Intuitive Art and Science of Midwifery
Intuitive Art and Science of Midwifery
by Diane Barnes
In 1975, Diane Barnes began attending births. Little did she realize that by wanting to help women bear children, she was challenging a male-dominated Western medical establishment very willing to attempt to manipulate the legal system for its own ends. In order to fulfill state requirements in Missouri where she resided, Diane studied at San Diego State College in California to become a certified nurse midwife. In 1987, amidst litigation which was aimed at stopping her practice, she opened a clinic in Monnett, Missouri, which has since moved to Reeds Spring just northwest of Branson. She has attended the births of well over 1000 babies with remarkable results. Since 1990, she has served as president of the Midwives Alliance of North America (MANA). The Drs. Condron, Barbara and Daniel, met Diane when she assisted in bringing their son, Hezekiah Daniel, into the physical. They interviewed her during Barbaras labor. In the conclusion of our three-part interview, Diane Barnes talks about midwifery -- its rich past, controversial present, and enduring future.
The word midwife means with woman, just being with woman. To define midwifery...someone who has the skills and knowledge to maintain normal but be able to be patient enough to just be with woman. I have grandmothers come in and watch a stern labor like we are now. I had one comment to me once just after the baby was born, I watched you through this whole labor and I was really starting to wonder if what you do to earn your living is just visit. But then when the time of birth comes you really put yourself in gear, get it all done, and then you just disappear and back off again like it was the normal thing to do. Thats my job: to help [the birth] to remain as normal as possible, to observe for nuances that are moving us away from normal and help direct it back to normal, and to put the empowerment toward the mother first of all, and to empower the family unit. I feel like that is my definition of midwifery: to protect the normal and to empower the woman to become this mother; and the family unit, to keep it intact and support both parts of it.
[Right now my vision for myself is to] stay right here in this birth center until I retire which I dont think will be too many years off because I dont think I can keep up the pace Ive been keeping without needing more help. Id like to work actively until Im about 59 or 60 and then Im going to do more administrative work and take over during vacations for other midwives. Id like to find at least two or three midwives who will take over this practice. I think by the time Id retire thered need to be three cause I think the numbers will keep growing.
I have a hard time with students who want to come in because theyre trained in the didactic thing of everythings hurried and its by a certain semester level. I have 26 births in a month. But I have to explain to all students who come here you wont get [to attend] 26 births in a month. You wont even get to deliver a baby in the first month you are here because this is a private practice. Mothers have to get to know you and they have to invite you to catch their baby. This is a private practice, this isnt a welfare hospital where theyre just running the crowd through and you get to do your numbers in practice; get your numbers of everything in that you have to do.
[Thresholds: Its not how much gross production you can produce in a month. Like a communist or socialist system.] No, cause there most midwives get their skills training in welfare hospitals and the mothers have to take whats available. This isnt that kind of mentality and the midwives who choose to come here as students under me, they know that to begin with. They know that their learning here is an attitude - a mentality - in addition to skills. Theyre not coming here to demonstrate skills but also to learn some skills. They have the didactic training. They have the theory; the didactic bookwork learning. They do learn all the theory in school. They have few skill workshops; they dont actually do hands-on until they complete everything and theyre basically graduated. Then they have to go get their births, come back with their evidence of their births and what theyve learned, and present case studies. Then they can take their comps and go for the National Certification Test.
I explain to students that they need to be here at least six months to a year to think that theyre gonna get 20 births, which is the minimum number ACM requires. The preceptor has to be able to say, youve got enough births, youre done, youre good enough, or no, you still need more practice on a particular area. Theyre not going to get that many births in a short period of time. Theyre going to be helping and theyre going to be observing. Theyre getting to know how to labor with a woman. Theyre going to be catching some babies along the way because it takes a certain number of prenatals to meet people and get to know them. I mean thats whats been upsetting this last couple months here because we had such a big turnover with everybody. [Of Dianes three assistants at WomanCare: one, a nurse, had her second child, Dianes daughter Debbie became pregnant and wanted time off, Tracy went to working weekends only while pursuing a nursing degree full time.--Ed.] I mean a lot of mothers were going aughh! We had two mothers transfer out. They would rather go to the hospital and take a total unknown than have the upset of the turnover we had. It was like that makes sense? Okay. I had to back down myself because I was upset by the turnover and the change. But Im the one constant so far, as long as I stay healthy were all right for now. And yet I realize I have to take a break and Ive already contacted another midwife to come in in March and give me a long weekend off. Because I cant plan to take off. I could be called in at any time, so I have to leave town if I go. I cant be here at all.....
