The Midwifery Model of Care

While still at Bastyr, I fell in love with Sweden.  Why, you ask?  Because they are just doing so much right there!  For decades now they have boasted the best infant mortality rates in the world.  How do they accomplish this?  Women are seen by midwives as a norm not as an exception.  Obstetricians are utilized where they are best trained, in surgery.

I interviewed yesterday by phone for an hour with Mike Flowers, nurse recruiter for the Tsehootsooi Medical Center.  I learned from Mr. Flowers that not only are all tribal healthcare facilities moving towards Baby-Friendly designation, but they also have adopted the Midwifery Model of Care.  100% of native women are seen exclusively by nurse-midwives.  CNMs practice with a great degree of autonomy in these facilities and are truly primary care providers.  Obstetricians are brought in only for the rare cesarean section.  TMC boasts a 6% c-section rate, whereas the national average is 34%!!!  They are obviously doing something very right.

What is the Midwifery Model of Care?

The Journal of Nurse-Midwifery defines it this way:

The midwifery and medical models for the care of pregnant women are based on particular perspectives on pregnancy and birth. The approaches resulting from these perspectives are complementary and, as a result of midwives and physicians working together, there has been significant merging of the models. Instead of two mutually exclusive ways of managing birth, there is wide variation. Nevertheless, there are important differences between the two models, including differences in philosophy and focus, in the relationship between the care provider and the pregnant woman, in the main focus of prenatal care, in use of obstetric interventions and other aspects of care during labor, and in the goals and objectives of care. The midwifery model has advantages for many women because it avoids unnecessary interventions during labor, thus helping the process remain normal, and because it addresses needs that are often not adequately met by the medical management model.
J Nurse Midwifery 1999;44:370–4 © 1999 by the American College of Nurse-Midwives.

MARIE BERG is a senior lecturer in the Institute of Nursing, Faculty of Health Caring Sciences at Sahlgrenska Academy, Göteborg University, Sweden. She is also a senior lecturer at the Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Sweden. She wrote an excellent article entitled, "A Midwifery Model of Care for Childbearing Women at High Risk: Genuine Caring in Caring for the Genuine" that can be found at the link below.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595225/

The organization Midwives of North American (MANA) defines it this way:

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events.

The Midwives Model of Care includes:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• minimizing technological interventions and;
• identifying and referring women who require obstetrical attention

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.

 

The Midwives Model of Care definition above is Copyright © 1996-2001, Midwifery Task Force, All Rights Reserved.

I feel very blessed that I will be working in a system that honors the traditional role of the midwife as the primary care provider for childbearing women.  This is in keeping with a major precept amongst the Navajo, the Dine', that being líná ba chánáh hasin or, when translated, Honoring Life.

Definitions of common terms associated with the practice of midwifery:

<><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><> <><>

		American College of Nurse-Midwives (ACNM)
		American Midwifery Certification Board (AMCB), formerly ACC
		Certified Midwife (CM)
		Certified Nurse-Midwife(CNM)
		Certified Professional Midwife (CPM)
		Citizens for Midwifery (CfM)
		Direct-Entry Midwife (DEM)
		International Confederation of Midwives (ICM)
		International Definition of a Midwife
		Lay Midwife
		Licensed Midwife (LM)
		Midwifery Education Accreditation Council (MEAC)
		Midwives Model of Care (TM)
		North American Registry of Midwives (NARM)
		Preceptor

Tsehootsooi Medical Center

A wonderful thing happened this morning! I received my first response to all the emailed cover letters and resumes I have submitted through the IHS, the USAJobs.gov site, and to all the Navajo Area Unit nurse recruiters.  A recruiter from Window Rock, the capital of the Navajo Nation, contacted me.  Mr. Flowers began his reply so encouragingly and wrote extensively about what awaits me there:

Good Morning Ms. Lindberg,

Thank you for your resume and interest in Nursing opportunities on the Navajo Reservation. I am the nurse recruiter at Tsehootsooi Medical Center (formerly Ft. Defiance Indian Hospital), and I’m glad to assist you in any manner possible to find a position that fits you well and will allow you to maximize your talents and skills, whether or not that position is at TMC or one of the other facilities on the Navajo Reservation. I think you will find that Nursing practice on the Reservation is both challenging and very rewarding. I also think the experience you gain here will really help prepare you for a career as a CNM . . .

