Monday, July 19, 2010

Naturopathic midwifery - Part 1

Posted by Tatiana

Naturopathic midwives make up a small minority among midwives. They are naturopathic doctors who practice midwifery either in conjunction with a larger practice, or as their primary practice. I was introduced to the existence of this subset of midwives recently and personally vacillate between being compelled by the notion and turned off by the notion. I want to know more. I'm investigating it further by interviewing some ND midwives, but I want to first provoke questions I haven't considered from the rest of you.  

Here's a breakdown of my current understanding and opinions of naturopathic midwifery:

Education is expensive and comprehensive. To become an ND is four-five years of graduate level schooling at the clip of about $25K per year. An ND education from a school recognized by the AANMC has substantial overlap with MD training but of course approaches it from some vastly different modalities.  Most naturopathic colleges offer specialization in midwifery.  Naturopathic midwives generally become NDs plus CPMs, LMs, CNMs.

What I regard as the pluses:

ND midwives are able to care for women and their children before pregnancy, during, and ever after. There's an opportunity for continuity of care that most other midwifery paths don't offer. I'll note that it is also possible to create a similar model of practice as a CNM and Nurse Practitioner.

The inherent philosophy of naturopathy is more gentle than allopathic medicine - the trust of the body's innate ability to heal itself, the focus on lifestyle and diet changes in conjunction with other less invasive treatments, etc.

When you're talking about being a midwife, this is one of the more financially lucrative paths to take - there is a much higher earning potential for naturopathic midwives than CNMs (outside of hospitals), CPMs, LMs, DEMs, and others not coming to mind. What appeals to me about the ability to make substantially more money is the ability to subsidize things of value and great need - such as providing midwifery care for women who otherwise would have difficulty accessing it, and supporting the education of midwives from less privileged backgrounds. (Have you noticed that the demographics of midwives and student midwives do not reflect an accurate cross section of the ethnic and economic differences within the US?)

At the naturopathic midwifery conference I attended in May I enjoyed hearing talks by naturopaths on midwifery topics. The combination of the medical research and evidence-based practice with the basic rawness of midwifery is definitely appealing. The willingness to examine and employ mainstream medical approaches when they "work" alongside the naturopath's own toolkit has its own appeal, and I like that the scientific and medical training of a naturopath makes critically examining research more accessible.

What I regard as the minuses:

It's hard to refute that naturopathic medicine practitioners serve a pretty specific and limited demographic of primarily caucasian primarily upper middle class folks. I don't enjoy the narrowing of that lens. That's an issue in midwifery care that I'm already uncomfortable with, and I don't want to compound it further by creating a practice that is even more inaccessible.

The cost of education - holy smokes! You'd better be prepared to willingly serve those folks of means for quite a few years before you pay off that 'spensive schooling.

The downside of having continuity of care is that by offering well woman care for women at all stages of life, and perhaps pediatric care for the children of those women through childhood, you lose a lot of time you would otherwise spend midwifing. 

Homeopathy. I'm just not entirely on board with the "evidence-based-ness" of that one. (I'm not in the "its all bogus" camp, either. I use it for my kids, but I think of it as primarily placebo-based therapy.)

Here are some questions I'd like to pose to Naturopathic Midwives:

What are the demographics of your practice?

Was the cost of the education worth it?

How does being an ND improve your practice of midwifery?

What do you see as the advantages and disadvantages of naturopathic midwifery?

Can you be a naturopath if you're not on board with homeopathy?

Do you think your training medicalized your view of birth?

Are you bound by tighter protocols than a non-ND midwife would be?

I invite you to suggest further questions for me to ask before I dash off to grill these folks. I'm going to post my findings in a "Part 2."


  1. As a side note Bastyr doesn't have the midwifery option for NDs anymore now that they have the Masters in Midwifery option. At least that is the current status-it may change in the future.

    I had some friends in the ND program at school and NONE of them were 100% on board with all modalities of alternative medicine. I think it is just like any other major where on occasion you learn the info in order to pass the tests and when you are done you do it your own way.

  2. Wow, I've never heard of ND, CNMs! I'm really curious about where these practitioners practice, are they in California and New York? Are NDs licensed to do birth if they are not also licensed as midwives? Do they have to become nurses in order to become CNMs or do they have to take a nursing course separately? So interesting! Thank you for bringing this to my attention!

  3. I can pretty much speak to your questions now, Katy. So basically, while there are people out there with both CNM and ND credentials that's more a result of a change of mind about career choices than a planned course of action. (One case I heard of was basically an ND midwife that ended up wanting to work less hard for more money so got her CNM later.) What you have to look at if you're interested in is the laws specific to where you live. If you plan on practicing in a state that recognizes NDs (New York does not) you can be an ND and whatever sort of midwife is licensed to practice at home and have a naturopathic midwifery practice. There is an ND Obstetrics certification with its own board exam (ACNO). Most naturopathic midwives who do home births are also LMs or CPMs or LDMs or whatever is the route in their particular area. I believe (and you probably know more about this than I since you're going that route) that nursing is required of CNMs, period. While you could go on to become an ND along with your CNM credential, you'll still have to pass the ACNO and specialize in midwifery at ND school (though it would be a breeze for you! And I'd wager that a bunch of your work and experience would be recognized.) Since California recognizes both NDs and CPMs (not sure about CNM home birth laws there) it is a viable career there, and there are plenty of ND midwives in CA.