Continuity of Care:
The Essence of Midwifery

Story by K. Andarin Arvola

Usually ideas for articles come from something I’m at least somewhat familiar with, but not in this case. A friend who’s a midwife suggested this topic. Not having had children means I started from scratch. But wait a minute, I have attended the births of numerous cats, dogs, cows and horses. I certainly had a profound feeling of awe at the majesty and miracle of their birth.

Those animal mothers seemed to take comfort in my presence and on occasion I helped in a difficult situation, once saving a foal from smothering when the amniotic sac didn’t break upon birth.
What then must it be like to be at the birth of a member of our own species? Who are these midwives, mostly women, who attend numerous human births? Midwives and birth attendants (doulas) have been around since the beginning of human civilization.

What is midwifery?
Midwifery is a health care profession wherein individuals give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant.

Nurse-midwives in the United States are advance-practice nurses. In addition, they provide primary care to women, including family planning and menopause care.

Midwives are specialists in a low-risk pregnancy, childbirth and the postpartum stage. They strive to help women have a healthy pregnancy and natural birth experience. They are trained to recognize and deal with deviations from the norm.

Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to “actively manage” labor, while midwives are taught not to intervene unless necessary.

Midwives refer women to obstetricians when a woman requires care beyond their area of expertise. In many areas, these professions work together to provide care to childbearing women. In others, only the midwife is available. Midwives are trained to handle certain situations that are considered abnormal, using non-invasive techniques.

Defining midwifery
More specifically, a definition from the International Confederation of Midwives and one adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics tells us that “a midwife is a person who, having been admitted to a midwifery educational program that is recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the qualifications to be registered and/or legally licensed to practice midwifery.

“The educational program may be an apprenticeship, a formal university program, or a combination.

“The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.

“The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare. A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.”

Not everyone agrees with the seeming exclusion of traditional midwives, who in developing countries often are the only people available to assist women in birth.

Early historical perspective
As long as woman have been giving birth there have been woman assisting them. In ancient Egypt the Ebers Papyrus which dates from 1900 to 1550 B.C.E. tells us that five columns deal with obstetrics and gynecology. Bas-reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.

Midwifery in Greco-Roman antiquity covered a wide range of women. In the second century the physician Soranus described a “good” midwife: “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses, sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.”

There appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and considered a medical specialist with a concentration in midwifery.

In the eighteenth century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives. At the outset of the eighteenth century in England, most babies were attended by a midwife, but by the onset of the nineteenth century, the majority of babies born to people who could afford one, had a surgeon involved.

In the United States
There are two main divisions of modern midwifery in the United States: nurse-midwives and direct-entry midwives.
Based on a model used in England and Scotland, nurse-midwives were introduced into the U.S. in Kentucky in 1925. This combination of nurse and midwife was very successful. A substantially lower maternal and infant mortality rate was reported there than for the rest of the country. It was concluded that if this care was available to other women in the
United States thousands of lives would be saved.

The Frontier Graduate School of Midwifery began in 1939. It is still educating nurse-midwives today but in a new way; in 1989 students were able to do their academic work online, and their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member.

In the United States, nurse-midwives are licensed, depending on the state, as advanced-practice nurses, midwives or nurse-midwives.

Certified Nurse Midwives [C.N.M.] are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition, many have a master’s degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices. They may deliver babies in hospitals, birth centers and at home. They’re able to prescribe medications in all fifty states. Nurse-midwives provide care to women from puberty through menopause. They may work closely with obstetricians, who provide consultation and assistance to patients who develop complications.

A direct-entry midwife is educated as a midwife but doesn’t have to become educated as a nurse. They learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns, primarily in out-of-hospital settings.

There are several types of direct-entry midwives: a Certified Professional Midwife (C.P.M.), a licensed midwife and lay midwives. All have different types of training, education and apprenticeships.

Are all midwifes woman? Currently, two percent of nurse-midwives are men.

What has remained consistent since 1960, is that one percent of births are home births in the United State, according to the Journal of Midwifery and Women’s Health (March/April 2009). In 2005 there were 24,468 home births in the U.S.

