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15 Questions To Ask Before Choosing a Midwifery Path and Program

Posted by Midwives Alliance on July 21st, 2015

What midwifery credential should I choose? How can I tell if a midwifery school is right for me? As a practicing midwife, I am asked these questions by potential students as they decide between becoming a certified nurse midwife or certified professional midwife and when trying to choose a midwifery program.

I have gathered together the 15 questions I often ask potential students to consider as they make their decisions. Give yourself a few minutes, jot down your answers, and don't think too hard about any one question! You might be surprised at some of your answers. I hope these help you find the path that is right for you.

Choosing a path

Where do you want to practice? Consider both the place of birth - home, hospital or birth center - and the state or states you want to practice in. Research the license/credential requirements for the state and place of birth you'd prefer.

Who do you want to serve? Teen mothers, low income families, a small rural community, a big city busy practice with other midwives - who do you dream of serving?

What are the laws concerning midwifery (and student midwifery) in your community? Is it legal for a CNM to attend home birth? Can CPMs practice legally? Where? Do you need to register with anyone? Do you need to be enrolled in a school program to attend births as a student midwife? Can CNM student midwives have an internship with an out of hospital midwife?

Do you want to be able to move about the country and work in a wide variety of settings? Nurse midwifery may be more flexible when moving a lot, and also has the advantage of being able to work as a nurse as well.

Choosing a program

Are you interested in a Nurse Midwifery program? a Certified Professional Midwife program? Portfolio Evaluation Process? or a MEAC (Midwifery Education Accreditation Council) approved program?

Are you able to relocate to go to midwifery school? Do you have the resources to move and attend a midwifery school in another community? Is there an at-distance or online alternative?

Are you able to organize yourself and learn independently? Would a program that offers few "extras" and where you would need to work independently be a good fit? Would you be more comfortable with a structured program, that includes a clear plan for success? Do you want to work with your local midwifery community to learn in an apprenticeship model? Do the programs you are looking at have "perks" - support groups, libraries, database search engines, writing labs, or other extras?

Do you enjoy group learning activities? Do the programs you are looking at offer an opportunity to build community with other student midwives?

Does the program you are interested in offer clinical internships in your own community? Is your local community large enough for you to find a midwife preceptor who can help you finish your clinical requirements? Do your local hospitals offer Nurse Midwife internships? Does your program help you find a preceptor?

Do you need to complete any portion of your academic program before beginning your clinical training? Some programs, and some mentor midwives require that you complete up to a year of academics before starting clinicals.

How many of the students who start the program or apprenticeship you are considering finish, and go on to pass the credential and/or licensing exams?

Finding your resources

What are your financial, emotional, spiritual resources? What is your community support like? Does your family support your chosen work? Can they manage living "on call" with you? Are they concerned about liability issues?

Do you need a midwifery program that has federal financial aid? Nurse Midwifery and some MEAC approved programs offer Federal Financial Aid. Some MEAC approved programs do not offer aid but are much less expensive than those that do.

Do you have the time necessary to commit to midwifery training? Do you have time in your life for rigorous academic and hands-on demands? Can you be on call? Part time or full time? How much flexibility do you need?

Will you need to work while you are in midwifery training? Is it realistic? What is the expectation of the midwife you are working with or the program you will be attending?

 

I hope these questions have helped you to become clearer about how to choose a midwifery path that is right for you. Becoming a midwife is often a winding path, challenging at times, but rewarding! Good luck to you all!

 

About the author

Treesa McLean, LM, is a homebirth and birth center midwife and has been involved in the birth community as a consumer, an advocate, and a birth professional for more than 30 years. She teaches a workshop "Becoming a California Licensed Midwife" and has been the preceptor for a number of student midwives.

