intensely trivial

Aspiring midwife

You might remember that I’ve previously mentioned becoming a midwife. I’ve said little about it, because, frankly, I wanted to get comfortable with that newfound piece of my identity first before opening it up to the world. And I needed to know how I was to go about the pursuit of midwifery (which is, incidentally, pronounced “mid-WIFF-er-y,” with a short I).
Well, it’s been a breathtaking ride over the last 10 months or so. (Is it a coincidence that this move has gestated for the length of a human pregnancy before it’s made an appearance to the rest of the world?) When I realized that I kind of was already a midwife internally, it was the wildest, most dizzying joy, not unlike the double line on the pregnancy test. Really? Could it be? Could I be the one chosen for this? And yet, in my depths, I wasn’t surprised; those who know me best had known it before it dawned on me.
And then came the difficult decision-making process of what kind of midwife I. . . could be? was? (Maybe this part was like the nursery decorating and the layette gathering. I dunno. Don’t want to make the metaphor too cheesy.)
People ask me questions about this when they find out I want to be a midwife, since it’s not common knowledge what the options are. So let me simplify. There are two main types of midwives in the U.S.: nurse-midwives and direct-entry midwives. Nurse-midwives start out as RNs and then go on to get an advanced credential in nurse-midwifery. The abbreviation after their names is CNM, certified nurse-midwife. The majority of CNMs practice in hospitals, although some attend birth-center and home births.
Direct-entry midwives are trained through a variety of avenues, including midwifery schools, apprenticeship, self-study, or a combination thereof. Some direct-entry midwives in the U.S. go on to attain a credential through the North American Registry of Midwives, ending up as a certified professional midwife, or CPM. Direct-entry midwives attend births legally in most states (including Kansas) but do not work in hospitals, so they attend home or birth-center births. They have differing levels of regulation, depending on their state of residence.
Between these two types of midwives, there is in general a common belief that birth is a normal, healthy process. Midwives specialize in attending healthy women throughout the childbearing cycle, and some provide other women’s healthcare. Unlike obstetricians, they are not surgeons; they see OBs as specialists to whom they will refer their clients if there is pathology. Midwives tend to favor lower rates of intervention, and research has shown midwifery care results in just that — lower intervention rates — with outcomes equally as good as those with OB care.
Both CNMs and direct-entry midwives can practice true midwifery. I suspected CNMs would get more respect no matter where I lived, but especially in conservative Kansas. That’s true across the country, as CNMs are legally employed in every state, unlike direct-entry midwives. CNMs tend to mesh better with the medical model of care, following hospital protocols and working alongside other medical caregivers; they are trained in hospitals, under a medical model. They also make more money, take out malpractice insurance, and answer to obstetricians, even though in some hospitals the official line is that neither OBs nor midwives have authority over the other. Finally, CNMs deal with a lot more women than direct-entry midwives do, so more women receive midwifery care under them, but they also take much less time to devote to each woman.
Direct-entry midwives, on the other hand, practice more holistically (I know that’s a terrible overgeneralization). They are trained in the circumstances under which women should be transferred to medical care, but in normal situations, they do not see birth as a medical event. Physiological, yes; medical, no. They bring equipment, sometimes allopathic medicines, and herbs to births in case those things are necessary. They monitor babies’ heartbeats when necessary. In general, they trust that birth works and that women can do it. And outcomes of planned homebirths are equally as good as those of hospitals, with a lower intervention rate.
There are variations in education, credentials, and licensing within these two categories of midwifery, which I won’t go into, since this is a summary.
The journey toward midwifery, and then the question of exactly which path to take, have been deeply emotional, personal, and spiritual for me. I could write chapters about that process, how lovely and providential it was. I don’t mind discussing it, not one bit. 🙂
After a lot of soul-searching, prayer, and counsel from trusted family and friends, I decided to go the direct-entry route. I am now Rachel Andresen, doula and aspiring midwife — and soon to be “student midwife.” In about two weeks, I will start the advanced midwifery studies program at Ancient Art Midwifery Institute, a distance program that I expect to take about 3 1/2 to 4 years. I hope to continue doulaing throughout my midwifery studies, because what better learning experience could there be, besides apprenticeship? After I finish the program at AAMI, or maybe concurrently, depending on what God brings my way, I will seek an apprenticeship. Somewhere. I’m confident that God will provide that at the right time and in the right place. And then, finally, I plan to sit for the NARM exam and gain my credential as a CPM.
So now you know, and you should feel free to comment or question. 🙂 I. can. not. wait. to get started! Thinking about it keeps me up at night with excitement. I am outrageously blessed to be doing THIS.
“God was kind to the midwives. . . ” (Exodus 1:20).


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  1. * Kelly says:

    Oh Rachel, I am so excited for you! I *love* reading your birth stories–even the discouraging ones– and learning of your experiences. Please, please keep us as caught up on your studies and experiences as you can. And really, we MUST meet sometime when you are in KC! 🙂

    Posted 7 years, 9 months ago
  2. * Gail says:

    Sounds exciting, Rachel! I love to hear how passionate you are about this–you’re going to be the best student out there! Very exciting!

    Posted 7 years, 9 months ago
  3. * shelley c says:

    I am so thrilled to hear this update! I know that you will help women experience one of God’s most humbling and powerful experiences not exactly known to man, but certainly to woman. I hope you will help revolutionize the birthing options in Manhattan, or wherever you might practice. Thanks for sharing!

    Posted 7 years, 9 months ago
  4. * Sandie says:

    I’m excited for you and know you will make an awesome midwife! I just watched “The Business of Being Born” and could totally picture you in there as a starring midwife! May your tribe increase. Sandie

    Posted 7 years, 9 months ago
  5. * Eleia says:

    I’m so happy for you!

    Posted 7 years, 9 months ago
  6. * Erika says:

    I am so excited you are doing this!! You will be so good at it and if you had been doing this when I started having kids, I would definitely have considered having YOU deliver them! I think this is an exciting direction for you. 🙂

    Posted 7 years, 9 months ago
  7. * Terri says:

    I love hearing some details of this new chapter of your life! What a wonderful and exciting time. 🙂

    Posted 7 years, 9 months ago
  8. * manhattandoula says:

    Thanks, all you wonderful people, for your comments of encouragement! I’m so thankful you believe in me. Remind me of that a couple years down the road, when I’m wondering if I’ll ever make it.

    Posted 7 years, 9 months ago
  9. * Rhonda says:

    Oh Rachel I am just so so happy for you. I hope everything goes well.

    Posted 7 years, 9 months ago

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