TO MY CURRENT PATIENTS: What you are about to read will NOT happen until NEXT FALL. Repeat after me: NEXT FALL.
OK, gonna jump now. I’m moving to Canada next year.
I want to move to Canada because everything about how I want to work as a midwife is available up there without a struggle. That’s the positive frame.
From the other side: I want to do home and hospital birth. In my career, I’ve spent about six years attending hospital births and six years attending home births. Of those years, the middle four were spent doing both. Think Venn diagram.
I spent the first half of 2009 searching in vain for a hospital to let me on staff. Interestingly, the reasons given for not letting me past the first step were quite varied, and some didn’t even say that it was because I did home birth. Various hospital VP’s and/or department chairs told me it was because they didn’t have the structure to accept an independent midwife on staff. Said midwife has to be a hospital or physician employee.
I’ve spent the first half of 2010 getting mentally prepared to start searching again, having learned a few things about how to speak the language of hospitals-chiefly, money-as well as how to create a paper trail.
In the meantime, I’ve been attending home births and loving every minute of THAT part of my job. I’m enjoying a significant wave of repeat clients, and this past year I had two third time clients.
During these two years of attending home birth exclusively (I prefer the word “exclusively” to “only”), every time I have to transport a laboring mother to the hospital (and therefore out of my care), and I could darn well have kept her as a patient had I been on staff—well, I can be flowery/woo woo and say my soul bleeds a little. And I will, because it’s true.
But I’m also angry. I’d like to just go to a thesaurus and copy and paste synonyms for anger and post them here. I’ve felt all of them for varying degrees in the past two years.
So let’s rewind to about six months or so ago. A midwife who cannot legally work in Illinois was moving to a state where she can (this is another posting), and was having a going away party. A midwife student was there and talked at length about how she and her husband were moving to Toronto, and described the Canadian system as ALL midwives attending home and hospital birth. I drooled, and at one point asked her to put me in her suitcase and take me with her.
Upon saying that, a short wordless conversation happened in my head. (This happens quite a lot. When I’m particularly overwhelmed I will sometimes have the conversation out loud.)
Here’s the nonverbal version:
*pokepoke*?, huhWHA?!?, <:/
(That last is an emoticon I just made up-raised eyebrows. You’re welcome. Maybe it’s been done already, but for the moment I’ll be proud of myself for thinking that up.)
Here’s the translation:
*pokepoke*?: “Jen, that sounds like exactly how you want to work. What’s stopping you from going? Why do you need to be smuggled?”
huhWHA?!?: “WHAT? Are you SERIOUS? I have the business to think about!”
And that was it. The seed had been planted, but the conversation in my head happened in less time than it takes to brush your hair back from your eyes. For the short haired folks who may be reading this, just run with the metaphor, K? 🙂
A few months ago a confluence of events (some of them being in my personal life) swirled together that brought a few realizations. One is that I don’t want to fight anymore. I want to do home and hospital birth, I want to work in a group, and I would like to not have to need a doctor’s signature to do my work as an advanced practice nurse. This is a requirement in my state. About 15 or 20 states have gotten rid of the written requirement, and Illinois is in the process of trying-there is a bill before the state legislature. More on that later.
Can I get all of those things here? Yes. I can hire a partner, I can get on staff somewhere, and the bill will become law. Hiring a partner could happen when I decide to get one. Getting on staff somewhere is a possibility with lots of convincing, persuasion, and a generous dollop of luck. The bill may pass next year or in ten years.
Anyway-back to being tired of fighting. I’ve held a lot of imaginary presentations to a variety of doctors and hospital administrators. In these fantasies I come to the presentation with sheaves of letters from patients. I show them the award the business won last year. I show them and emphasize the practice’s statistics. I point out to them the research that clearly states that home birth is safest WHEN THERE IS A SEAMLESS MEANS OF HOSPITAL TRANSPORT. And I conclude with the amount of money I/my practice would bring to their institution.
I’m devastatingly eloquent and they wither in the face of my logical and persuasive arguments. I’m so convincing that I have multiple hospitals courting me to be on their staff.
Ahem. So. Another of my recent realizations is figuring out the difference between optimism and wishful thinking, and the difference between pessimism and an honest assessment of the situation.
