Welcome to the “Ask Her Anything” Series at The LightHouse Birth Collective!
(Spoiler Alert: It’s the most fantastic Interview Series you’ll ever read. I’m just telling you now.)
“Ask Her Anything” is the fresh, brutally honest cousin of ‘The Boring Old Interview.” In this unprecedented opportunity, The LightHouse is merging nearly three whole centuries of our Members’ combined birth experience with the chance for prospective clients to be brave and ask the questions that are really on their minds.
One by one, our Midwives, Doulas, and Birth Photographer are answering all kinds of questions that were submitted by our followers – real reader questions that deal with pregnancy, partners, childbirth, and beyond. The questions are intimate, they’re vulnerable, and they’re raw – much like the childbearing year itself – but if you know “birth folks,” you’ll know that they love a good challenge, and our Members didn’t hesitate to tackle even the toughest questions.
I’ve been waiting patiently (ok, not even close to patiently) to introduce you to a truly extraordinary midwife.
Carrie Keane is unique among the members of The LightHouse because she’s our only Certified Nurse Midwife, and she doesn’t have a Home Birth Midwifery practice. As a hospital-based midwife, Carrie has caught more than 2,000 babies, and currently provides full-spectrum gynecological, prenatal, postpartum, menopausal, well-woman, and reproductive/sexual health care to women (and guys, too!) from all over Delaware.
Carrie’s services are a cornerstone of The LightHouse Midwifery team, because Carrie has a scope of practice that’s different from our other midwives – she serves clients who are higher risk or who have more clinical needs, or who are just in a different phase of life than childbearing. Essentially, she provides the warm, compassionate care that homebirth midwives are famous for, to the clients who need to be seen in a more medical environment.
Carrie is a dream come true for her patients, because she’s fully supportive of low-risk home birth (she’s attended a bunch!) and she appreciates natural and holistic health care. Carrie provides a truly impressive range of services with a gentle, intuitive, and honest demeanor. Even though she’s a graduate of Yale’s Nurse Midwifery program, she isn’t a stereotypically snooty Ivy League gal, either – just last fall she traveled halfway across the world to live and volunteer as a midwife in a Syrian Refugee ‘tent city’; she’s worked under some of the toughest circumstances and with some of the most vulnerable citizens in our own nation, too.
There’s no doubt that Carrie Keane is a once-in-a-lifetime midwife, and in this candid interview we got her to tell us about some of the most memorable midwifery moments she’s ever had – the good, the bad and the ugly – and Carrie breaks it down for us about how she managed to survive as a homebirth-friendly Nurse Midwife in a system that seems hell-bent on making true midwifery a distant memory…
1. What’s a Nurse-Midwife (CNM), and how is your scope of practice different than the other midwives in the LightHouse (CPMs)?
Certified Professional Midwives (CPM)
- Licensed and trained in midwifery only
- You can become a CPM without going through a formal academic program
- This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process)
- If you go to school, you can go to an MEAC-accredited school or one that isn’t accredited
- Non-accredited schooling requires PEP as well
- Entry-level education for an MEAC accredited school seems to range from Associates to Master’s Degrees
- Can practice in most states, but some states will not license CPMs
- Can only deliver OOH (Out of Hospital) in the home (if legal in the state) or in a birth center
- Does not always require physician oversight
- Cannot write prescriptions
- Care is limited to pregnant or postpartum women in some states
- Other states allow well-woman care as well
- Licensed and trained as Registered Nurse and in midwifery
- Entry-level education: Master’s Degrees
- Can practice in all states, although their scope (what they’re allowed to do) varies from state to state
- Can deliver in all settings (home, birth center or hospital) depending on state regulations
- Can provide care from “menarche through menopause” (menarche being the first menstrual cycle)
- Need physician oversight in most states
- Can write prescriptions
The major difference between the two, in my professional opinion, is the tendency for certified nurse midwives to practice a more medicalized model of midwifery, although this is not always the case. Certified nurse midwives are also trained to provide a broader scope of well-woman practice, caring for women throughout a lifetime, not specifically for gestational/childbearing time frames. Thus, you will find more certified nurse midwives caring for menopausal women, say, or for women post-fertile, or for routine well women care. Not to mention, as prescribers of medication, certified nurse midwives are not limited in providing contraceptive medications or STD treatments for all females, and even for males.
2. You were an English and journalism major in college at The University of Maryland, but made a big switch to midwifery when you earned your Master’s of Science at Yale. What happened in your life that made you take such a different direction?
