labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, October 3, 2007

More on the Lonely Soldier

I am really glad to see that I am not the only one who wonders why some midwives and midwifery students adopt the medical model of birth. I think there are so many factors involved, and there is no way to easily draw a line between any of those factors. I received an email from Brittanie who asked some great questions that add to this topic. Her questions are in italics, my answer follows.

Midwifery students that do not support home birth...why? You suggest misinformation and fear of litigation, and I think you must be right.
Nurse midwifery students many times start out as labor and delivery nurses. L&D nurses are trained under the obstetrical, or medical, model of childbirth care. They are trained to view birth as inherently risky, where anything can go wrong at anytime. I work with nurses who, after 30 plus years of experience, can not see beyond this. I work with new nurses who quickly adopt the medical model. And many times, I can't blame them. It is very easy to not be able to see beyond what presents itself everyday. (Little do they realize that some of the complications they see are created out of the very things we impose in medical childbirth care).
When I was a new obstetrics nurse, I would have read my own blog and thought the person writing it was a lunatic. Homebirths? Midwives? No operating room to run to? No fetal monitoring? I was totally against it. Homebirths were for people wanting to risk their and their fetuses lives, midwives were for hippies and the indigent who could only afford second class care, c-sections were needed more often than not, and continuous monitoring was a must because that fetus could be having a deceleration at any time. I also thought that every woman would be better off delivering at a tertiary teaching hospital with a large NICU. But I was biased. My first ob nursing job was in a very large teaching hospital with a very large NICU with a very large proportion of high risk pregnancy. As a matter of fact, there was a large unit just for the high risk pregnancy women who needed to be admitted. And it was always full.
Honestly, I don't know when my opinion started to turn. I think it was gradual. When I went into labor and delivery at another large teaching hospital, laboring women were treated as incompetent sick people that were precariously teetering on the brink of disaster. The anxiety this caused me was nearly unbearable; it didn't feel right. And when I moved on to a large outpatient hospital clinic, I began to dislike how the women were thrown into this birth machine and treated like they had a disease. And so I started to question everything.
At my current job, I had a clinical preceptor who said to me, "Stop looking for the bad things. Look for the good. You'll see that there is more good to be had here if you don't go hunting for bad things!" And it made perfect sense.
I certainly believe there is a fear of litigation that drives practice. This is true for both obstetricians and midwives. However, midwives are sued less often. This is likely because they deliver evidenced based, safe care to low risk women. But when many midwives are practicing under policies set forth by the hospital or their collaborating physician or even malpractice contracts, then they have to follow rules that were put in place because of litigation fears. This point could turn into a book, so I will leave it at that. For now.

Do you think the midwifery program is another one of the culprits behind this misinformation? Are CNM midwifery programs changing?
I'm not sure that midwifery programs are the culprit per se, but certainly play a role in how new midwives view their care. So far, my program has not taught anything or even hinted at a medical model of care when it comes to childbirth. Everything that is presented to us is backed by current literature. The clinical experiences of student nurse midwives can vary greatly, however, depending on who the preceptor/mentor is. I have fellow students who are being trained by obstetricians. I often wonder how this will alter their approach. I have purposely chosen to be trained by CNMs because I want to keep my education in midwifery care.
I have no idea if CNM midwifery programs are changing. I'd imagine that they are, and hopefully in a positive way. My program is very heavily steeped in evidenced based midwifery care and political advocacy. I would imagine that nurse midwifery programs even 10 years ago didn't have these underlying focuses. But I consider this a good change.

As a midwifery student, do you feel that your instructors/program/school are supportive of homebirth, or is this just an issue of a few of your fellow students being misinformed?
My current preceptor is supportive of homebirth, but in a fairly limited capacity. She certainly isn't as liberal as some on this, but I'm happy that she does support it. Some of my professors have done homebirth, but I haven't gone into it with them. I think that my fellow students are just having a hard time letting go of their L&D nurse mindset.

Have you talked to these students about why they are choosing midwifery instead of obstetrics?
Hell, no! Just recently a fellow student said to me, "You know, the more I get to know you the less abrasive you seem." Clearly you can tell I am outspoken in my beliefs and have rubbed some the wrong way. I think if I asked that question it would come across as an argument.

1 comment:

Forest Green said...

I appreciate your thoughts on this topic. I am currently a nursing student who has gone into nursing as a pathway to midwifery. I am trying to navigate the balance between the medical model in which I am currently being immersed and my own beliefs about health, healing, birth, etc. I do not want to lose touch with why I am doing this. One thing I am doing is studying to become a doula. I feel like this will help keep me grounded where I need to be.
Thanks for sharing your experience!