A few months ago, the midwife I used for Dio’s birth invited me to come to her office and meet a CNM she was thinking of adding to her practice. (Having a solo home birth practice is very demanding. Adding a second midwife would allow her to actually take vacations more than once every few years, to do more well-woman care, and to have more time for breastfeeding support as an IBCLC). Here are some recaps from our conversation.
My midwife Penny and the prospective midwife Holly talked about their backgrounds and how they came to both midwifery and home birth. Both worked as OB nurses for many years before they even thought of midwifery or home birth. Both eventually pursued a CNM degree with the intention of opening a home birth practice. Penny worked for several years in a large university hospital. It was the end-of-the-line for obstetrical cases, where you’d go if a high-risk situation arose in a smaller, less-equipped hospital; if you needed care for a 26-weeker; if you had an extremely complicated obstetrical history. Penny’s time working at Large University Hospital (LUH) taught her the limits of what medicine could do. Sometimes they could save lives and improve women’s and babies’ health. But other times—all too often—all they could do was offer compassion and support, unable to save every life or prevent all bad outcomes. And this was at the most tertiary of tertiary centers.
Penny said that working in such a high-tech, high-intervention setting gave her much more confidence to pursue a second career as a home birth midwife. She knew first-hand what the most advanced medical care could and could not do. There was no mystery or mystique about what a hospital could offer—something she sees as a great advantage, compared to many home birth midwives who have never worked intensely in a hospital environment.
During her years as a nurse at LUH, Penny loved taking care of home birth transfers. She was able to offer excellent care for the specific medical issues that needed addressing, while otherwise supporting and facilitating the woman’s desire for a gentle, unmedicated birth. I remember her telling me the story of catching one woman’s baby in the bathroom and putting the baby immediately on the mother’s chest—something she thought entirely commonsense, but something she got a lot of flack for from her co-workers. It was these experiences that pushed her to become a midwife.
Penny highly values the knowledge and skills she acquired as an OB nurse in a high-risk setting. She is totally fluent in inserting IVs, administering medications, intubating, resuscitating, etc. Now, she hardly ever uses these skills as a home birth midwife, because they are rarely, if ever, needed. (In fact, one skill she says is becoming rustier than she’d like is suturing, because women in her practice hardly tear, and if they do it’s rare that the tears need stitches—something she attribute to her hands-off approach. Dads or moms usually catch their babies; she steps in only if they do not want to catch or if neither parent is in a good position to do so.) But if/when her medical skills are needed, she is really, really good at them.
While we were chatting with Holly, Penny said to me, “you know Rixa, because of your background with unassisted birth, you hired me for different reasons than many women typically hire a home birth midwife. You didn’t need me so much for labor support or guidance. You really hired me for that 5% chance of needing really skilled medical assistance, something that I can do really well.” I thought about that and realized that I agreed with her. I am really independent and pretty much labor and birth all on my own. I don’t rely on my husband or female companions for labor support or encouragement. In fact, I prefer to do things on my own for the most part. So I wanted a midwife not for the 95% of stuff that she does during labor—now, that 95% is quite valuable and many women love the support and guidance their midwife offers during labor—but for the small chance that I’d need some kind of additional intervention or emergency skills.
Which brings me to another point I want to make—the more exposure I have to midwives, the more I realize how credentials and background do NOT translate into a certain style of practice. I have a lot of experience interacting with “lay” midwives, direct-entry midwives (CPMs), and home birth nurse-midwives. A CNM degree does not mean that a midwife will have a more “medicalized” style of practice (although it is true that most nurse-midwifery programs are geared towards preparing midwives to practice in a hospital setting).
Now, I am sure some people reading this are thinking, “Oh, Penny is such a MEDwife!” But nothing could be farther from the truth. She is very professional and very highly skilled. Very respectful of women’s desires at birth. She had such a quiet presence at my birth that I hardly noticed she was there; she honored all of my requests and wishes that we had talked about prenatally. She was especially adamant about not disturbing the immediate postpartum period. She doesn’t care about liability and has deliberately chosen to forego malpractice insurance and go “bare.” She is willing to go beyond the “standard of care,” to borrow a phrase from Dr. Denise Punger. Her attitude is “you need to prove to me why you shouldn’t have a home birth.”