Frequently Asked Questions

Lately I've gotten a TON of interest from all walks of life about what I'm up to - midwifery in general, licensed/direct-entry midwifery in particular, and even more particularly where I am on my path. Some of the same questions keep coming up over and over again, so I thought I'd write an FAQ... sorry if some of these answers sound curt or leave out some of the subtle beauty of midwifery. If you want waxing poetic, look at my last entry!

What's the difference between a midwife and a doula?
A birth doula offers physical, emotional, and informational support to the birthing mother, providing a presence that adds comfort to the woman's experience. A midwife is the care provider who is responsible for monitoring the mother's and baby's well-being to ensure that the birth is as safe as possible. In this way she takes the same role that an OB or a family care physician would take at a birth, though midwives are very different care providers than OB's. Midwives at home generally do also provide physical and emotional support for the mother, and providing information is part and parcel of midwifery care, but this is a doula's entire scope, whereas a midwife's primary job is monitoring the health and safety of the mother and baby.

OK, so what's the difference between an OB and a midwife?
OB's are physicians who have chosen a surgical specialty which enables them to diagnose and treat issues related to the female reproductive system, including pregnancy and birth. Obstetrics generally addresses pregnancy and birth as an abnormal state for a woman's body which often requires intervention to keep it safe. Midwives specialize in healthy pregnancy, birth, and postpartum, and view it as a physiological variation that is normal though not the default state of being for a woman. They are experts in facilitating birth without resorting to medical intervention, and in recognizing when a complication may be arising, in which case the client is referred out to the specialists in medical intervention (OB's, perinatologists, pediatricians, and neonatologists) for a consultation or to transfer care completely. Midwives believe that the process of birth usually works best when left to itself, that women labor easiest when they feel safe, that the judicious use of medical technology is life-saving but that routine use is risky. OB's are ideal care providers for women with medical conditions or complications that increase their risk in pregnancy or birth; midwives are ideal care providers for healthy women having healthy pregnancies. OB's work within an authoritarian system, in which they are to diagnose and lay out a treatment protocol for their patients. Midwives in hospital also have to work within this system. Midwives at home work as partners with their clients, giving them information about their health and the options available to them, including the risks, benefits, and alternatives of their choices. Perhaps the starkest difference comes in looking at rates of intervention. In our country, for healthy women carrying a single baby, head-down, full-term, planning a vaginal birth, in the most recent study done in North America, the cesarean rate for OB's in hospital was approximately 20%, and for homebirth midwives it was 3.7%, with equal outcomes of mortality across the two groups. (Note that midwives do not perform cesareans, they transfer care of their client to hospital and OB care.) In other words, a healthy woman having a healthy pregnancy beginning her labor in hospital with an OB has 5 times the chance of ending her labor with major abdominal surgery compared with beginning her labor planning a homebirth with a midwife, but does not increase her chance of having a live, healthy baby by choosing OB care.
"Knowledge of ovarian cancer staging, or the ability to perform a laparoscopic hysterectomy does not make me a better caregiver for the patient in labor, and yet the midwife’s focus on facilitating the normal birthing process in healthy women does lessen their chance of adverse events, and this mode of care should at the very least be an option for women." - Henry Dorn, M.D.

I thought you had to be a nurse to be a midwife.
There are different ways to become a midwife. Nurse-midwives are RN's first and then have two additional years of training in midwifery. They are trained in all types of nursing and retain their ability to work as a nurse in any department. They are able to work in hospitals under the supervision of doctors, and in some places and instances may be able to attend home births. The route I am taking doesn't require a nursing degree, it's called direct-entry midwifery. Direct-entry midwives take a three-year didactic and clinical program. The didactic program can be at a brick-and-mortar school or a distance school, and their clinical learning is generally an apprenticeship with a midwifery practice providing home birth care or at a midwife-staffed freestanding birth center. Hospitals do not generally grant privileges to direct-entry midwives, so it is an educational process appropriate for aspiring midwives who want to work outside of the hospital system. There is a national certification, the CPM (Certified Professional Midwife) which is recognized in some states and allows the CPM to legally provide services there. In other states, midwives have to pass state licensing requirements which are usually roughly equivalent to the CPM; for example, in California, one has to be licensed by the state medical board and is a LM (Licensed Midwife), and a licensed midwife in Utah is designated a DEM (Direct Entry Midwife). In a few states, licensure/certification is not required at all; for example, in Utah one may choose to become a DEM or to be a lay midwife. A lay midwife is one who has obtained her own education through self-study and apprenticeship and who has chosen not to become a CPM/LM/DEM etc. In most states, lay midwifery is illegal or alegal, and in several states, no licensure is available and the CPM is not acknowledged, making direct-entry midwifery alegal in total. I am seeking my CPM and my state license.

Do you have to get a certain number of hours?
Similar to that, but instead the program ensures a minimum experience level by what's lovingly referred to in the student midwifery community as "getting numbers" - counting numbers of different types of experiences. Number of births as primary midwife under supervision is the holy grail that everyone latches on to, but there are several categories, which apparently vary by school (all meeting requirements for the CPM). My school counts the following: number of initial prenatal visits, number of subsequent prenatal visits, number of births as assist, number of births as primary midwife under supervision, number of newborn exams, number of postpartum visits in the first 5 days, and number of subsequent postpartum visits or well-woman exams. All of the required visits/exams are as primary under supervision.

How much longer do you have to go?
Ack! What a question!
Timeline-wise, I hope to take the licensing exam in February 2012, which means I have to have the application submitted by December 1st of this year, which means I have to have all my school requirements completed including my numbers before then. I actually hope to have all my numbers done by September 1st. It usually takes a few to several months after sitting the exam to receive one's license, just waiting for the red tape.
Numbers-wise,
I have 11 and need 9 more initial prenatals
I have more than I need of the 75 follow-up prenatals
I have more than I need of the 20 assist births
I have 7 and need 13 primary births
I have 19 and need 1 newborn exam
I have 20 and need 20 more postpartum visits in the first 5 days
I have 22 and need 18 more 6+ day postpartum visits and/or well-woman exams

It's a humbling and inspiring process. Thank heavens I have incredibly skilled and compassionate midwives to learn from.