We here at Birth by Design celebrate and support birthing women, no matter what their birth looks like. From home births to planned c-sections, we are here for you!
However, since May is for Midwives, what is it like to be a midwife or to use a midwife in Arkansas? (look for more concerning what it looks like to have a doula at a c-section, VBAC, and all sorts of other births in the coming months!)
So let’s explore what it means to hire and use a midwife in our state!
Every state has different laws about where, when, and how midwives can operate. In some states, midwifery is illegal. In the rest, laws range from unregulated to fully able to practice and even bill medicare. Midwives Alliance of North America has a comprehensive list.
In Arkansas, midwives are able to practice and be licensed as lay midwives or certified nurse midwives, and are overseen by the Arkansas Department of Health and the Arkansas State Board of Nursing.
The guidelines for Arkansas midwives can be found on the Department of Health website, but what does it take to become a midwife? The regulations say that a midwife must have basic education (high school graduate or equivalent), be up to date on TB tests and immunizations, and CPR certified for adults and infants. Then there’s the practical experience. Midwives “must demonstrate competency in performing clinical skills during the antepartum, intrapartum, postpartum, and the immediate newborn period.” What does that look like? Well…
“a. The applicant must attend a minimum of 20 births as an active participant.
b. Functioning in the role of primary Lay Midwife under direct on site supervision, the applicant must attend a minimum of an additional 20 births, of these:
a. A minimum of 10 must occur in an out-of-hospital setting and
b. A minimum of 3 must include at least 4 prenatal exams, birth attendance, the newborn exam, and 1 postpartum exam, each conducted personally by the applicant with direct supervision.
c. 75 prenatal exams, including 20 initial exams
d. 20 newborn exams
e. 40 postpartum exams”
Y'all. That’s a lot of work. But there’s more!
After all that apprenticing, midwives still have to pass several exams.
“1. Pass the North American Registry of Midwives (NARM) written examination. The exam may be administered by the Arkansas Department of Health and Human Services, Division of Health, or at a regularly scheduled test site arranged through NARM.
2. Pass the Arkansas Midwife Regulations exam with a score of 75% or higher. This exam is administered by the Division.
3. If necessary to obtain a passing score, the examinations may be taken up to three times. If the Midwife fails either the NARM exam or the Arkansas Midwife Regulations exam three times, she must repeat an apprenticeship before being allowed to re-test. “
After this, there’s licensing renewal (including continuing education requirements) that occurs every two years.
So, what does it look like to actually use a midwife?
First, you have to qualify to use a midwife and homebirth. “The Licensed Lay Midwife may provide complete obstetrical care to women who are determined to be at low risk for the development of medical or obstetrical complications of pregnancy or childbirth.”
Second, you have to satisfy these requirements…
Now you’re ready to give birth! There are more requirements! (yay?)
The midwives have all sorts of responsibilities during labor, not the least of which is supporting the laboring mother. They check fetal heart rates, mother’s blood pressure, etc… My favorite line of the rules and regs… “All services should be provided in a supportive manner and in accordance with these regulations.” A supportive manner is in the laws!
After labor, midwives assess the placenta, repair tears (if needed), check all sorts of vital signs and physical symptoms of both mother and newborn. She’ll stay until everything is within normal, and then come back for a follow up visit within 24 hours. Midwives are also responsible for the newborn heel prick (required by law), fills out the birth certificate and social security paperwork. Then, just like with an OB, there is a follow up check at 6 weeks.
What else do midwives do?
Record keeping. So much record keeping. They turn in a monthly log of their midwifery activities. Document, document, document. Keep records for 24 years. Submit to audits.
What about midwives in hospitals? Currently, in central Arkansas, certified nurse midwives are only available at UAMS. According to the UAMS website, “The UAMS nurse-midwives in the OBGYN department are primary health care providers to women and are able to perform physician exams, order laboratory tests and ultrasounds, diagnose and treat common problems, provided prenatal care, women’s health care, labor and birth care, as well as health education and counseling. Our nurse-midwives attend labor and birth for the patients in the hospital setting, working in collaboration with physicians trained in Obstetrics.” Practically, this means that women birthing at UAMS can request a midwife attend their birth, but it’s not guaranteed.
I hope this gives some understanding to the hard work that goes into midwifery in Arkansas. The women who choose to become midwives are caring, motivated, organized, responsible, capable and so hard working!
(There’s lots of things happening concerning the status of midwifery in Arkansas, Check out some of it here.)
As part of a celebration of midwives, and as an ongoing series, we'd like to introduce Arkansas Midwife Kim Jacob! She is a certified midwife working in the central Arkansas area. She has been licensed by the state of Arkansas and certified as a Certified Professional Midwife since 2005.
