I could feel it, too. And it was really intense and wonderful. But I can see where some folks might not be aware of the fact that they can ‘feel’ what others are feeling, and simply know that being in the presence of a birthing woman feels uncomfortable. I can also see where there would then be a need to control that experience and make it less uncomfortable.
I am fully aware that much of what I am writing about here is considered ‘hippy-dippy, voodoo nonsense.’ But this is my truth and I feel compelled to tell it. When women receive care from a midwife, when they are allowed to experience birth on their own terms, to feel all of their fears and finally embrace them and surrender to something more powerful than themselves, they are transformed. Through both of my births, I discovered that there is tremendous power in being vulnerable, in giving up the need to control everything. The experiences we have in life and the emotional responses we have to them cannot be proven, but does that make them any less true or real to us? This is the element that is at the core of what’s wrong with maternity care to me – the medical model allows no room for the emotions of birth. The objective is logical – deliver a healthy baby from the mother. There is no consideration for the way the mother feels about her treatment. I prefer the holistic approach of the midwives model, and I will continue to fight to preserve it.