"Below is some general information about our facility and community. I have also attached a profile of our OB Unit FYI. I will be in training all day today, but would like to speak with you about the opportunities we have here and at the other facilities on the Reservation. What is a good time for me to call you? I look forward to speaking with you and working with you in the future."

Window Rock is 30 miles WNW of Gallup.  Much to think about.  Government Housing is provided:

"Tsehootsooi Medical Center, formerly Ft. Defiance Indian Hospital, is a fairly new facility (opened in AUG 2002). We serve an active user population of 43,000 people spread over a 2,500 square mile area (called a service unit) surrounding Window Rock, the capital of the Navajo Nation. We have 48 in-patient beds with about a 90% occupancy rate, and average 220,000 out-patient visits per year. Ft Defiance is located in a rural setting about 30 miles WNW of Gallup NM along the AZ/NM border. Life here is relaxed and peaceful, yet we are within a 30 minute drive to the conveniences of Gallup, a town of 20,000. We are located at 6,800 ft elevation and have pleasant weather year round with low humidity and summer temperatures averaging in the upper 80’s/mid 50’s and winter temps of low 40’s/teens. We do get snow and occasionally sub-zero temperatures in the winter. Most of our rain falls in the “monsoon season” from mid-July until mid-September, and gives us comfortable weather during the hottest part of the summer.

We have housing available on the hospital compound, so most employees walk to work. Like the hospital, the housing is new and modern. Our new housing has 1 or 2 car garages, gas heat and air conditioning, dishwasher, gas stove, refrigerator/freezer, and washer/dryer hookups. They also come with a patio and fenced in back yard. We have a very close community of employees and families who work, live, and socialize together. There are lots of outdoor activities locally or within a 2-3 hour drive including hiking, biking, hunting, fishing and water sports, snow skiing, etc.

We have a 12 bed OB/L&D in-patient unit with 5 LDR beds and average 40-50 deliveries per month (see attached department profile). I can also email photos of our hospital and housing if you’d like."


We will see . . . we will see.  I promptly completed the online application for that specific facility and for the one in Sanders, AZ. Tomorrow I will be having a phone interview with Mr. Flowers. Exciting.

"To provide superior and compassionate healthcare to our community by

raising the level of health, Hozho, and quality of life."

http://fdihb.org/

IHS is Baby-Friendly!

How cool is this!?  This is a strong motivator for me to serve amongst the Indian Health Service . . . They are working to achieve the WHO and UNICEF Baby-Friendly designation for 14 of their obstetric facilities.  I want to be a part of this initiative in Navajo Country!

Standard of Care

The Indian Health Service supports policies and practices that foster exclusive breastfeeding—meaning no formula and no other liquids or solids—in the first six months of an infant’s life and continued breastfeeding, with the introduction of solid food, in the second six months of life. Research shows that hospital practices affect a mother’s choice to breastfeed. See Hospital Practices and Women’s Likelihood of Fulfilling Their Intention to Exclusively Breastfeed.

The 10 Steps to Successful Breastfeeding created by the World Health Organization and UNICEF ensure that maternity services provide a healthy start for every infant and the necessary support for mothers to breastfeed. Hospitals around the world follow the 10 Steps. The maternal and child health consultant for the Aberdeen Area has created a model policy [PDF – 199 KB] for Indian Health Service hospitals. In addition, the Academy of Breastfeeding Medicine has developed a model policy in addition to the 10 Steps that obstetric facilities can adopt.

Baby Friendly

The Baby-Friendly® Hospital Initiative of the United States designates facilities as baby friendly—a designation that’s a positive marketing tool for a health facility and a signal to the surrounding community that breastfeeding is important. And, research shows that baby-friendly hospitals increase the proportion of infants who are exclusively breastfed. See Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level?

The baby-friendly designation process involves accepting the 10 Steps and demonstrating through an intensive review process that policies and practices have been changed to support breastfeeding. The Indian Health Service is working to achieve the baby-friendly designation for 14 of its obstetric facilities. We’re encouraging tribal obstetric facilities to adopt this initiative as well.

