Am I a “medwife?”
One frustrating part of midwifery is that the consumer can not differentiate the broad spectrum of practice styles among midwives. On one end of the spectrum is the midwife who actually wants to be an OB but doesn’t want to go to school for it. She practices in a hospital like an OB and is in strong alignment with the medicalized model of care. On the other end of the spectrum is the woman who calls herself a midwife but may not have any formal training or credentials. She might say she practices on intuition and simply takes her cues from the mother she joins in labor. All of these women are likely to call themselves by the same title (though the latter might also call herself a birth keeper to stay legal).
CNM-Certified Nurse Midwife
CPM-Certified Professional Midwife
LM-Licensed Midwife
“Medwife” is a term denoting a midwife who is deemed too “medical.” This is obviously subjective. Any midwife on the right side of the spectrum might call a midwife anywhere to the left of her a medwife. In my mind, a medwife is one that does not utilize natural options first and is fast to use interventions. She may not be aware of chiropractic care, cranial-sacral work, Spinning Babies practices, herbs, NORA tea…
It always frustrated me when a client moved away from my area and asked me how to find a midwife in her new location. Finding a midwife who practiced in the hospital meant nothing as far as how natural minded she might be. I often longed for some other title so the consumer could know what practice style she was getting.
Before I go on, let me be clear that medically minded midwives are desired by some families. There is a midwife for every family. I don’t have anything against these practitioners personally, I just wish there was a way to understand where they land on the spectrum. A title change seems logical to me. Just don’t ask me for title suggestions.
Generally speaking, a CNM could be anywhere on the spectrum but she is often on the left side. CNMs who gravitate to the right side are more likely to practice in birth centers and a few even love home birth. CPMs can vary in their medical mindedness but usually hang out more in the middle and right side of the spectrum. She will always practice in the community setting (that’s the new phrase for out of hospital) and depending on what her state allows, she may be able to carry medications and write prescriptions or she may have to rely on herbs. Some may even have to practice under the radar in an illegal or alegal state (no laws permitting or restricting midwives). Texas is generous to its CPMs and we are allowed to carry medications, order ultrasounds, write prescriptions, order blood work, and so on. Even so, some CPMs land further on the right side than others in the same state.
The far right end of the spectrum is occupied by non-professional birth workers who call themselves birth keepers. They feel they are working around the law by not calling themselves midwives but the client knows she’s hiring someone to take care of her and her baby. I’ve listened to birth keepers on a podcast and met one who was in training. They say they only take heart tones (the way the baby tells us he/she is doing well) if they feel intuitively that they need to or if the mom wants them to. They may just sit in the room with the mom. One doula training group trains birth keepers with a weekend seminar on birth emergencies. After attending this workshop, the doula/birth keeper is likely to encourage moms to ditch their midwife or doctor and just have the birth keeper attend the birth. The one I met was alarmed that we would have any oxygen in a birth center and said, “This must be for the moms who want a medicalized birth.” I know oxygen is going out of style in birth but we still may need it for babies should we need to start chest compressions in the neonatal resuscitation protocol. That sentence alone would make a birth keeper call me a medwife, I suspect. However, I don’t have any respect for this type of birth worker, I find them dangerous and irresponsible. I won’t do a birth with a doula trained in this way. Their practices make all legit midwives look bad, and they set our credibility back by miles.
So where do I fall? When I was in midwifery school, I heard other birth workers’ gossip about me through the grapevine. Because my preceptor was an experienced hospital CNM turned birth center midwife, it was assumed that I’d be a medwife. It didn’t help that some of my good friends are hospital based practitioners-two OBs and a CNM. Those friends know all the ins and outs of my struggles as a new midwife and where I hope to go from here. I tap into all three of them for advice on the regular. One of them provides my standing orders. But none of them especially influence me to be more medical. I think they all know that’s virtually impossible.
It’s impossible because I believe, deep down in my soul, that we are designed by a brilliant Creator to give birth. We’ve been doing it for thousands of years (yes, I’m a Young Earth girl). We’ve done it before pitocin, $10,000 warmers, before inductions, before ultrasounds. Now I see a need for all of those things at the right time, but never used in excess. Why don't we put baby on mom’s chest so her own oxytocin can stimulate her uterus to contract? Let’s keep our voices low and the room dark so the hormones will work as they were meant to work and the placenta will release. Let’s try the herbs God blessed us with to encourage that release if needed. And let’s not unnecessarily meddle with birth in the first place so that the bodies at play can work as designed, when they’re ready. I don’t break water, I don’t encourage miles of walking (actually I hate when people walk to bring on labor, it doesn’t work that way) and tablespoons of castor oil just because we’ve hit the due date. Cervical checks are great tools when needed and consented to, but I can hear where mom is in labor just as well as I can feel it, if not better. We only need them if the information will change our clinical decision making-otherwise, my fingers have no business in my client’s body.
On the other hand, I’m not willing to catch a baby that we’ve not seen on a 20 week anatomy scan. If bleeding gets a little heavy after birth, I’m reaching for the pitocin. It would be irresponsible to do anything else thirty miles from a hospital. If that doesn’t work, I have three more drugs at the ready, and I have IVs to help replace her blood volume if needed. It does not make me a medwife because I want to help my client feel better and avoid the hospital if she bleeds a little too much. It is nearly impossible to become proficient at IVs as a CPM-we just use them so rarely. Therefore I want a natural minded RN on my team, one who can do IVs in her sleep. This makes the process easier on the client-who wants multiple sticks during a hemorrhage (or ever)? If a hemorrhage is occurring, the midwife has other tasks that may keep her hands occupied (i.e. getting the placenta out or compressing the uterus until it stops bleeding).
Sadly, I’ve seen CPMs shy away from the clinical skills we don’t use much. Then those who do utilize those skills are called medwives. It’s terribly unfortunate because parents just don’t know that their midwife has a stance against IVs based on her own lack of confidence in starting them. In the medwife case, the midwife doesn’t utilize more natural means because of her lack of familiarity with them and may even act condescendingly about midwives who do use the natural methods.
See how it’s a really messed up world? Its frustrating for me, but that’s nothing compared to the frustration for parents shopping for a midwife. Ask questions. Then ask more questions. Make sure you’re comfortable with the answers. If you have yellow flags about your alignment with your practitioner in pregnancy, know that they usually turn into red flags in labor. If you have already started with a provider and sense that you need to change, don’t hesitate to explore that option. Doulas can help! I used to text one of my OB friends all the time and say, “I have a doula client who has realized her OB isn’t a good fit, can you take her?” He’d take them all because the gets it. It’s not personal, it’s just a philosophy issue. You can love your OB or midwife and still realize it’s not an ideal fit. It’s your birth, and you won’t offend us if you realize we aren’t “the one.”