Why I’m Not Pursuing Nurse-Midwifery, Part 1

Sometime mid-2017, I decided to pursue becoming a midwife. It was a thought long in the making, but one that I had not given much attention to. After discussing my options for school, career paths, options for financial aid, and more with my husband and anyone else who would listen to me process. After some amazing advice from fellow student midwives in Orange County and beyond, I decided to pursue nurse-midwifery specifically. I began taking classes to complete prerequisites in order to apply to nursing school; I threw myself into allll the science courses that I had always avoided, knowing I just needed to get through them, then just needed to get through nursing school. Someday, finally, I would be able to study and practice the birthy stuff my heart, mind, and spirit so adore. I would just need to be patient…. The video below (transcription below that) is me chatting about how I realized that the nurse-midwifery path was not for me and how I came to understand my values around birth, human rights, and the medical model of care more clearly.

Amanda: Hey all. I have decided to do a little bit of journaling, but in video form. Mostly because I think it would be much quicker than actually writing down all of my thoughts and feelings at every step of the way. Even though I feel like that would be much more effective for my own processing purposes long-term, and even though I feel like it’s healthier for the mind and body to do it physically, I know myself – I won’t have time, I won’t have the consistency to actually follow that through, so this is my first journal kind of video blog thing. I don’t actually know where this is going to go. But I recently decided that I did not want to become a certified nurse midwife, which was kind of a goal of mine that I announced earlier in the year. I had some interesting feelings about even announcing it to begin with because I wasn’t sure what it would look like in reality. I wasn’t sure if even getting to point where I was in nursing school would be a thing, and I wasn’t sure how nursing school itself would go. I wasn’t sure if I’d actually like being a nurse. So, there are many layers there, unto itself.

I did start that path. I started going to my local community college again, which is where I went for my first part of my undergrad degree. While I loved being back at school, and while I really appreciated the more science-based classes and learned a lot quickly, it was problematic in a lot of ways for my life and in total when it came to my vision for what birth could be in our culture. What it is now is not where I think it could be, where I think it should be… and it’s definitely not where the evidence shows that it should be at all. So, I want to delve in a little about that because I feel like I went through kind of an about-face overall for my own process and journey here.

I had these amazing conversations with multiple people who had originally intended to become midwives through the CPM route – and if you’re not an American, that means Certified Professional Midwife, which is a national certification, and then each and every state has their own laws, regulations, or lack thereof, regarding that kind of midwifery. It’s mostly the homebirth midwives, even though here in California homebirth midwives can also work at birth centers, so we’re a little bit more fortunate that we have some progressive-ish legislation and laws in that regard. But, I’ve talked to quite a few of my friends who decided they didn’t want to go that route anymore, that they wanted to expand their possibilities of their practice long-term by becoming Certified Nurse-Midwives, the CNM route. Most of them had really amazing reasons for this and I love all the reasons for it, and I feel like if we lived in a different world I would absolutely take all those reasons and run with them.

The reason that I’ve heard more often than not is, “I want to give midwifery access to people who need it the most, who can’t afford homebirth midwifery, or don’t have access to homebirth midwives in their state because of legislature issues-or are on Medi-Cal, Medicaid in our area.” So, most of the time, homebirth midwives don’t accept it, or it’s just a really lengthy process to get reimbursed and the reimbursement itself is not very fiscally, financially, beneficial for midwives in our area that do take it out of hospital. So, all that argument is amazing and I love those future midwives who really wanted to be able to provide their services and support to families no matter where they went in the nation, no matter how – clinics, hospitals, homebirths, at birth centers – whatever it may be. They really wanted to make sure they had as many options as possible for supporting their clients, and also as many options for themselves. Let’s be real, if you can work in every state in America, that’s a lot more access to potential jobs and employment.

And then the other argument that I heard many times is that having your own midwifery practice is hard. And as a doula who owns her own practice, it’s hard. It’s hard running a business, it’s a lot of work all of the time. Financially, the responsibility of it is quite large and looming, the being on your own and the not being employed by somebody else, so you can’t really can’t walk away from your job ever. Yeah, it’s challenging. It’s a lot to think about on a constant basis, and so I absolutely feel like the student midwives who want to be midwives but really want to be employed midwives – who want to be able to work at a hospital and have someone give them a paycheck and benefits and stability in that way – and long-term that stability feels really important to a lot of people, so I understand that want and drive for your own financial and lifestyle stability as well as the ability to offer your services to clients in lots of different realms.

