Becoming a midwife

I’m not sure anyone in their right mind chooses to be a midwife. The long hours, getting called out in the middle of the night, being occasionally doused in another person’s bodily fluids, never being able to take a vacation that isn’t planned a year in advance, standing in responsibility on the threshold between life and death, lack of professional respect and the modest income potential don’t sound appealing to the average person. No, midwifery is a passion which chooses you. Which is not to say that midwifery doesn’t offer its own rewards.

When one realizes she has been chosen, she faces a multitude of educational options in this country. In many countries, midwifery has been recognized for the unique profession that it is, separate from the practice of medicine or nursing. But in our country, midwifery has taken a more convoluted path.

Perhaps most widely known and legally recognized in every state, is the Certified Nurse Midwife (CNM). This midwife has completed nursing school with a RN. She often works several years as a nurse, and then proceeds to earn at least a masters in nursing while attending midwifery school. Sometimes she is also trained as a family or women’s health nurse practitioner. CNMs may have an independent home birth practice, but it is more common to find them in birth centers and hospitals. They usually work under a physician’s supervision, or within his practice. The Association of Certified Nurse Midwives (ACNM) oversees the CNM credential, and also offers a certified midwife (CM) credential for non-nurse midwives who have a background in another health field.

Many women prefer to avoid nursing school, since the medical training encompasses vastly more disciplines than a midwife needs, and a different philosophy in addition. These women choose to enter midwifery directly, as some variation of direct entry midwife (DEM). DEMs practice primarily in out-of-hospital settings. There are both on-site and distance learning schools to train direct entry midwives. Outside of book learning, DEMs are trained in the apprenticeship model, whereby an experienced midwife teaches the aspiring midwife by welcoming her into the senior midwife’s practice, allowing her to gain experience and increasing her level of responsibility with clients as that experience grows. Once she has been trained, the direct entry midwife then has several options, depending on her state and the state of its laws.

Many states have a procedure for licensing midwives (LM). Some states allow midwives to practice without licensure (generally midwifery has simply not been regulated by the state), and several states outlaw direct entry midwifery altogether. The most common method of achieving state licensure is by attaining the Certified Practical Midwife (CPM) credential offered by the Midwives Alliance of North America (MANA) through the North American Registry of Midwives (NARM). Again, the aspiring midwife will find that there are several avenues by which one may achieve the CPM certification, and she would do well to investigate the paths before she makes a decision on her schooling.

One way to become a CPM is to attend and graduate from a Midwifery Education Accreditation Council (MEAC) accredited school. These schools tend to cost more than non-accredited schools, but part of the procedure for achieving the CPM is contained within the schooling process. If one chooses a non-accredited school, or decides to simply apprentice and design her own learning path, she will have to participate in the portfolio evaluation process (PEP) requirement to achieve CPM. The second aspect to earning the CPM credential is passing the NARM exam. All CPM candidates are required to sit for the exam.

Depending on the state, the midwife will either become an LM upon completion of her CPM credential, or will have to meet several additional requirements, such as number of births as primary attendant. There are also fees associated with being licensed which have a great range depending upon the state laws.

In states which do not license midwives, an aspiring midwife may still choose to become a CPM. By obtaining a CPM, she has met a certain minimum of standards for her profession, and is obligated to compile her own written protocols and standards of practice for her practice.

Many women decide that being certified is not meaningful to them or their clients. They recognize that the title is not a guarantee of good practice, and make the choice not to pursue it. These midwives complete their schooling and apprenticeship and begin offering their services.

In some situations, it is impossible for the midwife to attend a school or especially to find an apprenticeship. Such was the case some 20 years ago when the direct entry midwife had all but become extinct due to pressure from the medical establishment. There were no schools or apprenticeships to be had. In some rural areas or illegal states, it may currently be impossible to find an apprenticeship, but a woman may still find herself called by her community to midwife. In such a situation, the woman becomes an empirically trained midwife. She learns through experience. It is the empirically trained midwives who have reinstated the profession of direct entry midwifery in this country today, and many have become widely known as they have written and taught others through their experiences. The empirically trained midwife educates herself from whatever material she can get hold of, usually obstetrical texts in decades past, but now often from midwifery texts as well.

Since the re-emergence of the midwife, midwifery is beginning to flourish. Midwifery is an essential key to lowering infant and maternal mortality and morbidity, with the training to attend normal birth and keep it normal and healthy. To investigate your own state laws regarding midwifery, check out the Citizens for Midwifery (CfM) site. Midwifery Today, the premiere American midwifery journal, has more information on how to become a midwife.

~ by Bekah on May 18, 2006.