Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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Updates Galore!

I have made it past the 3 month mark…it’s hard to believe it’s only been three months. Almost four now, but still…

Here are some highlights and lowlights from my world these days…

1. Looking forward to the Socialism Conference.

It’s this weekend — an extended conference this year, it started today. But I can’t take any days off work until my six month work anniversary, so I’ll only be attending Saturday and Sunday. Here are some talks and featured events this year that I’m looking forward to:

Special Education & Disability Rights

Marxism and indigenous feminism

Women, race, and class: A history of Black feminism

Who needs gender? A Marxist analysis

Capital’s missing book: Social reproduction theory and the global working class today

Who cares: Work, gender, and the repro­duction of labor power

From criminalization to “rape culture”: Re­thinking the politics of sexual violence

From restrictions to criminalization: The fight for reproductive rights today

Capitalism, socialism, and mental illness

What should socialists say about privilege checking?

Microbes and Marxism: Capitalism and public health

“Obamacare” as neoliberal health care reform

…OMG there is so much! Obviously won’t be able to make it to all of those sessions, but those are some of the ones I thought might be of particular interest to readers, and which speak to some topics I’ve been thinking about/excited about lately.

2. I’m sick of the judging.

I feel like everyone I work with is burnt out and cynical. I’m sick of victim blaming, slut shaming, poverty-ignoring, moralizing attitudes coming from people I work with. Especially the OB I work with. It’s poisonous, and trying to figure out how to respond with fierce compassion. Patients and staff deserve to feel human. 

3. Getting into the hospital…

This will of course bring new challenges. Now, I kinda have it good. Getting used to being in clinic full time, getting to know my patients, learning what basic and expanded skills I need to have for clinic. But it will be nice, come September (fingers crossed!), to have hospital privileges so I can actually start to be present with my patients in the hospital. I still have to have a bunch of deliveries supervised by the aforementioned physician, and hopefully by some midwives I’ll be working with, but it’s good to know it’s on the horizon. 

4. Got a rad shout-out by the fabulous Feminist Midwife!

My friend, mentor, and trail-blazing hero over at Feminist Midwife gave me and a fellow red midwife a lovely mention in her recent post here, honoring the work of sharing the journey via the blogosphere. Thanks, FM!

5. Feeling appreciated

Though every day is emotionally and clinically challenging, it is also rewarding. I am feeling every day that I make a difference when I provide good care, and I can see it in my patients’ faces and in their continuing to come in for care and opening up to me. Another perk is outside of clinic — being known among friends, fellow activists, and family, as someone who knows some things about reproductive health — and who can be trusted to ask about it. Maybe it’ll get old one day, but I doubt it. I love those calls/texts/FB messages about family planning, pregnancy, and sexual health. So, thank you to those folks who have come to me with those questions, and I hope I have been helpful. 

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Why You Should Choose a Nurse-Midwife for Your Pregnancy/Primary/Well Person Care

When I started on this path, I was in my mid-twenties. None of my close friends had ever continued pregnancies or chosen to parent. This is partly why midwifery had never occurred to me as a career at that stage in my life — none of us were in that place in their lives. But now that we are approaching “AMA” or “advanced” maternal age, or the ripe old age of 35 (haha), many of my friends are now starting families (or trying to). Lucky for them, they now have a midwife friend! 

So, this is an open letter to all my baby-making (and aspiring baby making) friends and family. 

My basic advice/message is:

Choose a nurse midwife for your pregnancy care!*

Here are 5 reasons why many pregnant people should consider using a certified nurse midwife (CNM) as their prenatal care provider and birth attendant.

1. Client education and counseling

Nurse-midwives aim to spend time with our patients and get to know you. We want to know what is important to you and meet you there. If you want a provider to listen to you and to openly and without judgment respond to your concerns about pregnancy and birth, you have a pretty good chance of finding this in a nurse-midwife.

2. Supporting physiologic processes

This is a hallmark of midwifery care. Take initiation of labor, for instance. A midwife will take a holistic approach — to ensuring your due date is correct, to providing physiologic means of helping you go into labor on time, and choosing not to admit you to the labor and delivery unit until you are really in labor. All of these are part of an approach that supports the pregnant person’s ability to have a baby when it’s time. It may also mean helping you push your baby out to minimize trauma and tearing of the perineal muscles, and certainly avoiding cutting your muscle to make room for baby’s head or shoulders (episiotomy). 

3. Evidence-based practice (EBP)

From my first semester in nursing school, EPB was drilled into my brain. I can’t tell you how many papers I wrote about EPB…but I’m glad I did, because it instilled in me a drive to provide care that is based on rigorous review of current evidence and is patient-centered. What does this mean? A good provider (social worker/doctor/physical therapist, etc.) draws upon current research and literature reviews to determine how they practice. I am very proud that this is a centerpiece of nurse midwifery education and culture. Not that seeing a CNM is any guarantee of this, but it certainly something that most CNMs should be familiar with. The CNM professional organization put together this fabulous resource compiling data about how we use EBP – Midwifery: Evidence-Based Practice. Our practice is not (or at least should not be!) based on expert opinion, tradition, convenience, fear of malpractice lawsuits, or other provider-centered philosophies — but rooted in solid evidence and a patient-centered approach. 