Right now, in order to be legal in this state they would have to be a CNM. Right now there is a student in Springfield who is going to be coming here in May. She will finish her didactic portion in May and she is going to a midwifery school in Kentucky that is affiliated with the university in Cincinnati. She has been working labor and delivery at St. Johns [Hospital in Springfield, Missouri] for five years. She is working at the hospital doing what she has to do to make her income so that she can afford to go to school. Once they knew she was becoming a midwife they set her up for failure several times. One of the physicians that I know, that I dont like very much, came in with a "drop-in" [a laboring woman admitting herself into a hospital rather than a doctor admitting her]. "Drop-ins" dont get treated real well, particularly Medicaid "drop-ins" dont get treated very well -- in general -- by some physicians and this particular physician is worse. But he checked this woman and she was seven centimeters and moving along very quickly and had already had two kids. I mean her labor could have gone from seven to complete [ten centimeters] in a couple of minutes. But he decided he was going to leave the floor and he told this student midwife, Im gonna leave the floor; Ill be on my beeper. She said But shes seven centimeters. Shes almost ready to push. He said, I said Ill be on my beeper. Well, where are you going to be? I said, Im going to be on my beeper. When he left the floor, immediately after he went out the door, the mother started calling to the nurse. She went in and she [the mother] was complete and she called him on the beeper and said, Youre needed stat. He didnt come. Called him a second time. He didnt come. Called him over the intercom, over the whole floor of the hospital. He didnt come. And she ended up catching this baby on the bed in the labor room. She got put on report for having midwifery values and allowing this women to precept. So she got put on report and may lose her job over it, and he really did it on purpose. He knew exactly what was going to happen.
What makes it even worse is that the nursing staff dont like midwives either. They think theyre uppity and that theyre going beyond the call of nursing and that nurses are supposed to be there to serve physicians. Theyre not supposed to get independent and do their own thing. There are a lot of nurses who think that way. The midwifes worst enemy all over the country are nursing staffs. The nursing staff will foul them up more than anybody. So thats what shes finding and having a very difficult time coping with it because they put her on report for allowing this woman to precept which was pretty silly. But shell be here and probably work with me for a couple of months before shes been around enough to have moms feel confident enough to say Ill catch your baby. Even though shes got all the skills and shes caught babies at the hospital already because labor and delivery nurses do catch babies, shell have all of the theory and everything else behind her.
Its even harder for me because there are all different kinds of midwives all over the country. There really are a real variety just like there are in any other area or profession or anything. Im pretty stiff and rigid in the way I want things done. [Laughs] As far as I dont want a lot of intervention but I want them to be able to do intervention if its needed and know when that is and when it isnt. I dont get along well with real loud boisterous people, theyre just too loud. They need to know when to be quiet. I mean I talk a lot, and when I do talk I dont mind talking, but during birth theres a time to be quiet.
Attitudes toward women I feel are really, really important and because of where we are here in this part of the country there are certain things that wont fly. Like one midwife that really wanted to come work here who was lesbian. I dont have anything against them. I myself would not become a lesbian; my religion has a basis against lesbianism, but I have also an even stronger belief in free agency. Everybody has to choose their own path and go their own way but many, many of the people I care for would not be comfortable. A persons sexual choice is their own business but when they wear it on their sleeve and that becomes the emphasis of their fight for their life then thats not what I want to do. I want midwifery to be at the forefront. That was one of my vilifications I went through with MANA, because a woman who had support lesbian midwives [on her shirt] and a mohawk haircut wanted to come work with me, and I said, It just wont be comfortable in Monett. Its not anything against you personally but it will not fly. Its gotta be somebody who is willing to live in the middle of the country without a lot of diversity. There are a lot of midwives who really want a lot of cultural diversity around. Theres not a lot of options here. Mostly middle class, white Americans. Whereas on the West Coast the midwives take care of most of the population. Most of the births are done by midwives. I was up in Oakland [California] I only had one person who spoke English out of six births in twelve hours. It was crazy. And in Southern California it was mostly all Hispanic, and some Oriental, but it was just a culturally diverse group of people and that just doesnt occur here. But I love the amount of diversity we do have.
