tag:blogger.com,1999:blog-8145421138565946044.post2234832680439492535..comments2023-11-03T16:00:37.953-07:00Comments on The Beginning of Motherhood: Childbirth education: Normal Physiological labor....something medical professionals don't seeRachelhttp://www.blogger.com/profile/08774138114705555836noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-8145421138565946044.post-77685972032635961652011-08-13T09:57:05.411-07:002011-08-13T09:57:05.411-07:00Interesting discussion. I think we need BOTH more...Interesting discussion. I think we need BOTH more standardized education for direct-entry midwives and more experience with minimally-disturbed birth for hospital providers. As I understand the NARM exam to become a CPM is pretty easy and they are not required to do very many births before they can get that certification. State licensure requirements vary drastically--from just getting the CPM credential to what we have in my state, which requires graduation from an approved, MEAC-accredited midwifery education program and additional births. You just can't lump all CPMs into the same category, because there is so much variation in their training! I have thought about becoming a midwife, and I don't think you necessarily need to have training as a *nurse* to be a good midwife, I think it is very possible to learn everything you need to know from a very good direct-entry program. However, unless there are some really big changes to CPM training in this country between now and when I am ready to start that path (if ever), I will choose to pursue a CNM degree, because nurse-midwifery training is more respected and standardized, and I feel it would be more likely to prepare me better for the serious responsibility of midwifery, not because of the nurse training itself, but because the midwifery training once you are a nurse is typically better.<br /><br />I also believe we need good standards as to which women are too high risk for homebirth, but in order women who prefer homebirth but don't qualify because of risks to feel comfortable going to the hospital, we need more natural-friendly hospital care, and options for vaginal delivery of twins, breech babies, and VBAC in the hospital for those who are good candidates and want to birth vaginally--women shouldn't be forced to choose between a high-risk homebirth and a cesarean.Brittanyhttps://www.blogger.com/profile/00621569580858604541noreply@blogger.comtag:blogger.com,1999:blog-8145421138565946044.post-73443586730789098732011-08-12T19:49:46.222-07:002011-08-12T19:49:46.222-07:00And Rachel, I'm so glad to hear you say that a...And Rachel, I'm so glad to hear you say that as a nurse, you took the initiative to educate yourself about normal birth so as to be supportive. YOU, unlike many nurses, are therefore able to recognize that a hands and knees position may have actually had benefits for this mother. That doesn't imply that being on her side was "a danger", as the first commenter read into it. But as care providers trained in normal birth understand, a woman's body signals her as to the most efficient position to birth in. There is a difference between normal labor pain and "this isn't what I need to be doing" pain. When a baby is malpositioned, it will create more pain for the mother, and she can often instinctively find the position to help reposition the baby by finding the position that relieves some of the pain. This is known to work by birth professionals all over the world. Turst a woman when she says "I don't want to be in this position" because her body might be telling her something that a textbook can't. Kudos to you for learning more about it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8145421138565946044.post-58647319990263685782011-08-12T19:43:02.168-07:002011-08-12T19:43:02.168-07:00CPM's ARE trained to recognize abnormalities s...CPM's ARE trained to recognize abnormalities specifically because of their understanding of normal birth. You have to know what's normal before you can recognize what isn't. No, they are not surgeons, and cannot perform highly invasive procedures, but they are trained and qualified to handle minor complications non-invasively and to transfer acre when the need for intervention is beyond their scope of expertise.<br /><br />Which brings me to my second point: Who said that because birth is "norml" that it needs no intervention at all? Sometimes it does. That's one of the reasons that so many women choose homebirth midwives. To have a knowledgable birth attendant who can assist them in monitoring their labor for signs of a problem, and if one arises and medical attnetion is needed, they can access it. This is different from being in a medical environment with a staff who is unfamiliar with the variations in normal labors, and will see the same problem s amidwife will see, except that they'l see them even when they don't exist because they've never been taught otherwise.<br /><br />You make it sound as though it's a competition between midwives and nurses. It's not. Nurses work in medicine. Medicine is pathology. Midwifery is not pathology. And normal laboring women are not pathological. As long as midives are properly trained to recognize a pathological labor and TRANSFER care to a nursing staff, then there is no compeition. And I don't know where you met your midwives, but all of the ones that I know are very , very well trained in doing just that.