Baby-Friendly® is a registered certification mark of UNICEF.

A Room of Their Own

Nursing mothers should have a dedicated space—a lactation room—in a clinic to be able to nurse their babies or to express milk. While there are no clinical requirements that we know of concerning what a lactation room should look like, there is a federal law that requires employers to provide a safe, private place for employees to be able to express milk.

Cross-Cultural Medicine

So much to learn.  I am an eager student.  Traveling to another country is vital to becoming a well-rounded person.  I was 13 when my family moved to Heilbronn, Germany.  Still a westernized country, but very different than the United States.  I learned much in my mid-teens.  I learned to love the people on their own terms, not on US terms.  I learned the strength and wisdom that comes with centuries and centuries of living on a land and becoming a people. It takes time to become "a People."  To hewn out a deep-rooted, meaningful identity and way of living.  I wrote a poem when I was 16 likening the United States, a whole of 200 years old in 1976, to a two-year-old toddler.  Tantrums.  Demanding.  Insecurely independent.  It takes time . . . 

I am grateful for living abroad and for living and traveling throughout the United States as well during my formative years and post high school years.  Abroad:  Germany, France, Poland, the former Czechoslovakia, Switzerland, Austria, Italy, Monaco.  Stateside:  California, Arizona, Texas, Kentucky, West Virginia, Virginia, Maryland, Florida, Illinois, Washington, Oregon, New Mexico, Louisiana, Mississippi, Alabama, Georgia, the Carolinas, New Jersey, New York, Connecticut, Pennsylvania, Ohio, Wisconsin, Minnesota, Missouri, Nebraska, the Dakotas, Wyoming, Montana, Utah, Idaho . . . just about every state in the continental US.  I have seen much.  I have learned much.  I am continuing to learn.  There are many ways to walk in the world.  They are all valid and worthy of respect and to be treated with dignity and appreciation.

In preparation for this new journey, this new "road" along my life travels, the office of the Indian Health Services has much guidance to impart to a would-be traveler to this native land like myself:

Medfeather



Cross cultural medicine offers unique opportunities for service and at the same time it offers individual growth for those serving. While new employees of the Navajo Area Indian Health Service may have been exposed to cross cultural environs as they grew up, during academic training, or previously in their professional careers, exposure to diverse peoples only partially prepares one for life among the Diné (the Navajo People). The subtleties of interpersonal relationships (which, when understood by health professionals make them more successful in caring for patients) are particularly important among the Navajo.

In all of the Navajo healthcare facilities the following situations or realities may be encountered:

