Can I do this???

[*Bethany*]

I want to become a CNM. I realize it's a very long road ahead of me.

I believe strongly in natural birth and I get really upset watching shows like Birth Day or A Baby Story when the birth completely medicalized. I do realize that there are situations when medical intervention is warranted, but in SO many cases, the cascade of interventions is completely unnecessary and complicates things more. I really hate it when I see a Dr. being deemed a hero for "saving" a baby from a bad situation that the interventions themselves may have caused in the first place!

I myself have had one hospital births and 2 homebirths. I feel a strong calling to midwifery, but I live in a state where the only way can be a midwife LEGALLY is to be a CNM. I worry that along the way I'll either #1 lose my faith in womens' ability to birth normally and naturally and become a "med"wife or #2 I won't be able to work in an environment (and keep my mouth shut) where I see things happening that I completely disagree with (how in the world can I give a woman labor inducing drugs when I am all about letting nature take it's course and allowing a baby cook until he/she is ready to come out on his/her own???).

I was just over in the OB nursing sub-forum and there's a thread about ideas for t-shirt slogans for OB nurses and one of them was "Home Delivery is for Pizza." My immediate gut reaction was :angryfire being that I'm a big homebirth advocate, but if these are the type of people that I'm going to be working with, how do I suck it up and bite my tongue???

~Bethany~

Not yet a student, but a full time SAHM to 3 adorable kidlets and who has a PASSION for all things pregnancy/birth/baby related.

[*Bethany*]

Nobody has anything to say?

[feminist-mama]

Well Bethany, you're really the only person who can answer that question! Can you do it? Would you be able to provide services to folks who didn't share your exact philosophy? Would you be able to help women achieve the births that they dream of- as opposed to the births that you dream of? Would you be able to get along with co-workers who aren't as "enlightened" as you are?

Obviously, once you're a CNM, you could opt out of caring for folks who are open to induction, medication, vag exams, etc. I'm not sure what the current situation is regarding CNM's and homebirth and Liability Insurance, but clearly you could make that choice as well, to only do homebirths, with or without insurance.

My experience as a student has certainly been births that are full of interventions, with lots of medication to go along with them.

Good luck to you! I hope you find what you're looking for!

[Yin Yang]

Nobody has anything to say?

I understand where you're coming from, but I believe the previous poster is correct. Do you only want to do natural births and would therefore not allow a woman to have the birth experience she desires, even if it includes pain medication, etc.? Perhaps an alternative would be to become a doula. I had a doula for my birth and she was invaluable. I had planned natural birthing, but my dd had other plans (I had pre-eclampsia & had to be induced a month early for both our health). The induction led to every intervention known to man, including an emergency c-section, but, I still don't know how I'd have managed without her. Good luck in making your choice.

Kathy

[wubbakat]

Bethany, Congratulations on wanting to be a CNM! While you highly value "natural" birth, you will learn in midwifery school that there is a time and place for interventions. You will be fine. Susan-CNM

[SiennaGreen]

Hmmm..I have had similar concerns. I certainly don't want to spend 6+ years of training and countless thousands of dollars to be in a position that doesn't make my heart sing. I am a second career student, and quite honestly have done that already. The next 30 years are about what drives me and what I really believe in. I don't have any sound advice, but I do believe there are CNM's who do practice with a more natural philosophy. I know many of them, and their struggles are not to be taken lightly. They believe strongly in their mission though, and that is to support women in all of their choices and to do their best to ensure that those choices are informed ones.

However, have you considered going a CPM route and just moving to a state that is more friendly to CPM training/certification? Check out sites such as www.MANA.org; www.narm.org; www.midwiferytoday.com

[*Bethany*]

Thank you for the replies. I do realize that there is a time and place for interventions. I am not so caught up in my belief in natural birth that I'm completely opposed to intervention. I just feel that there are many circumstances in which intervention is completely unnecissary and avoidable, if a woman has a provider who is willing to take the more natural route.

Yes, this is a question that I must answer for myself. I guess I misworded my original post. Maybe I was looking for some CNM's who've also been in my shoes and could share their stories.

I actually have considered moving to a state that is more midwife friendly, but I don't want to uproot my family. My husband and I have 3 children and all of our support people (family and friends) are here.

[traumaRUs, MSN, APRN]

Bethany - I see that you are in IL - I live near Peoria. You are right, that IL is better suited for MDs then CNMs. However, in my area, I know that there are several currently employed CNMs. Good luck.

[np_wannabe]

Hi Bethany.

I know it has been a while since you have posted this, but I just wanted to reply.

Like you, I VERY STRONGLY believe in a natural childbirth and natural parenting. In my area, we have a free-standing childbirth center, run by an OB and a CNM. The CNM is also the only CNM in town who does, "Home Delivery" (it's not just for pizza!) and the OB is very pro natural childbirth as well.

We have a very big Attachment Parenting community where I live, and most AP moms use this MD/CNM.

Maybe you could find a place like that??

As much as I would love to be an L&D nurse, I don't know that I could do it either--for the same reasons as you describe. There are things that would just make me cringe to witness.