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8145421138565946044.post-29417049358933552942011-08-12T19:35:02.676-07:002011-08-12T19:35:02.676-07:00"How about we do away with CPMs and LMs and p..."How about we do away with CPMs and LMs and push for home birth and natural birth training for CNMs and RNs. Let's make it easier and more appealing to CNMs to attend home births. Let's working on changing the whole system so qualified nurses who can handle an emergency also know how to handle a "normal" birth. I say get rid of CPMs all together and give nurses who want more training in the care of normal physiological birth that opportunity. "<br /><br />I agree with this absolutely. I am a Labor and delivery nurse that has trained myself in natural births and I am calling for the same thing you are. I can tell you though, that RN's are not given that opportunity...that was something I had to push for myself. And I never meant this post to be a push for cpm's or homebirth...it really is a call for educating medical professionals in normal birth. Which I can attest we(as I am one of them) don't get it.Rachelhttps://www.blogger.com/profile/08774138114705555836noreply@blogger.comtag:blogger.com,1999:blog-8145421138565946044.post-55441335550360772402011-08-12T19:31:23.537-07:002011-08-12T19:31:23.537-07:00You know, I have not dealt with the homebirth worl...You know, I have not dealt with the homebirth world personally, but more from an outsiders perspective. I am sure what you are saying is true and many of them do need more training. That is something that should be addressed. Actually, what I would like to see is a better back up system so that CPM's can refer safely those who need more help.<br /><br />That said, many medical professionals mistake something that is normal for something that is not and use needless interventions for this. <br /><br />What I meant to imply is that the woman did not have to labor on her side to be safe. In fact, being on her hands and knees may have been an even better position. Having worked in hospitals as an RN, and certified in fetal heart rate tracings and NRP, I feel like I am able to discern some of these things that perhaps others. That said, my point with this story was that woman can be safe and comfortable. And that this particular woman did not need to be in more pain to help her baby, yet her nurse did not understand this.Rachelhttps://www.blogger.com/profile/08774138114705555836noreply@blogger.comtag:blogger.com,1999:blog-8145421138565946044.post-42175848674447920192011-08-12T19:16:04.416-07:002011-08-12T19:16:04.416-07:00Likewise most CPMs and lay midwives have never had...Likewise most CPMs and lay midwives have never had to deal with emergencies or been taught how to deal with them correctly. CPMs and lay midwives need so much more experience dealing with and recognizing red flags and dangerous complications in order to help woman labor safely and effectively. Any suggestions on how to do that? I wish very much we could take what both types of midwives are good at in combine it into one. However, I will tell you it would take a lot less time to teach a CNM or an RN what CPMs know and are good at then it will be to teach CPMs everything that CNMs and RNs know. How about we do away with CPMs and LMs and push for home birth and natural birth training for CNMs and RNs. Let's make it easier and more appealing to CNMs to attend home births. Let's working on changing the whole system so qualified nurses who can handle an emergency also know how to handle a "normal" birth. I say get rid of CPMs all together and give nurses who want more training in the care of normal physiological birth that opportunity. However, if birth is so "normal" and in need of no intervention at all, then why would a women need someone to help them labor safely and effectively at all? If I had to choose between a midwife who knows only how to deal with a normal "birth" but no idea how to deal with emergencies or a nurse who knows how to deal when things get "unnormal", I'm choosing the nurse. Statistically speaking most births would turn out fine if the women labored all alone with no help at all. I'm much more concerned about having someone there to help me when thing don't seem to be going fine at all. My friends can hang around and encourage me when I'm having a normal birth. I don't need to pay a midwife to do that! I want someone around just in case things to go wrong. Just because that woman found laying on that side uncomfortable doesn't mean it wasn't safe or effective for the nurse to ask her to do it. You seem be implying this nurse was some how putting this woman in grave danger. Yes perhaps it was more uncomfortable for the laboring woman but it's a lot safer then letting a woman labor at home with her waters broken for days which seems to be becoming a common scenario lately with home birth midwives who have so much of the experience you seem to think is more important. You want nurses to learn more about normal birth and I want CPMs to start being trained to admit when things aren't normal anymore.Rain Clairhttps://www.blogger.com/profile/14673396235819148444noreply@blogger.com