ChicagoDoula » Rachel Dolan Wickersham

Six Months Later

Rachel Dolan Wickersham — Sun, 29 May 2011 04:29:40 +0000

Long, long ago, Amy promised for me that I would post a follow up to her post about the fire that took my family’s home. Today is the six month anniversary of that fire and it’s high time I followed through on the promise. So here we go.

Just now, six months later, we finally had the house demolished. It happened last week. It went down in a day. It felt good to be done with it.

Just now, six months later, I finally got to order my midwifery textbook replacements. I plan to spend the summer studying these books for my autumn CPM (Certified Professional Midwife) exam.

Just now, six months later, we are working through some of the PTSD that still lingers for some members of the family.

Just now, six months later, we are beginning to feel ready for another kitty to join our family.

Just now, six months later, I look back and am grateful for our lives and for the love and support we received from the childbirth and parenting community.

Just now, six months later, I look back and I laugh as I remember how, on the day of the fire , as I sat in the car, a block down the street with two pets and five girls in their pajamas, I pulled out my doula bag and found food, clothing, clogs, toiletries, emergency cash, rescue remedy and lavender – in short, plenty to cover immediate needs and calm us down. To a doula, its nothing – just regular birth bag ingredients, but to a doula whose house was burning down it was desperately needed, not only for the items but for the bit of humor it injected into the situation. As one of my daughters said, “only mom would have stuff like this in her car.” Given that their usual complaint is how I’m weird and not like other mothers, this was a compliment.

Just now, six months months later, my doula bag is packed and ready for the next birth or for any crisis that may come.

Just now six months later, we are still working through a few things, but basically we are doing just fine.

Thanks for reading

Importing Midwives and Exporting Babies: Illinois’ Little Secret Gets National Attention

Rachel Dolan Wickersham — Thu, 30 Sep 2010 15:05:17 +0000

Illinois midwifery and home birth have gotten a lot of national attention lately. In late August, there was a Time Magazine article on the controversies surrounding home birth in the U.S.A. In the opening paragraph, there was a description of an Illinois home birth mama who eventually jumped the border to have her baby in Missouri because the home birth situation in Illinois was so full of angst.

Late last week, the New York Times published an entire article about Illinois home birth. The title was (to us activists) exciting and provocative – “Use of Midwives Rises, Challenging the State to Respond”. This article features an Illinois student midwife who crossed the border, moving to Wisconsin to complete her education and work legally. Also in the same article, is an Illinois mama who moved to Wisconsin to follow her midwife.

Is there a pattern here?? Yes – moms and midwives crossing the border into friendlier states. It’s as if there are signs at the border pointing AWAY from our state → This Way To A Better Birth.

This is only half the story, however. The Coalition for Illinois Midwifery is also aware of women bringing midwives IN to Illinois. Although not clearly stated in the NYT article, some of the mamas interviewed actually imported their home birth midwives from other states. And they’re not the only ones. Over the past several years Illinois home birth mothers have brought midwives in from Wisconsin, Iowa, Missouri, Indiana, Kentucky, Michigan, Minnesota, North Carolina, Ohio, Texas, Oregon, Montana, California, and probably quite a few more.

Bringing a midwife in or taking a jaunt across the border are both viable options for women, but are they really the best options?

Comfort is an issue. Anyone who remembers the last few weeks of their pregnancy knows the last thing they want to do is take a long drive anywhere, much less in labor.

Safety is an issue. Should a woman need a higher level of care, her imported midwife is unlikely to be familiar with the local options. And for mamas who have traveled, ending up in a strange hospital, miles from their supportive network of friends and family, can negatively impact their well-being.

Pride is an issue. Can we not serve our own?

With national attention finally on the subject, we can hope that our state legislature will find it in their hearts to make sure that women who choose home birth in Illinois, have enough providers willing to serve them. Given that we have at least 30 years of evidence that nurse-midwives and physicians cannot and will not meet that demand, it is time to recognize those who will and assure that they have met national certification standards. Licensure of certified professional midwives (CPMs) is the only way.

Otherwise we’d better start building those border signs.

Who Is ChicagoDoula?

Rachel Dolan Wickersham — Fri, 04 Jun 2010 06:31:38 +0000

So Amy is trying to get me to blog. I have to say, I have never considered this and am not so sure how good I’ll be at this. I’m only here because she has the smarts and the drive to get us both here. Maybe I can start by giving you the back story. For the past 15 years, I’ve practiced as a childbirth educator, doula, doula trainer and occasional midwife’s assistant. I’ve used the web since the beginning and have always used the screen name identity “ChicagoDoula.” But as the web developed, I remained a very basic user – email, the occasional instant message, web-browsing.

