In the course of studying anthropology, it is medical anthropology, or the relation between physiology and culture, that I find the most fascinating. Society and culture shape the way that humans think about health, illness, and body image in general. The magnitude of cultural forces is clear when it defines the way that we physically care for ourselves. I plan to continue studying the theoretical aspects of medical anthropology and ideally combine it with my “clinical” training in midwifery/women’s health. It is this goal that led me to the site of my internship. Seattle Midwifery School accepted me as an intern for the summer of 1995. The director of the school and I planned that I would do research that would both benefit the school and my own personal interests in learning more about the work of midwives.
Going into this internship, my goals were somewhat clear. I knew for one that I wanted to be around midwives. I wanted to be around people who know midwifery as a career, who knew the reality of it. I wanted to sort out the pros and cons of direct-entry midwifery and certified nurse midwifery. Being two very different avenues within the same practice, I needed to know what really distinguishes the two.
At the onset of this internship I was very enticed with the idea of being a direct-entry midwife. With its focus on home birth and a highly natural or unmedicated approach to pregnancy and labor, direct-entry midwifery was and is what I consider to be “true” midwifery. So, I decided to spend time with direct-entry midwives and their teachers in Seattle, Washington. I worked for six seeks at Seattle Midwifery School, which is one of the few accredited schools of direct-entry midwifery in this country. The following will be an account of the work that I did at the school, how I felt about the work, and finally what I came away with from this internship and where it has led me on my path of midwifery and anthropology.
I essentially did three projects for the school. The first was compiling and summarizing individual class, overall program, and alumni evaluations. The second was a detailed research of the current legal status of midwifery in this country. The third project was contacting midwifery schools and organizations and having them send current information on their programs in order to update our files at SMS. Another small project was a bibliographic search of the history of midwifery.
The first of my tasks was a perfect introduction to the school. On my first day, I was introduced to the staff, taken on a tour of the small school, and then plunged right into the work. JoAnne (my supervisor) had all of the class, program, and alumni evaluations ready for me and a pretty good idea of what she wanted to have done with each of them. The goal was to have a prepared presentation of the evaluation outcomes ready for a faculty meeting that was scheduled one week from my starting day.
As most courses everywhere do, each one at SMS has a final evaluation of the course filled out by the students. So I read, tabulated, and summarized the evaluations for each class. After that, I did the same with program evaluations that are filled out by each graduating student. Next, I read and summarized alumni surveys that had been mailed out a few months prior to my arrival. All three of the evaluation outcomes were to be prepared for the next faculty meeting, and I was to explain the findings, although I covered that by making a handout with the summaries of each.
JoAnne wanted the faculty to have knowledge of the outcomes and comments early in the summer so that they would have time to plan alterations before the Fall session. More importantly though, the school’s curriculum is going to be evaluated this fall by ACCET, an accreditation board of some sort. The program evaluation summaries that I prepared are a part of Seattle Midwifery School’s own preparation for the accreditation process. Fortunately, they were able to use the summaries as a part of the accreditation packet that is required for ACCET.
I cannot think of a better project to start out with. I was immediately introduced to the midwifery curriculum at SMS. I feel like I really got an honest look at the program. It made the curriculum clearer to me while I also saw what the students feel about the instructors and class content/organization. Considering that one of my goals of this internship was to feel out the pros and cons of a direct-entry program, I’m not sure if their was a more concise way to do it than this first project. In retrospect, I think that this part of my internship was the most enlightening and rewarding.
The second project was researching the legal status of midwifery in this country. Direct-entry midwifery has been, and still is, a very controversial issue. Since direct-entry midwives are those midwives that practice without a degree in nursing, it is thought by many that they are unqualified to care for pregnant/laboring women. In some states there are clearly defined laws against direct-entry or licensed midwives. In other states they are free to practice; however, they must have special training and pass a licensing exam. Still, in some other states the laws are vague or obsolete, meaning that when a midwife is in court her case is an individual consideration and she may be charged with practicing medicine without a license.
