Saturday, March 01, 2008

Midwifery education

Kneelingwoman's post on midwifery education (What Have We Got to Lose?) has inspired Navelgazing Midwife to reflect on the same issue. In Midwifery Education a long and detailed post, and she raises important issues.

On the value of nursing education and training:
Twenty-one years ago, I met Mary Carole Akers, a Certified Nurse Midwife in the Army and talked to her about becoming a midwife ... I whined about having to do all that nursing crap... geriatric care, tending to post-op patients, blah blah blah... B-O-R-I-N-G! Why did I have to listen to a thousand hearts and lungs that had nothing to do with listening to a newborn? Wisely, she looked at me and said, "When you listen to a thousand normal hearts, you quickly learn to distinguish the not-normal one." Snap!...
On whether birth at home is any different than birth in the hospital:
When I was just beginning to do homebirths, midwives around me arrogantly (I believe) told me that my experiences in hospitals and birth centers needed to be set aside as I learned homebirth midwifery. Their belief that birth was different in the home always made me turn my head sideways and say, "Huh?" ... I found that, generally, birth is birth and homebirth isn’t all that dramatically different than hospital or birth center births.
On learning midwifery by apprenticeship:
Honestly? An apprenticeship is only as good as the preceptor. And I’ve met some really crappy homebirth midwives and wonder how their students/apprentices are going to make it as primary midwives. Will they learn how empty their apprenticeship was when they encounter complications they never anticipated in the homebirth setting? At least a midwife in midwifery school is exposed to many different preceptors. If she encounters one that is less-than, she can dismiss her stupid teachings and move on to the next good mentor.

Many cities have a "homogenous" homebirth midwifery community because one apprentice becomes a midwife who takes on another apprentice who becomes a midwife who takes on another apprentice... the single-threaded line continuing without dilution from outsiders to alter the course of education or training. Unless outside influences, either from new midwives or from a midwife or apprentice venturing out to experience birth in other places occurs, the sameness can be quite limiting to the moms in those midwives’ practices...
On the differences between CNM and CPM training:
I have a (radical) belief that LMs and CPMs will be phased out over the next few years. I believe that as more women get licensed (and there are around 1300 CPMs compared to over 7000 CNMs) the legislators and attorneys will see how inadequate our education really is...

a. 10 Preconception care visits (compared to none for CPMs)

b. 15 New antepartum visits (compared to 20 for CPMs)

c. 70 Return antepartum visits (compared to 75 for CPMs)

d. 20 Labor management experiences (compared to 10 for CPMs)

e. 20 Births (CPMs [tend to] use the same 10 whereas the CNMs I have asked have said the births are separate from the Labor Management experiences. So, 10 total for CPMs compared to 40 for CNMs)

f. 20 Newborn assessments (same as CPMs)

g. 10 Breastfeeding support visits (0 for CPMs)

h. 20 Postpartum visits (0-7 days) (Compared to 40 for CPMs – add i. for CNMs)

i. 15 Postpartum visits (1-8 weeks) (Con’t. – When added to h. = 35 for CNMs)

j. Primary care visits:

1) 40 common health problems (0 for CPMs)
2) 20 family planning visits (0 for CPMs)
3) 40 gynecologic visits including perimenopausal and postmenopausal visits (0 for CPMs)

= 300 separate patient interactions

Anyone arguing that CPMs have equal education or experience at the beginning of their careers is wrong. The numbers prove this. Are some CPMs and LMs phenomenal? Of course! Could they be better? You bet...
Navelgazing Midwife has reached a decision:
I’ve enrolled in school.

I’ll be 47 years old this month and it might take me another several years to get through Nursing School before I even catch a whiff of Midwifery School, but I am going to walk towards that CNM – or die trying. I’ve wasted 20 years wishing; it’s time I lived it...

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