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So, You Want to be a Midwife?

Things you need to know about becomming a midwife
by Casey Makela, Published in The Calling, 1992

Do you want to be a midwife? Then first, let me tell you what you are not. You are not a “new-bee” or a "wanna-be". While these may be the current vogue definitions for some to label onto newly interested ones, I absolutely abhor them as disrespectful degrading terms that mock and can even discourage sincere interest.

Do you want to be a midwife? What you are in fact is this: an aspiring midwife. To aspire is to "have an earnest desire or ambition, as for something high or good". This is the correct definition of the calling you hear and your desire to achieve it; aspiring midwife. And may I tell you that you are a real treasure to the survival of the profession. Your interest in midwifery is what will preserve it for the next generation. You are not only important to the profession of midwifery, you are also a crucial link of birthing choices for women in the future.

Do you want to know the best part? Midwifery is an in-born female birth right, an intuitive instinct in every woman. It is just more evident in some than others. Would you be surprised to know you already are a midwife? You are, you just need to refine and nourish your desire! Welcome sister, your journey has just begun!

Now that we have cleared that up, the challenge begins. You've clarified the interest that your heart yearns for. Now you must begin the work of choosing your path. What kind of midwife do you want to be? Is this just an complicated question? No. You must decide where you want to begin so that you can follow through with a plan that best serves your future goals. The following information will be helpful to those in the U.S.

Midwifery in the United States is a complex profession with many facets of professional definition including: Lay, Empirical, Direct Entry, Traditional, Independent, Domiciliary, Certified, Licensed, Nurse and Professional.

These multitudinous delineations can be confusing at best, especially if you are new to all of this and you don't understand the issues. Where do you see yourself? If you want to be a midwife then you must clarify your long term goals.

Certified Nurse Midwife

If you are in nursing school or see yourself there in the future, then becoming a Certified Nurse Midwife (CNM) is probably the best route to practice for you. Becoming a CNM through an accredited college program of study is the only fully, nationally accepted avenue to midwifery practice today. CNM's work in hospitals or private practice. They are able to bill their services to insurance companies, they can gain liability insurance on themselves, they usually get benefit packages as part of their salary and can have employer supported retirement funds. So if you want all of that plus some measure of job security and clear job title definition, becoming a CNM is for you.

But what about all of the other midwifery titles to choose from?

Direct-entry or Licensed paths to midwifery have some form of legally structured definition in some states with educational programs to support them. Notice, that is some states, not all. Plus, what one state may accept for licensure, another may not. You can't take reciprocity for granted because there are states in which the practice of midwifery is clearly illegal and can be prosecuted as a felony charge of practicing medicine without a license.

Despite the legal perils, many still feel called to serve birthing women in a Home birth environment attending as a midwife. If that care provider (midwife) isn't state licensed through a program that their state actually recognizes, endorses and approves of, then no matter what the state-statutes are that define midwifery, she probably represents herself as a midwife within one of the following categories:

Direct-entry (this term is used with or without a license)
or just plain Midwife

All of these terms can usually be interpreted to mean that such a midwife has not been licensed or certified by a legally recognized agency of any kind. She came from a variety of legitimate educational backgrounds including apprenticeship, self-study, structured academic programs combined with an apprenticeship, or some other model of education.

Now, before you start to mistakenly believe that such a care provider couldn't possibly be qualified to attend births, think again. This nations foremost, authorities on midwifery and Home birth, who themselves are respected and known today in the broadest medical circles, practiced and taught for years as just this type of midwife and wrote popular books and taught at midwifery conferences. Their expertise was gleaned and refined without regulatory control of any kind and with no initials after their names.

How can that be? Because birthing women took responsibility for themselves and wanted better births for their families. Because the bottom line is whether or not conventional medicine and governmental agencies say otherwise, birth is a normal body function and midwifery is not the practice of medicine. The grass-roots midwives who are now looked at as experts proved it by practicing it with no letters after their names. This type of midwifery is still in existence today and always will be. But the issues are confused.

It is not so much that standard medical groups and associations don't recognize, endorse or respect community based midwifery care (falls into one of the categories above)...they haven't respected birth and birthing women, ever. Just take a look at antique obstetric books. Why should midwives feel singled out. The fact is, birth in the U.S. has become totally absorbed into the medical standard of pathology management. It is part of the medical machine that generates billions of dollars a year. Money. Birth is the #1 reason women are admitted into hospitals. Birth = Big money.

And now, to make it easier and more convenient on everyone involved, hospitals and doctors are selling epidurals like the Candy Man. Women are being lulled into surrendering their right to birth by the most effective lure modern medicine has ever cast; chemically induced pain free birth. Another test group begins. It won't be long before a women who refuses an epidural will be brought up on criminal charges of child abuse and neglect. No, it's really not that far fetched. Honest.

Certified Professional Midwife
In an effort to combat the harassment of midwives and create an avenue of Direct-Entry practice and definition, a new midwifery standard was developed, mostly by non-nurse lay midwives, set into place in the 90's and adjusted and refined throughout until it became The Certified Professional Midwife (CPM) program. It was created and established by NARM (North American Registry of Midwives)in association with the Midwives Alliance of North American (MANA) accredited by the Midwifery Education Accreditation Council (MEAC). These three groups were self created in cooperation with each other to promote and advance midwifery as a profession. They have done an extraordinary job.

But it must be made clear to aspiring midwives considering the CPM process that they will not be earning a professional title that is nationally accredited and accepted in the conventional health care industry as a recognized profession. The AMA does not support it. It is not the same as a CNM. The CPM certification is not always clearly understood by birthing consumers either and CPM's must be very careful about their personal representations. While it does not offer the professional benefits of becoming a CNM, it is another good choice of midwifery education.

What's in a title? Supposedly clear identity definition. Yet, some midwives adopt no letters or titles. Perhaps they are the most honest after all. They don't market. They serve their communities in a more spiritual sense allowing families to make their own decisions.

Decide where you belong but don't get discouraged. There's no rush. Midwifery is an ever changing life long journey!

Casey Makela, 1992

Member of
American College of Traditional Midwives

Michigan Midwives Association

Director of
Michigan School of Traditional Midwifery
The first licenced school in North America to ever offer a vocational diploma in Traditional Midwifery.

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