Good luck.

[Selke]

Dear Bethany,

Are you aware a bill has been introduced into the Illinois State Senate to legalize birth centers? I've copied information below, plus contact information. They need volunteers to call on their senators and representatives to sponsor this bill and get it passed. Midwives don't have the deep pockets the Illinois medical associations do, who all oppose this bill BTW, so the political tactic is a grass-roots campaign. Politicians pay attention to widespread grassroots organizing.

There is also another bill to decriminalize, to legalize and license CPMs in IL.

Just a thought for you to put your energy into something you are passionate about. In midwifery one is an advocate for women and their choices concerning their reproductive selves. One learns to be a missionary in a hostile land, to make friends and positively influence enemies. Politics is a learnable skill. It is necessary to be politically active in this field.

Also, I hear through the midwife grapevine that there is a huge shortage of homebirth midwives in Chicago, and there is likely a demand for them outside of Chicago, too. Homebirth CNMs turn away many potential clients. The consumer demand is there. This is a possibility for you in the future.

I agree with you 100% on use of medical interventions routinely, when there is no need for them. However, it is good to know about these interventions and know when they are needed. There are many battles to be fought, and when you are in the business you learn which ones to fight, which ones to let others fight, which ones to leave alone. Finding a place to learn midwifery where medical interventions aren't the norm is problematic. I did not personally find anyplace in Chicago that offered non-medical OB care and there were plenty of "medwives." Finding preceptors skilled in manual and low-tech but high-touch maneuvers may take some searching; there must be a few in IL. I suspect UIC's program is medwife-oriented. Do you have doula training? I suggest this to anyone interested in OB nursing or midwifery as an excellent start, and a way to start getting to know birth professionals in your area for networking, help with career advice, where to work, good schools, &c. Labor support skills and optimal fetal positioning are important to midwifery, and few OB nursing units support this. But I hear that a few years ago Rush in Chicago started a labor support protocol they routinely use, so maybe there's some hope.

Best of luck to you.

[email protected]

Illinois Birth Center Task Force

SB 264: Free-Standing Birth Centers

Framework:

Birth centers are ambulatory care facilities providing quality, cost-effective family oriented care to women expecting a normal labor and birth. Service includes prenatal care, labor & delivery, immediate postpartum & newborn care, family planning, and health education programs. Birth centers exist in 35 states in the U.S., including most states surrounding Illinois: Michigan, Indiana, Missouri, Iowa, and Wisconsin.

Rigorous screening assures birth centers provide safe care to low-risk women. Birth centers are successfully operated in urban and rural settings and low-income and suburban neighborhoods. Care is provided by certified nurse midwives, obstetricians, or family physicians using standards written in Rules and regulations for Birth Centers. The American College of Obstetrics and Gynecologists (ACOG) states: "Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous. The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings (Guidelines for Perinatal Care, 5th edition)

Birth centers participate in the Illinois Perinatal System under the Developmental Disabilities Protection Act. This establishes an agreement with a hospital to ensure safe and appropriate care.

Statistics:

Birth centers are cost-effective; roughly ¨ö-¨ø the cost of a hospital stay.

The Cesarean section rate of birth centers is 4.4%, half that of comparable hospital populations studied.

Birth Center intrapartum and neonatal mortality rates ware reported as 1.3/1,000 births, compared to the national hospital average of 2.5/1,000. (The National Birth Center Study, 1989)

Access

¡¤ Birth centers provide access for low-income women and women living in rural and suburban communities. With fewer physicians attending births due to the malpractice crisis, FBCs can provide safe care to pregnant women with Certified Nurse Midwives.

¡¤ Accessibility, reduced cost, comprehensive care, shorter waiting times, friendly and culturally sensitive care make birth centers an important option to have available to all women.

¡¤ Birth centers provide continuous education about pregnancy, birth, labor support, baby care, nutrition, and women¡-s health. The full-scope maternity care reduces the fragmentation of services in traditional models of obstetrical care.

Personal Attention

¡¤ Birth centers minimize intervention and provide intimate and personalized care, helping women feel at home and in control.

¡¤ Birth centers empower women, giving them control while providing a comfortable and supportive environment involving family and friends.

In Illinois

¡¤ In 1992, a statewide task force convened by the Illinois Department of Public Health conducted a feasibility study where birth centers were deemed to be a positive medical concept for the birthing process.

¡¤ 26 counties in Illinois have been designated as health professional shortage areas by the U.S. Department of Health & Human Services and might be served by a FBC

¡¤ Illinois Senate Bill 264 provides for the establishment of pilot birth centers following guidelines recommended by the American College of Obstetricians and Gynecologists.

Key Proponents: American College of Nurse-Midwives, Alivio Medical Center, Illinois Women's Health Coalition, Health and Medicine Policy Research Group, Coalition for Illinois Midwifery, ACLU

Health and Medicine Policy Research Group, 29 E. Madison Street, Suite 602, Chicago, Illinois 60602-4404

TEL [phone] FAX [phone]

E-mail [email protected] http://www.hmprg.org