Midwifery legal circumstances frequently change due to influence of new cases, the growing popularity of midwifery, and reassessment of old laws. SMS has an extensive filing of midwifery legal issues; however. most of the statues that were on file were quite dated. My second project was to work in the University of Washington’s law library in order to update the law files, especially the statues for each state. I also did a search for journal and law review articles that pertained to midwifery and the law.
This work landed me many hours in the law library looking up each individual state and its position on licensed (sometimes unlicensed) midwives. This does not include certified nurse midwives who are permitted to practice legally in all states. Eventually, I developed a routine in looking up each state’s midwifery status. Most states did include a statute regarding midwifery. The aggravation came when the state would have no mention of midwives, which would necessitate my looking under other key words to find some mention of midwifery. Few times did this ever produce any findings.
I also had a list of cases that I was to locate and make copies of. I am so grateful to Emily Mansfield, who teaches the legal issues section at SMS. She showed me how to actually use the law library, and she helped me when I ran into walls within certain states (sometimes it was a wild goose chase to find the midwifery section). It would have been a lot more complicated if I had not had her help.
I really did not enjoy doing this research all that much. But I do feel like I contributed significantly to the school. They now have current legal information in the files, which is important to the students who are considering practice in various parts of the country, as well as providing better material for Emily’s class. This project, though tedious, shed even more light on my contemplation between direct-entry midwifery and certified nurse midwifery. It is obvious to me now that, as a certified nurse midwife, a person has much more working freedom, through legality of practice, than a direct entry midwife does. This is one of the most striking differences between the two tracks of midwifery as I consider one of the two as a career.
Toward the end of my six-week internship I had already felt like I accomplished a lot at the school. I had about two weeks left and JoAnne and I were considering a couple of different projects. Around this time we met with a woman who is a professor of history in British Columbia who was in Seattle doing research on the history of midwifery among Asian immigrant populations. Her search had landed her in Seattle and at the school in hopes of our having some information on past midwives from the area. After talking to Lorie, JoAnne and I decided that I would work on accumulating a bibliography of the history of midwifery articles from dissertations, theses, and journal articles. Working again at the University of Washington, I gathered the bibliographic information and compiled it.
While I was working on the bibliography project I was also contacting various midwifery schools and organizations around the country. In another attempt to update SMS files, I asked them to send us information on their programs. This was a great project for me to do because it was a chance to talk to a lot of different midwives all over the country. It also enabled me to speak with people and see the material from various university programs of midwifery, or CNM programs. Doing this, again, added to my comparison between the direct-entry route and the CNM route. I was fascinated to hear about the different places that the midwives I spoke with were working. For example, I spoke with a wonderful woman in western North Carolina who is the only midwife in the state that is practicing legally without a nursing degree because of the grandfather clause. She’s worked for thirty years in a rural area of North Carolina. It was a time of touching different options, different places, and possibilities of midwifery and anthropological work. It was, and is, exciting. Midwives are needed everywhere, which makes it such an excellent skill to combine with anthropological work.
These two final projects were lighter than the first two and were a nice way to finish my work at Seattle Midwifery School. I was able to go into the internship with a lot of enthusiasm and energy and apply it to the work. As time went on, the intensity of things at the school tapered off as I began to focus my energy in other directions. One of those things, and a direct result of my work at Seattle Midwifery School, was the opportunity to take a Labor Support Course. As a result of this class, I have learned how to work as a Doula, a perfect stepping stone to becoming a midwife. As well as introducing me to Doula work, my internship created an incredible network. I have met so many influential people and opened many windows to resources that were more available through being a part of Seattle Midwifery School. I have been able to make decisions, some long and hard, upon the knowledge I gained through my work at the school.
Honestly, this internship was not much of a clearly anthropological endeavor. However, on my path as an anthropologist, especially as a medical anthropologist, it was invaluable. I was able to create a base from where future work and education can be built upon. As I currently study medical anthropology, I will be able to combine the knowledge from my internship to make connections for future work.