Sunday, July 5, 2009

Educational Diversity in the Midwifery World

The other day, I received some disturbing news in the mail. The letter was from the midwifery licensing board (of the state where I now live). It basically stated that my application for licensure was denied because I had not received "the right type" of midwifery training. I wasn't surprised. I did not receive the type of training nurse-midwives might get in this country. Nor did I attend a school that is accredited by the American College of Nurse Midwives. So, the midwifery board in my state says I cannot get licensed until I fulfill those two requirements.

It's not that I'm under-educated. I have a Bachelor's degree and underwent 3 years of a rigorous direct-entry midwifery program that prepared me quite well to attend to the needs of women and babies during pregnancy, labor, birth, and postpartum. I then passed the North American Registry of Midwives examination without much difficulty. My training was, in some ways, formal. We met for class at designated times, attended lectures, completed assignments, and had mandatory clinical hours to fulfill. But, in some ways, it was far from conventional. We were required to take on an overnight shift once a week for the entire three years. We had on-call days (and nights) 3 times a week our first year and 7 days a week by our senior year. If you were called to a birth, it didn't matter if you were at work or at a family function or across town, you were required to hustle your butt to the side of that laboring mama. There was no "clocking out" according to your shift. You left when the work was done. Period. Doing these things readied us for the realities of midwifery. Women don't go into labor when you want them to and babies aren't born according to our schedules or timetables. Continuity of care is important because the more familiar you are with a mom's (or baby's) norms, the sooner you can be alerted to a deviation from that norm and take the appropriate measures.

I don't regret taking the route I did to become a midwife. I had several options and purposefully chose this one. However, there are some who feel that there is only one "right" or "best" path into this profession. That is a very limited view. For many years, education was done on a one on one basis - knowledge passed from master to apprentice. This practice still goes on today all over the world. For many years, this was the only way to become a midwife and, for some, it still is. There are many routes one might take to enter this great profession and all of these routes should be respected. Just because someone does not receive knowledge in the traditional euro-centric fashion, doesn't mean that knowledge isn't just as powerful. As an educator (remember my Bachelor's degree?), I understand the need to verify learning according to a certain standard. As midwives, we are charged with the responsibility of caring for mothers and babies. There are certain standards that we should follow to ensure the safety of both. However, let those standards be measured by a non-biased exam of some sort. What we should not do is declare our chosen path to midwifery as the yardstick by which all other midwives are measured. We need to respect the many kinds of knowledge that exist and the various packages in comes in.

As for me, I'm most likely going to appeal the board's decision. If I wasn't a fighter, I wouldn't be a midwife.

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