Will the NARMs new preceptor guidelines actually reduce the number of potential CPMs in the US?

My midwifery journey is not that different than many others. I birthed all four of my children with midwives, two CNM’s, a CPM and a traditional midwife. After completing all of my pre-nursing requirements, graduating with a Bachelors of Science degree in psychology, working as a Certified Nursing Assistant and working for five years as a doula and childbirth educator I began my apprenticeship with a traditional midwife. She had had a whirlwind apprenticeship that ended with her spending 5 weeks working at a birth center in the Philippines and returning home to a full practice as her preceptor moved out of the state while she was gone. About a year later I began my apprenticeship with her. She was a great preceptor. Matching my skill level where I was while continuing to stretch my thoughts and learning by working out situations both intellectually and hands on as they evolved in the births I attended with her. She encouraged my didactic education spending numerous hours studying and reviewing information, protocols, and reports written in my personal study. I quickly stepped into the primary under supervision role. We worked together like a well oiled machine. After about three years I had completed all of the required numbers in order to apply to sit for the NARM through the PEP process. I was surprised to discover that all of the forms and paperwork had changed since I had originally printed them in 2008. I was also surprised to find that they were putting restrictions on who would qualify as a preceptor.
Preceptor guidelines are as shown from the NARM.org website “ A preceptor for a NARM Entry-Level PEP applicant must be credentialed as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), or Licensed Midwife. Preceptors must also have an additional three years of experience or 50 births, including 10 continuity of care births beyond the primary birth experience requirements for CPM certification.
Preceptors who do not meet the above requirements must be approved by NARM before signatures will be accepted on CPM Applications. Exceptions will be considered only for midwives who meet the experience requirements but do not yet hold the required credentials.
No new preceptor exceptions will be accepted after January 1, 2012.”
My main preceptor applied for an exception as did another midwife that I occasionally attended births with. My main preceptor was denied as a NARM preceptor. She had met the experience requirements concerning the number of births but was about a year short of being on her own long enough and had no goal of acquiring the CPM credentials. My second preceptor, a midwife with 25 years of experience and an intention of applying for the CPM credential in the next year was approved. There is only one CPM with in a 200 mile radius of where I live and practice and she was a personal midwife of mine that ended in a very traumatic birth. Apprenticing with her was not an option for me. So where did that leave me on my personal journey?
When I contacted NARM about the denial they replied that “ACTUALLY, NARM HAS BEEN PLANNING TO REQUIRE THAT ALL NEW CPMs BE TRAINED BY CPMs SINCE THE BEGINNING OF THE CERTIFICATION PROCESS. IT IS FOR EDUCATIONAL QUALITY ASSURANCE. THIS IS THE FIRST STEP TOWARD THAT GOAL...THAT IS WHY THEY CREATED THE PRECEPTOR EXCEPTION. WE ENCOURAGE
EVERY MIDWIFE TO BECOME A CPM.”
They have a goal of only CPM’s being able to act as preceptors for students wishing to take the NARM? I was flabbergasted. What about areas such as my own where the CPM credential is not valued? What about areas where midwifery isn’t legal? Can they really put such restrictions on who can sit for the NARM exam? I thought the whole purpose was to increase the accessibility to midwives nation wide by having a national standard?
When I voiced my concerns about the limited access that traditionally trained midwives (who do not apprentice with CPM’s) will have in attempting to sit for the NARM I was encouraged to look at out of state options such as a high volume birth center in order to get “my numbers”. I then questioned NARM about the possible complications of taking midwifery training and experience away from the obvious need in my community to train as a birth center midwife when my goal was to work in the home setting. I also questioned my families needs not being met by me leaving them to “get numbers” at an out of state or country clinical setting.
This was the response I received “IT TAKES MANY MIDWIVES 3-5 YEARS OR LONGER, DEPENDING ON MANY LIFE INTERVENTIONS, TO COMPLETE THEIR EDUCATION. I ENCOURAGE YOU TO KEEP PLUGGING AWAY AT IT. IT ALSO SOUNDS LIKE YOU HAVE A FAMILY THAT NEEDS YOU, AND SOMETIMES THAT IS THE PRIORITY AND MIDWIFERY EDUCATION TAKES A LITTLE LONGER. I GUESS THE OLD ADAGE THAT "PATIENCE IS A VIRTUE" IS APPLICABLE, BUT MORE THAN THAT IT IS A CRITICAL LIFE LESSON FOR A MIDWIFETO LEARN.”
When I addressed that almost all of the midwives in my community didn’t find value in the CPM credential so my potential NARM approved preceptors were essentially non existent I was told that
“IT IS A PROBLEM THAT WE ARE AWARE OF. HOWEVER, IT REALLY IS A COMMUNITY PROBLEM AND NOT SOMETHING THAT NARM HAS ANY CONTROL OVER.”
Really? . Here I was trying to bring midwifery and the CPM credential to an area that found little value in it and they were trying to tell me I wasn’t being patient and that I needed to put my family first and work on my priorities. I had more than completed all of the requirements laid out by NARM for the PEP process but the new stipulations of only allowing CPM’s to act as preceptors changes the entire dynamic of the PEP process for the traditionally trained midwife. Also the lack or responsibility from NARM for the affect it has on communities was disheartening. So that leads to the ultimate question, will NARM’s new preceptor guidelines actually lead to fewer CPM’s? I believe the answer is YES, and I may just end up being one of them.