• Direct eye to eye contact with others is not common on the Navajo.
• Handshakes (when a hand is extended to someone) is a touching of hands as opposed to a firm handshake.
• The perception of time is different in that problems may have begun "awhile ago" and menses may be marked in their relationship to lunar cycles. The history of present illness for an acute illness may result in a story which relates the cause to events in the patient's personal life as far back as 50 or more years.
• History taking is perceived particularly by Navajo elderly as unnecessary. Traditional healers "know" what the problem is without oral history taking sessions. Combining the history while a physical examination is underway can yield better results.
• The review of systems can be particularly problematic in that if the patient felt they had concerns about a particular organ system they would have informed the practitioner of such at the outset of their interaction. Again, combining ROS with the P.E. can be helpful.
• Most often the answer to a question like "you don't have a headache do you" will result in an answer of "Yes", which means "Yes, I do not have a headache".
• Religious beliefs should be understood so that therapies of education can be appropriately tailored to each individual. Counseling emphasis for a prenatal patient is best given once religion is determined as the approach would be different for a Navajo who believes traditionally, for Navajo American Church members (who use peyote) and for Navajos who have converted to Christianity.
• Providers should offer tissue to patients for disposal such as toenails (after removal), scalp hair (if removed to suture a laceration), and even normal placentas. Traditional Navajos know what is appropriate for the disposition of these.
• Many Navajos still point directionally with their lips and not with their fingers and arms.
• Family decisions regarding health matters are common place. This is particularly true of surgery and delays in surgery may be misunderstood by those not appreciative of the fact that families require time to gather and weigh the options with the patient.
• Therapies may be delayed by the patient so that a traditional healer can be consulted and on occasion a ceremony performed in their hogán (home).
• Practitioners should always ask (especially the elderly) before showing X-Rays with patients as some have strong beliefs about any pictures of themselves and X-Rays have certain meaning to some patients.
• Assessing the home environment is essential before therapies are prescribed. Many people still have no electricity (no refrigerators) and no in door water source (no bathroom). Alternatives exist seasonally for ice/heat treatments and storage of medications and these should be appreciated by the practitioner.
• Conversational "courtesies" which are common in non-Navajo society (thank-you, excuse me, etc.) are infrequently heard on the Navajo but appreciation is felt and expressed by patients particularly after they get to know their provider over time.
• Translation into the Navajo language (which is descriptive) is extremely difficult and many health related terms have no single word counterpart in Navajo. A "simple" question when interpreted into Navajo takes much longer to ask in Navajo than in English.
• Patients may arrive for healthcare with their skin blackened with charcoal which mean they have recently had a ceremony performed for them by a traditional healer.
• After ceremonies, patients have to observe certain practices outlined by the healer (only eat certain foods, avoid anything dead, etc.). These do not generally interfere with prescriptions by non-Navajo practitioners.
• Pinon tree sap and herbs may be placed on wounds prior to arrival in the E.R. and harsh criticism of this (which represents a belief system) will adversely affect the relationship with the patient.
• Patient encounters with spider webs cause problems for some patients even though the non-Navajo practitioner may not be able to see a rash or believe that shortness of breath is a spider web induced.
• Avoidance of the phrase "there is nothing wrong with you" is best. Advising the patient that one can't determine the nature of their problem at this time is better.
• Many Navajo believe that by stating something may happen in the future (potential complications including death for example) will cause the event to occur. This has obvious implications for health education efforts.
• Navajo concepts of being, health, disease, and the environment are deeply intertwined with Navajo religion.
• There are many types of traditional healers (crystal gazers, herbalists, stargazers, hand tremblers) and the right one must be sought out for the patient (by the family) for specific problems. Navajo Area Indian Health Service employees must respect the patients served which includes their belief systems. Doing so will lead to mutually satisfying relationships among patients, families, community members and those who choose to live among and serve the Diné.

We are taught these general concepts in nursing school, but do not always have the opportunity to exercise what we learn and stretch ourselves in our capacity to understand with compassion and respect.  I have always embraced diversity.  My parents were bigots.  I have never been.  I treasure the ways of ancient peoples.  I hope to absorb their wisdom and continue to learn and grow from these people I will serve.  A mutually beneficial interchange.  That is my vision.

Coming Full Circle

Have you ever felt that you were on a secret journey, a path that was planned well in advance without your awareness and choosing?  Somewhere along the way you seem to stumble upon that road, sometimes it is straight at places, sometimes it takes sharp bends and curves, sometimes it is bumpy, sometimes smooth.  That has been my journey.

Caregiving, healing, nursing has been a part of my life story since early childhood.  It is a hard path to be on as you constantly risk losing yourself and expending all your life energy pouring yourself out to others.  Healer, heal thyself.  So important to remember.

I knew I wanted to be a midwife when I was in my early twenties.  My undergraduate nutrition work kept bringing me back around again and again to where health starts for any individual, at conception, in the womb, in the early formative years.  The groundwork is layed.  The cellular coding and memory are embedded.  The call of the midwife whispered ever so gently at that time.  My young, confused, searching soul did not listen.  I had more to learn yet.  So, I went on to graduate school focusing my energy on the early work of those pioneering the field of maternal-infant attachment.  I felt on a deep internal level that touch was the foundation for all learning.  I became a certified infant massage instructor at that time and met some amazing women in public health nursing.  They left a huge impression on my psyche.  More time passed and I plunged into an assistant position with a local midwife.  Birth.  The rhythm and sway of a woman as her body brings forth new life.  More impressions left on my psyche.  Then my own two precious babies were born from my body, in my bed, into my heart.

