Career Day: Midwife

Tell us a little about yourself and about your job?

My name is Eve German. I’m from Hockessin, Delaware, and I currently live in Salt Lake City, Utah. I am a Certified Professional Midwife, meaning that I am a midwife who specializes in and was specifically trained to attend birth at home and in birth centers, as well as to provide comprehensive care in pregnancy, labor, birth, and the postpartum and newborn periods for normal, healthy, low risk women and newborns. I have a bachelor’s in English Literature with a minor in editing from BYU, and a master’s in midwifery from Bastyr University, which is in the Seattle area of Washington State. I practice at The Birth Center in Salt Lake.

What does your job entail?

My job entails providing healthcare for women during pregnancy, labor, birth, and the postpartum period, as well as providing newborn care* for the first two weeks of each baby’s life. This breaks down into two main parts in terms of my schedule. 1) During the week I have scheduled clinic hours just as you would have in any medical office, where I see clients** for prenatal visits, postpartum and newborn visits, and well woman visits for non-pregnant women. This involves the actual face-to-face time with clients, performing any blood/lab work that they need done, and then charting each visit afterwards, and reviewing all lab results for the regular lab work and ultrasounds that are performed for our clients. I also facilitate a Post-Cesarean Support Group, which is held monthly, and provides support and healing for women who have felt traumatized by birth via c-section. I am also the Clinical Director for our clinic, and so I have regular administrative work of ensuring that our staff and midwives are meeting the highest standards of safety and care as they practice in our clinic. This involves regular chart reviews, where I review how cases were managed, regular individual meetings and group trainings with staff to review and discuss how practice and safety can be improved, and regularly reviewing and revising our practice’s written safety protocols and procedures to ensure that they are up to date, and reflective of the highest standards of care in midwifery and out-of-hospital birth. All of these responsibilities we call “clinic.” That’s about half to three-quarters of my job, depending on the week. The other part of my job is 2) being on call. This involves having my work cell phone with me at all times (I carry two cell phones: a personal phone, and a work phone for clients to reach me on), so that I can immediately receive any calls or texts from clients who have a need, and respond accordingly. The bulk of my call time I spend attending labors/births, primarily in our birth center (about 80-90% of births I attend at the birth center in any given month), but also at home for families who choose home birth (10-20% of our clients in any given month). Most births happen in the middle of the night, so call and births involves missing sleep on a fairly regular basis. While the bulk of my call time is given to labors and births, it also includes providing any care or answering any questions that our clients might have, from urgent to non-urgent needs and questions at any point in pregnancy or the postpartum, as well as general women’s health questions and concerns.

*At our clinic (and at every midwifery clinic that I have ever worked in) we treat moms and babies as a dyad, a single unit, conducting their follow-up care in the postpartum by seeing them together, and thereby treating them as the unit that they are. I and my colleagues are licensed and trained in newborn care for the first two weeks of life, and routinely perform all the tests, checks, and assessments that would be performed by a pediatrician during that time frame (PKU tests, newborn hearing screenings, congenital heart defect screenings, weight checks, jaundice checks, etc.), while also offering extensive breastfeeding support, and frequent checks of and support to the mother’s physical recovery, and her physical and emotional transition into the postpartum/newborn period.

**We midwives prefer the term “clients” to “patients,’ because we believe it is language with less of a power differential between healthcare provider and patient, and also reminds us as the healthcare provider that the client has hired us, we work for them, and as such we should treat them with respect, equality, and our best services, rather than taking a “Doctor knows best” approach.

What drew you to midwifery?

God. That is the whole answer for me. I never would have chosen this field for myself; it’s too demanding and the responsibility too crushing. I seriously didn’t even know that it was an actual profession. I thought it was illegal in the U.S., and that it was a practice so outdated and so unsafe that it would only be practiced in third-world countries if it was practiced at all. Like most people, what I imagined about midwifery, and what midwifery actually is, were two totally different things. I had no idea that it was an established, respected field, with outstanding outcomes for mothers and babies. I was shocked when I learned that research consistently shows that midwifery care at home and in birth centers is actually safer for healthy, low-risk women than delivering in a hospital is. And that was just the beginning of what I had no idea about.