What kind of women seek my services? Everybody. There isnt really a stereotypical person. The richest of the rich or the poorest of the poor so its really not financial. Primarily, before I became a CNM, it was the self-employed who had a hard time finding insurance but made enough they didnt qualify for Medicaid. So it was that one who fell through the cracks in the middle which was the majority. But now insurance covers our practice, and Medicaid, so it is like a new direction. Now a majority have some college education. A majority, like the West Coast people who are looking for out-of-hospital birth experiences, are yuppies and people of an alternative lifestyle who are looking for something different and theyre wanting to buck the system. When I go to conferences people have a real hard time. In El Paso, its Mexicans coming across the border wanting an American birth certificate. So theres reasons for these pockets of midwives who have big numbers of births. In Chicago, its a lot of Arabs who are not wanting -- or Muslims -- who do not want any male attendants at all so they look for the midwives. Here its people believe birth is normal. You know, this is the Midwest. We see animals. We know that birth works and is basically healthy. Nobodys doing anything weird or different. We have a few who are looking for an alternative, but the majority of them are just wanting health care. I was closest. I was cheapest. Once they have a birth experience they get a bit of a testimony that its something different. 98% of the people who come here come from word of mouth. We did surveys several years ago. We asked everybody, How did you know about us? Like we used to put pretty good size ads in the phone book trying to make sure, but nobody ever looked in the phone book. They had no idea that there was a midwife in the phone book. So we laugh about that now. Now we just have single line ads. Were in there but were not making any big deal about it. And it is word of mouth. It still frustrates the physicians. One person will transfer from a physicians office and traditionally women when they get pregnant will go to their friends and say Who are you going to? Cause they want to go to somebody that they feel like there is some degree of trust even if they have to borrow it from their friends. So quite often if somebody transfers from a physicians office and comes to us and then likes us and then tells the friends about us then their friends will transfer. So all of sudden I get a call from a physician, I had four of my patients transfer to you this week. What are you doing down there? Are you legal? What is it that you do that they like? (laughs) Ask them.
[Yet you need physicians for your protocol] Well its a confusing bunch of terms that it took a long time to get the nursing board and the political entities to understand what they were asking. I have to have standing orders signed by a physician for the medical part of my practice: for injecting medications, for carrying drugs, for prescription privilege. And the standing orders are very short. They basically are letting me do episiotomies and suturing and then using medications. He has to review my protocols which are my practice plans. For this situation, this is what we do. This is how we identify it. These are the signs and symptoms. This is the title and what that process is being called, and how we treat it. So my protocol manual is about six inches thick now. And I keep adding to it. Some midwives have little short ones. Missouri wants everything detailed. So I just made it as completely thorough as I could. When the nursing board wanted me to present a case for the breech they thought they were going to have me and I said well, Its according to my protocol and its right there in my protocol. They have a copy so theyre like, Oooo...it is in there! She has breeches in there! Its right in the protocol. The biggest threat of having such a detailed protocol is that I still believe in individualized care, so there is the possibility that I wont do exactly what a protocol will say. And that they could hang me on any one specific point. So we have a disclaimer at the end but we do individualize our care -- this is the typical protocol but its not everything.
Other than the obvious medical care of surgical intervention and crises management, how does the care I offer as a certified nurse midwife differ from that of a physician or a nurse in a hospital? Well, nurses do the same thing as the physicians in as far as men have to be doers; they have to be fixers and doing it. Nurses have a hard time to not also do. Like Dr. George [the first physician Diane attended] just didnt show up until the last minute so he wasnt doing a lot of things and even when he came he would go off and go to sleep. But nurses in hospitals -- theyre employed -- and youre supposed to work and not sit around on your duff. Youre supposed to be doing things. So to earn their money they have to actively participate in doing something for this person so they are in there either hooking up monitors or watching the monitors or running around checking the I.V.s or giving medications or offering medications or getting very actively involved in the beginning part of the birth process, after the mother is complete, getting the mother to push and push too soon. This (is) regimented and authoritative kind of behavior.