 

4. Labor support!

The best midwives will support you while you’re in labor — not just leave you to labor on your own and then show up at the end to do the delivery. In some busy practices, that may not be possible, so I always encourage pregnant people to find out what their provider does. Midwives are trained in labor support, meaning they can help keep you active and can provide comfort measures that can help you out throughout the process. Unfortunately, many physicians do not (but should!) receive training in normal birth, and often do not know what to do to promote your comfort during labor other than offer drugs. Midwives understand that labor is hard work and can support moms through it. 

5. Greater chance of normal birth

According to a recent survey of research on midwifery, you are more likely to experience the following when getting care with a certified nurse midwife: 

• Lower rates of cesarean birth,
• Lower rates of labor induction and augmentation,
• Significant reduction in the incidence of third and fourth degree perineal tears,
• Lower use of regional anesthesia, and
• Higher rates of breastfeeding. (Newhouse, Stanik-Hutt, White, et al, 2011)

These are not reasons you should not use a nurse midwife

1. I want an epidural

If you choose to have your baby in a hospital, your nurse midwife can still order you an epidural, if that is the anesthesia/analgesia option of your choosing. 

2. I want to have my baby in hospital

No problem – the vast majority of midwife-attended births are in hospitals. You may not even realize it, but there may be midwives at your local hospital. 

3. Midwives don’t know enough stuff

So you may have heard that terrible slam Bill O’Reilly made about advanced practice clinicians (APCs, formerly known as mid-level providers, yech!) — worried that the increase in care by folks in these professions aren’t qualified be good healthcare providers. (Yeah, I know, my readers are big O’Reilly fans.) “Lenny from community college” couldn’t possibly be my provider, he said of physician assistants! (See the response from the American Academy of Nurse Practitioners here.) Even so! Many people don’t know what training we receive. O’Reilly’s ridiculous comments (among thousands he’s made over the years) aside, becoming a CNM is no joke. I’m proud to say that I have attended many community colleges throughout my education, but I also will report that CNMs are required to have a bachelor’s degree, be a registered nurse, hold a master’s degree, pass a rigorous certification exam, and become licensed through the state they live in as both a registered nurse and an advanced practice nurse. We are very well prepared to take care of people when it is within our scope of practice.

4. I want someone I can see always, not just when I’m pregnant

No problem! Loads of midwives work in settings where they can provide well woman, gynecologic, family planning, and even primary care. It depends on how the midwife’s practice setting works, but in many cases, you may be able to see your CNM across the reproductive lifespan. 

5. Doctors know best

Haha, I know no one reading this blog would think that. But I really ran out of reasons why you should not see a midwife. 

***

So…if you are low risk (not diabetic, chronically have high blood pressure, etc.) you may be a great candidate for working with a midwife! Get out there and FIND A MIDWIFE!!! And if there isn’t one in your area…well, shoot. Maybe you should get on the path to become a midwife, or tell someone you know who would make a great CNM to get on that path. We need more great women’s health providers. If you are feeling the call…better answer!

 

Reference:

Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nursing outcomes 1990-
2008: a systematic review. Nurs Econ. 2011;29(5):1-22

*Or your well person/family planning/gyne/primary care. More on “women” later…


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How I Got Here; Or: Why I Am a Nurse-Midwife

Now that I’m here, I’ve jumped through the hurdles of getting my degree, passing boards, getting licensed, and becoming employed, I thought it would be nice to reflect on how I got here. It’s easy to take for granted sometimes, now that I just wake up and go to work every day. But I’m doing what I set out to do! I’m midwifing! So…how did that happen?

Back in the day…

My background is in languages and literature. I studied English and Spanish in undergrad. Like many undergrads, I had no idea what I would do when I grew up…Like many women, I thought I was “bad” at science and hadn’t really taken myself seriously in that regard. When the nursing shortage blew up in the mid-2000s, my mom suggested I look into nursing. I didn’t really think it was for me. I had the old-school pre-feminist movement (and very middle class) idea about nurses as doctor’s handmaidens and couldn’t see myself doing it. But then I started looking into it, and taking my prerequisites for nursing school (adventures to tell of another day), and more and more found it seemed like the right next step for me. Hands + heart + science + possible unionism + healthcare activism…that I could get into.

I originally planned to be a WHNP. When I started nursing school, I had never attended a birth, and I really didn’t know much about midwifery. I liked the idea of working with women, but I didn’t want to try to get into a program/field that I wasn’t as passionate about. I knew folks who were planning to be midwives, and they were excited about Ina Mae Gaskin and doulas and home birth. But I was in my mid-twenties, and no one I was close with had had a baby yet, and these topics were remote from my experience. The abortion world was more my bag, and I knew that as a WHNP, I could possibly train to provide early aspiration abortion or at least do lots of cool family planning work.

