Monday, July 23, 2012

Courage under fire.

And oh, the fire I'm sure there will be.  I want to rant here, a moment, about something near and dear to me.

"Medwives" versus "Midwives."

Now, before I get started, I want to acknowledge that there are exceptions to both sides, and more than one or two.  I have met lay midwives that have attended more births than two OB's combined, who are very knowledgeable than said OB's.  I have met nurse midwives who couldn't figure out which end the baby was supposed to emerge from.


I firmly believe that nurse midwives are the way to go.

I believe in home birth.  I believe in taking back your birth.  But I'm also a realist.  I KNOW that things go terribly wrong.  I know that in those moments, the difference between the education a CNM has versus that which a CPM has can mean life or death for one or both patients, mother and/or child.

"But Mama Jackie, you wanted to be a midwife.  How can you say such things?" That's just it.  I never wanted to be just a lay midwife.  I wanted to be a CNM, with my ARNP, practicing in a high-risk HOSPITAL environment.  I wanted to work cohesively with an OB who was similarly minded, with the ideal of giving a high-risk mother the option to have a more personalized, transparent experience.

Now, don't throw Ina May Gaskin in here.  Yes, she's a lay midwife, but she's attended over a thousand births, and not only has she worked within the medical community, she has developed a model for resolving shoulder dystocia during vaginal birth that is taught to every OB practicing.  She is an exception, and there are very few lay midwives that even pale in comparison, let alone come near her wealth of knowledge.

Let's look at a situation close to home here, and the comparison between how a CNM would be able to handle it and how a LPM would be able to handle it.

Post-partum hemorrhage.  Without going into textbook citations, the steps for management are as follows: External massage, internal massage, administration of antihemorrhagics, fluids, transfusion.  A CNM would  be licensed to have those antihemorrhagics on hand.  Those include Oxytocin/Pitocin and Tranexamic Acid.

PPH can become fatal in as little as five minutes.  In this situation, the attending practitioner must be well-trained in such a trauma situation and be able to assess and act quickly.  A LPM would not have received the clinical experience to efficiently deal with such a complication.  The insertion of an IV alone by a LPM, if they did happen to have those drugs on hand, could take up to five minutes alone as they receive little to no training in venipuncture in most cases.

Think, mamas.  Think about the pro's and con's, and remember that not all midwives are created equal.  Is it worth the life of you or your babe?


  1. There are no CNM's in my state (midwifery is "alegal", meaning that there are no laws for or against it). But I did choose to go with a midwife who had been an L&D RN for fifteen years before becoming a CPM.

    I also know that in this state there are many CPMs who illegally carry meds because of PPH issues. Reason to vote for legalization, I suppose.

    1. Reason to vote indeed. Like I said - there are exceptions. I just get so frustrated when I hear "My lay midwife is better than your medwife because she's in touch with her instincts, and doesn't need the indoctrination of intervention that comes with western medical training," or a variance thereof.