I always thought I should make more of it. I even took a website design class. I created a draft version of a very pretty website. And it sat there on my computer for years. I had no idea how to get it published. Two years ago I finally figured out that I needed to purchase a domain name. So I did. But that sat there too. When Facebook came along, I figured it out to some degree, though I only have personal pages – no business page.

Then along came Amy, a new doula on the block, with some really neat ideas. She hoped to develop a website and call it ChicagoDoula.net. I agreed to this because after all, though I’d been using the name for years, I did not yet have a website and thought I would never get around to it. Amy began building the site and after a time we realized it was something we could work on together. We began to think of ChicagoDoula as a concept rather than a specific person and several months later, here we are.

Who is ChicagoDoula? She is a little bit of everything, just like the city she serves. She is an activist, a doula, a mother, a midwife (of babies or ideas or communities), a mentor and a student. She is experienced and wise, yet she is fresh and enthusiastic and full of new ideas. She is knowledgeable about a variety of childbirth preparation techniques and is comfortable working with them. She believes that life is precious and she also believes in a woman’s right to make a full range of decisions about her reproductive health care – whether that means choosing to terminate a pregnancy, choosing an epidural for labor, or choosing a homebirth with an underground midwife. She strives to help women understand the full implications of their choices and help them find their innate power, so their choices are not driven by fear. She understands that there is no single right answer for any given situation. She is willing to support women in whatever choice is right for them.

ChicagoDoula loves her city and the people in it. She joyfully serves families from all walks of life. She is ever-hopeful with a strong vein of cynical, anti-racist, queer-friendly, working on recognizing her privileges as well as her own internalized oppression, challenging others and herself to see and understand things differently. When faced with obstacles, she looks for creative solutions rather than struggling to achieve particular outcomes.

She envisions a world where all women get the support they need across the spectrum of pregnancy, labor, birth and parenting – a world where every woman in every community has access to the information and support she wants and needs so that she can be affirmed in her choices.

She envisions a world where women are respected, safe, honored and empowered.

In short, ChicagoDoula is many things. We invite you to get to know her, us, as we continue posting here and continue building our websites.

Thirty Years Too Long

Rachel Dolan Wickersham — Fri, 26 Mar 2010 19:37:07 +0000

Journalist Amanda Robert’s story highlighting the homebirth situation in Illinois, says it all in the tag line: “Thirty years later, Illinois midwives fight for birth rights.”

For 30 years the state of Illinois has been aware that some 800 – 1000 Illinois women per year choose home birth and choose the care of a midwife especially trained to attend home deliveries - a direct-entry midwife (entering the profession directly rather than through nursing – sometimes also called lay midwife).

Thirty years ago midwives and families lobbied the state to license such midwives and were turned down. Every so many years they went back and were turned down again. Yet home birth persisted. It did not go away.

Since the year 2000, home birth and midwifery advocates have gone to Springfield for every session under the banner of the Coalition for Illinois Midwifery. As the Coalition, we’ve developed the language of the licensing bill to reflect the standards of the time. Instead of talking about lay midwives we are talking about CPMs (Certified Professional Midwives) – women (or men) with years of training, who have passed a national exam administered by a credentialing organization that is accredited by the very same organization that accredits the nurse-midwives organization.

We’ve gained the support of the Illinois Public Health Association, the Illinois Society of Advanced Practice Nurses, the Illinois Maternal Child Health Coalition, and even the AFL-CIO. And most importantly, we’ve set the highest level of educational requirements for state licensure of CPMs in the nation.

House Bill 226, the Home Birth Safety Act, is currently is gaining momentum in the Illinois House.

Home Birth STILL persists and rates are climbing –increasing 5% from 1990 to 2006, according to the CDC. It is time for our state legislature to take action and finally license and regulate the midwives who are out there attending it. Thirty years is a long time to stay underground.

CNMs, CPMs and DEMs…Oh My!

Rachel Dolan Wickersham — Tue, 26 Jan 2010 06:36:20 +0000

Note: This is a first post by doula extraordinaire, midwife-in-training and legislative advocate, Rachel Dolan Wickersham. Amy and Rachel are thrilled to begin our work as a team to bring ChicagoDoula to you in its new format as a collaborative birth blog. Enjoy!

I’ve had a lot of requests for a basic primer on the different types of midwives available to home and hospital birth mothers and families. Generally, everyone understands that midwives have a more holistic approach than MDs, spend more time with their clients, and get better outcomes for both mother and baby. However when it comes to figuring out which type of midwife is best for a given situation, the devil is in the details. Here is my best shot at sorting out who’s who.

