Deborah McBain talks to a student of nurse midwifery to get a glimpse into her vision of the future.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 6 Episode 8

This final episode of season 6 may be my favorite. It’s hard to choose. It was a mind blowing roller coaster and carousel ride full of frightening and exhilarating twists and turns. This thrill ride begins with the narrator saying: "Our future can never be wholly known to us. Our present, like an arrow can point the way ahead but we never know where it will land or what will be waiting for us as we fall to earth." As I reflect on the recent discussions with my modern day midwife colleagues, I am moved by the synchronous events that caused us to land together.

There is no doubt that we have made a difference to the women we have touched. The midwife colleagues I have featured in my blog posts this season have been part of purposefully changing women’s health care over the last several decades. Together we have broken barriers, bringing midwifery back into the American medical mainstream and championed safe, humane and evidenced based birth practices. What does the future of American midwifery hold? I looked to a student of nurse midwifery to see where she is pointing her arrow and get a glimpse into her vision of the future.

Rosa Lee Avila has come to the University of Michigan by way of California and Missouri. She studied nursing at Missouri State University then spent two years in a Neuro trauma ICU after receiving her BSN in 2012. Her first experience with birth was watching a video at age 7 in preparation for the birth of her brother, the first of four other siblings. She also recalls witnessing her first birth while a nursing student and described it as “eye burning.”

Those events must have ignited a flame in her heart because when she had the opportunity to volunteer at a freestanding birth center she took it and then was hired as part of that birthing center’s nursing staff. Certified Professional Midwives (CPM) staffed this freestanding birth center. A CPM is an alternative entry point for midwifery that does not entail a nursing degree. As time came for her to advance her skills and education, as she had always planned to do, she applied to several Graduate programs around the country. She was delighted when she was accepted by her first choice. The University of Michigan would provide her with the dual credentials of Family Nurse Practitioner and Certified Nurse Midwife.

Coming to Michigan also gave her the opportunity to strengthen some family connections here. While she waited to start her graduate program she worked as a staff nurse in labor and delivery at Henry Ford Hospital and there she was introduced to hospital based nurse midwifery and to me.

As this episode ends the narrator says: "At times the present seems most perfect when its seeds lie in the past and at other times life is rendered flawless as we look toward the future, glimpsing from within one golden moment all the joy days to come might hold.... We cannot stand still because the world keeps turning. Every year gives way to the next and its stories must be folded and tucked away, like children's clothes; outgrown, cherished and never quite forgotten." I decided to use these concepts to explore Rosa’s midwifery journey. The seeds in Rosa’s past are explained in the paragraphs above. Below are the answers to the other questions I asked her.

How have your most current experiences changed your goals and expectations? (What golden moments allowed you to see the potential of the future). What has been unexpected in your midwifery journey? (Where has your arrow fallen to earth unexpectedly?)

Because her first vision of midwifery was formed in an out-of-hospital birthing center model of care with CPMs in contrast to nurse-midwives, Rosa did not know how midwifery fit into a hospital environment. She found herself a bit judgmental about hospital-based midwifery. She says now that she is a bit embarrassed by that attitude. Her respect for hospital-based midwives grew as she saw how our practice in Detroit and the midwifery practice at University of Michigan Hospital incorporated midwifery philosophies into the hospital setting.

What perceptions and attitudes have you outgrown? What has midwifery outgrown? (What stories must be folded and tucked away?)

Rosa says she has outgrown her fear of hospital based midwifery practice. She now sees hospital practice as the “frontier” of midwifery as its presence continues to challenge how birth is done in a medical environment.

As she pursues a dual credential of Nurse Midwife and Family Nurse Practitioner she is excited by the expanding role for nurse midwives to care for whole communities. Midwives have historically been the health care providers for marginalized and isolated communities. What is outgrown is the notion that midwives are somehow less qualified than other health care providers.

She believes midwifery has outgrown the notion of “classism” between certified nurse midwife (CNM), Certified Professional Midwife (CPM), certified midwife (CM), direct entry midwife (DEM) and lay midwife. Confused? Here is a link for for more information about the different entry points and credentials for midwives.

What currently inspires you and motivates you? (What arrow is pointing your way ahead?) Where do you see midwifery in the future and where do you see yourself in relation to that vision? (As the world keeps turning, how will you and midwifery move forward with it?)

Rosa has been greatly inspired by her midwife mentors and midwife leaders as she moves through her education. She is inspired by her growing knowledge of the vast need for midwifery care and its role in changing “how birth is done.” In the future, she sees a professional environment that continues to clarify and standardize midwife credentials and educational standards across all state borders. She envisions a community of care providers in which all midwives respect each other’s chosen path and role.

She pictures a future with more choices for women in terms of types of providers of birth services and locations. She sees a future in which midwives providing home birth services are networked with midwives in birthing center and hospital practices. This would provide a smooth safe transition from one environment to another as risk status evolves.

Just as my retired colleagues and I did, the future midwife Rosa sees herself as a change agent and advocate for women and health care for vulnerable communities. I trust that the stories of those of us who went ahead of her will be cherished and not forgotten. But the world continues to turn round and round and the painted ponies go up and down. We are all captives on the carousel of time (cue Joni Mitchel, LOL). Despite the uncertainty of the political maneuvering of health care I remain optimistic. The future is unknown but it lies in caring and compassionate midwifery hands.

Deborah McBain (CNM, MS, BSN, RN) is a retired certified nurse-midwife and practiced full-scope midwifery in Metro Detroit for 20 years. For 23 years before her midwifery career she practiced as an RN in medical/surgical, obstetrical and neonatology units. During her career, in addition to her midwifery practice, she taught childbirth education, led menopause support groups and mentored nursing, midwifery and medical students as well as physician residents.
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