So those are also the reasons I thought I wanted to become a CNM (certified-nurse midwife) and pursue nursing. I knew that it was going to be a longer route. I knew that it was going to be more costly long-term to become a CNM. I was okay with both of those facts, and I knew that it would mean I would be taking a lot of classes that potentially wouldn’t directly affect my practice long-term. It might influence how I feel, how I think, and how I process information. It might also help me understand the underlying premise to the physical body aspect of midwifery, but overall what I found in my very first semester at community college on the path to become a nurse midwife was more problematic that I could handle, personally. And I do know that this is a personal thing. Don’t get me wrong; I know there are midwives out there who have grappled with this and have come out the other side and said, “I still want to become a CNM. I still am going to pursue CNM work, and I know that there’s challenge in that, there are going to be struggles. I know that there are going to be things that I don’t like that I’m up against every single day in the hospital system and our medical system in total. And I’m okay fighting that battle from within.” Or people that feel like “yes, there are problems, but it’s better than a lot of other cultures – it’s better than a lot of other systems we have.”

I think both of those thought processes are totally valid, but what I found was right from the get go, once I announced that I was planning to be a nurse first and then a midwife secondary, that that’s exactly how it felt – that I was planning to become a nurse first. I was planning to become a person who primarily works in a hospital setting or clinical setting, a person who takes orders from doctors (primarily male doctors), a person who works within a larger system and a larger network where I really wouldn’t have any basis for an expectation that my experience and my knowledge base and any of my effort would necessarily be appreciated or even considered, in many cases.

And I know this to be true because I have nurse friends, and because I’ve worked in environments in hospitals where I’ve seen nurses ‘round the clock for two days straight being treated really awfully. I’ve seen nurses who have so much hands-on experience with women in labor be absolutely dismissed as soon as an OB walks in. An OB who hasn’t been there, who has no understanding potentially of what the client actually wants in that moment, what their value systems are or what’s been working for them personally or not. These nurses are just kind of pushed to the side because the OB has more experience, more knowledge, obviously a higher degree and level of education. But ultimately what it actually comes down to is that the authority lays in the obstetrician and not the nurse. If I’m really calling a spade a spade, that’s what it is. It’s authority and the power idea, and I found that to be the most problematic aspect of going back to school to become a nurse right out of the gate.

I found that the classes I was taking, all my prerequisites for nursing school, were great in theory. On paper I understood why I needed to take them, yet, there was one set of curricula that I needed to follow and there was no other path. There was no room for wiggle or for questioning, and that’s true within the classes and also within just the plan in general, or the path to the nursing degree in general. There’s no room. There’s no room for movement and there’s no room for questions. Even in my first microbiology class- obviously there’s a lab and there’s a theory class and they’re two really separate things. And the first problem I had personally was that I really did not understand – nobody ever said it – that they were two separate classes. It made no sense to me because a lot of the things that we were learning in our theory class in our lecture hall, could absolutely be applied to our lab class and vice versa but we weren’t at that point, we weren’t at that stage in each of the separate classes, so sometimes I would remember something in a more practical way than in a logistical “this is what the textbook says” at this stage, or “this chapter that we happen to be reading right now in the lecture class”. So, I’d go to my lecture class and we’d have a quiz and I’d be like, “Oh this is specifically what we discussed in lab class, so this is going to be my response,” and instead they want exactly the response that the textbook says because that’s what the textbook says. And that in itself triggered something in me that made me immediately start questioning is this actually the right path for me?

Does this make sense for my brain, for my life, and for the practice that I want to have long term? Am I someone who can go through years of education with the understanding that the answers I provide on tests, quizzes and papers are expected to be one thing and one thing only? And how will it be handled if my answers deviate at all, or if I have questions, if I have concerns about what I’m learning? If I have different knowledge, if my experience says this thing is not as black and white as it feels or is being taught, based on my own experience, my real life in the workforce, working with people, working with their bodies, understanding birth, reading research that’s coming out right now- not ten years ago, which my textbooks apparently all were based off of… If none of that can be taken into consideration now, in prerequisite classes, how would it be for me in nursing school and in clinical rotations, and how would it be with actually working alongside OBs? And really what I mean is under obstetricians. I know that there are OBs out there who are freaking awesome because I have met them. And I know that there are nurse midwives in the hospitals that I’ve worked with who are amazing… just like I’ve worked with amazing nurses who are phenomenal at their job even though they’ve probably been torn down a million different times, a million different ways because they had questions – just because they dared to question something, they had some other knowledge, or some other experience they wanted to pull in the entire conversation