I also journeyed on various spiritual paths.  I spent many years amongst the Swinomish of the North Coastal Indians.  I became attuned with the lifegiving sustenance of the cedar, the salmon, the eagle.  The Red Cedar Circles that I participated in taught me the stories of these peoples, their history.  I learned through the sound of the drum and the chant of their song of their journey from living on the land to being torn from the land as youth and brought to missionary homes where their names and language and clothing and beautiful, sleek, long, jet-black hair was ripped from them.  Then, how they were returned to their land, stripped of identity, lost, confused, not knowing which world they really belonged to.  It can all be heard in the drum and the song.  It tells the story.  The drum.  The heart beat of Mother Earth.  Johnny Moses and Fred Jamison, cousins, shaman, healers. 

A naming ceremony was held for my oldest daughter on our land in the Upper Skagit when she was an infant.  Drumming, chanting, a blessing way was given by Fred Jamison.  She was named in the Swinomish tradition.  Potlatches that I was privileged to attend, private, ancestral exchanges that have continued for thousands of years up and down the Puget Sound coast and through the Northern Passage of Canada.  All these peoples are of one People.  Their potlatches would last for days, weeks.  Gifts were exchanged, one chief trying to outdo another.  Much honor.  Much pride.  A coming-of-age naming ceremony where a youth is given the name of an ancestor to keep that ancestor's spirit alive in the tribe.  And, then, the longhouse with it's low-ceiling cedar structure.  Hot, burning cedar fire, drumming, chanting, like being in the womb of Mother Earth.  Trance-like.  I have been privileged to be a part of all of these as a white woman amongst brown faces.  Privileged.  Honored.  Blessed.

Many of us become very practical in our thirties.  The work of the adult is to be productive, to be generative.  Many find their productivity developed in the work place and growing a family.  So it was for me over the next 15 years.  As I nourished my babies at my breast, cradled them in my arms, carried them on my back, slept with them snuggled against my body, watched them emerge as distinct and unique individuals, I grew.  I grew in my wonder of this cycle of life.  I surrounded myself with other women who shared my love of parenting that is aligned with our human biology.  I learned from them.  My sisters.  My teachers. 

Eventually, our children grow.  The mate that we chose to give us children may or may not be the one to see us into the span of the next part of our journey.  In my case, this was not to be.  I chose an individual who carried with him the legacy of my abusive childhood.  I changed that life story to some degree through my life course, but not enough.  Healer, heal thyself.  Those thoughts kept echoing though my mind and heart.  Caregiving can become toxic.  And so it had.

A woman goes through various phases of her life.  I am at one of those major junctions in the road.  Reclaiming my personal strength and power, I have struck out on my own as my children have needed me less and less.  I am coming full circle.  I have returned to reclaim pieces of me that I left behind.  I am a teacher, I am nurse, I am a midwife.  Once again, I was privileged to study at the feet of Diana Moore, infant massage instructor and infant mental health specialist, my same mentor and trainer 20 years prior.  So, too, I have been blessed to once again study at the feet of Penny Simkin and pleased to benefit from all the work she has accomplished over the past two decades.  Again, my work with Toni Weschler has come full circle as well as I work with women who are trying to conceive at a time when conception is severely threatened.

And, now, my early roots amongst the natives of the Northwest is coming full circle.  While raising my daughters, I embraced Christianity, as manifested in the most ancient expression of that Faith, walking in the footsteps of Christ and his early followers, modeling First Century teachings.  I have given my daughters a strong, moral foundation in the Truth of God's word.  I have reparented myself through it's healing balm.  And, I have made numerous treks down to the Southwest over these past two decades to witness the marriage of my Christian faith amongst the Navajo people.  Full circle.  It is time.  It is where I am meant to be.

And, so, a merging of my outward life with my inner life, my life work with my spiritual foundation.  Do you believe in serendipity?  Do you believe there is a pre-destined purpose to our existence?  That all of our life experiences are part of a bigger plan?  Do you believe we all have a life calling?  I am beginning to.