Trust Women Tiller

Then, I fell in love with birth and also realized that, as I later saw expressed beautifully in the documentary After Tiller, trusting women and being pro-woman/pro-abortion was midwifery. The issues of birth and family planning and abortion are inextricably linked. And, from a practical standpoint, I realized that it made sense for me to provide pregnancy and birth care as well as the other family planning and gyne care I would do as a WHNP. Why hand off patients to another provider to attend the birth, when I could actually be the one to be there for the whole lifespan? So, during nursing school I asked the women’s health department if I could switch to midwifery. They OK’d me.

An Alternative Route

For a variety of reasons, my path to practicing midwifery has not been traditional, at least how it’s done “typically” by CNMs. According to tradition, an RN works in labor and delivery, then goes to midwifery school, then works as a CNM. When I finished my nursing program, nursing jobs in labor and delivery were hard to come by. I got one interview on a hospital unit but did not get the position. I applied to dozens of others. I also had put out my feelers for work in abortion care and managed to get a position through a student colleague connection, at the abortion service in the county hospital.

My first nursing position was a nightmare, but it paid the bills for my first semester of midwifery school and gave me valuable insight into the lives of women seeking abortion in fairly desperate situations. I then got a scholarship so I didn’t have to continue working as a nurse during my program, but it required me to complete it in two years. I babysat for a wonderful family and watched their family grow throughout my graduate studies. Then, as I was completing my final semester of my masters program, I landed another position in abortion care, which eventually turned into a broader family planning nursing role. That is the last job I held until beginning this current job.

After I passed my boards (got certified by the American Midwifery Certification Board), I again looked for jobs around my city. This time around, I had more interviews and got a lot more interest, but still, employers and even my mentors questioned if I could work as a full-scope (meaning: catching babies, not just working in the office) CNM without having worked as a nurse in labor and delivery. Some suggested that I should swallow my pride and try to get such a position and then try again in a year or two for a full scope  job. It was a full six months between my initial interview and my start date for the position I landed, and there were times that I considered this option. Luckily, this position came through, and I got to do things the way I originally thought I could (more or less).

Acceptance

What is midwifery? Is it only possible to be a midwife if you’ve been a nurse during hundreds of births, many of which were probably complicated or high risk? I don’t think so.

It’s hard being one of the handful of people who graduated from programs like mine, that allow you to graduate without having to work labor and delivery, having to prove that you belong and that you can hang with the more experienced nurses. But I am not alone, and I’m grateful for others who blazed the trail before me — whether they intended to or not.

Midwifery is a whole lot of things.* True, the only births I’ve attended are the ones where I was doing the baby-catching (or doing labor support in a few instances). I haven’t seen a ton yet. My career is young. I am humbled by all I have to learn. But I have also worked in women’s health for over six years, and have learned compassion and to not judge women’s lives and choices. Midwifery is trusting women, it’s listening to women, and it’s being present with women. You can’t learn that from a textbook or demonstrate that on a board exam, but you can show it in the type of care you give. I am confident that, as one quarter of women in the United States will have an abortion before the age of 40, my background in abortion provides a ton of useful clinical and emotional skills to be a good midwife. Good midwifery care has to include all phases of the reproductive lifespan, including abortion. (And hopefully one day CNMs will be legally allowed to provide spontaneous and elective abortion care in all states!)

Now

Tomorrow will mark three months as a practicing CNM, but I think I’ve been practicing the midwifery model of care for more than that. I respect that other midwives took other paths — and they may have done so out of their own necessities. I hope that as I enter the birth setting again in a few months, when I get my hospital privileges, I can continue to safely develop my labor and birth skills and humbly continue my journey with new mentors and teachers.

 

*There are, of course, other paths to midwifery outside of nursing. I respect direct-entry or certified midwives, but I don’t claim to know much about their paths. I can only speak as someone that went the CNM route, and know that non-nurse midwives have their own contributions to women’s healthcare that may differ from where CNMs might be coming from (e.g. Ina Mae Gaskin).

Socialism Conference 2014 – Coming Up in Chicago!

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Socialism BannerSocialism 2014 Promo Pic

I’m really looking forward to attending this year’s Socialism Conference, which I have been attending annually since 1997. I always learn a ton of history, theory, and current events, and get re-energized for another year of struggle. Unlike many conferences out there, it’s truly participatory and accessible. …

OH, and if you need some famous people in attendance who will be speaking, you can look forward to seeing there:

Glenn Greenwald

Amy Goodman

Howie Hawkins

CeCe McDonald

Liliana Segura

Wallace Shawn

Gary Younge

Dave Zirin

Jill Stein

The entrance for the whole weekend is very affordable, and worth every penny. This conference can change your life — or at least give you new perspectives on the challenges of the movements, insight to history from a working class lens, and lots of positive vibes from being around so many bad-ass and brilliant anti-racist, anti-imperialist, anti-capitalist, and anti-sexist folks for the weekend.

Hope to see you there, fellow feminists, activists, marxists, and curious folks who want to change the world.