Whether you turn to the right or to the left, your ears will hear a voice behind you, saying, "This is the way; walk in it." - Isaiah 30:21

Friday, October 5, 2012


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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