Prison and Birth

Posted by Midwives Alliance on July 21st, 2015

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Desiree Robles, a student midwife at Midwives College of Utah, shares with the MANA community the current state of maternity care for incarcerated women in the United States, along with policy recommendations for improving outcomes for mothers and babies. This post is a part of our student midwife guest post series. Are you a student? Please consider sharing a guest post with us! Contact MANA at publicaffairs@mana.org for more information.

Pregnancy and birth have the remarkable ability to be a common process for all women, regardless of economic status, race, or culture. They can occur at any time in a woman's reproductive life, including when they are sentenced to time in jail or prison. How these instances are handled in the United States is the subject of controversy and varies greatly depending on location but, collectively, is in need of reform. In the United States, incarcerated pregnant women deal with several reproductive issues that need to be addressed, including lack of proper prenatal care and nutrition, use of restraints during transport, labor, and postpartum, and a lack of birth education and support.

Despite the importance of prenatal care and proper nutrition during pregnancy, many inmates are not guaranteed access to them. According to the Committee on Health Care for Underserved Women (CHCUW), thirty-eight states have failed to institute policies requiring that incarcerated pregnant women receive basic prenatal care. In addition, forty-one states do not require prenatal nutrition counseling or do not ensure that these women receive proper nutrition (2011). What is important to note is that, according to a study done by Martin et al. in 1997, prisons are required to provide all pregnant inmates with appropriate prenatal care. However, according to a Women's and Children's Health Policy Center publication, less than half of correctional systems require screening of new female inmates for pregnancy and STD's (2000). Even with more than half of the United States correctional facilities not providing the proper prenatal care and nutrition for these inmates, some of these same women may still be at the same high risk or may actually be better off than if they were pregnant at home. A study done by Clarke et al. points out that pregnancies among incarcerated inmates are usually unplanned, high risk, and have poor outcomes because of, among other things, lack of or failure to access prenatal care and many of these women having poor nutrition (2006). Thankfully, many studies, including one done by Martin et al., have found that incarceration allows these women to have improved maternal and fetal health thanks to access to shelter and regular meals (1997). It is important that we implement screening protocols for incoming inmates at all correctional facilities so that their reproductive health can be addressed if need be, as well as making sure these inmates receive the proper care needed if they are found to be pregnant. 

Using restraints on pregnant inmates during the process of labor is a sensitive issue that has been the subject of scrutiny for years. There have been various studies that have delved into the adverse effects of restraining women in labor both physically and psychologically. While progress has been made in stopping the use of restraints on pregnant inmates, according to the Committee on Health Care for Underserved Women, thirty-six states and the Immigration and Customs Enforcement agency of the Department of Homeland Security have failed to limit the use of restraints on pregnant women during transportation, labor and delivery, and postpartum (2011). Use of "shackling," as it is called, causes discomfort for the pregnant inmate during a time when she is most vulnerable and many times the officers present are male. In an article done by Anderson, there is implication that birth transport often results in numerous medical and mental health complications, thanks to the security precautions used, including shackling. These precautions increase instances of injury and stress while stress in itself can cause complications in labor. Also, the women have limited movement, which adds discomfort and restricts their ability to protect themselves in instances such as falling (2003). An Amnesty International article brings to attention the traumatizing experiences of shackling on the laboring inmates. These included having their legs shackled to their bed post for almost the entirety of their labor which, again, caused restricted movement and hindered their ability to position themselves in more favorable positions during labor (2000). To add to their distress, according to Codd, women in prison many times give birth to their babies who are taken away almost immediately or at discharge from maternity ward, causing the mother much distress and robbing the baby of their mother's important breast milk (2004). Laboring inmates deal with these stressful situations that, while slowly being resolved, would be helped, in part, with childbirth education and support from, at the very least, female officers during labor. 

