ChicagoDoula » midwives

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

Why a Doula is Better Than Your Best Friend

Amy Catania — Mon, 23 Nov 2009 09:20:55 +0000

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.

Homebirth Safety Act Update – And Pictures!

Amy Catania — Thu, 26 Mar 2009 21:48:27 +0000

Despite a setback earlier this month, and what this article might lead you to believe, Rep. Julie Hamos and the co-sponsors of the Illinois’ Home Birth Safety Act, HB 226, are still working on getting the bill passed this session. They need all the help we can give them to turn legislators’ “no’s” into “yes’s”.

If you live in Illinois, please let your legislators know that you support HB 226 and women’s right to give birth where we choose. You can go here to find out who your state representative and senator are and get their phone numbers and mailing addresses. For tips and talking points you can refer to info here and here. This bill needs ALL the support we can give it, so please understand – I am asking YOU to join me and do this!

As an incentive, I finally finished going through my pictures from the road trip I took with my kids to lobby for the bill earlier this month. (Thanks to Kathleen, for helping me figure out how to post them). The photos aren’t going to win any awards (except maybe one that Elijah took). But they tell the story of the day, so have a look at them and then support the effort and call and write your legislators!

Roll Call and Next Steps

Amy Catania — Wed, 04 Mar 2009 19:39:34 +0000

I promise to write about the road-trip-to lobby-with-children part of yesterday and upload the pictures as soon as I am done sorting them.

As far as the legislation goes, here is the roll call for the vote to pass HB226 out of committee yesterday:

Yes:

Mary Flowers

Keith Sommer

Mike Zalewsk

Julie Hamos (subbing in for Esther Golar)

No:

Greg Harris

Will Burns

Lisa Dugan

Karen May

Mike Connelly

Joanne Osmond

Rosemary Mulligan

Tim Schmitz

There is re-grouping happening to decide next steps, but what is clear today is:

- Rep. Julie Hamos deserves tremendous appreciation and support from all of us who support this effort, because she has gone all out to make it possible for women in Illinois to have the choice to give birth at home.

- We have our work cut out for us to turn these nos into yeses! If we are to succeed, we must talk to representatives across the city and state. If you haven’t done so, please consider calling, writing a letter to your representative – or even better, go to see them and give them information about why a mother might want to birth at home vs. the hospital and ask them to do every thing they can to support this bill the next time they see it. You can look up your legislators here: http://www.ilga.gov/ If they are a supporter already – please thank them!

If you want to call, write, or visit and haven’t gotten around to it, please let me know and I will help!

What I Wrote Before Collapsing Into Bed Last Night (reposted from Facebook)

Amy Catania — Wed, 04 Mar 2009 16:17:37 +0000

We are home and settling in. The hearing was packed and the hallway outside was lined with mamas and babies and kids and dads. I was barely able to get into the room but was able to speak to two Reps in person beforehand – Rep. Osmond, who just doesn’t get it and was not open to hearing new information at all (but was very sweet to the kiddos) and Rep. Currie who is the House Majority Leader (but not on the committee) and is doing all she can (and was even sweeter to the kids).

But it didn’t have the votes. A few of the reps really showed that they don’t understand why women want to give birth at home and why midwives don’t “just go to school to be nurses.” So, despite the tremendous showing, and a two-hour hearing with lengthy questions and answers – including supportive MD testimony, the bill was not passed out of committee. We needed 3 more votes. Yet, there were signs of progress with some of the committee members and potential openings and next steps. More tomorrow – w/ pictures!

“Mother of All Rallies” Tomorrow!

Amy Catania — Mon, 09 Feb 2009 22:30:04 +0000

Join homebirth advocates in Springfield as we let legislators know how much we need midwives in Illinois:
Tuesday, February 10, 2009
Illinois State Capitol
S 2nd St & E Monroe St
Springfield, IL 62701
11 am – Stratton Building Cafeteria

For more info visit: http://homebirthishealthy.org

Homebirth Safety Act Update

Amy Catania — Tue, 13 Jan 2009 22:19:19 +0000

Happy New Year!

Sadly, Illinois’ legislative session has come to a close and the Homebirth Safety Act – SB385 – did not make it out of its committee. A new session has begun and now the bill starts over. Stay tuned to find out if it keeps the same number. In the meantime, if you have not contacted your state legislators (senators and representatives) to let them know that you support licensing direct entry midwives, please do!

Update Part II: We have a new bill and a new number for the Homebirth Safety Act: HB 226. For more info on advocacy and the Srpingfield rally visit Illinois Families for Midwifery.

Action Alert in Illinois

Amy Catania — Tue, 30 Dec 2008 21:40:47 +0000

Work to license direct entry midwives in Illinois has been happening for many, many years. The state nurses association has recently changed its position to neutral on the current bill in the legislature – which is a hugely positive development. This could be the moment we make it happen!

If you support the option for pregnant women in Illinois to have safe homebirths with midwives of their choice, please take a moment to look up and call your state representative to ask him or her to vote yes on SB385 in the last two days of this session: January 12th or 13th. Please also consider joining the two-day rally in Springfield to show your support in person.