Traditional Midwifery and State Licensure

Since admitting to myself last fall that I want to be a midwife, a new law has been passed in my state. It turns what was previously an a-legal (neither legal nor illegal, and completely unregulated) profession into one that will need to be licensed or face possible legal issues. Licensure was hard fought for by many midwives in the state who desire the [expected] safety of an officially legal status, and a board of governance  (composed mostly of midwives) that will set standards and review cases when things go wrong, as well as the possible privilege of prescribing a few key medications without fear of being accused of practicing medicine without a license. I can see the benefits here. I think I can.

And yet I’m not in favor. At least, I don’t THINK I am. That is to say that I want to be teachable. It’s possible that I’m not fully understanding all the implications of and positives in licensure, which is why I’m seeking out conversation with the midwives I’m aware of who championed this bill and pushed it through, so that I can hear their perspectives, being open to the idea that I’ll be otherwise persuaded. This means that what I’m about to share here is my perspective from where I now sit, and it may change with time and further consideration.

I’m pulled to midwifery for many reasons. But one thing that I love about midwives is the feminine. Women tend to have different ways of knowing things, and feminine knowledge originates in body and soul, it’s intuitive and evolving, it’s relational and connective. All the best of what women have to offer to the world is expressed in traditional midwifery. It’s one of the few remaining frontiers in which women’s way of knowing and doing haven’t been usurped by a more masculine and patriarchal structure of logic, reason, linearity, hierarchy and competition. Midwives are women serving women, and until relatively recent history, men didn’t enter into the spaces that they occupied, which were seen as women’s domain. So there’s something really special there, and really sacred, a rarity. The midwifery model of care — though it has of course changed over time in some small and some larger ways — is so completely other than the medical model. It is an entirely different beast, being measured by it’s own standards, reigned over by a different paradigm, and this is why I treasure it, and why I chose it for myself when I had my own babies.

Midwives have traditionally been chosen by their communities, recognized as having a gift and a calling to do the work of being with other women in childbirth, then apprenticed under another older midwife to learn the ancient wisdom of midwifery. Midwifery is not merely science, best practices and didactic education (though all of that has a place). In fact, the way to be a midwife has always been more about calling, and the equipping has come through what you could probably call discipleship — a process of coming along behind a teacher and learning to walk and think and act like she would. Midwifery is of women, for women, and by women. We serve one another in our most vulnerable moments, and we bring to the table not only our skilled hands and sharp, quick minds that have learned how to unstuck a shoulder, revive a baby slow to breath, or sever a cord, but also our spirits. We bring our intuition and our love to the table, we bring our sympathy as other humans who have walked the same road of transformation as the birthing mother who is currently receiving our help. We check our egos at the door, and we hold space so that a mother can find herself, her power and her knowing.

[Notice: I’ve stopped writing about midwives in the third person and have begun to use the pronoun “we.” Interesting.]

SO then, what happens when we take that old “system” of traditional midwifery and subject it to standards, paradigms, and structures that are fundamentally different? What happens to that beautiful and ancient way of walking with another woman through the most ordinary of miracles when we say it needs to meet medical standards and appease government regulations? Will it not inevitably begin to shift in spirit? Will it come to doubt its own wisdom and begin to look more and more — in tiny and at first imperceptible ways — like medicine? Will herbs and homeopathy and other ways of healing that are derived from God’s gifts to us in creation begin to be crowded out with prescription drugs? Will soft hands standing by in trust begin to be replaced by ones that are too busy, trying to actively manage a birth with tools and manipulations? Will research and evidence-based protocols begin to silence the intuition that tells a midwife that in this particular birth a specific and perhaps seemingly illogical action is really what’s needed for this woman and this birth?

Then there’s the question of the path to becoming a midwife that this law now requires to be taken if one is to be a legal/licensed midwife. For all of human history, the only “education” a midwife underwent has been apprenticeship until deemed ready by your teacher to be sent out on your own, or diving in because there’s no one else available to the needed work of helping women have babies. In recent decades, since certification came into the picture (which is different from licensure but a step in that direction), it has thus far been true that one valid pathway to becoming certified is what’s called the PEP process, which is entirely apprenticeship based, but requires specific documentation of births attended and skills mastered, followed by sitting for an exam called the NARM. However, with the new law, the PEP process will no longer be considered valid. The only way now to become certified and therefore also licensed is to obtain a midwifery degree from a college accredited by the MEAC. Apprenticeship no longer has a role (as of January 1, 2020) in the making of midwives. I mourn this! It really troubles me.

I have never believed that a good minister/pastor is made by seminary. It’s not to say that seminary cannot play a part in the making of a good pastor, but seminary alone actually has a tendency to turn out a lot of cerebral, proud, and out-of-touch managers of institutions we call churches, rather than the fatherly shepherds of grace to human souls we would hope that they would be. Similarly, with midwives, a head full of book knowledge and many tests of memorization plus some clinical experience does not make a midwife, as it doesn’t touch her soul or her very way of being. A midwife is made by God’s call on her life, by the sort of woman that she is, by the life experience she has and the wisdom she’s accrued through her life, and by the teacher whom she’s followed and imitated. Why would we do away with apprenticeship? Removing it is another example of making midwives via the avenues through which doctors are made. But a midwife is not a medical professional, just as birth is not (usually) a medical event.