What is a doula?
A doula is a person who provides various forms of non-medical support (physical, emotional and informed choice) in the course of childbirth. Based on the individual doula’s training and background, she may offer support with prenatal care, during childbirth and/or postpartum care.

The word doula comes from Ancient Greek and refers to a woman of service. In Greece, the word has negative connotations, denoting “slave”, as some doulas have discovered through their international social networks. For this reason, some women choose to call themselves labor companions or birth-workers.

A birth doula is a care provider for labor. Thus a labor doula may attend a home birth or might attend the parturient woman at home and continue while in transport and then complete supporting the birth at a hospital or a birth center.
A postpartum doula typically begins providing care in the home after the birth. Such care is provided from the day after the birth, typically providing services through the first six weeks postpartum.

More on doulas
Labor/birth-support doulas attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks or vaginal exams but rather, for example, massage or suggest positions to help labor to progress as well as possible. A labor/birth-support doula joins a laboring woman either at her home, birth center or hospital, and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported.

Doulas can also work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures. The terms of a labor/birth doula’s responsibilities are decided between the doula and the family.

Postpartum doulas are hired to support the woman after birth, usually in the family’s home. They offer families information and support on breast-feeding, emotional and physical recovery from childbirth, infant soothing, mother-baby bonding, and coping skills for new parents. They may also help with light housework, coordinate freshly made nutritious meals for the mother, and help incorporate older children.

In some cases, doula care can last several months or even to a year postpartum—especially in cases when mothers are suffering from postpartum depression, or have children with special needs thus requiring longer care, or there are multiple infants. The terms of a postpartum doula’s responsibilities are decided between the doula and the family.

Some hospitals and foundations offer programs for volunteer community doulas. Volunteer doulas play an important role for women at risk for complications and those facing financial barriers to additional labor support. All doulas offer continuous encouragement and reassurance to laboring women. Volunteer doulas can encourage and motivate a woman to feel in control of her pregnancy.

The doula is an ally and occasional mentor for the father or partner. Their respective roles are similar, but the differences are crucial. The father or partner typically has little actual experience in dealing with the often-subtle forces of the labor process, and may receive enormous benefit from the presence of a doula, who is familiar with the process of birth. In the United States and Canada, labor/birth and postpartum doulas are not required to be certified. However, certification is available through several different organizations.

Some benefits
Birth companions, of which doulas are one type, offer numerous benefits both to the mother and child. Women with support have a reduction in the duration of labor, less use of pain relief medications, lower rates of operative vaginal delivery and in many studies a reduction in cesarean deliveries.

Regardless of the support, be it a female friend, relative or a doula, the newborns in these births have lower rates of fetal distress and fewer are admitted to neonatal intensive care units.

In addition, one study found that six weeks after delivery, a greater proportion of doula-supported women, compared to a control group, were breast-feeding. These women reported greater self-esteem, less depression, and a higher regard for their babies and their ability to care for them.

Often doula support, even without childbirth classes, may be more helpful than childbirth classes alone. In particular, it was noted that women in the doula-supported group reported their infants as less fussy than the group attending childbirth class without any doula support.

Interested in becoming a doula locally? Intuitive Doula is a certification business operated by Carla Stange and Marilyn Lemos. More information under Sources at the end of the article.

A thousand and one births
Carla Stange is a Certified Nurse Midwife, a Family Nurse Practitioner and a graduate of the Frontier Nursing Service.
For twenty-three years she has lived and worked in Mendocino, California. As a passionate advocate of alternative birth options, Carla was one of the first midwives in northern California to study the benefits of waterbirth for both the mother and infant. Her belief in the instinctive nature of birth has helped her guide over a thousand women through the birth process. Carla currently manages and attends home births.

In 2005, along with Marilyn Lemos, Childbirth Educator (C.B.E), she launched Intuitive Doula, a distance learning/mentoring course to train and certify birth and postpartum doulas.

Carla Stange, Marilyn Lemos and I meet at the Mendocino Family Healthcare office in Mendocino. We have a lively conversation about midwifery and doulas.

