Awesome Ways to Support Midwifery in LA
May 5th is the international day of the midwife. If there's one thing I have learned since being in Louisiana, it's that this state is full of, you, who support midwives. It may be because you are pregnant, and after doing the research, you have decided that the Midwifery Model of Care is what makes the most sense for you and your family. It could be because your grandmother had all of her babies with midwives, and you honor the tradition of the midwife. It could be because of your faith, you believe that trusting in the design of birth brings you enhanced faith in your creator. It could be because you are a feminist, so the woman-centered nature of midwifery appeals to your sensibilities.
Ultimately, though, not all of us are pregnant and using a midwife; and, with fewer than 10 of us currently practicing in the state, it's safe to say that most of us are not midwives. You may not even want to use a midwife in the course of your own childbearing. So the question is, how can a person support midwifery in Louisiana so that midwifery is an accessible option for you, your wife, your sister, your daughter?
Here are four awesome ways to support midwifery in our state.
1. Know and talk about the educational requirements for licensure in this state. Here's a cheat sheet: We start out with a nursing didactic and CPR for healthcare professionals and neonatal resuscitation, then we move on to our clinical training which include hundreds of contact hours with pregnant women and their families. Alongside this is an intense academic component. Midwives finish their apprenticeship once they have logged the required number of hours in clinical attendance; which include births, and postpartum, as well as demonstrating hundreds of skills for their own preceptors. Once this hurdle is crossed, the student midwife must be tested in a practical exam where she is required to perform the skills necessary to a particular client (no studying for this one!). Finally, the student must sit for an 8-hour written exam which she must pass with a score no lower than 80%. The midwife must then apply for licensure in the state of Louisiana which requires background checks, letters of recommendation, and personal interviews. Midwives, by the time they are licensed, usually have participated in and managed no fewer than 50 births (usually more).
2. In the state of Louisiana, a licensed midwife is required to have a physician back-up. Safe midwives recognize that birth out of the hospital hinges on three crucial elements: a low-risk woman, a skilled attendant, and ready access to medical care in the event of an emergency. If any of those are not in place, out of hospital birth is not as safe as women and babies deserve. In Louisiana, a physician can effectively restrict the midwife's practice by refusing backup and, thus, restrict the birthing family's options. Therefore, the time to select a physician is before you are pregnant and need a midwife. Ask your physician if he or she supports midwives. You may love your physician, but if his or her answer is no, then he or she does not love you back. Find a new physician. This is conscious consumerism, and money talks.
3. Respect a birthing woman's intelligence and autonomy. I have never met a sane, well-bonded pregnant woman who intentionally chose something that she thought was harmful to her baby. This means women who have their babies at home have made an informed choice to do so based on the information available to her. Conversely, a woman who chooses to birth in the hospital and even, in some cases, to schedule here cesarean section, are doing so because they believe that is the best decision for her body and her baby. This brings me to my final point. . .
4. Respect your own autonomy and authority in your healthcare decisions. Know your choices and educate yourself about them. There are many ways. As a healthcare provider, I can tell you that while what I practice is evidence-based care, there are millions of "evidence-based" studies out there with wildly varying conclusions. Asking your practitioner if there is another way is not disrespectful. It's intelligent. Almost nothing is an emergency. Take your time researching medical advice and treatment options.
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