There is some frustration too at being a female and having a lot less leeway to spend with the patient. It becomes territorial. Last time I went to the hospital one of the nurse managers told me I was going to wait outside while her nurses checked her in and I said, No Im not. I am with the patient and the patient wants me with her and the physician told me I could be with her. She told me that when the physician runs this ward then I can do what the physician says but that she was in charge there. And it was like Oh, Ive got to keep this in mind -- how we approach things. I stared her down and finally with a flourish she said, Go ahead. Then after I talked to the mom and got mom settled down I was able to retalk to the nurse and say I have no intentions of usurping your authority or interfering with your process. Im here solely to participate with the mother, to support her and provide interaction that will facilitate a transition from a birth center atmosphere to the hospital atmosphere and from a change in plans of what she is planning to do. Then the nurse settled down some. She had had a bad day. But she wasnt happy with me for pushing her and for not accepting her authority. We did a little tap dance on who had more authority.
Thats something that I have really been paying attention to lately. As women we accept things but a lot of times we just want to talk it to death. You know just talk it through and talk it through, and men dont want to talk a lot, in general. Ive been married for 29 years now and probably in the last three years we finally figured this out. I can talk to him just so long then I have to take a break so that he can go. A friend of mind says he can watch my husbands eyes and know that were done. We cant talk to him anymore. We have to do something else and talk again later. Its fun to see it finally and to be mature enough and far enough down the road that we can understand the differences and to recognize its okay. There is no way we can legislate equality there. They are totally different. But there are an awful lot of similarities between men and a lot of similarities between women that arent similar to each other. Particularly in prenatal classes I see it over and over when we talk about accepting the differences in the women during pregnancy. Because there is a shift in thought process and the direction were going. There is an innerness that comes up in pregnancy. When you become pregnant a lot of times the thought processes kind of turn towards inner thoughts. There is a lot of awareness of the body changes. Its like you cant miss them and they are so real to us because we are enduring them every day. You want to talk about them and men are kind of like well just live with it. You know, itll pass. You only have nine months of it. Itll go away. But its so amazing we want to talk about it and revel in it and you know go with it. A friend of ours just had a baby out of wedlock and gave it up for adoption and she did not talk about any of her body changes. She did not give in to any of the normal complaints of pregnancy. She just ignored them. But when were happy in the relationship were in and what were wanting to do its like lets experience every nuance. I think the closest men can get is a glimmer, and for some women the closest they get is a glimmer. Because they are so unintuned with their own body. So afraid to touch their own belly or anything else that they cant even imagine exactly what is happening. They are fearful of hurting the baby if they rub on their stomach too hard. So thats been fun educating women along the way that its okay. Our bodies are okay...
MANA (Midwives Association of North America) has grown up a little bit more. Its more mature in that now were identifying that we do need certification of our own. Sister organizations have developed that are now providing certification of direct entry midwives without a nursing degree. The process has occurred so rapidly and weve gathered steam and membership so clearly that two years ago at the ACM convention one of their members got up and proposed that nursing no longer be a prerequisite to midwifery. Theyre now trying to catch up, theyre trying to use our impetus and take over the steps weve made and create another entry into midwifery -- which if they do succeed it will become the American College of Midwives rather than the American College of Nurse Midwifery.
The nursing board would be violently opposed to that because they like the control they have over midwives. Physicians, surprisingly, are in favor of it for the most part. The higher ups are because then midwifery would be an independent practice and they wont be held responsible for what midwives do. Its kind of a self-protective thing. Theres a recognition in the government that midwives have such a tremendously lower C-section rate and better outcomes and lower malpractice suits that it would be more cost effective if we go to a national insurance to have midwives during the normal births and reserve obstetricians for the complications that occur. When there are complications and you need a C-section, midwives are really glad the doctor is there and we dont have to do that. We want to do normal things.
What does the future hold for midwifery? Well my vision of the future is that instead of midwives doing 3% of the births midwives will do 97% of the births and obstetricians can do complications and the hysterectomies and the other things that they do. Our C-section rate will drop and match the rest of the world and well be down to three to five percent rather than 35 percent. That prenatal care will be offered to all women instead of the United States being 39th or 40th on the list for the World Health Organization for maternity care. And women will take over the rights to their bodies and have more support in making decisions of what they are going to do, make more informed consent on what theyre doing, instead of being impressed with bells and whistles and technology. Thats my dream of whats out there. I think there will be national health care somewhere down the line and I think midwives will be employed because it will be cost effective. Its going to be up to midwives to protect midwifery in a pure state and not just become physician extenders.