Doula Life

As I grow in my service to women, becoming a primary provider, I do not want to lose touch with the women I serve.  I do not want to just "catch" babies.  This is what serving as a doula to women, beginning with the first birth I attended in 1988, has taught me:

When I am with a woman at birth, my personal and professional experience tells me to go to the pain, embrace it and transform it. I have never experienced or seen distractions and avoidance work. Rather, I move with the woman and am with her in the moment. I breathe with her. Each and every contraction. We work with where the baby is at and completely visualize that baby in it's journey down and out. Where is it now? What corner does it need to navigate at that moment? How can the woman adjust her body to assist at that time for better passage? What breath is most helpful to meet the pain and intensity of the contraction head on, go into that pain and melt it away, transforming it and then moving on to the next that will come in a few minutes. If she clenches, stiffens, tries to run away and fights the pain, it hurts more and slows down the progress of the baby being born. Greet the pain, breathe into it, feel where it's at, transform it, move on. Over and over and over again. Rest in between. Bask in knowing the baby has moved forward a little bit more and that you have faced things and moved through them consciously, courageously, with full awareness. The body, when in sync, produces endorphins to help" lubricate" the sensation of pain, making the woman better able to cope. That natural mechanism is only kicked in by working with the pain long enough without fighting or running away from it. It creates calm and peace in the woman.

Before active, yet involuntary, pushing begins there is a transition stage. It is rapid, constant, wave after wave of contractions without let up. The woman often loses her bearings, can feel panicky, wants to run away, feels nauseous, wants to throw up, doesn't think she can bear anymore. But she can and she will. She will breathe faster, meet each wave, pant, stay very, very focused, not run away from the intensity, but increase hers to match. She needs lots and lots of support during this brief and intense unrelenting wave of pain.

And then, when the body has expanded to it's full to allow this new life to emerge, there is a quiet, peaceful, restful time. We call this being "complete." A time to regroup before the hard work of really getting that baby out. Then this overwhelming force takes over. A woman can not fight it. She has to go with it and work with it in order to bring this new being into the light. It is active and all consuming. It's always two steps forward, one step back. If she fights it, there will be little progress and the baby may go into distress. Violent measures may be needed to forcefully rip the baby from the birth passage. If the woman listens to and works with her strong body urges to push the baby out, the baby will descend and be born. But, it's always two steps forward, one step back. Baby emerges, then slides back. Baby emerges, then back again. Finally, the baby emerges and does not retreat. One more push, just one more, and the head emerges. It is the most magical and most frightening moment. The head alone is visible. It is bluish grey, lifeless, not breathing. Caught in this moment between life and death. Then, another surge of energy and force and the entire body is expelled. A new life has been born.

Death, too, must be embraced for the transition to occur with grace and peacefulness. Breathing changes to meet each stage of the process. If death is not accepted, if one fights it, it becomes a gross, hideous anomaly. It is not dignified. If allowed, accepted, supported at each and every stage, it becomes just another passage from one existence into another. Yes, morphine is given to suppress the pain, but simultaneously it heightens the person's awareness of what is really important to them. They conserve and expend their energy purposefully, consciously according to the needs at the time. If one does not accept that the person is dying and tries to distract or carry on as usual, they impair the process and make it into an ugly phenomena. Acceptance, going with the flow of the moment, embracing the transformation turns it into something beautiful.

Living is the same. I do not do distraction well. I do not do avoidance well. I am a Doula. I am with a person, beside them, present for them, breathing with them, feeling with them. Embracing the pain of change, knowing that crisis is an inevitable part of the process, and that the opportunity for growing and creating a new life, a new reality is on the horizon, waiting to emerge. I can not do distraction with you. I am here to walk with you, to be by your side, to breathe with you, to face the situation and transform it and you into something new, more beautiful, stronger, wiser than before. It's just what I do.

This is the essence of being with a woman as she breathes life into the world.  I do not want to lose those roots.  That is the vision.  That is the plan.  To bring all my 50 years of wisdom forward and add to it new wisdom and experience.

Conception

Birth. Life. Death. I am being reborn into a new life where I will likely take my last breath, my body becoming one with the bones of Mother Earth, the deep, rich, ochre red rocks of the southwest.

