In New Hampshire, “CPM” is the
designation for a direct-entry, non-nurse-midwife. These are highly
trained, licensed professionals who attend statistically low-risk births in homes and
independent birth centers. Nurse-midwives can attend births in these
locations as well, but typically work in hospitals. Both embrace, at
least on paper, the whole person, midwifery model of care. To become
a CNM, one must first be a registered nurse, then train as a midwife.
A year and a half ago, I began a
two-part post detailing why I intended to be a nurse-midwife. The
first part was meant to explain why I was pursuing midwifery, the
second part, why I had chosen the nursing route to get there.
Mysteriously (or not) the second half was never written. Go figure.
Switching to a CPM track has been a
nagging idea that has popped up at inconvenient times for several
months now. Wrapped up in it are many conflicts about the way I view
pregnancy and birth, wondering what babies really need as they enter
the world, what mothers need as they become mothers, plenty of
struggles regarding the integration of family and personal calling,
and an ongoing disgust with the mismanagement and impersonalization
of healthcare. Oh, and that whole emergent birth, preemie care, NICU
stay firsthand experience thing.
So yesterday, I wrote a long post
detailing all my über-logical,
black and white reasons that I finally decided to make the big
switch. I wrote for a good chunk of the day, yet I just couldn't seem
to wrap it up properly. Yesterday I couldn't figure out why, but now
I think I can.
When I was first working through my
postpartum anxiety, my therapist asked what drew me to birth work in
the first place - it almost doesn't fit with my Type A personality
(my words, not hers). After a long pause, I shrugged and said, “It
seems really chaotic and beyond our understanding, but it usually
just works itself out. It's like chaos with an underlying order to
it.” Whether birth is entirely straightforward or complications
arise, both the mother's body and the baby's have an inner wisdom
that goes beyond what science has been able to identify, and certainly beyond what medicine has been able to manage. It starts
with conception – no, even with the cycles that precede it. Our
bodies have an incredible, mysterious order that connects us to the whole earth, to the skies, even. And dare I say to God? Yes,
giving birth made me feel a much deeper connection to the God who
made the universe, and made me, and my husband, and my babies.
Disagree with that all you want, analyze it to death, but it did. And
birth gave me a deeper connection to myself, too, which is arguably
just as important.
Science is amazing. I live in awe of
the knowledge that's been obtained, of the nuances to these things
that have been discovered. The hormonal cocktail that floods the
brain, the physiology of the stages of labor, a baby's innate
protective reflexes. The amount that we understand about this very
mysterious act of making and supporting new human beings is
impressive. But science isn't all there is. Direct-entry midwifery
has been referred to as embracing the “art and science” of birth.
And, as much as I take issue with any philosophy that claims birth
works out 100% of the time - so much so that really, who needs a qualified
attendant there anyway (ARGH!) – I do believe that birth work
involves a necessary element of trust in the process. Extensive
knowledge, yes. But with a very, very healthy dose of trust.
In nursing school, I felt the art of
care and trust in the body being taught out of me. This is not the
case for everyone, and there are many, many wonderful nurses and
nurse-midwives who are able to embrace both the art and science of
traditional nursing care with ease. When I began the program, in
fact, I was thrilled to learn that nursing is considered its own
discipline, separate from medicine, and by definition it requires
whole-person care. On paper, it looks like the perfect compliment to
birth work.
But my
experience thus far has been the complete opposite. My learning style
is largely kinesthetic – I learn by doing, not by talking about it,
so what the books say is less significant to my development than what
I do in clinical. And what I'm required to be doing
involves very little trust, and minimal appreciation for holistic
care. The nutrition standards are out of date by decades; herbs are
portrayed as dangerous things to avoid, rather than potent
supplements to understand; and there's a med for everything (or
rather, for every symptom).
Doing poorly? Here, take pill. Oh, you're taking good care of
yourself? You're not quite where we'd like to see you yet. Here's a
prescription. Big Pharma continues to have a disturbing hold on
healthcare, and nursing is no more immune than any other element. I'm
tired of feeling so frustrated.
The
evidence supports exercise and a whole foods diet as not only
prevention of but even treatment for heart disease, Type II diabetes, and (of
course) obesity. It's in all my textbooks. I have yet to see these
recommendations make it into practice. We just tell people no salt,
no fat, and no red meat. And for the second time I'll remind myself –
you probably don't want to hear that rant. Suffice to say, pregnancy
and birth are no more immune to this archaic approach than any other – ahem - “medical
condition.”
So.
Anyway. I'm not going back to nursing school. (Gee, that was rather
anticlimactic, huh?) Instead, I am working toward becoming a CPM, a direct-entry midwife who attends low-risk births in homes and birth centers. I
have not yet decided which route to take toward NARM-certification. There are a variety of options, all of which have significant
pros and cons. Nor have a decided on my timeline. Anxious as I am to
get started, I can't help but agree with the stance put forward by
Elizabeth Davis and Carol Leonard in The Women's Wheel of Life, that midwifery,
in traditional cultures, comes after
motherhood – that is, there are significant benefits to waiting
until small children are older. In the coming weeks, I'll be talking
to some local midwives about what apprenticeship would entail, and
whether it's something I can take on now or should put off for a few
years. In the meantime, I'll be training and working as a birth doula.
Nursing
school was a valuable experience for myriad reasons. I'm grateful to
have done it. But when I made the decision not to go back, I felt the
proverbial weight lift off my shoulders. Nursing school was like a
worthwhile detour that temporarily took me off the path I'm meant to
walk, and now I am beyond thrilled at the opportunity to get back to birth work without reservations. I'm done with predicting the details of what this
might look like – that never works out the way I expect. But getting back on this path is exciting, and I can't wait to see where it takes me.
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