Saturday, January 24, 2009

Unity...or lack of...

I read a post from a CNM-to-be recently on the reasons she wants to be a CNM. They were lovely reasons! Anyway, I made a comment about the division in midwifery. Basically, how sad and unfortunate it is that we 'midwives' can't get it together to bring unity to the betterment (is this a word?) of women. I've seen a lot of discussion on the ACNM listserv about this division. It seems to have become a CNM versus any other type of midwife battle. CNMs seem to be portrayed as part of the establishment....the'enemy' so-to-speak. Unless they are doing birth center or homebirths...then it's ok to be a CNM. Anyone doing hospital births is a sell-out or a medwife.

Kathy, blogger from Woman to Woman Childbirth Education, commented in response to my comments. The following, with her permission, is a copy of her response with my thoughts interspersed...

I just had to comment on the "increasing division in midwifery" and CNMs being part of "the enemy" and "medwives."

I'd be curious to read more of your thoughts on this. Just from your short paragraph, it seems like you're talking about home-birthers viewing CNMs as the enemy. It probably goes both ways -- many in the home-birth community would probably call just about any CNM a "medwife"; while many in the hospital-birth mindset would be upset by many CNMs. They seem to be in the middle, pulled or squished on both sides. (However, many times, CNM groups will join with OBs to oppose legislation that would legalize non-nurse midwives, so there may be some veracity to the "sold out" epithet. Then, since non-nurse midwives are not legal, and no legal birth attendant can/will attend out-of-hospital births, women are forced into having an illegal attendant, an unassisted birth, or an unwanted institutional birth. And they might expect OBs to oppose home-birth, but when midwives also oppose it, it rankles them worse.)

As I mentioned, I believe the deeper issue IS homebirth versus hospital birth. Hospital birth is always made out to be this evil machine that grinds women up and spits them out. I have no doubt that this does happen. After all, I have worked as a labor nurse in less than supportive hospitals when it comes to low-intervention, natural childbirth, etc. But the bad things tend to get all the publicity - there's no interest or drama in the normal, wonderful experiences that women may be having in the hospital. Just as when bad things happen in homebirth - that's what will get televised, talked about.

I can't speak to other states, or areas about the CNMs siding with OBs. I don't see that here in my area. As a whole, our region is supportive of birth choices and providers. Personally, I am as well. Working in a practice that focuses on low-intervention philosophy of care, we have women that come to us and say they may switch to a lay midwife for a homebirth. I never try to convince them they shouldn''s their choice and I will support that.

When people say the words 'many times' a group does this or that, I take that with a grain of salt because I would imagine what we hear about are few, sensational cases of this. The efforts of midwives to band to together, regardless of their differences in education and practice location, seem more likely to go un-noticed.

The CNM who attended my first homebirth was subsequently forced to go back to only hospital births because she had to have malpractice insurance which she couldn't afford. She contacted nurse-midwifery organizations, and there was no help available because she attended home births. Whatever group(s) she got in touch with had no interest in helping a fellow CNM attend home-births.That was 4 years ago. And, from what I can tell, she wasn't "the enemy" because she was a "medwife" but that she attended women who wanted to give birth at home. She didn't want to be in "the establishment" of a hospital, but had no other course to take if she wanted to continue to eat.If you blog about it, feel free to use my story and/or reference back to this comment.Yeah, it's sad that there isn't more unity in the birth field, because we all want the same thing -- happy and healthy mamas and babies; we just differ in how best to accomplish that, and focus more on our differences than on our similarities. I agree with you -- very sad stuff.


There IS help through the ACNM for CNMs wanting to do homebirths. However, this is not a guarantee that malpractice insurance will be affordable. Unfortunately, ACNM has no control over this issue. This is a whole other topic getting into malpractice insurance so I won't go there. That one makes me want to bang my head against the wall!

I absolutely agree that we all want the same thing - sad that we can't generate more unity to achieve this goal.

Just FYI for my readers....

My ladies who want natural childbirth...

Do not have to have an IV
May have intermittent auscultation
Can labor in the tub
Can walk
Can be in whatever position they choose
Can birth in whatever position they want
Dad can catch if that's what the parents want

The list goes on....

In fact, the director of maternity services has been asked to submit plans by the CEO for a separate birth unit to be used only by the midwives. This is exciting as I would love to be offering waterbirth, which would be an option in the plan. The center would be staffed only by nurses who are trained specifically for this. Essentially, it would operate pretty close to a freestanding birth center.

One other comment about CNMs that are forced to choose between being medwives or mini-residents and eating...they can make a difference too. They shouldn't be chastised for society's inability to see the value of true midwifery care.


Rita said...

I'm curious if you ever offer another option for natural childbirth: declining cervical checks. I did that with the birth of my second, I and my midwife just listened to the sounds I made and the way I moved to know how far I was, and it was wonderfully relaxing and helpful to me, personally, to be given the respect and authority to chose for myself. I'm convinced I dilated the last few centimeters extremely quickly because I was able to fully relax in the tub and not try to decide anything about cervical checks. Nobody was asking if I wanted one, it was up to me. (And that might seem counter-intuitive, but for me being *asked* if I want something in labor puts enormous pressure on my to accept, whatever it is. I've found I'm sensitive to that during labor.)

Ciarin said...

Rita - I offer a modified version...A vag exam is done prior to admission. I will not admit someone who is 2 cms (or some varying degree). After that, I leave it up to momma as to when she wants to be checked. That may be in two hours or not until she feels like she needs to push. I do believe in minimizing these exams and making sure momma has the control over them. I absolutely believe that most women can be watched, giving the midwife a good idea of where she is in labor.

womantowomancbe said...


Thanks for your more in-depth response. I'm glad to know that there are many CNMs who are supportive of natural and/or out-of-hospital birth.

Here's hoping that midwives like you grow in number!

And the "separate birth unit" sounds wonderful -- staffed by midwives and specialists trained in unmedicated births!