Midwifery has been and is a calling for me. And I don’t mean that in the aggrandized sense of that word. I mean it in the burden/duty sense of the word. Don’t get me wrong; I love my work, I love midwifery, and I love. love. love working with families. But more than I love my work, I believe in my work, and more than I believe in my work, I know that this is the work that God wants me to be doing–whether I like it or not. I know this because of the experience that first led me to choose midwifery as my career.

I was a missionary at the time, serving my mission in the New Zealand, Wellington Mission. I had been out about a year, had been recently transferred into an area that my companion and I were opening up as a sister missionary area for the first time, and was working to get the work going in this previously very quiet area. On this particular day, we were going to knock the doors of very old “Potential Investigators” contacts that we had found in an Area Book that hadn’t been touched in about five years. I can still see the name and where it was on the page: “Dale, [his address], ‘has good questions.’”

Our area was very rural. In fact, the population of sheep and cows quadrupled the population of people. Dale lived in a tiny, little railroad track town, where there was one small corner store, a dance hall, and maybe fifty houses, all cut right down the middle of town by a busy railroad freight line. We knocked on Dale’s door, which was about 15 or 20 feet from the railroad track. The conversation was running its course. We must have been trying to set an appointment with him to come back and teach a full lesson, because he started to talk about what he had to do that next week. He mentioned that he had to watch his granddaughter that week so that his daughter could take an exam for her midwifery course.

As soon as he had said the words “midwifery course,” three things happened simultaneously: 1) a fast train suddenly roared by, totally drowning out any sound but itself, so none of us could talk to or hear each other, 2) Dale turned inside to look for a book he’d been telling us about, while my companion turned away from me and looked the opposite direction towards the street, and 3) a feeling hit me, directly in my chest, harder than any feeling had ever hit me before. It was electric, and it reverberated up and down my body many times over. The feeling was so strong, so physical, and had hit me so suddenly and so unexpectedly that I actually stumbled back a little bit, and stood wide-eyed as the feeling coursed through my body. With the feeling, came an overwhelming and an undeniable message. Clearer than words could ever dream of being, this message was communicated directly to my soul. Its meaning was so clear that I could never question it, wonder what it meant, or doubt that it had really happened. To translate that message into words, it was, “You should–and you will–receive training as a midwife. This is your next mission.” The train was fast and loud, and so it passed relatively quickly. It took maybe 15 or 20 seconds for me to be hit with that shock wave, stumble, receive the message, be slightly bent at my waist panting and both wide-eyed and teary-eyed, and then collect myself and start acting normal again, at which point the train was gone, everything was quiet again, and Dale and my companion turned back in to continue our conversation.

The timing of that train was so cosmic, and so filled with a heavenly love and compassion for me, because it gave me privacy: a rare and precious moment of privacy. For one, the almost total lack of privacy that comes with missionary life was one of the hardest aspects for me of my mission experience. I know that Heavenly Father knew that, and that He gave me that moment of privacy as a tender and personal gift to just my heart. But more important than that, that privacy, a few moments with no eyes on me, gave me time to fully receive and react to that message that would change my entire life from then on, without having to quickly recover, cover up, act normal, and divide my mind between breathing, acting, and talking normally, and trying to interpret this powerful feeling and the message that came with it.

It took me five years from that day to fully transition or adjust to my new life as a midwife. Those years were really hard for me. Birth was amazing, the women I worked with, trained with, was trained and mentored by were even more amazing, and I knew that I was lucky to witness and participate in the things that I was involved in day to day in my work. But it was hard, too; it was stressful, exhausting, and occasionally terrifying. In addition, life on call, never knowing when I might be called away or when I might be back, was really hard and really sad, because it took a heavy toll on my closest relationships. I spent five years feeling sorry for myself on a pretty regular basis. When people would gush and tell me that I “have the most magical job in the whole world! You must be like a magical birth fairy.” I would just stare back at them, having no idea how to communicate the raw, painful reality of my work, let alone the energy to try to convince them otherwise.

I was single for the first two years of my three-year master’s program, and I had made a solemn oath that I would never partner with anyone or have children, because I didn’t feel like I could inflict on my family the pain of leaving them so often, and during the times when most babies are born: nights, weekends, and holidays. But God had other plans, and along my partner came, and with him the only other feeling in my life that has ever been as strong as that feeling that called me to midwifery: the feeling that I should marry him.