Birth education and support for pregnant inmates is lacking in many correctional facilities but are excellent resources that would greatly benefit these vulnerable women. According to Hotelling, with the right support and prenatal care, expectant new mothers often discard lifestyle behaviors which would compromise the health of their babies. Some programs have been initiated to provide physical and mental health care to incarcerated women. These programs depend on help from volunteers, grant money, and various organizations coming together in order to thrive (2008). The Bell et al. study noted that what is needed for incarcerated pregnant women is comprehensive programs that include enhanced prenatal care services in the community and greater transitional resources. This would be ideal, given that most women are incarcerated for smaller crimes with shorter sentences than men (2004). A great place to start would be birth education and breastfeeding workshops. In a study by Huang et al., pregnant inmates showed positive views on pregnancy and link it to a new start for them as mothers and in their life in general (2012). Childbirth education and support for pregnant inmates should be available at all correctional facilities as a way to help these women deal with the stress of pregnancy in an already stressful situation for the sake of their health and future as well as their children's.

Pregnancy during incarceration happens whether correctional facilities want it to or not. For this reason, protocols should be made mandatory at all correctional facilities to screen for pregnancy, as well as STD's, to ensure the health of their inmates. While prenatal care is required for all pregnant inmates, screening for pregnancy is not. This very important loop hole should not occur in our correctional facilities, as early prenatal care and nutrition is imperative to the health of both the mother and her infant. For those women who do experience labor during their stay, the use of restraints and shackling should be limited to actual need instead of standard protocol. Women in labor should have the ability to move freely, regardless of their situation. Maternal and fetal health is put at stake when they are put under stressful situations, and shackling only exacerbates the situation. Lastly, childbirth education and support during pregnancy and birth are a great rehabilitation tool which correctional facilities should try to make mandatory. The benefits include healthier inmates both mentally and physically and shorter births which would cut healthcare costs tremendously, considering many incarcerated women are considered high risk. Implementing these policies would help these already vulnerable women and hopefully give them the needed support to change their situations for the better.

Reference List

Amnesty International. (2000). Pregnant and imprisoned in the United States. Birth, 27(4), 266-271.

Anderson, T.L. (2003). Issues in the availability of healthcare for women in prison. In S.F. Sharp & R. Muraskin (Eds.), The incarcerated woman: Rehabilitative programming in women's prisons (pp. 49-60). Upper Saddle River, NJ: Prentice Hall.

Baldwin, K. & Jones, J. (2000) Health issues specific to incarcerated women: Information for state title v programs. Retrieved from http://www.jhsph.edu/research/centers-and-institutes/womens-and-childrens-health-policy-center/publications/prison.pdf

Bell, J. F., Zimmerman, F. J., Cawthon, M. L., Huebner, C. E., Ward, D. H., & Schroeder, C. A. (2004). Jail incarceration and birth outcomes. Journal of Urban Health, 81(4), 630-644.

Clarke, J. G., Herbert, M. R., Rosengard, C., Rose, J. S., DaSilva, K. M., & Stein, M. D. (2006). Reproductive health care and family planning needs among incarcerated women. American Journal of Public Health, 96(5), 834-839.

Codd, H. (2004). Prisoners' families: Issues in law and policy. Amicus Curiae, 55, 2-7.

Committee on Health Care for Underserved Women. (2011). Health care for pregnant and postpartum incarcerated women and adolescent females. Committee Opinion, 511, 1-5.

Hayes, S. L., Mann, M. K., Morgan, F. M., Kelly, M. J., & Weightman, A. L. (2012). Collaboration between local health and local government agencies for health improvement. Cochrane Database of Systemic Reviews, 10, 1-141.

Hotelling, B. A. (2008). Perinatal needs of pregnant, incarcerated women. Journal of Perinatal Education, 17(2), 37-44.

Huang, K., Atlas, R. & Parvez, F. (2012). The significance of breastfeeding to incarcerated pregnant women: An exploratory study. Birth, 39(2), 145-155.

Kitzinger, S. (1997). Sheila kitzinger's letter from Europe: How can we help pregnant women and mothers in prison? Birth, 24(3), 197-198.

