“You’re going to Utah?” ” What are you doing there? Are you moving?” “Are you going to be a midwife when you get back?” These questions have buoyed me with support as it makes it clear to me that I haven’t communicated well about what I do and all that it takes to do what I do.
As some of you know, I wear various hats in this community working in different capacities. I am a childbirth educator, La Leche league leader, lead MotherWoman groups, offer private postpartum support, labor doula, a student midwife, placenta encapsulation specialist as well as being a mom and wife. Now that laundry list of jobs makes sense to me, but if this isn’t your everyday vocabulary list it may not make sense to you. So, a little explanation may do us all well.
What’s a doula? What’s a midwife? What’s the difference?
The differences between a midwife and a doula are great. The two professions compliment each other and many skills do overlap, though many do not. Both work with pregnant women to provide information, physical and emotional support. That’s where many of the differences end. A midwife is a clinical care provider meaning that we can provide holistic care during pregnancy, labor, birth, and the postpartum period. That means that you can receive prenatal, home birth, and postpartum care for you and your baby with a midwife. Since I am a student midwife I thought it may be helpful to understand what that means and how I am accomplishing my education living 30 miles out to sea.
I am working towards becoming a Certified Professional Midwife (CPM). “A CPM is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. Most CPMs own or work in private home or birth center based practices throughout the United States, Canada, and Mexico. Providing continuous care for women throughout their childbearing cycle, CPMs generally carry a relatively low client load (averaging 3-6 births per month) which allows for more personalized and comprehensive care than typical obstetrical practices. The scope of practice of the CPM is derived from the NARM Job Analysis, state laws and regulations, and individual practice guidelines developed by each midwife according to her skills and knowledge.” From The National Association of Certified Professional Midwives As mentioned, there is training focused solely on midwifery and out of hospital births. That course work is an accredited 116 credit hour program that I have been enrolled in for the last three years. I am grateful to have Sybille Andersen as my preceptor who oversees my academic training.
In addition to academic skills there is a long list of clinical skills that needs to be accomplished as well. These clinical skills include everything from taking a blood pressure, checking dilation, assessing fetal heart tones, to dealing with shoulder dystocia, suturing, recognizing and responding to complications in labor and birth, performing a thorough newborn exam, four to six week postpartum check up, comprehensive well woman care, and so much more. Four pages of specific skills in fact.
And there are shear numbers of births that need to be attended in different capacities; as an observer, an assistant, and a primary student under supervision. My trip to Utah is to help me gain experience as a primary student midwife as I have the experience in the other areas already. I will be attending all births in the four clinics Better Birth has and if a client chooses to have a student midwife attend them I will be working as the primary student midwife with the direct supervision of senior midwives. What I like about this is Better Birth does an outstanding job of providing competent comprehensive care. Utah is a state where midwives are nationally and state licensed, unlike Massachusetts where there is only national licensure but no state licensure. The additional state licensure means there are clear guidelines on what midwives there can offer clients. For instance in Utah midwives can run IVs, offer specific medications for postpartum hemorrhages, bill insurance for lab work and care, and these centers offer nitrous oxide for pain relief for clients who request it.
On the heels of all of that information, I was having a discussion with a friend recently who assumed a midwife just caught the baby at home. It is foolish of me to have thought folks would know that midwifery in the 21 century can look very different from the image she had in mind. As a future midwife on Nantucket I want the best care for moms and their babies. I am fortunate to work closely when needed with Dr. Koehm and have a comprehensive set of tools. I do carry a hand held doptone (those hand held monitors that are used in the hospital) to monitor the baby’s heart rate during labor. You aren’t hooked up to a machine at home but you and your baby’s health are closely monitored. In addition, I do carry and use a fetoscope, an non electronic tried and true way to listen to the baby’s heart rate, oxygen for both mom and baby should they need it, am certified in neonatal resucciation, perform a complete newborn exam, newborn screening, and am an EMT. In addition to carrying what I consider standard tools for caring for a laboring woman- urine dip sticks, blood pressure cuff, pulse oximeter, amniohook, pH paper for testing for rupture of membranes, a portable birth tub that you can deliver in(each client buys a new disposable tub liner for their birth), as well as many specific tools that I won’t bother you with here.
So, long story long, I hope this helps clarify what I am doing going to Utah and what I hope to come back to Nantucket with. There are some really special people that have made this entire journey possible, some of whom don’t want to be named. I couldn’t have done this without their support, the unwavering support of my family, the guidance and skill of Sybille Andersen CPM, Audra Karp CPM, Sarafina Kennedy CPM, and the midwives at Better Birth. I am grateful for this opportunity and am existing to bring these skills back to my beloved Nantucket community.