First Trimester Thoughts
Nope, I'm not pregnant. (For that first trimester post go here). I'm wrapping up the first three months of my midwifery apprenticeship at the Concord Birth Center and wanted to take a moment to consciously reflect on what it's been like and what I've learned.
To become a community midwife (a midwife who attends births outside of a hospital, so, in homes and in free-standing birth centers), there are a couple of different routes. I'll say a little bit about the track I'm on and why I chose it.
Community midwifery training in the United States basically follows one of three paths:
attending an accredited midwifery school and apprenticing with a midwifery practice
attending a non-accredited midwifery school and apprenticing with a midwifery practice
self-study and apprenticeship
Community midwives can either become certified (Certified Professional Midwife, or CPM) or not, in which case they would have to apprentice with another certified midwife. Some states, like New Hampshire and California, require state licensure as an additional credential. For more details on becoming a CPM and the different routes, see the National Association of Registered Midwives (NARM) page.
I decided to attend an accredited school and to pursue CPM status and, if we stay in New Hampshire, state licensure, for a couple of reasons. First, even if we don't stay in New Hampshire, the legal winds seem to be blowing in the direction of states' requiring that midwives hold CPM status in order to practice (and note, community midwifery is still illegal in some states). Even though the cost was significantly higher than a non-accredited program, I decided that, down the road, the cost to me could be even greater if I had to backtrack and re-do my education or have to make a difficult choice between serving someone legally or underground. I have no issues with underground midwives, but I'm not someone who could practice that way with confidence.
My midwifery training first started four years ago through a non-accredited community based program called Womancraft Midwifery in Amherst, MA, which allowed me to dip my toes into midwifery without having to break the bank. I liked midwifery and wanted to keep going. I began attending births in Massachusetts with a midwife who chooses not to be a CPM, and over the course of three years learned a ton about compassionate, continuous-care midwifery in peoples' homes. But, because she doesn't hold CPM status, those experiences didn't "count" towards my certification. They did nonetheless contribute immensely to my own learning.
Two years ago I enrolled in the National Midwifery Institute, an accredited distance learning program. A year ago, I sent out feelers to local certified midwives to inquire about apprenticeship opportunities. I also got involved with my local midwifery organization, the New Hampshire Midwives Association, and now serve as their outreach coordinator. For students seeking an apprenticeship, it's so critical to get to know the community and to let yourself be known. Word of mouth is key. Showing up is important.
Three months ago I started at the Concord Birth Center. For the first month, they had me attending prenatal and postpartum appointments so that the families could have a chance to get to know me before I started attending births. In April, I began attending births as an as assistant midwife, and since then, have been to nine births; two at home and seven at the birth center.
To become a certified midwife, the process looks like this (from the NARM website):
10 births in any setting, in any capacity (observer, doula, family member, friend, beginning apprentice).
Phase 2: Clinicals as Assistant Under Supervision 20 births, 25 prenatals (including 3 initial exams), 20 newborn exams, 10 postpartum visits as an assistant under the supervision of a qualified preceptor.
Phase 3: Clinicals as Primary Under Supervision 20 births, 75 prenatals (including 20 initial prenatals), 20 newborn exams, and 40 postpartum exams as a primary midwife under supervision.
I had already completed my ten observe births and began by attending births as an assistant under supervision. So what does that look like? We have another student who is currently wrapping up her primary births, so my role is to support her, to chart what's happening, bring the midwife anything she might need (hand me a washcloth, hand me a stethoscope, etc), do cleanup, take care of the family as needed, take vitals, fill out paperwork, and so on.
Because it's a birth center and we do so many prenatals, I quickly finished my requirement assisting 25 prenatals and have been attending prenatals as a primary midwife under supervision. This means that I lead the appointment, asking questions about how the pregnant woman or person is doing and feeling, whether they have questions, what they're eating and drinking, how they're sleeping, how they're moving their bodies, how we're collaboratively planning for their births, and so on. I palpate and measure their bellies, I feel their babies heads and butts and little feet kicking me through the layers of muscle and skin, I listen to their heartbeats and take mama's vitals and sometimes draw her blood and send off the labs. I explain options and offer choices and support her and her family in their decisions. It's fun. I really enjoy getting to know people and feeling the awareness of them as a whole person deepen over time.
By the numbers:
138 prenatal appointments (26 of which I've led as the primary midwife under supervision)
20 postpartum appointments
10 births, one of which I caught
8 newborn exams (I missed one in order to rush off to another birth!)
9 blood draws
1 pap smear
1 night spent on the green velvet couch at the birth center
1 set of 3 births in 24 hours and 2 sets of 2 births in 24 hours
2 breakfasts from Tuckers, which the midwives order from when it's been a long night
1 walk in the woods behind the birth center
And just checking in with where I'm at emotionally, honestly, I feel very, very happy and very, very lucky. I love long days at the birth center, with lots of appointments and lots of learning. I love learning from the midwives and the soon-to-be licensed midwife that I work with, and I'm grateful to them for their patience and teaching. I'm also grateful to my husband, who hasn't made any fuss about me having to leave him on toddler-duty short notice. I watch the time passing quickly (already three months! only nine left! oh no!) and know that when I wrap up my fourth trimester (because you know there are four, right?) I'll be in a different place from where I am now.
Tomorrow is the first day of Ramadan, which means that I'll be fasting from about 3:30am to 8:30 pm for the next lunar month. I did it with a nursing baby, I did it with a toddler, so I'm used to going into Ramadan with a bit of anxiety about whether or not I can come out of it in one piece, and I always seem to surprise myself. This year is no exception. Can my head stay on with the double whammy of missed sleep from births and Ramadan? Can I keep my stamina with an empty stomach? I think so. I hope so. I hope that it just opens up a new dimension to my work and attentiveness to what's being shown to me.
While I don't want to rush anything, I'm excited to see what the next three months bring.