Martin, S. L., Rieger, R. H., Kupper, L. L., Meyer, R. E., & Qaqish, B. F. (1997a). The effect of incarceration during pregnancy on birth outcomes. Public Health Reports, 112, 340-346.

Martin, S. L., Kim, H., Kupper, L. L., Meyer, R. E., & Hays, M. (1997b). Is incarceration during pregnancy associated with infant birthweight? American Journal of Public Health, 87(9), 1526-1531.

Minkler, M., Glover Blackwell, A., & Thompson, M., Tamir, H. (2003). Community-based participatory research: Implications for public health funding. American Journal of Public Health, 93(8), 1210-1213.

Walker, J. R., Hilder, L., Levy, M. H., & Sullivan, E. A. (2014). Pregnancy, prison and perinatal outcomes in New South Wales, Australia: a retrospective cohort study using linked health data. BMC Pregnancy and Childbirth, 14(214).

 

About the author

Desiree Robles is a student midwife, attending Midwives College of Utah. She resides in the San Francisco Bay Area and is currently beginning her clinical training with Pearl Yu, LM of Motherborn Midwifery. Desiree also works hard as a volunteer for California Families For Access to Midwives as a member of the social media team.

Albuquerque Has "Poquito de Todo"

Posted by Midwives Alliance on June 23rd, 2015

Albuquerque has "poquito de todo" - a little of everything! We enjoy great mountain views, petroglyphs, hot air balloons, art galleries and many opportunities for cultural learning. There are plenty of things to do in New Mexico no matter where your interests lie.

You might be surprised to learn that New Mexico is a great place to grow lavender, pecans, peanuts, grapes, pinto beans, and more. Of course, we are famous for producing the best chile peppers, a staple in New Mexican dishes.

The MANA Conference will be held at the Hotel Albuquerque at Old Town, right next to colorful Old Town Plaza, a favorite spot to enjoy authentic cuisine and arts. Within walking distance of the hotel are several family oriented museums: Explora, The Museum of Natural History and the Albuquerque Museum.

A short drive from the hotel will take you to the National Hispanic Cultural Center, the Indian Pueblo Cultural Center, and the Albuquerque Bio Park and Zoo.

Albuquerque boasts the world's longest aerial tramway, which runs to the top of the Sandia Mountains. The breathtaking views will give you more reasons to fall in love with New Mexico. If you're brave & into biking, you can also take the chair lift up the mountain and bike down! Beautiful hiking trails are also abundant.

You'll find lots of wineries and craft breweries in the area. There are even bus tours that will do the driving for you! The ABQ trolley will take you on a guided tour where you can see local landmarks, including Breaking Bad filming scenes.

If you're looking for a wonderful day trip, the Jemez Mountains offer gorgeous views, hot springs, canyons, waterfalls, red earth, tall pines and Aspen. Magical Santa Fe, the oldest city in New Mexico and the oldest State Capital in the U.S, is less than an hour away and is home to the Georgia O'Keefe Museum. Just an hour from Santa Fe, in Abiquiu, visit Ghost Ranch.

You can find more info about New Mexico here. For things to do in Albuquerque, visit here.

The New Mexico Midwives are proud to host SHINE MANA#15 in Albuquerque, where we can share with you our history, culture and the amazing support that our community offers midwives.

Please join us for #MANA15 in Albuquerque! Register by clicking the button below.

     SHINE MANA#15

Register for SHINE MANA#15 Now!

About the author

Kelly Camden, LM, CPM, BA, is an Albuquerque-based midwife who is thrilled to serve as the local coordinator of the 2015 MANA Conference. Following her first homebirth 16 years ago, Kelly began attending hospital births as a DONA doula and home births as a midwife's assistant. Later, she became a staff doula at Presbyterian Hospital, where she was recognized for excellent service. Kelly endeavors to empower families through education; she is founder and coordinator of the Albuquerque Birth Network, has taught breastfeeding, prenatal yoga, and childbirth classes and has published articles on pregnancy related topics. Kelly served as Consumer Advisor on the NM Certified Nurse Midwives Advisory Board and Event Coordinator for the ABQ Rally to Improve Birth. Currently, she is a Regional Coordinator for the NM Breastfeeding Task Force. Since 2011, Kelly has practiced as a Licensed and Certified Professional Midwife, offering home and birth center births. She is proud to be a midwife in New Mexico, where a blend of culture, tradition and necessity has led to a continuous history of midwifery care.