It may seem cliche, but it was literature that turned me on to midwifery. Prior to that, my interests were in writing and nature. In my undergraduate program at University of Maryland, I worked as an intern for the National Academy of Nursing which took me to Mexico for a conference. The president of the Academy was kind to me and knew my interest in reading and science. She gave me two books from her own shelf, Immaculate Deception by Suzanne Arms and Spiritual Midwifery by Ina May Gaskin. Reading those books turned me into a rabid devotee to the midwifery world; I read every single thing I could on the topic. I read historical novels with midwives as main characters, old obstetric textbooks, new treatises on midwifery models of care, I read all about Mary Breckinridge and the Frontier Nursing Service in Kentucky, ultimately moving there to apprentice as a courier for the service. My time in Kentucky turned me on to a world I knew nothing about, a world of class struggles, poor health, and the burden of under-education. I read Silent Knife, about unnecessary cesarean sections, Water Babies, Midwives, Witches, Midwives and Doctors, Gentle Birth, Childbirth Without Fear.
I literally became obsessed with the topic, joined a home birth midwifery alliance in DC, wrote papers and articles on midwives, and started a job at the Pregnancy Aid Center as a social worker for teenage moms. There, my partner and I did home visits to assess need and we began a program to dole out free bags of food and newborn essentials like diapers and cribs. While at this job, I was contacted by Rory Kennedy, who was filming a documentary about third-world-like conditions for pregnant women in some parts of America, and I was featured as a caregiver for the underserved.
It became an anthem for me to care for the disenfranchised and the poor. I applied and was granted a scholarship to Yale as a National Health Service Corps Clinician for the Underserved. The scholarship paid my full tuition to Yale University’s Master of Nursing program for four years, but in return, I had to pay back my time in service in a location in which no one else wanted to work. After graduation, I got “sent” to work at a chicken factory women’s wellness clinic, offering services to mostly immigrant women from Haiti, Mexico and Central America. Now, I have been working for the indigent in different capacities in my midwifery career. As well, I have had clients who sought midwife-specific care for all of the many reasons I signed up to do this job. Presently, I am putting my undergraduate coursework to use by writing my own book on my life as a midwife.
3. What range of midwifery care are you offering right now? (And if women wanted to come and see you for a well-woman visit or a prenatal visit, how can they do that?)
Presently, I’m working in the capacity of office gynecology, sexual and reproductive health. What this means is that I see clients for any of the following scenarios:
* pregnancy testing
* prenatal care
* std screening
* std treatment
* gynecological diagnostics and treatment
* menopausal wellness visits
* pap screening
* breast examinations and referrals to mammography
* hormonal analysis
* contraception, including natural family planning, IUDs, implants, free condom distribution, hormone pills, patches, rings, injectables
* HIV prevention with PREP medication
* counseling for sexuality
* sex education
* infertility options counseling, including early diagnostics and management of infertile conditions
* PCOS treatment and diagnostics
* well-women care
* male std treatment, prevention, screening, counseling
* vaginitis treatment
* preconception discussions
* vulvar biopsies
* genital wart treatment w/ cryotherapy, and/or chemical application or excision
* excision and drainage w/ curettage
* polyp removal
* endometrial biopsy
* post abortion routine care
* nutritional counseling
* early pregnancy ultrasonography
If someone wants to make an appointment for any of the following, a call can be placed to the call center at Planned Parenthood by calling 302-678-5200 and following the prompts. Or, walk-in appointments are available Monday, Wednesday and Thursday in the Dover location. Late night hours are offered until 7 pm on Thursdays.
4. What are some of the most unusual things that have happened during appointments and births with your clients? Don’t hold back, now.
Well, just today I had a male client present for STD screening because he was too drunk to remember if and with whom he had sex over the weekend. Evidently, he literally got caught with his pants down and had no idea what had transpired the night before. Regularly, because of the intimate nature of sexuality and the psychology and sociology surrounding it, I am faced with a heavy burden of taking on the stories of humanity. Daily, I must question my taught mores and society’s ethical constructs. As a result, I have developed an interesting perspective on human behavior and strive to erase stigma from my clinical thinking. I have been tasked in my role as a midwife to serve as a witness and narrator to the human story.
I have had a ninety year old female client with dementia complaining of being raped at night by her son. On examination, inside of her vagina, I found a purple plastic deodorant lid. I have had to call the police to report rape by a school teacher who was having sex with female students who wanted lead roles in the yearly musical drama. I have caught more than one baby that were not the product, genetic offspring, or same race of the father who was in the birthing room expectantly waiting for their new baby to be born. I have witnessed their realization that the long-awaited infant was obviously not their progeny.