I married him three months before I graduated from midwifery school. We dated and were married long distance while I finished school. After graduation, I moved from Washington State to Salt Lake City where he lived, and got a job at the birth center where I’m currently working. A year and a half later, I gave birth to our first baby, and took a seven month maternity leave. It was my son who taught me, showed me, how miserable I had been making myself by feeling so sorry for myself all the time about how hard and demanding my work was. For years I had ideated about having “a normal job,” with “normal hours,” and I felt sorry for myself because I didn’t have that. Through those early newborn days of taking care of my son (who had a terrible time learning how to sleep), I realized that I was feeling sorry for myself a lot. It was a revelation to me. As familiar and frequent as that feeling was, I had never called it “feeling sorry for myself.” I think if  I had, I would have realized a lot sooner that I needed to change my attitude. But as it was, that feeling had remained subtle and unnamed for years, stealing my power, blocking my joy, and stunting my growth as a person. As I felt sorry for myself that my son struggled with sleep, I realized that I was showing several symptoms of postpartum mood disorders. As I triaged myself and problem solved how to remedy my struggles with mood, I realized that I could be in the exact same circumstances and either feel sorry for myself, and therefore be weak, depressed, anxious, daunted, and depleted, OR I could feel willing–sincerely willing–to do the work of serving my son, and immediately feel strong, peaceful, content, and equal to my task. The circumstances were the same, but my heart was totally different. The Spirit taught me, gently and gradually, that I had been doing the same thing in my view towards midwifery, and that it was time for me to be different. It was time for me to be willing, sincerely willing, to serve in my work, and to therefore have true and unhindered joy and satisfaction in my work for the first time. *I want to be really clear that I am in no way saying that “being willing” is an adequate treatment for postpartum mood disorders. This is just one isolated part of my individual experience.

I had enjoyed and loved my work before, but always it had been overshadowed by my own self pity for how hard it was. I have been back to work for eight months now, and as much as the work is the same as it always was in terms of demand, I can honestly say that I have joy in it, that I love it all the way now and not just part way, and that I would choose this work now for myself, in a way that I never would have for the first five years that I was a part of it. Each day, each week, each labor and birth, each night away from my baby who still co-sleeps and nurses to sleep (and nurses to stay asleep), I see the direct correlation between my joy, my ability to be spiritually guided in my work, and my ability to strangle the self pity out of my heart, and let true willingness grow there. It is this practice, the practice within my own heart, that I believe is the reason why God called me to practice midwifery. There are so many others who can do the things that I do for families. They don’t need me. Not really. Someone else could do the same things. But only midwifery can provide the treatment to my heart that it most needs. I feel that midwifery is a calling given to me to transform me, and to accomplish my own personal Plan of Salvation. Midwifery is given to me to save me, to create me, to break me, and re-make me. And this year, for the first time, I realize that the gifts of midwifery are so much more, in quantity and in quality, than the things that midwifery might take away from me. And among the greatest of those gifts is having so many families to fall in love with, having such good, gentle, and important work to do for them, and having the sacred privilege of keeping them safe, and treating them the way that I would want my family, my baby, my body, my heart to be treated in the process of bringing my babies Earth-side.

What kind of education/training is required? What skills/personal characteristics are important to have/develop?

One of the main issues facing midwifery in our country, is that it is not standardized. That means that there is not one pathway, or one set of requirements for becoming a midwife. There are a number of ways that someone can become a midwife, depending on what kind of midwife they want to be, so that makes this a complicated answer. I’ll try to break it down to be as uncomplicated as possible.

Certified Nurse Midwife:

Bachelor’s in Nursing, with an RN (usually a three to four year program)

Master’s in midwifery, (usually a two year program)

Certified Professional Midwife:

Meet the prerequisites for the particular midwifery school you are applying to. Typically these are about the same as the pre-reqs would be for a nursing program.

Some schools require a bachelor’s degree, some don’t.

Complete the program, which is half academic, and half clinical practice apprenticing under a trained/qualified midwife or group of midwives.

For my school, it was a three year master’s program where I was required to complete a master’s thesis, complete all my coursework, and fulfill a long list of clinical requirements (demonstrating routine and emergency skills in a series of comprehensive exams, provide documentation of attending at least 100 births, had conducted 300 prenatal visits, a certain number of postpartum visits, well woman visits, newborn checks, etc. etc. all while being supervised by a trained/qualified midwife.)

