New Resource for Pregnant Trans* Parents

H/t to Radical Doula for information about this new website designed to help trans* parents find trans* friendly providers: Trans Birth:

Trans Birth is a directory created to connect trans* and gender non-conforming people and their families to midwives, OBGYNs, and doulas who provide welcoming care to our communities.

Categories include Midwives, OBGYNs, Doulas, and Other Providers. It does not have a category for Childbirth Educators/Classes, but perhaps that could be included under Other Providers.

As of this writing there is no one listed from Chicago or Illinois. Let’s change that! If you’d like to be listed, here’s your chance.

Radio Interview on Birth Trends and Midwives

ChicagoDoula’s own Rachel Dolan Wikersham (who in addition to being a doula is also a Ceritifed Professradiowavesional Midwife or CPM) joined local Certified Nurse Midwife, Hillary Keiser today on WBEZ’s Morning Shift with Tony Sarabia. In addition to addressing concerns of several callers, they explained the difference between types of midwives, discussed the opposition of MDs in Illinois to licensing CPMs, and went further into details about homebirth and requests some parents are making in birthing such as delayed cord clamping. Listen to the full interview here:

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

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.

Thirty Years Too Long

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!

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

Why a Doula is Better Than Your Best Friend

When we are pregnant, most women “know” on some more or less abstract level that this will eventually end with a birth. Chances are good that around 30 weeks or so, the thought that you will actually have to go through this birth yourself and that you will have to open and push this baby out of your body becomes clear in a much less abstract way. This is when many expectant parents begin to more seriously prepare and gather their resources and support people around them, including making a plan for how they would like birth to go, who will be there and what their roles will be.

In my first pregnancy, this part of my preparation included taking a Birthing From Within class, chatting with my midwives about when they would be there and asking my best friend if she would come as well. I never considered hiring a doula because, in addition to my partner and my best friend, I had not one or two, but three midwives. I figured I’d be set for support. I learned through first hand experience why, even with five loving, supportive people in the room, that a doula to offer continuous labor support might have been a good idea.

A doula is someone who is knowledgeable about normal birth and familiar with possible medical interventions in a way that most family and friends are not. She gets to know you and your desires before birth so that she can better help you when you are in the thick of it. In labor she can be a buffer or bridge depending on the need. She can translate from “obstetric” language to everyday language in the event that parents misinterpret doctors, nurses or midwives.

On the day of your baby’s birth your doula is someone who will remain with you continuously and whose role is unique. She is someone who will not be having a baby that day (or grandchild, niece or nephew). She won’t be watching a loved one in pain and isn’t likely to be overwhelmed by the resulting combination of high running emotions and exhaustion common for laboring parents. She is someone who will be on-call for you, get to know you, who will accompany you through the whole process and who will not be attending dozens of other births that week or that month.

Even if your midwife or doctor can be on call for you, your doula will be there to attend to your emotional and spiritual well being in a way that your midwife or doctor simply will not.

The beauty of continuous labor support from a doula is that it can look however a laboring mother needs it to look. For one woman this might mean a constant companion there to hold her hand and speak words of encouragement and reassurance through each contraction, then wipe the sweat from her brow, and stroke her hair in between… and for another it might mean a trusted presence knitting in the next room, holding the space, listening and keeping watch, at the ready if needed, but out of sight and earshot in order for this woman to have the privacy she needs to birth in her own body. Both are forms of continuous support. For many mothers, the support they instinctively want and need shifts through the course of labor depending on where they are and what else is happening around them and, ultimately, may include a combination of a little bit of both of these ends of the spectrum.

For yet another woman, the term continuous labor support could mean having a person there solely for the purpose of backing up her husband or partner – offering reassurance, water, and suggestions to her partner as he or she stays physically and emotionally in contact with the mother. Sometimes a team approach works best and a partner can remain in front of a laboring mother maintaining eye contact, while a doula provides massage and counter pressure on her back or hips from behind her. It’s the mother’s facial expressions, body language or directly spoken requests that tell her doula what support she needs in any given moment.

On the day your baby is born, your doula will most likely be the one and only person in the room in that in between space who can understand what is happening from multiple perspectives. She will work to get to know you to get a sense of who you are emotionally and spiritually as well as what fears and hopes you have for your labor, birth and postpartum period.

A doula is also familiar with terms of midwifery and obstetrics. She knows her way around a labor and delivery room and can be trusted to explain medical terms or proposed procedures. Yet she isn’t a part of the medical staff and influenced by the powerful force of a hospital’s or particular practice’s work routines and day-to-day rhythms and expectations for birth. Most importantly, she is someone who is comfortable with and knows birth and knows the value and benefits of the unique kind of continuous labor support she offers.

Midwives and doctors must focus on fetal and maternal health and safety and may not be able or inclined to consistently attend to a mother’s emotional needs – especially if she wants more support early on before “active labor” has begun.

Friends who offer loving support but are unfamiliar with or at all wary of birth, can miss how important it is that support begin early in labor and be continuous. They can also be unprepared to help parents make difficult decisions along the way – during active labor and pushing as well as in the immediate postpartum period.

And partners who remain present throughout with no one else to back them up can get exhausted or emotionally overwhelmed.

Each of these possibilities were in fact realities in my first labor and birth. It seemed fitting then, that at my second birth, in addition to loving family and friends, I had not one, but two doulas (and just one midwife). My doulas offered me what I now understand was the invaluable benefit of continuous labor support.