©1995Vol. 13 No. 3
The legal battles
someone like Diane -- someone who wants to use their talents to serve others -- incurs are amazing, offensive, distracting, and absurd. There is no doubt that the American Medical Association [AMA] serves an important function when it polices its own. Too often however these New Age physicians use their recently gained clout to threaten and destroy approaches to health and healing that differ from their own. I use New Age because in the scope of time the past century is a small measure. During the 1900s, the AMA has been quite effective in usurping the respect and position once given to other healing arts such as homeopathy and osteopathy. It is interesting that the male-dominated medical machine has in less than a century overtaken a purely female experience -- bearing and giving birth to offspring -- and in so doing has almost ousted one of the oldest and most enduring of professions; midwifery. During our conversation, Diane spoke of the continuing modern-day quest for the recognition of rights and responsibilities for midwives.--Ed.
In 1959, there was a major move all across the country by the American Medical Association to put into legislation a law to either eliminate licensure of midwives in the states where there was licensure or to make midwifery illegal. In one short span of time -- Ive been told it was a weekend -- the movement went across the country and where there were laws to license or regulate midwives they were wiped out. Many ended up like in Missouri with laws all over the books that say a midwife will -- or on birth certificates it says a physician or midwife will have the birth certificate in by 10 days. Under the health laws a physician or midwife will instill prophylactic antibiotics in the babys eyes. All these references to what midwives will do but the law that licenses the midwives is gone. It was a sunset law that went through. Just one by one the midwives who were licensed at that time kept practicing until they died or quit. But there was no new licensure.
I co-authored a study with the Public Health Department Statistical Division on out-of-hospital births from 1979 to about 1984. I got a list of the licensed midwives who were still licensed and then I knew all the underground midwives across the state. I was given a copy of all of the birth certificates, a big giant printout, and contacted the midwives who were in the vicinity of where these births were to identify which births theyd attended. Some of them had gone quite a distance across state to take care of people and help to evaluate the outcomes and the quality of care given. At that point we were trying to prove that you didnt have to be a nurse [to attend a laboring woman] but that there was some recognition of standards [among midwives]. So we had the Missouri Midwives Association recognize midwives. We really didnt do a certification but we recognized the skills. The association had agreed to interaction and evaluation among peer pressure without any kind of universal claim of what went on with midwifery practice. The statistics I gathered showed that once we took out the miscarriages and births that werent intended to be outside of the hospital then, even with those included, we had better statistics than the hospital did. When we took out the unattended births -- like the miscarriages and transfers en route -- we had much better statistics than the hospital. Then births were categorized by physicians, certified nurse midwives [CNM], and then they recognized midwives, and then other or not attended. The other-attended had the worst [statistics].
There was a group in Kansas City that was promoting do it yourself. I think it is a religious group that still does practice. They believe that you shouldnt have any care. That if you are truly in tune with God and you are truly doing what you should, the baby will just fall out. Whatever happens happens. You dont need any help, so they dont do any heart tones. They dont do any blood pressures. They dont do any risking out [recognizing pre-existing health factors] and they have had several maternal deaths and fetal deaths because they have tried to have unattended births for diabetics. Two diabetics, the women died, and those were unnecessary deaths. Any of us would agree they were unnecessary deaths. But other than that particular group then the statistics went with the physicians had the worst statistics, the CNMs had the next worst statistics, and then the midwives had the best....
[The legislators] are not going to repeal the 1959 law but we have put in new laws every year since 1984. Theres been a bill submitted every year since 1984. The current bill would license direct entry midwives who have completed a course of study, passed a national exam, had two preceptors approve skills, and completed an assortment of documentation of skills; ie. attended a minimum of 50 births with a qualified preceptor. I did a lot of work with steering committees, with legislative hearings, all kinds of things. Either the Board of Healing Arts or the nursing board has succeeded in killing the bill every year.
One year we got it through the House and then it went to the Senate. It was looking really good like it was going to pass and a physician from Joplin, Dr. Frank Clark, had been in attendance of a baby that Id transferred to the hospital who had beta strep and hed accepted the baby and started the medication and then left the hospital. Later I found out, he assumed the baby died. We did transfer it from Joplin to Springfield to the neonatal unit and the baby survived and was alive and quite well.