Lack of Support for Birth Trauma in the United States

There is a huge misfortune occurring to women and babies in this society. Birth trauma is greatly misunderstood and rarely believed to be a problem. Other countries such as England and Australia have well organized groups to help combat and heal from this real problem. Too often women who have suffered a traumatic birth are told to "just move on", to "get over it" to "take accountability for their choices", that "they have a healthy baby so what is the big deal". This is demeaning to women and our culture as a whole. How a woman and baby experiences birth is trans formative for their family and society as a whole. I have no doubt that if more births were gentle and peaceful the family unit would be as well.

After my own traumatic birth(see http://completebeginnings.blogspot.com/2010/09/birth-of-my-third-everett-roger.html)it took so much work and healing to come to a place where I felt like I could parent and welcome another child (see http://completebeginnings.blogspot.com/2010/09/birth-of-my-fourth-scoot-october-24th.html).
My experiences were transformative. The healing was powerful. I feel the need to help other women come to a place of peace and healing regarding their own births.

I have several plans in motion and encourage my sisters in birth to consider taking similar strides in their communities and practice.
*I have started a local support group for birth trauma.

*I am attending a series of trainings over the next three years to become a practitioner of Somatic Experiencing (see www.healingtrauma.com) as a way to help even more women and other people dealing with trauma in their lives.

*I am also involved in the rebuilding of a internationally well known childbirth education organization to add a birth trauma prevention and healing component to their instructor training.

*I also make it my life goal to respect the women that I work with and if trauma does occur, because sometimes it does regardless of how careful we are, that their feelings will be taken seriously and resources provided for healing.

I encourage practitioners and those working on healing trauma to also visit www.solaceformothers.org and support this organization.

How Many Hours to Become a Midwife?

Posted by DyAnna

I came to my midwifery journey in a round about basis. I can't say that I always knew I would be a midwife but my life experiences have definitely helped bring me to this place. I looked into becoming a Certified Nurse Midwife briefly while on I was on the nursing track. After the birth of my second in 2005 I looked at different distance education options including Midwifery College of Utah and National College of Midwifery. My midwife for my second offered to be my preceptor if I went with a school she was familiar with. I also looked into finishing my nursing degree and then doing my CNM through Frontier School of Midwifery. In the end we moved away and I resolved myself not to do midwifery or other birth work. We moved to an area that had no CNM's or licensed midwives that did home births. I was very grossly misinformed regarding the education it took to become a traditional midwife and thought I would never want to train with any of the midwives locally.

I took a little over a year off. Few people even knew I had ever been involved with birth work and it was a much needed break. After the difficult birth of my third I knew that in order to be sure that quality midwifery care was offered in the area I would need to help by providing it myself so my midwifery journey began. I attended a few births of mutual friends with a local midwife I had been friends with for a few years. We hit it off and before I knew it I had transitioned from assistant to apprentice.

I still struggled (and still do) about whether or not I needed a more traditional school. In the end it came down to a few things. 1- I had already done the traditional college route and done it well graduating with and A- average and learned and retained very little compared to the amount of time spent. 2- Money. We already have so much student loan debt for my husbands law degree that the thought of spending more money on my school for a career that wasn't a huge money maker just wasn't possible for my family. 3- I wanted to be able to tailor what I learned and avoid the busy work. So far I think I am holding my own with a curriculum I established on my own and tailored to my needs.