Marilyn tells me that her degree is in psychology but her real love is anything associated with childbirth. “For twenty-three years I’ve been able to work in that field. I feel quite blessed,” she says. “I enjoy teaching, especially childbirth education.”

It started when she was working for two doctors and a midwife in a family practice. She was interested in home births and “they were willing to have me help.” She took her training with the Association of Labor Assistants and Childbirth Educators.

“My second child was born at home. I think if I’d had a doula with my first child it would have gone much better,” she states. “I’ve talked to so many woman and they always want to tell you their birth stories. Most of them tell me they wish they’d had a doula and more information and support.”

Their training program for doulas started when “I realized how health care had changed,” says Stange. “There wasn’t the support for women in childbirth so we (Marilyn and I) said ‘we could do that!’”

“The important thing about doulas is that their only role is to the laboring woman, her partner and family,” interjects Lemos. “Some programs break down the roles of the doulas into prenatal, parturient and postpartum, but we don’t. We feel that if they are going to be involved in childbirth, they should be involved in the whole thing.”

Where do the woman training to be doulas come from? Do they attend sessions here on the coast?

Marilyn tells me that they have people from all over the country [in their training program] and no, they don’t come here. They attend online.

Stange informs me that helping women support pregnant women in their own communities is her goal. “I want to insure that every woman has pregnancy, labor and postpartum support. For instance, in some areas the cesarean rate is 40 percent! This is unnecessary and unconscionable.” She mentions recent articles in The New York Times on the subject.

“The cesarean section rate in America is alarming and anything that we can do to bring that down is a plus,” adds Lemos.

Stange tells me that what got her started in the childbirth profession was the birth of her own child. “It was in the mid-seventies and coincided with the natural childbirth movement. We’ve sure reversed that these days,” she says. “I lived in Berkeley working as Nursery Intensive Care Nurse at Alta Bates Hospital. I’ve always loved babies and working in the woman’s healthcare field.

“It sounds corny but since high school I knew I’d be in healthcare. Later I knew I wanted to be a midwife so I attended the Frontier Graduate School of Midwifery (which began in 1939) in Kentucky. This is one of the poorest regions of the country,” Stange continues. “I wanted to go to a school that had a strong midwifery tradition so I moved to Kentucky and lived in Appalachia for two years.

“After I moved back to the Bay Area no one would hire a new midwife. I called all the hospitals because I didn’t have a clear idea I wanted to do home births. I also wrote a bunch of letters, and Suzan Wells said they needed a midwife in Mendocino.” She and Marilyn start laughing. “I drove up in my old beater of a car and had a flat tire in the parking lot. This was in 1985.”

“I was working at the office as a receptionist and helped push Carla’s car to Schlafer’s (a service station)—and I was pregnant,” says Lemos. “The first thing Carla asked me was ‘when are you due?’”

“That’s when I started being mentored by Suzan and we ended up doing home and hospital births for about thirteen years,” says Stange with a sense of wonder. “Now I’ve been in this office twenty-three years. It’s a family-centered practice. I take care of the women, the men, their children and then—their children.

“I was initially attracted to this area back then because it had a strong reputation for midwives doing the births,” says Stange.

Lemos tells me that “after my first child was born in the hospital I knew I wanted to work somehow in the field of childbirth.”

“I could not not do this. I’m compelled to be a midwife,” says Stange. “The thing about giving birth is it empowers women; you watch women grow up. It’s a powerful rite of passage.”

“It certainly happened that way for me,” says Lemos. “Something I want to clear up, there’s a lot of emphasis on whether to have a home birth or a hospital birth. It doesn’t matter where women give birth. What’s important is that the woman have an informed choice and plenty of information.”

“I see myself that birth can be as instinctual as possible,” says Stange. “I tell women that our bodies know what to do.”

“Carla and I were attending a birth once and she asked if me if I get an adrenaline rush when that baby is born. And I said yes!” adds Lemos.

“Yes, so do I,” notes Stange. “Even after twenty-three years.”

From home to hospital
As Suzan Garcia-Wells and I talk, I mention that my style isn’t like the National Inquirer when I write articles.