I have rushed a crying, bleeding woman from the emergency room to perform a stat ultrasound because her baby was no longer moving, only to discover that she wasn’t even pregnant in the first place. I have had to tell a smiling woman at full term that the baby inside of her was dead. I have watched with glee as a 42 year old woman called her husband of 14 years to tell him that her pregnancy test came up positive for the first time. And in the next minute, watched a different woman crying desperately over an unwanted pregnancy. I have pulled tampons out of vaginas that had been left unremembered for months. I recall a woman who tried to get pregnant by stuffing her roommate’s dirty underwear in her vagina.
I have pulled out various sundries from the female nether regions, including but not limited to rotten maraschino cherries and a sprouted potato. I have seen a minutes-old baby breastfeeding from a breast emblazoned with a giant tattoo of Redd Foxx as Fred G. Sanford from Sanford & Sons. I have seen a thousand really bad tattoos, with misspellings and crossed out names of ex-lovers. I have seen more dripping cherry tattoos than I can count. Once I saw an older woman with a tattoo on her buttocks that said #blessed. Another tattoo on a different buttocks said, “Hit it hard.”
I have cared for a mother and daughter client duo who were simultaneously pregnant with the same due date. I had a favorite patient who would travel to her prenatal appointments on a riding lawnmower because she lost her license and her vehicle to a DUI charge. I have caught a baby born to a quadriplegic mother. I have attended Amish home births and the births of Hasidic Jews, and the births of fundamentalist Muslims who read the Koran throughout their entire labor. I have sang joyfully through a labor with a woman here alone from Somalia, and I have sang mourning prayers with a Guatemalan grandmother careening with her stillborn grandson in her arms.
I have seen a poor young teen who had been putting honey on her herpes outbreaks because she was too ashamed to be seen and treated. I have had famous patients and poor patients and really, really poor patients. I’ve lived in a tent city with Syrian refugee mothers who starved themselves in pregnancy so that they would have more food to give to their living children. As a midwife, I have spent more time consulting and counseling on relationships between lovers, fighters, and many mother in laws. Truly, this question is loaded… And, it is impossible to even relay the depth of the stories I am honored to be privy to each time I walk into an examination room and introduce myself as a midwife.
5. Midwifery is famous for being one of the most emotionally and physically grueling careers in the world. What have been your biggest challenges as a midwife – and what are those moments that get you through them?
It should be said that none of the above stories drain me emotionally or physically even half as much as the system within which I am practicing as a midwife. In other words, it is not the women I care for, or the care itself, but the culture of care that is grueling.
For a pilot to work safely, hours are limited and for good reason. We know that lack of sleep has been equated to driving while intoxicated. We know the inherit dangers to our health, in terms of blood pressure, weight and metabolism control, cardiovascular disease, depression, adrenal fatigue, infertility, immune system suppression. And yet, limits on hours worked have never been enforced in medicine or midwifery. There were days when I literally worked 24 straight hours with no end in sight. It is not unusual for a midwife to work more than 80-100 hours in a typical week. Labors are unpredictable and many do not go quickly. Meanwhile, the business of healthcare, especially that of private practice, forces ‘quantity over quality’ of care. It was not unusual for me to see close to 30 patients in an office day, with literally less than 5 minutes to see each one, sometimes double booked, and sometimes while on call and having had no sleep the night before.
The dollar bill dictates healthcare in this for-profit U.S. system. And while I went into this profession with my heart leaning one way – toward natural, holistic, family-centered care – it quickly became apparent that the doctors with whom I worked as my back-up physicians had a different approach and different expectations. My practice became medicalized, fast-paced, prescription and lab focused, dictated by policies and procedures and mandates and costs. I found myself becoming a slave to the schedule, with little personal time off, little time to recover, little time to actually give, and this lent to a calloused form of care-giving that I was both ashamed of and martyred by. I was forced to perform just like a doctor, while suffering from the lack of dignity and respect that MDs receive, and rather than stepping back to gain perspective, I continued to get further entrenched in the system I railed against.
Presently, by working in a non-profit clinic, much of these pressures have been reduced. I now have the ability to give care for free, or for a much reduced fee based on a person’s household income. I am buoyed by funding for non-profits through grants and NGOs that actually care about access and quality rather than payout.
Also, volunteer work and writing have given me an outlet to remind myself of my original intentions – my heartstrings.
Too, I have learned to limit myself, to say no, to do less, to live more, to have more freedom and fun, to work better, not harder. I am trying hard not to be a martyr to the midwifery profession.
You can read the professional profile for Carrie Keane, MSN, CNM on her LightHouse page, where you’ll also find her contact information and more details about her midwifery background and services.
Please note: She is absolutely sublime.
Please Also Note: The home birth community in Delaware will always be grateful to Carrie for remaining a steadfast supporter of a woman’s right to choose out of hospital maternity care, and for the many years that she took on great professional risk by standing alongside her Sister Midwives while they fought for licensing and legalization. We won’t forget it, Carrie. Thank you.