There is a second option, which is a process called the PEP process, which is apprenticeship only, self study, without attending a midwifery school. Keeping this option open as a pathway to midwifery is a heated controversy in our field, and the odds of it being closed/phased out in the next several years is high, so proceed with caution if you choose this pathway.

What kind of job opportunities are there in your field?

Primarily working either as a solo midwife in your own practice with no partners, or working in a group of midwives either in a hospital-based practice (must be a nurse midwife), or in a birth center/home birth practice.

The University of Utah, and some other schools are now offering a PhD in midwifery, which is not a very long program, and many of the midwives who graduate from these programs do only midwifery research, and do not practice midwifery in the typical sense.

There is also quite a bit of activism and legislative work to be done in midwifery, that most of us volunteer for in addition to our regular jobs. But some people do just legislative/lobbying work for midwifery. There is a specialized one-year master’s program for this type of work offered at Bastyr University.

What types of jobs have you had within your profession?

Working as a member of a group practice of midwives as a staff midwife, and as the Clinical Director of our practice/facility.

What is the best part of your job ?

The families.

What is the worst part of your job?

Being on call and missing a lot of sleep.

What’s the work/family/life balance like?

Difficult, but something that I feel very strongly has made every member of my family stronger and more selfless to have to learn how to balance. My marriage is stronger, and my partner and I as individuals are undeniably made better by the hard work that it is to regularly sacrifice for the service that we provide to families. My partner views my work as a service that our whole family provides. He often says to me, “I’m a midwife, too, because the work I do makes it so you can go and do the work you do. Our whole family helps babies to be born. It’s all of our work.” (He is an artist, and teaches middle/high school art at a local private school, so he works as well.)

What is the biggest misconception people have about your job?

That midwives are unsafe, untrained, unprofessional, and without legitimate medical training and medical equipment. So, so false.

What opportunities have you had because of your education and profession?

Really, I’d have to say the whole experience has been one that I wouldn’t otherwise have had. I had only ever wanted to be an English professor. And if it weren’t for that train, I would be, and would never have known or experienced any of the things that I have as a midwife, and as a student midwife prior to graduation.

What stereotypes or criticisms have you faced as an educated Mormon woman with her own career?

I don’t feel like I deal with this one much, honestly because, for better or for worse, Mormons value birth, are more likely to support midwifery, and tend to see midwifery as “women’s work,” and even as a calling, which culturally fits in much more comfortably with most Mormon’s societal views than many other professions. I’m not saying it’s right or fair that they see it that way. I’m just saying that’s the way it is.

What spiritual guidance have you felt as you have pursued your education and developed your career?

So much spiritual guidance. I have had experiences in emergent situations, where I felt as if my hands were on puppet strings, and I watched as my hands performed complicated and life-saving procedures that I had never performed before, and/or that I would not have known to do on my own. I feel the Spirit nudge me, teach me, prompt me, show me, and expand me and my capacities almost constantly in my work, mostly in the talking and listening that I do with people in their visits, though I feel it guide my hands fairly regularly too during birth. I feel that my worthiness has very little to do with the Spirit working in me or through me, but that it has everything to do with how much God loves these families, and how critical it is that these babies are born both safely AND gently, without fear. I could say a lot about this one, and tell a lot of stories, but I will leave it at that for now.

3 Comments on “Career Day: Midwife

  1. Thank you for sharing your experience with pursuing and working as a midwife! Your voice was so personal, I was enthralled throughout your whole post. What a beautiful job you have. I wish I had read this months ago as I am 8 months pregnant! I appreciated you dispelling some myths about midwifes! I had lumped midwifes and doulas together. And while I didn’t view either one negatively, I do believe I fell for the myth that treatment from a midwife would be less safe. Thank you for dispelling that. You don’t need to respond, but what is the difference between doulas and midwives? I’m assuming the biggest pieces are education and certification, but would love clarity there. Thank you again for your wonderful essay!

  2. Apprenticing midwife here: Thank you for sharing your journey!!! I completely understand the feeling that this work/service is more of a calling than a “choice” 😉 It was so fun to read through your experience and find a connection. I wish you all the happiness and success in SLC ❤️

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