Navajo Country has called to me for more than a decade now. The red earth cries out to my soul. Midwifery, too, has whispered softly, beaconing to me, for the past 10, 20, almost 30 years now.  It is time.  Time for me to listen. And answer.

I am ready. I am ready to rebirth, to start anew, cradled in the warm womb of these ancient red rock formations.

I am a nurse. I nurture. I comfort. I heal.
I am a doula. I hold the space. I mother the mother.
I am in a state of metamorphosis.  Transforming from crawling on my belly to spreading my wings, shining, glistening as a midwife.  Into my hands life will come forth.

My journey began in 1984 when I entered John Bastyr College (aka Bastyr University), the first accredited Naturopathic college in this country, born in the mecca of alternative medicine, Seattle. I knew then as I know now that good medicine starts at conception. I focused my studies at Bastyr on prenatal and infant nutrition studying under such renowned personages as Penny Simkin, the mother of the modern doula and natural childbirth educator.

Upon graduation, I began working with local midwives assisting at births. My own two daughters were born at home with the assistance of midwives in 1989 and 1993. For the next 15 years, I mothered and learned from these little people in my care. I lived out traditional, aboriginal, mothering wisdom, applied home remedies and homeopathy, and became a teacher to my children.

In 2004, I returned to school bringing with me all those years of hands-on experience, intuition and alternative medical knowledge. I began my growth as a nurse, doula, childbirth educator.  I am at the end of that journey, finishing my nursing degree on March 21, 2012 and am ready to start this new adventure taking all that I have learned over the past 50 years and shaping it and molding it into the caregiver I believe I was intended to become - a Midwife.

In this journal of sorts you will read about my road of becoming a Certified Nurse Midwife, learning about traditional Navajo practices, serving where there is a great need.  I am excited, nervous, scared.  I will be leaving my adult children behind as I depart from the Evergreen state, the great Northwest, that I have called my home for the past 29 years.  I have made many trips to Red Rock country where my soul resides and am ready now to embrace all of me and all of what the peoples and the land have to teach me.

The Plan: 
Complete my nurse training in March, take my national exams shortly thereafter, and relocate to the western border of New Mexico, the eastern edge of Navajo country.  I am applying for Government Service positions through Indian Health Services at facilities sprinkled throughout the huge northern expanse of Arizona and New Mexico.  During my first year establishing residency in New Mexico, from the Summer of 2012 through the Summer of 2013, I hope to complete all the requirements needed to sit for the International Board Certified Lactation Consultant (IBCLC) exam.

After one year of residency, the University of New Mexico in Albuquerque awaits me.  New Mexico has a long history of midwifery according to the UNM Nurse-Midwifery website:

There is a very long history of midwifery in New Mexico beginning in the Spanish Colonial times with the use of traditional Hispanic Midwives (parteras). The first U.S. university-affiliated Nurse-Midwifery education program was the Catholic Maternity Institute (CMI) in Santa Fe.  Under the leadership of the CMI midwives, the American College of Nurse-Midwives was incorporated in New Mexico in 1955. Midwifery has been a part of New Mexican cultural heritage for many generations.

Additionally, there is much support on the state level to fund nurse-midwifery education fully:

We are one of only a few totally state supported programs in the US. Because we are a state institution, tuition for a UNM nurse-midwifery education is one of the most reasonable in the country.  Many nurse-midwifery students are also eligible for the Federal nursing loan program, which pays a monthly educational stipend. Other financial aid opportunities include the New Mexico Health Service Corps and the US Public Health Service Corps, both of which have loan for service programs.

And, so, I will be applying for one of these loan-for-service programs whereby after my training I will return to the reservation to practice.

You will find included in my posts links to resources that have helped me map my course.  These are intended as a road map so you can follow me along the way or if this is a journey you too would like to travel one day.

http://www.ihs.gov/Jobs/index.cfm?module=ViewPostListing&option=SearcherPostListing
http://webs.wichita.edu/?u=CHP_NURS&p=/HumanLactationOnline/index/
http://nursing.unm.edu/programs/Masters-in-Nursing/nurse-midwifery.html
http://www.ihs.gov/

That is the plan . . . follow along as conception takes place and this baby grows . . .