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.)