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Notes From the Salon: Midwifery Paths and Practices

By Becky Michelson, BADP volunteer

On October 23rd, the living room of Langton Labs overflowed with people eager to learn more about midwifery paths, lifestyles, and perspectives. To understand the distinctions, nurse-midwifery student Holly Carpenter moderated a conversation with Kim Dau, a certified nurse-midwife (CNM) and Maria Iorillo, a certified professional midwife (CPM). Kim is the Assistant Director of the nurse-midwifery education program at the University of California, San Francisco (UCSF) while Maria has attended over 1100 births, primarily in homes.

Some general points of departure between CNMs and CPMs are their education, places of practice, and privileges. CNMs are initially trained as nurses, may practice in hospitals and clinics, and can provide first trimester non-surgical abortions in some states (and recently in California, thanks to the passing of AB154). CPMs can choose from a combination of midwifery certificate programs and apprenticeships and practice in homes and birth centers. There are many nuances regarding the legality of both roles on a state basis. Many research studies cite the benefits of having a midwife as your primary health provider, such as lower rates of preterm births and interventions.1 The American College of Nurse-Midwives has more information on essential facts about midwives.

The Salon Series was intended to shed light on the different ways of practicing midwifery and their respective certifications, work dynamics, and parameters. Instead of having this instructional focus, the gathering felt more like a community bonding through story sharing. Despite their differing paths, both midwives shared stories that reaffirmed their life’s purpose of being in service at births where they felt in awe of the immense courage and vulnerability displayed by mothers.

Kim’s path began working in a laboratory after finishing her undergraduate studies in Biology. She missed connecting with people in her work and her desire to pursue midwifery was sparked from reading Immaculate Deception by Suzanne Arms and Spiritual Midwifery by Ina May Gaskin. She embarked on a journey west to gain experience by working at birth centers in Oregon, New Mexico, and Texas. After attending the UCSF nurse-midwifery program she worked in North Carolina at Duke University for several years, before returning to San Francisco in clinical capacities at both Kaiser Permanente and San Francisco General Hospital. In the past few years, she has maintained a clinical role at SFGH while fulfilling her dream of working in CNM education as the Asst. Director fo the nurse midwifery program at the University of California, San Francisco. Meanwhile, Maria Iorillo attended midwifery school at age 23 and received her licensure in New Mexico. When she moved to California, midwifery was illegal. She has maintained attending 4-8 births a month and has been practicing her incredible craft for over 28 years.

Upon painting a picture of their paths, the conversation shifted toward what midwifery is about and the elements of inspiration. Maria explained that to her, midwifery is about creating a safe space for women who are being vulnerable and courageous enough to seek their own authentic power. Women often seek her care with a deep belief that they are capable of birthing, and she facilitates their connection with that inner power. Maria told two stories about unexpected c-sections and home deliveries where despite the unexpected changing circumstances of the women’s intended births, they emerged supported and empowered. Kim also shared poignant birth stories that included a family confronting melanoma and a laboring woman who was recently grieving her partner. Kim stayed present in these intense experiences, holding space for the brave families. She also spoke of how offering support during trying situations has led to her own potent self-growth.

The Salon Series also included a handout called, “A Baker’s Dozen Ways for Doctors and Midwives to Preserve Simple Birth.” Kim and Maria’s stories included elements of the handout’s holistic advice that supports birth as not just a clinical but also a social process. A few of these recommendations include:

  • Ask permission to touch the laboring person in your own language

  • Dissolve fear by providing options

  • Keep the baby and mother together

Both midwives also highly recommended Witches, Midwives, and Nurses: A History of Women Healers by Barbara Ehrenreich.

In thinking of a vision for cultural change, both midwives promote women being treated with respect, kindness and as if they are smart enough, which they are, to make their own decisions without the manipulation of hospital staff. Beyond the birthing process itself, Kim is excited that more midwives are sitting at tables they previously have not before, meaning that the midwifery perspective is being taken into account more frequently on issues such as neonatal and infant care on state and management levels. Midwives are still a minority health care provider, but at least in the Bay Area, interest and support for them is rapidly growing.

After an evening of stories filled with with births, unexpected events, midwifery muses, and raw inspiration, Holly exclaimed that the UCSF midwifery program should be expecting many more applicants this year. With the full house of doulas, advocates, allies, and aspiring midwives bubbling with questions, anecdotes, and curiosity- she must be right. Thank you Holly, midwives, Salon Series team, and engaged audience!

1. http://www.huffingtonpost.com/2013/08/20/midwifery-benefits_n_3787058.html 

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