So this is how it has broken down give or take. For the last 2 1/2 years of my life I have spent time studying individually, studying and discussing with my preceptor, teaching childbirth classes, attending doula birth, attending prenatals, births, and postpartum visits, doing skills classes, attending workshops. In the end of my apprenticeship assuming another 18 months the break down will likely look like this.

Time spent studying individually, reading, writting protocols etc.
8 hrs a week x 208 weeks =1664 hours

Time spent doing prenatals and postpartum visits
6 hrs a week x 208 = 1248 hours

Time spent in skills class (suturing practice, exams, etc.)
5 hrs a month x 48 months = 240 hours

Discussion, review and study with my preceptor
2 hrs a week x 208 = 416 hours

Birth attendance
2 births a month at an average of 8 hours per birth x 48 months = 768 hours

Additional workshops
24 hours total

Childbirth classes and doula births
3 series a year at 18 hours per series plus another 20 hours a year doing doula births x 4 years =296

Total: 4,656 hours of study and instruction

NARM the national midwifery association that provides the test for your Certified Professional Midwife required a minimum of 1350 hours.
I think I've got it covered.

Grandmother's at Birth

Posted by DyAnna
 
Having your mother attend your birth seems like a relatively benign thing. Wrong, really, really wrong. Your mother's influence at your birth is so powerful both for the good and the bad that can come from it. It seems like it would be a natural part of human nature. Years ago before we all lived in large cities most of us lived in extended family groups. Your mother would be at your birth as well and many other births in the family. It was a normal part of every day life. Fast forward many years when fear and women's rights meet with a vengeance. As women were requiring to be seen as full citizens of the USA, meaning we get the right to vote, we also rebel against Eve. Who was she to doom women of all time to painful child birth? Liberated women have a right to pain free childbirth. Enter anesthesia for childbirth. Mothers were removed from being at their daughters births in almost a single generation as their roles were taken by nurses, doctors, ether and stirrups. Fast forward a few more years. Woops we made a mistake and women still want their mothers at the births of their babies. Let's let them back in the room. Sounds like a perfect solution the joy of choice in childbirth, natural or medicated, with your mother by your side. Unfortunately it is more often than not like a train wreck. But it is not the grandmothers fault. For the past 80 years nothing but fear and distain has surrounded childbirth. So when you explain you want an unmedicated birth, to have your baby underwater and maybe even have your baby—gasp—at home what is a grandmother to do. Unfortunately most of the time it is panic. She was never encouraged to listen to her own instincts and intuition in her births or often even with her parenting. How can she be expected to support you while you do the same?
I most often see three different types of grandmothers when it comes to their daughters or daughters in law giving birth at home.

First- grandmothers who want nothing to do with the experience. They don't want to know or hear anything about birth. From the midwives approach these ones are easy to deal with unless the mother has a burning desire to have her mother there. Then it gets more difficult as the pregnant mom feels abandoned because her mother doesn't want to be involved in her life changing event.

Second- grandmothers who want to be there and are super supportive. These are often women who a- either had amazing empowering births that they can't wait to share with their families or b-had completely unfulfilling births and want to see and experience how different and normal birth can be. These women are often wonderful helpers to have at a birth IF and I do mean IF their daughters want them there and they can follow directions and respect boundaries. If they are not welcome and can't respect boundaries it is a recipe for disaster.

Third-grandmothers who want to be there because they want to protect their daughters. Unfortunately my mother falls into this category. She wants to help me and protect me from anything that could possibly go wrong with my birth. They often bring fear, distrust and belittlement into the birth experience. Not only making it frustrating and difficult for the mother to manage but potentially dangerous as well.

All of these situations have the potential for disaster or success. So much of it has to do with the pregnant woman talking to her mother about her wishes for her birth and her mother's role there, the pregnant woman discussing her mother's role at her birth with her midwife, and a hopefully uncomplicated labor. If any of these three things don't occur, aren't clear or go astray there is likely to be hurt and frustrated feelings.