“I was in the National Inquirer!” she says. “It was in 1976. A woman wanted her eight-year-old daughter to be in the birth room. You have to understand, they’d just been allowing fathers in the delivery room. Having her daughter there just wasn’t done! We had to go to all sorts of state agencies but it was eventually allowed,” Garcia-Wells shares. “Somehow the National Inquirer heard about it and came for an interview and a picture of the mother and infant—and me.”

Garcia-Wells graduated from nursing school in 1971 at Northwestern State University in Louisiana and “about six months later I knew that being a nurse-midwife was what I was going to do.”

She graduated from Meharry Medical College in Nashville, Tennessee in 1980. “In the twenty-eight years that I’ve been doing this, there’s been a steady stream of midwives throughout the country. I think it’s been fairly consistent.

“During the 1970s there was a tremendous interest in home births in conjunction with the back-to-the-land movement. Many women wanted a choice about their births and they still do.”

Garcia-Wells moved to California in 1974, and to Fort Bragg in 1975, and began working at a hospital as a labor and delivery nurse. She was doing home births while she was pregnant and had her own baby at home in 1976.
When she returned after graduating from midwifery school in 1980 she worked with two family doctors (both women) and did hospital and home births.

“When both women moved, Carla Stange and I took over Mendocino Family Healthcare, which is still in the same location in Mendocino,” she tells me. “We’d do home birth births together.”

Who can have a home birth, are there exceptions?

“Woman who look at having a home birth are willing to make a responsible choice. Although not every women is a candidate, the majority of women are healthy and low-risk in that they have no known serious medical problems. Those problems could be high blood pressure, diabetes, a previous cesarean, pregnant with twins, and maybe obesity. Those, and other, conditions make a home birth too complicated,” she says.

Do you always know when that baby is coming?

“No warning,” she says simply. “Although there’s almost always time to get things in place.” She tells me about a woman, twenty years of age who came to the hospital and gave birth ten minutes later. “That’s unusual,” she says emphatically.

“When Carla and I would do the births together one of us would be with the mother, then the other would attend the birth. It could take a few hours,” she looks up, “to days.”

“If a woman’s labor is not progressing—maybe she’s too tired or the baby is not doing well—we go to the hospital.”

In 1999 she worked with the Mendocino Coast District Hospital-based practice Caring for Woman, doing hospital births. “A few years ago when our hospital was in bad shape financially, they closed down the Caring for Woman clinic,” Garcia-Wells says.

“Historically we (midwives) have served poor woman. As healthcare became more expensive, clinics were shut down because doctors wanted the business for themselves,” she says. “With the clinics a doctor can do without the midwives, but midwives have to have a doctor backup so they can no longer function.”

Currently she works at Kaiser Permanente in Santa Rosa and has for three years. “I like the people I work with; they love their jobs. The doctors are good.”

“It’s very different though. I have to manage a lot of pregnant woman at a time, usually three to nine,” she informs me.
“The volume of births is ten time that of the coast. At Kaiser we have 150 to two hundred births a month; on the coast it’s more like 150 to two hundred births a year.”

What would she like to see happening around births?

“An ideal construct would be a continuity of care. That’s the essence of midwifery, to be there before, during and after a woman’s birth.”

“I’ve been involved in about fifteen hundred births on the coast. I’ve delivered the babies of babies I delivered. One large local family invited me to a sixtieth wedding anniversary. As I looked around I realized I’d delivered seventeen of their grandchildren and great grandchildren.”

This doesn’t happen in her practice now, she tells me. “The coast is where my life is but I like working in Santa Rosa. I just work, sleep and work again. My work is more of a job, rather than my life, and at this time in my life I like it.”

Full bloom
Kei Velazquez is home grown, she grew up on the coast and went all through schools in Mendocino, graduating in 1991.

When she talks about her life it’s no surprise that Velazquez has become a midwife. Her aunt was a nurse-midwife in the 1960s and seventies in the Bay Area and went on to become a professor in California and in Texas specifically teaching midwifery at the university level. “She was an inspiration,” Velazquez tells me. Plus, Velazquez grew up across the street from Suzan Garcia-Wells who was another inspiration. Garcia-Wells also delivered Velazquez’s two children.