Update from the States: Delaware CPM Legislation Passes House and Senate

Posted by Midwives Alliance on June 1st, 2015

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New legislation will make it possible for CPMs to practice in Delaware

House Bill 70 was introduced and passed through both the Delaware House and Senate which will allow for Certified Professional Midwives and Certified Midwives to practice legally in Delaware without a written collaborative agreement beginning June 30, 2016. Since 1984 to present, CPMs needed a physician alliance and written collaborative agreement. This has prevented practice by all but one CPM who currently practices legally and has a written collaborative agreement. That practice currently is limited to serve only the Amish and Mennonite communities per the physician agreement.

Over the past 10 years, there has been continued education and community support for changes to be initiated in the current restrictions toward legal practice of CPMs. Through the many committee meetings with members of the medical community, State Board of Health, and legislators, discussion and education regarding the credentialing process of CPMs has become more clearly understood and accepted. Documents were submitted from numerous states where Certified Professional Midwives are working and valued as a safe option for out-of-hospital birth. Much discussion and work towards safe standards of care has been in process over the past year and now can start to be implemented once the Midwifery Council is designed and in operation. The Midwifery Council will draw up both standards of practice and scope of practice in the state which will then go to the Delaware Board of Medical Practice for approval.

Many thanks to the many members of the medical community, legislators, state board of health and families who were instrumental in helping this goal become realized. Also a special thanks to Shannon Burdeshaw, retired CPM and Karen Webster, CPM for all the time, energy and expertise in assisting the legislative process. Their prior legislative experience in other states served as a great asset to having Delaware join the many other states whose laws recognize and regulate Certified Professional Midwives as primary maternity care providers.

 

About the author

Pat Gallagher, CPM, has been a practicing midwife for 31 years in Delaware. She has been the only CPM legal up to this time due to the need for written collaborative agreement. She has had a physician alliance since 1984 with a practice limited to Amish & Mennonite families per physician back up. 

Pat is a Certified Childbirth Educator (ACHI). She designed and implemented a state wide paramedic refresher class in emergency childbirth and taught a workshop at MANA regional conference on breech & shoulder dystocia. Pat has been active in the legislative process to license CPMs & CMs and on the new legislation.

Meet the MANA Board

Posted by Midwives Alliance on June 1st, 2015

Colleen Donovan-Batson, Director of Health Policy and Advocacy

Colleen Donovan-Batson, Director of Health Policy and Advocacy

Way on way back when, I repaired helicopters for the US Army. It was the 1970s, and next to the hangar I worked in was the Medevac hangar, where the lifesaving Huey helicopters lived. If you're of a certain age, you know what a Huey is, and with them lived the Medevac nurses that made them lifesaving. I'd look at those nurses and think, who would ever want to be a nurse?

Fast forward several years, and I'd just given birth to my first child, in a military hospital. Shortly after Sean's birth, the call to midwifery started in my ear. I didn't even know any midwives, but soon enough I was assisting an experienced Los Angeles midwife, who was the cousin of a dear childhood friend. I'd barely moved into the oil-pouring phase of apprenticeship when a birth convinced me that the path to midwifery for me was via nursing.

It wasn't the birth that was the issue, as the care given was exemplary. It was the response and threats made when we transported a baby with a condition not compatible with life. The reception the family received was so hostile I will never forget it, and afterward I helped the midwife pack her equipment to take to the home of a friend. She expected to be raided by the police. This was the early 80s, well before licensure in CA, and with a husband and a child, I wanted to be legal. That incident led me onto a new path, a path to midwifery school via nursing school.