Can I get what I want somewhere else here in the States? I’m pretty sure I could. The home and hospital model is uncommon but it’s out there. I haven’t done an exhaustive survey or anything, but I suspect that most home and hospital midwives have someone, probably a doctor, on staff at that hospital who is their champion. I’m on a few national CNM listservs, and they have lots of inspiring stories about midwives who have struggled against the system and made it, only to have something in hospital administration change or perhaps their champion doctor moves or retires, and their practice vanishes. One midwife in particular has gone through something like that two or three times in her career. I met her at convention this past year and felt like I was meeting someone famous.
The fact remains that the home and hospital model of midwifery care is not a common one in our current healthcare infrastructure. (BOY, does that sentence make me sound smart.)
Now, Canada. Browsing official midwife websites and finding discussion boards of mothers in Canada, here’s what I’ve learned:
ALL midwives attend home and hospital birth. Some areas have a 70/30 hospital/home birth rate, others it’s reversed, others are in between.
ALL midwives are government funded but otherwise independent and autonomous.
NONE are hospital or doctor employees.
Midwifery care is covered by the national health plan for all women. OMG, guys. That means I won’t have to watch a woman choose a free hospital birth over an out of pocket home birth that she wants but can’t afford.
ALL midwives work in groups of 2 to 4.
Brief sidetrack: a midwife job posting in Vancouver (which they must have filled because it’s gone now, so I can’t post the link) stated, “We have four midwives but three working at any given time, because each midwife takes EVERY FOURTH MONTH OFF.” (Caps mine.)
Another of the life lessons/realizations is one I’ve learned before but I needed to learn again. If I’m unhappy about a situation, I can change it or I can accept it. Some years ago I learned a third option: sometimes the best decision is take myself out of the situation.
Here’s my crossroads: stay here and create the job I want, or move to somewhere where it already exists. The former looks like a sheer mountain face to be scaled and climbed with no safety equipment. The latter looks like an incredibly long journey on a prairie-the goal might be far, but the path is clear and flat with very few obstructions.
Another American CNM moved to Canada to be the midwifery program director at a Canadian university. She still does clinical practice and I found her bio on a midwifery practice website. In the bio she writes, “I feel like I’ve come home.” (She’s since moved on, so I can’t link THAT either. But it was there, promise.)
In many, if not most, consultation visits with potential new clients, I say that it’s possible to achieve a natural birth in a hospital-with lots of preparation and support, a good dose of luck, and keen awareness of the system they’re trying to work against. Or she can do it home, avoid the hassle, and just have her baby. If it becomes unsafe and we need to go to the hospital, well, that’s why she hired me.
Ironic though this might be, I want to avoid the hassle. My version of “staying at home” is moving. I don’t have it in me to catch babies, run a business, AND take on a system.
If this plan of mine inspires any sort of emotion in you, AND you live in Illinois please consider writing a letter and sitting on it until elections are over. Once our new senators/reps are in office, ask them for their support of the elimination of the WCA for advanced practice nurses (Senate bill 2567 but it might change). For patients, write, “My midwife is leaving the country because of this!” (Sounds a bit dramatic, but it’s also the truth, and politicians hear hyperbole more clearly than frothy appeals.)
You can also help with the other similar-but-different issue, even if you don’t live in Illinois: advanced practice nurses getting on staff at hospitals. National staff members of my professional organization, the American College of Nurse Midwives (ACNM), recently presented to the Center for Medicare Services (CMS). I don’t know if it’s a bill (CMS isn’t the same as Congress, but they’re certainly related), but whatever it is will require hospitals that receive Medicare funding-that is, 99% of them-to allow licensed independent practitioners (of which CNMs are a subset) on staff to the full extent of their education. If they don’t, the presumed punishment will be pulling of Medicare funds.
THIS, friends and neighbors, is a language that doctors and hospital administrators understand.
So hang onto that letter to your state senator/rep. An edit of the same letter can go to someone at ACNM. I’m trying to find out who the point of contact is.
*HUGE GUSTY SIGH*
I’m confident in my decision, but I’m still crying as I write this. A Woman’s Place represents the past five and a half years of my life. It’s my fervent hope that someone will buy it.
If you’re still reading, thank you. And guess what? Even if A Woman’s Place shuts its doors, I’m still here. I might be leaving the country, but I’m not leaving the blogosphere. And now that the blogging bug has bitten me, I’m here to stay. The story of the beginnings of A Woman’s Place is REALLY COOL with how it just unfolded, and it’s coming.
Stay tuned, guys, and thanks for being here.
Hugs to all-