Sensitive Midwifery - Issue 44 - October 2019

Midwife Elke Barnes describes the birthing landscape of Alaska, where midwives attend more births than anywhere else in the United States. Birth in Alaska H ello to my sister midwives in South Africa! I'm writing from the hotbed of midwifery in the United States – ALASKA! We are the 49th state – one of the youngest, since Alaska only became a state in 1959. Our state is huge, larger than your entire country of South Africa. Many know us for our caribou, salmon and glaciers, but what makes me most proud is that we have the most vibrant and active midwifery presence in the USA. Two types of midwives In Alaska (and the US) there are two kinds of midwives: the Certified Nurse Midwife (CNM) and the Certified Professional Midwife (CPM). The Certified Nurse Midwife comes from a nursing background then attends graduate school to become an advanced practice nurse. CNMs practise in all 50 states. They have a wide scope, including birth, prenatal and postpartum care, as well as well-woman care, gynaecology, and prescriptive privileges from menarche to menopause. CNMs work mostly in the hospital setting, within the medical system, often supervised by doctors. Unfortunately, the Certified Nurse Midwives tend to struggle for autonomy and to be able to practise the midwives’ model of care, though they do have very few regulations or limitations to their practice in Alaska. A Certified Professional Midwife, or CPM, is a community-based midwife who attends births at home and at non-hospital-a ffi liated birthing centres. CPMs are ‘direct-entry’ educated without a nursing background, completing a three-year degree programme and a 3 500-clinical-hour apprenticeship. CPMs tend to have a highly holistic approach to midwifery, utilising herbs, bodywork and other non-medical modalities in their care. CPMs are only licensed to practise in about half of the US states. To serve a wider population, many of the Alaskan CPM practices also employ at least one CNM due to their wider scope of care, including prescriptive privileges. CPMs are highly regulated and restricted in practice in Alaska. Midwives attend about 10% of births in the United States but the rate varies widely between states. Alaska has three times the national average with almost 30% of our 11 000 births a year attended by midwives. History of midwifery in the USA To understand why Alaska has such high midwifery rates, we need to look at the history of midwifery in the US. In the early 1900s, when birth moved from home into the hospital, US medical societies lobbied to outlaw midwives instead of integrating them. While the European nations were modernising and mainstreaming midwifery, our midwives had their licences revoked, mostly for reasons of financial competition, classism, sexism and racism. Only in pockets of poor and remote places did midwifery continue. One of the strongest places Read more about Elke Barnes on page 4 Birth Continued on page 19 18 eSensitive Midwifery Magazine Issue 44