CNMs and CMs (Certified Nurse-Midwives and Certified Midwives)

CNMs receive a degree in nursing and then go on to get a master’s degree in midwifery in most cases. There are a number of CNMs who have a bachelor’s in nursing and a certificate in midwifery, rather than a master’s, but basically, it’s nursing plus midwifery training. Starting in 2010, a graduate degree will be required for all CNMs and CMs.

CMs receive midwifery training alongside CNMs. They are part of the same program, however before the midwifery training they do not receive an RN. They do however, have to receive a bachelor’s before the midwifery training because they will be receiving a master’s in midwifery. Those who already have a master’s degree in a related field, may earn a certificate.

Both CNMs and CMs sit the same midwifery exam to receive their credential. The exam is administered by the AMCB – American Midwifery Certification Board. One is not required to prove out-of-hospital experience in order to sit the exam or receive a CNM or CM credential.

CNMs can practice in all 50 states. CMs can practice in 3 states – New York, New Jersey and Rhode Island. The vast majority of CNMs- or CMs-attended births occur in hospital settings. Less than 5% are outside of the hospital in homes or free-standing birth centers.

DEMs and CPMs

DEMs are direct-entry midwives - midwives who do not enter the profession through nursing. They learn through a variety of pathways. Possibilities include but are not limited to formal midwifery schools such as Seattle School of Midwifery, exclusive apprenticeship, or a combination of the two. These midwives may or may not use the same textbooks as CNMs and CMs. They may or may not be legal within their state. They do not carry a national certification unless they choose to become a CPM (see below). They may or may not have education equivalent to that of a CNM/CM. Whereas the CNM/CM proves her entry-level competence by passing the AMCB exam and earning her CNM/CM credential, the DEM who does not become a CPM has no such designation.

It is up to the consumer to discern their DEM’s level of education and expertise through asking questions, contacting references, and examining any evidence their DEM provides (such as certificates of training in neonatal resuscitation, etc). In some states, licensure is offered to DEMs who meet certain requirements. Often, but not always, the requirement is to earn a CPM (certified professional midwife) credential.

Some DEMs wish to prove their competence by meeting certain criteria and then sitting a national exam. These DEMs become CPMs (certified professional midwives). They may still receive their education through a variety of routes, (see DEMs above) but it is almost guaranteed that they will learn from the same textbooks as CNMs and CMs because the national certification exam draws questions from materials in these textbooks.

The national certification exam for CPMs is administered by NARM (North American Registry of Midwives). NARM’s exam tests for the same body of midwifery knowledge as the AMCB‘s exam. It does not test for advance practice nursing skills and knowledge (such as knowing how to calculate and prescribe narcotics doses for pain relief in a hospital birth) because CPMs are not nurses and are intentionally, out-of-hospital providers. In addition to passing the exam, in order to receive a CPM credential, the applicant must prove documented out-of-hospital experience (something CNMs and CMs do not need to do).

CPMs are legally allowed in 26 states and are selectively ignored in other states. Only 11 states actively ban them. In some states they even get Medicaid reimbursement, as can CNMs.

CNMs, CMs and CPMs have all earned certificates demonstrating competence in midwifery. Consumers should be able to verify proof of their certification. In the case of CNMs in all 50 states and CPMs in some of the 26 legal states, one can verify their state licensure. Where licensure is not available, it is up to the consumer to ascertain proof of education. To see a list of legal states for DEMs and CPMs, go to www.mana.org and click on the resources tab.

Illinois

Since I live in Illinois, I can comment on our situation here.

In Illinois we have no CMs. We have many CNMs. Most practice in hospitals. At this writing, there are no free-standing birth centers for them to practice in, though a law establishing a pilot project of such centers passed in 2007.

Five nurse-midwifery practices offer homebirth services in the Chicago area. Two practices offer homebirth services downstate. Altogether, these practices are based in only 5 out of 102 Illinois counties.

Currently in Illinois, DEMs of all kinds, including CPMs, are illegal but there is a bill before the Illinois House for licensure of DEMs requiring the CPM credential as proof of competence. Licensure would also require an associate’s degree with specific science-based coursework in addition to the CPM.

There are DEMs all over the state of Illinois. Some are in the open. Some are underground. Here in the Chicago area, we have only a few CPMs.

CPMs are legal in some neighboring states (Wisconsin and Missouri). They are generally allowed/ignored in Michigan. Iowa and Indiana are working on licensure for CPMs, as is Illinois.

For more information on Illinois Licensure, go to www.illinoismidwifery.org
For more information on CPM licensure nationally, go to www.thebigpushformidwives.org