While attending college in Maine “I did a semester abroad in Kenya where I studied traditional birth attendants and wrote my thesis on the subject,” she tells me. She earned a Bachelor of Arts in 1995.

She spent a year at the University of California, San Francisco earning her R.N. followed by two years of study to receive her master’s in nursing, and her degree in midwifery and as a nurse practitioner of woman’s health. “It was very intense,” she says with feeling.

After graduating from UCSF in 2000, her first job was in a small birth clinic named Holy Family Services in Weslaco on the Texas-Mexican border. It helped then, and now, that Velazquez is fluent in Spanish.

“Birth clinics are going away. Holy Family is one of the last free-standing birth centers in the U.S. Our patients were mostly immigrant women. We had four birth rooms and handled everything from prenatal to postpartum care. I really liked the continuum. Often woman had their children there and then their daughters came to us for their births. We were ten minutes from a hospital if needed and that was good, too.”

The Caring for Woman clinic at the Mendocino Coast District Hospital was Velazquez’s next stop until the clinic was closed in 2005. She also worked with Carla Stange doing home deliveries.

In 2008 she hooked up with Jenna Breton and they created Full Bloom Midwifery in Fort Bragg. Since it’s so new they haven’t had many births, one so far in 2009 and four more scheduled.

Another job is with Sutter Lakeside Hospital in Lakeport where she provides prenatal and gynecology care two to four days a month.

It seems we all have two or more jobs here on the coast, so Velazquez also works for Mendocino Coast Clinics in Fort Bragg. “I have numerous titles,” she says with a laugh. “I’m a childbirth educator— teach preparation classes, specializing in lactation services. I teach a breast-feeding class before birth and after birth. We have a drop-in breast-feeding clinic every Friday from 9:00 a.m. to 11:00 a.m.

“We’ve learned that breast-feeding is best for the baby so the mother needs to be informed. The most important aspect of it all is family cooperation,” she emphasizes.

“Breast-feeding is more complicated than it might seem. For example, you can’t as easily monitor the amount of milk the baby is getting as you can with a bottle. That’s a big question for many mothers: ‘Is my baby getting enough to eat?’” With support and reassurance, new mothers and their families can gain confidence that their babies are indeed getting enough breast milk, she tells me.

At the clinic, when Dr. Brent Wright is at the hospital attending a birth, Kei can give routine midwifery care. “It’s a great pleasure to work locally. It feels like I get to see all ‘my’ families,” she says. “I love the clinic.”

What would she have in an ideal world?

“I wish human’s would realize that we are mammals, too; that birth is a natural part of life. These days it’s hard to step back and let it (a birth) happen with our heavy reliance on technology.”

“One danger of all this technology is that one intervention will often lead to another intervention. For instance, our cesarean rate is raising in the U.S. compared to other countries. My hope is that the younger generations will reclaim natural childbirth,” Velazquez concludes.

Wanting to do more
Jenna Breton’s involvement with midwifery began in Marin County when she worked with Planned Parenthood. There she realized she wanted to train as a doula and competed that training in Oakland and began meeting with patients in Berkeley.

At each step in her training she wanted to do more so Breton trained as a direct-entry midwife in El Paso, Texas. “In the birth center there were thirty to forty births each month. There were three birth rooms in a beautiful old Victorian house,” Breton tells me.

And still she wanted to do more. This meant completing her B.A. at the University of California, Santa Cruz. After that came obtaining a master’s in nursing and the Certified Nurse Midwife distinction as a woman’s health nurse practitioner. “It was a lot of hard work, but worth it,” she says.

“My husband graduated from Mendocino High School and we’ve lived in the area on and off for ten years. Right after my graduation in 2007 we had a child.” This was Breton’s second home birth.

In April of 2008 Breton started working at the Mendocino Coast Clinics and in August she and Kei Velazquez started Full Bloom Midwifery in Fort Bragg. “I love working with people, especially when it’s one-on-one. Medicine and healthcare are passions of mine, helping people learn to take care of themselves.” Breton also speaks Spanish.