He decided to go back to school and become a neonatologist. While he was in Columbia becoming a neonatologist he was invited to be on the Board of Healing Arts. He was outspoken about not liking midwives and so the Board asked him to testify to the legislature; to go and lobby against this midwifery bill. The senator who represented our bill and our lobbyist both called me, the same day, saying, Why didnt you tell me you had a baby die? I said, Ive never had a baby die. You havent? I said, No. And they told me that this Dr. Clark was telling everybody that he knew that midwives killed babies and that he particularly knew one midwife who has killed three babies and the senator said, I only know one midwife down in your area and that is Diane Barnes. He said, Thats right and shes killed at least three babies that I know of and I can name one of them. The name was Keith Adams and I said, No Keith Adams is quite alive. So he had done his damage and it was too late and the bill died.
The President of the Friends of Missouri Midwives was working as a paralegal for an attorney in Rolla and she invited me to come up and talk to him and tell him the story. Well my lawyer, Mike Wolfe, called Dr. Clark and taped the conversations. So I have this tape of him saying, Yes, she killed babies, and Mike said, No, she didnt kill babies. Keith Adams is quite alive. How do you know Keith Adams? He said, Well it was real easy for me to remember because the administrator for the nearby hospital, his name was Keith Adams, and that is how we remembered his name. Well, Keith Adams happens to be very much alive. He couldnt name these other babies and he couldnt swear that I had anything to do with these other babies that had died. Somebody had dumped a baby in a dumpster and he was sure that it was me that had attended this birth and abandoned the baby. When he started finding out that it was a lawyer talking, he started backpedaling the lot. But nothing ever came of it.
I went up to visit this lawyer and he listened to the tape and said, Youve got grounds and if you want to pay me a retainer Ill sue him. I said, I dont really want to sue him. I want a retraction because I want to go back to the legislature with a retraction. He said it would take at least a $5,000 retainer to go after him. Hed already transferred all his worldly goods to his wifes name so he had nothing to be sued for. There was no way I was going to get anything out of him and I said, I dont care about money. I really want a retraction. So I went back home and kinda forgot about it.
Did you notice the poster above the filing cabinet there [in the reception area of the clinic]?.....One of our Jewish midwives went to an art store in New York when we had a convention there and came out with this beautiful painting that was of this Hebrew midwife. We eventually got the artist to do a watercolor and have posters made as a fundraiser for MANA. It has this quote out of the Bible and it says, And the midwives did not as the king commanded and saved the boy children alive. The next phrase after that is, And he gave them houses. I really know thats true because my husbands business had burned down and we had lost everything we had. We were living in an apartment above the Monett [Missouri] clinic. It was insane to live in this two bedroom apartment. I had two teenage boys and then my daughter Debbie came home from school and my older son came home from a [religious] mission. I had four adult-sized kids and us living in a two bedroom apartment. It was like this is not going to work.
I used to drive around when I wasnt at work looking for houses to rent. I found this nasty, nasty old house that I knew my husband could remodel. The guy was willing to do owner financing on it and he wanted $18,000 for it with $2,000 down. $2,000 was as far off as anything in the dreams I would ever have to come up with. $2,000 before he would sell it to somebody else. That day I got a letter from the lawyer in Rolla and unbeknownst to me he had followed up on it [Clarks accusations] and threatened the Board of Healing Arts that he was going to sue, publically sue, the Board of Healing Arts en masse and individually and Frank Clark. The Board of Healing Arts talked to Frank, found out he was lying, and got him to write a retraction. They would give me the whole retraction and a check for $2,000 if I was willing to not sue them. If I was willing to do that I should sign this paper and send it back to him, and since it was such a piddley sum he wouldnt even charge anything for the work hed done to get it. So I had the $2,000 for the house then. And the retraction. Clark stated, I fabricated the story without any shred of proof.....
We got really close to getting the bill passed two years ago. Got it through the House and out of committee in the Senate and it was down to just the vote on the floor and if we would have gotten the vote on the floor we would have won. Senator Singleton who happens to be an ear, nose, and throat doctor in Joplin stood up and said if this bill comes to the floor he will filibuster and filibuster until they will go home on the filibuster. So they kept putting it off hoping they could wait til he was out of the room and then run it. And he would not leave the room. It ran out of time and we didnt get it on the floor. So were back on that one again. He is very vocal about being against any nurse practitioners, any advanced practice. Im very well convinced that if a doctor has to become a legislator then he must not have been a very good doctor in the first place or he would have been busy and happy where he was. I think thats true of teachers. You know, the teachers that Ive seen in midwifery school, generally I wouldnt want them delivering my baby. So thats how I got from where I was to where I am. I just want to train other midwives and give them the opportunity to learn.
©1995Vol. 13 No. 3
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