All midwives go through an apprenticeship, and according to Kim, she had the privilege of working with several different midwives. "Every midwife has something unique and special to teach and I’m so lucky to have learned from some of the best." It took her about 4 years to get all the experience required to apply for the NARM (North American Registry of Midwives) exam. But she feels like her real training happened after she passed the exam. "My mentors continued teaching me, attending births with me and keeping me rooted in the wisdom and respect of birth. They still do! And this is also what I do for anyone who I train to become a midwife. The preceptor apprentice relationship is vitally important in creating a solid midwife. I believe this with all my heart."
Kim's love for the women and families she works with is so evident- especially in her reasons for becoming a midwife, "My births changed me. My midwife inspired me. It’s a human rights issue. I love Moms and babies so deeply and want to provide the care they deserve by using evidence but mostly love." Not only that, but her favorite part of being a midwife? "The people!!! I love meeting new people and helping them attain the births they desire. I love how we become friends through the process. I get to see women at their most raw, vulnerable, strongest and most beautiful times of their lives. There’s no hiding who you really are when you’re in labor. Gosh, I love that!!"
She also has loveley words to say about how being a midwife has affected her, personally. "Sleep deprivation? JK! Haha!! I think the mutual love that I have for and from all of my clients throughout the years is like a blessing or charm of some sort. All the love and continual good vibes I get must make me a lucky person in my day to day life. Just like we can curse someone by speaking ill of them we can bless people by speaking and feeling love. I definitely feel the love I receive makes me a millionaire in that way."
The role of midwives is so unique, with a midwife spending lots of time with a family before and after birth. Kim's favorite advice for the mom's she works with is genuine and open. "With a positive, can-do attitude you can have an ecstatic birth. But mostly, just set your space up as positively as possible with the support of people who love and respect you and then open yourself to all the possibilities. You can do it!! Also, always keep a good sense of humor about pregnancy, birth and especially parenting! Try not to take anything too personally."
More about Kim...
What are your other jobs/hobbies/interests, etc...?
I love to cook (but mostly eat), read and hang out with my main squeeze.
Tell us about your family. Husband? How many kids do you have? What are their ages?
My husband’s name is Nathan and he is the raddest of all the people I know. I don’t know anyone who is loved the way he loves me. He’s my biggest fan! My daughter, Tig is 18 and just graduated high-school. She’s working for family now and will be having a baby in October. It’s not what she had planned for but we’re all very excited to meet this new baby and spoil the heck out of him! I’ll be mostly taking care of her but my dear friend Shea Childs will probably be doing most of the “thinking” during the actual birth. ;) My son is 16 and even though he seems like a reclusive gamer dude, was voted class favorite at school last year! He’s super-cute and funny.
What is the last book you read?
I’m reading book five of the Outlander series! So good!!
I always have a hard time picking colors because I like ALL the colors! But I seem to have a lot of purple in my closet. ;)
Oh man. Didn’t I tell you eating is my hobby? Nathan and I are total foodies. We love to read cookbooks and other books about food, watch shows about food and discover awesome interesting food wherever we travel. Picking a favorite food is like picking a favorite color. Can’t do it.
I love Thanksgiving! No gifts, hanging out with family and ALL the best food! We usually host the family gatherings at my house so it’s especially fun to host a party with all the people I love the best.
I’m all about the earthy smells. My friend, Sabrina told me once that I started smelling like patchouli the day I became a midwife. Haha!! Nathan just bought me a fragrance that actually has the word “turned earth” in the description. I feel like I should buy up a few cases of this stuff because I’ll be a sad girl if I run out and can’t find it again.
It’s a tie between Spring and Fall. I like the weather mild y’all!
Favorite way to de-stress:
Netflix and a margarita is my fave. But if I can’t have a margarita, I’ll take netflix or a good book any day.
If you want to get in contact with Kim...
Kimjacobconwaymidwife.com. (This is being revamped at the moment and I’m super-excited!!) My number is 501-514-1277.
Our heart here at Birth by Design is for women. This month, we honor the women in our lives: the mothers, mother figures, aunties, sisters, cousins, grandmothers. The tribe of like-minded sister-friends. The women at work, the other mothers or mother figures at school pickup, dance class, summer pool. The solid group of women doulas, lactation consultants, nutritionists, chiropractors, massage therapists, nurses, doctors, and physical therapists we have the pleasure to work with.
We are a unique sisterhood of women supporting and serving women, and our support for each other overflows into our service for our clients.
We are honored to witness mothers being birthed. We are in a distinct position to laugh, cry, grieve, celebrate, comfort, endure with, sit in silence with, and empathize with the women we support. Our time with clients is short, but full! We love you and we see you.
We also know that Mother's Day isn't always easy, To those who experience loss, guilt or irritation, we hope that you find the support you need. We love you and we see you.
Happy Mother's Day from the doulas at Birth by Design!