In light of all of this, I have choices to make. Tim and I need to hash things out, discerning what is right for our family’s future. I need to converse with the midwife under whom I plan to apprentice to see if we can be on the same page. Most importantly, I need to hear God’s voice and instruction telling me which way to go. I can tell you what my heart (and spirit?) is inclined to do, but because it flies in the face of law and logic, I am taking a long and prayerful pause before taking a step.

 

But What KIND of Midwife?

worlfman-birth-8-14-16-115-of-305There are my kinds of midwives, each who have taken unique paths to become the sort of midwife that they are. Behind each sort of midwife there is a different philosophy, differences in training, and even more differences in the personality and natural inclinations of each midwife.

Because of my birth photography work, I’ve gotten to witness first hand many unique midwives at work. And they all amaze me. Midwives are incredible women who all have self-sacrifice, passion, and skilled hands as common characteristics, whatever other differences there may be between them. They’re also usually just really soulful, fun, and interesting people to spend time with, and I feel seriously SO lucky to get to be around them as often as I have been! I’m so encouraged to know that even in my mid-size city there’s a pretty good diversity of options for midwifery care. In Grand Rapids we have certified nurse midwives (CNMs) who work in hospitals, birth centers, and even homes. We have certified professional midwives (CPMs) who work in homes and birth suites. We have direct entry midwives (DEM) and lay midwives who work only in homes (and somewhat under the radar). Each one has a specific pregnant mama niche of women who need what she offers, and who will click with who she is. This diversity is awesome, because birthing women are diverse. For the entire community of midwives to be able to celebrate and champion what her sister-midwives bring to the table will only serve the greater good for all.

So as it comes time to make decisions about what sort of midwife I will become, and what path I’ll take toward that end, I want to be clear that I’m in no way making a claim to have found the best or most ideal path, nor chosen an option higher than the other options. I most sincerely do NOT believe that.

Rather, the path and type of midwifery I’m moving toward is “right” only insofar as it authentically lines up with my values/perspective, my personality and orientation to the world (an enneagram type 4, an INFP, a Christian) and the life experiences I’ve had (holistic health lifestyle, home births for all my babies, inner city ministry and community living, etc) and the training I’ve received that may serve me as a midwife also (a master’s degree in counseling, a health coaching certification from an integrative nutrition institute, years working for a naturopath/chiropractor, being a creative entrepreneur and a birth photographer) and even the life situation I am in (married to a pastor, raising 4 very small kiddos, living in the city). My job is to look at all those pieces listed above, plus the guidance of the good Shepherd with resolution toward obedience to it, plus the direction in which my heart leans… and to continue to walk in way that corresponds with all of that.

And here I’m about to get more technical than some will care to attempt tracking with, but my inclination is as such: to pursue a self-directed distance education program designed to adequately intellectually prepare me to sit for the NARM exam for certification as a professional midwife (if I decide to pursue certification at all, which is currently not legally required in MI), while also apprenticing under a second-generation midwife with the CPM credential, receiving my hands-on experience and in-the-moment learning from the wise  woman ways she is uniquely prepared to impart to me.

On a deep and intuitive level, apprenticeship-based midwifery training resonates with my core. It makes so much sense to me that elder midwives teach the younger ones through close, life-on-life “discipleship” over a myriad of experiences and across years. I’m excited to gain the kind of learning that only can come from watching and doing alongside someone practiced and passionate in her work, someone who learned her ways from the wise women with whom she herself once apprenticed in a similar fashion. Women have unique ways of knowing, and they possess secret insight into female health and birth that I frankly don’t believe men or science ever will fully “get.” So though I do not want to be dismissive of scientific study or evidence-based practices, I want to get a really healthy dose of the more womanly and intuitive way of transmitting knowledge, skills and wisdom!

Then, because I actually love book learning and research and desire to be fully equipped with vital information, I’m also going to apply for an educational program that will provide guidance and accountability as I wade through all the massive amounts of books and studies and information that there is to know. There will be text books, quizzes, exams, homework and all the trappings of “university study,” minus the degree. This more “traditional” education will be a great counter-balance to the apprenticeship. Between these two pieces, I feel like I’ll be given a beautiful training! It will work with my values, my style of learning, and my limitations and goals (both practical and financial), as well as utilizing existing relationships that I deeply value (as in the one I already have formed with the midwife who will be my preceptor/teacher and other midwives who have shown interest in and invested in my journey thus far).

And so in 5-8 years (??) I imagine emerging on the other side of that with a realization that has gradually sunk into my bones: that I have become in my heart and spirit a wise woman, a midwife… as well as possessing some standardized measurements to prove that I’ve acquired a certain standard of education.

What a feeling of accomplishment and joy it will be to walk forward into the world with those credentials — both tangible and intangible – and to offer it all up as a love offering to women and babies and their families, and to my Jesus.

I can’t wait.

But for now and for a long while yet, there’s the process. God give me patience for and delight in every step.