They both provide a variety of care including annual gynecological exams, birth control counseling, and prenatal care for woman who want either home or hospital births. She tells me that they welcome anyone and that the first consultation is without cost and consists primarily with finding out what a woman wants.

“At Full Bloom Midwifery Kei Velazquez and I have deliberately started slow with building our business. We both have young children at home and other jobs. Home births are also more time-consuming and most midwives don’t work with more than four deliveries a month,” says Breton.

“Midwifery is empowering for woman; educating them about the natural process of birth. With a home birth the woman is the one in charge, she’s in her own home where she feels most comfortable, usually with her family. She doesn’t have to have any interventions she doesn’t want, unless there’s an emergency. In a home birth a woman’s labor can progress more slowly, it’s not on a clock as it can be in a hospital. We do discuss that it may be necessary to go to a hospital and what decisions need to be made and when,” she informs me.

Breton points out that the women who have home births has changed over time; it used to be only poor women who had midwifes. “Now it’s better educated and more financially secure woman who request them more often. We provide information and education for any women so they can choose whether they want a home or hospital birth.”

Childbirth is the most natural thing in the world. As we’ve seen, the more information and support a woman has, especially with a first birth, the more naturally the process can progress. There are many people in our small coastal community with the education, training and experience to assist pregnant woman in a healthy, safe and joyful birth.

SOURCES & RECOMMENDATIONS
Carla Stange — Certified Nurse Midwife (C.N.M.)
Family Nurse Practitioner (F.N.P.)
Mendocino Family Healthcare
940 Ukiah Street/P.O. Box 1129
Mendocino, CA 95460
707 937-4202 • 707 937-6003 (Fax)

Marilyn Lemos — Childbirth Educator
Labor Assistant
Mendocino Family Healthcare
940 Ukiah Street/P.O. Box 1129
Mendocino, CA 95460
707 937-4202 • 707 937-6003 (Fax)

Intuitive Doula
Carla Stange & Marilyn Lemos
P.O. Box 1129
Mendocino, CA 95460
707 937-4202 • 707 937-6003 (Fax)
www.intuitivedoula.com • doula@mcn.org

Full Bloom Midwifery
Kei Velazquez (C.N.M., M.S.N., F.N.P.)
Jenna Breton (C.N.M., M.S.N., F.N.P.)
722 North Main
Fort Bragg, CA
707 964-8808

This contact information for schools and organizations was provided by Carla Stange:

• Midwives’ Alliance of North America (MANA): www.mana.org
• Doula Organization of North America (DONA): www.dona.org
• American College of Nurse Midwives (ACNM): www.acnm.org
• North America Registry of Midwives (NARM): www.narm.org
• International Childbirth Education Association (ICEA): www.icea.org
• International Confederation of Midwives (ICM): www.internationalmidwives.org
• Association of Labor Assistants and Childbirth Educators (ALACE): www.alace.org
• Midwifery Education and Accreditation Council (MEAC): www.meacschools.org
• Ancient Art Midwifery Institute: www.ancientartmidwifery.com
• Frontier Graduate School of Midwifery: fsmfn@midwives.org
• Lamaze: www.lamaze.org
• Childbirth and Postpartum Professional Association (CAPPA): www.cappa.net
• Citizens for Midwifery: www.cfmidwifery.org

A recommendation from Kei Velazquez: The Business of Being Born (available at Figueiredo’s Video in Fort Bragg).
Other recommendations:
A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812
by Laurel Thatcher Ulrich [1990, New York: Alfred A. Knopf; 444 pages, hardback.]

A Midwife’s Tale includes copious notes and an appendix of medicinal ingredients mentioned in the diary. A video based on the book, directed by Richard P. Rogers, has been produced by Blueberry Hill Productions.

The Call to Midwifery by Diana Janopaul — “‘You have the best job in the world!’ I hear this quite often when I tell people what I do. I agree, of course. I do have the best job in the world.…Well, not a job, really. For me, it’s a calling. A vocation—from the Latin word ‘vocare,’ which means to call or to summon.…What’s the difference between a job and a calling? It’s simple—you choose a job, but a calling chooses you. It finds you and then harasses you until you respond.”