I completed my BSN at California State University Sacramento, gave birth to Andrew and Caitlin along the way, and went to work in L&D in a large county hospital in CA. There I convinced the county to expand the existing midwifery practice to full scope and precept me in the clinic, as well as fund my training at the first distance midwifery program, Education Program Associates/San Jose State University. I later developed this into a county wide educational track for nurses to follow in my footsteps and train as nurse practitioners/midwives. In recent years, I completed my Masters degree in Midwifery at the Midwifery Institute at Philadelphia University.

Even though I decided to take the nurse path, I've always been involved in unity for midwives. I was an active member of both California Association of Midwives and California Nurse Midwives Association, working as a liaison to the boards of both during the licensed midwife practice act legislation in the 1990s, and lobbied extensively for both CNM and LM legislative efforts.

It's to this end that I feel so strongly about my role as Director of Health Policy and Advocacy, and the place of the Midwives Alliance in global midwifery. MANA began as a place of unity for all midwives and continues to hold that space today. While the MANA leadership is just as diverse now as in the early days, the membership has also grown and changed a great deal. The great majority of us are now certified or licensed in one form or another. This is the direction midwives tell us they want to go; to be recognized in their jurisdiction, able to order tests as needed, obtain and administer life saving medications, and bill for their services. We are working on your behalf in a variety of settings to help you reach your goals.

The Division of Health Policy and Advocacy

Our Division of Health Policy and Advocacy aims to make a difference in the world of maternity healthcare, working with you at the regional, national and international level. If you have a question or comment, or an idea for a collaboration or partnership, please contact me at healthpolicy@mana.org.

Some of our current collaborative work includes:

  • The US MERA collaboration is one of our priorities as we advocate for licensure of direct entry midwives in all fifty states, via a variety of training and education pathways. If you are not familiar with US MERA, read more about the inception and history here, and watch this blog for the report of our latest proceedings, soon to come. MANA is spearheading an EquityTaskForce within the US MERA coalition led by member and Access and Equity Committee advisor Indra Lusero, JD, MA, director of The Elephant Circle.
  • Working with legal organizations protecting a women's human rights; the right to birth at home, have a vaginal birth after a cesarean or avoid court ordered treatments or forced surgeries. These include Birth Rights Bar Association,whose aim is to develop a national network of lawyers who can provide legal resources to both families and midwives experiencing rights violations and National Advocates for Pregnant Women (NAPW), who fight for the personhood rights of pregnant women.
  • We participate in the Coalition for Quality Maternity Care (CQMC), most recently providing input into The Joint Commission's Perinatal Care Certification, as well as signing on in support of a variety of pieces of maternal newborn child health legislation.
  • Our longstanding membership in the International Confederation of Midwives (ICM) is crucial to remaining active in the maternity care world. We hope many of our members will join us at the next Triennial meeting in Toronto in 2017; in fact, we hope you will consider submitting an abstract to speak and represent the US at what is sure to be an exciting meeting. If you haven't been to an ICM Triennial Congress, start planning now. It is so exciting to be in the presence of thousands of other midwives from all around the world! Watch for info here as we get closer to 2017.

Additional plans for the Division of Healthy Policy and Advocacy include being available for testimony, providing policy letters for state organizations, and developing definitive policy statements and position papers.

We need you at the Midwives Alliance. Please become a member and tell us what you need and what you think. Share your ideas about policy and advocacy with me here. I look forward to hearing from you, and seeing you in person at MANA 2015!

Colleen Donovan-BatsonAbout the author

Colleen is a midwife and nurse practitioner living rurally in the mountains of far northeast WA. After years of hospital, community health center, and birth center practice, she now lives and breathes all things MANA, with a small home birth practice on the side. Colleen also tries to find time to travel to visit her children and grandchildren in far away locations.