As midwives we walk a fine line between support emotionally and support physically and with grandmothers it is easy for this line to get fuzzy. I highly encourage all pregnant mothers who are considering having their mothers at their birth to truly consider what both you and your mother have to gain from the experience. Now it may seem that I am calloused against grandmothers being in attendance and this is not entirely true. It can be a wonderful and bonding experience for the whole family, however often this is not the case. We are a different generation and we screwed up long ago removing our mothers and other support women from our places of birth and now we are reaping the consequences. It will take patience and careful navigating to mesh the natural and seamless beauty of a woman in labor supported by her mother with the thoughts of the world regarding normal birth.<

Erik Erikson’s Stages of Development and Dy’s Midwifery Stages of Development

Posted by DyAnna

So this wild road we call midwifery education has gotten me thinking a lot about my more traditional education. I studied psychology for my undergraduate degree and I must say that it transfers very nicely into midwifery. One memory that kept coming to mind was Erikson's Stages of Personal Development and I couldn't help but see how similar they were to my personal midwifery journey. For those who are not familiar with Erickson here is a quick run down thanks to about.com and copy and paste so I don't have to write it all out in my own words. One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experience and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence also motivates behaviors and actions. Each stage in Erikson's theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which he sometimes referred to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy.

Where I am, How I got Here, and Where I am Going

My name is Dy. I have been a practicing doula and childbirth educator since 2002. I was always drawn to the wonder of birth and was able to witness my first miracle at the age of 11. I am the mother of four children born at a hospital and at home. All four attended by midwives. Their births have helped me to realize the potential of what I am capable and focus the importance of everything I believe.

While getting my Bachelors degree in Psychology I once again found myself drawn to the miracle of pregnancy and birth. I focused my study on issues of pregnancy and human and child development. After the birth of my first child I trained and Certified with Doulas of North America (DONA) as a birth doula. I soon became a Childbirth and Post Partum Association (CAPPA) and Bradley Method (AAHCC) certified childbirth educator. I have been honored to attend over 50 births as a doula and have taught dozens of couples. My experience includes home, birth center and hospital births, women who chose medicated and unmedicated births, as well as births attended by doctors and midwives.

In 2008 I was given the privilege of coming to train under a wonderful preceptor. In that period of time I have learned so much about the physical and emotional care of the family in the prenatal, birth, and postpartum time period. In addition to the hands on experience I get by attending prenatals, births and postpartum appointments I am actively perusing my midwifery education in many different ways including: a distance midwifery education outline of study material and projects, active participation and establishment of a local study group for midwifery apprentices, as well as hundreds of hours of individual studying, reading and discussions with Laura and other birth professionals. I plan to end my apprenticeship with serving at a high volume birth center where I can get even more experience with higher risk pregnancies and issues that are rarely dealt with for those who birth at home in our community such as suturing and deep suctioning of the newborn etc. I plan to sit for the NARM exam (the national certifying exam for midwives in the United States) within the next two years giving me the use of the title Certified Professional Midwife. I am to the point in my training that I am taking clients as a primary midwife under supervision. Meaning I provide all aspects of care with my preceptor there in a supervisory role. I get the benefit of learning what it is to truly have the responsibility of being a midwife while the clients have the benefit of a highly motivated and attentive midwife. We are a great team and we love what we do and the women we serve.

PHILOSOPHY

I believe that a woman has an innate ability to birth her baby. It is a normal physiological process not a medical event. Women are often astounded by the options around them when they are nearing their time of birth. I believe that when women are given all their options, they will choose what is right for the health of their baby. I believe those present should trust the woman to know what is best for her and her baby. This leads to a sense of satisfaction and responsibility which follows them through the rest of their life. I believe in the value of women in service of other women.

There are many factors that play into a woman's choice for her birth. Her emotional, physical, and psychological well being should be taken into account and her wishes supported. Not fear, but understanding and intuition should be the motivating factors for her choices. I believe all women have the right of loving support from her partner and if she desires a doula. This is not a change she must undergo alone.

Goals

My goal as a doula or educator is to provide women the skills and knowledge they need to have the birth they desire. I believe birth is an amazing normal and natural experience and the birthing mother should be treated that way as well.

My goal as a midwife is to protect the sanctity of the birth and post partum experience. It is such a fragile time in life. It should be enjoyed and supported by those who are in attendance. The attending midwife should respect the natural birth process and provide her clients with the emotional, physical, and clinical support they need. My believe is that a midwife is a life guard for the birth process only there in case they are needed with an deep understanding that birth is a normal event.