We are the experiences that we have lived. Our own understanding and perspectives on birth are shaped by the training that we have had and the births that we have been witness to.
We are dynamic, ever-shifting, and absolutely imperfect beings. I don’t think any midwife walks into a birth expecting to see the same thing twice. This work is incredible BECAUSE we get to learn and to shift our care with each unique family and birth.
I have been reflecting on the lineage of healers, mentors and teachers who have brought me to this point in my career- people near and far who are part of me- who have informed my perspectives and understandings of this work.
They show up in little ways- in the way I take a blood pressure, the rhythm I have at emptying and deflating a birth tub, the tools I will reach for first during an emergent situation, the way I feel a uterus postpartum.
Every care provider has this lineage of healing or training that they have been brought up through- and we get to build on this as we do our work in the world and begin to train and to teach others.
And we get to morph and to change things as we go- as new information, new situations, new opportunities arise for us to show up in different ways.
I am forever grateful to ALL of my teachers- current, past and future- who have been a part of my path.
To be a midwife right now, there are a few distinct paths that one can take to do the work.
Amazing providers can come through any and all of these paths, but it may be helpful to reflect on the differences in the teaching lineage and perspective on birth that different types of midwives are trained to have.
If you are interviewing midwives, feel into what it FEELS like to meet with this person. Ask them why they do this work. Ask them about their experiences, and you will often see their passion and desire to help others shine through.
I do believe all midwives have this in common. We want to make the world a better place and we have certain gifts to share. We end up where we are meant to be, working with the families we are meant to be working with, so no judgment on someone’s letters - or lack thereof- behind their name.
THREE MAIN TYPES OF MIDWIVES:
Lay midwife/traditional midwife- This is where we all began. Before insurance companies, before the witch hunts, before the medicalization of birth- there were midwives. Trained by other midwives. With their hearts and with their hands and with their unique communities’ needs in mind. The lay midwives who are around now are hard to find. They are not regulated, so they may or may not have completed a certain degree of clinical training, and they are not bound by specific rules and protocols other midwives are. They can often provide care for people during low-risk pregnancies and births, but may not carry medications or be able to offer things like suturing, oxygen, and transparent transfers to hospitals if needed.
CPM-Certified Professional Midwives- These are the experts in out of hospital birth. Certified Professional Midwives have been trained exclusively on how to manage, witness and support birth from outside of the medical system. Our training involves years of didactic (school) training as well as hands-on apprenticeships with practicing out-of hospital midwives to get exhaustive experience in everything from prenatal care to working with pharmaceuticals while breastfeeding. Our training is a blend of both the clinical and emotional aspects of pregnancy and birth. We all pass a national exam after completing our training and then can go on to get licensed and practice by the rules and regulations specific to our states. (So they can then also have the designation LM, or Licensed Midwife). Learn more about this certification here.
CNM- Certified Nurse Midwife. These are first and foremost Nurses. People who have gone through nursing school and then gone on to specialize in Midwifery- this training is all done through an allopathic lens and under the hospital system. This is why you won’t find CPMs or lay midwives catching babies in a hospital - it’s a totally foreign system to us.
Nurse Midwives have been trained with protocols, specific equipment, duties and responsibilities that are distinct to the setting in which they practice- the hospital. There are incredible Nurse Midwives who bring their light and love for birth to the hospital setting, and then those who pivot from the hospital setting and go on to practice in homes or birth centers. There is often a lot of “un-learning” they report having to do, as they are switching systems entirely!
Insurance companies, more familiar with nurses and hospitals, often will acknowledge and reimburse for care given by Nurse Midwives more readily than other types of midwives. Nurse Midwives often have vastly different client demographics because of this as well. They often see a much more varied, perhaps closer to high-risk population, people who cannot access other type of midwifery care often because of a financial or state-regulated rule. I send all of the inquiries I get for people in bigger bodies (high BMI is regulated in Maryland), people on state insurance, people who have had cesarean births before, twin pregnancies…etc. to Nurse Midwives because they are “allowed” to care for these clients in the eyes of our state.
If this makes you mad, consider getting in touch with your lawmakers/representatives! Anything can change with enough support!
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