Being a Midwife in St Thomas

My first question is: Are you a US citizen or do you have a green card? Because without one of those, it is going to be difficult to move here.

Midwifery would not be the choice of many adolescents here, more for the hippy dippy nature people- and please, I mean no offense to them. Health care is still rather patriarchal. Licensing and credentialing would be done through the Health department.

Although I don't know how to become a CNM in the USVI...I can tell you a little about my experiences. I have a 9 year old son, a baby on the way, and live on St. John, and received/receiving all of my prenatal care through the Myra Keating Smith Clinic on St. John. They have a Women's Health Clinic and Veronica O'Brien-Powell, CNM is the wonderful woman who you will see there. She handles all of the women's health. If you have a high risk pregnancy, you will also be consulted by Dr. Sprauve. There are also private doctors you can see, and another clinic on island (Fran is a CNM as well and she is at the Castro Clinic).

9 years ago, when I had my son, I used Veronica for all of my care. I opted for a hospital birth in St. Thomas, but not a private doctor. I had an "on call" birth. Back then, the labor and delivery was staffed with all CNM and a doctor on call. As long as everything went ok, your birth was handled by the CNMs. The doctor was called in only if there was a problem or a cesarean was needed.

I don't hear about too many home births, but there is certainly a need for dedicated CNMs. There are no birthing clinics that I know of on St. Thomas. Anyhow... midwives are not just for "hippie-dippy" people 😀 and tend to do a lot of the prenatal and births in a clinical setting.

Okay, I'm sorry, Julie. Didn't mean hippy dippy in a bad way.:-) But she said "adolescent" mothers, and I don't get the idea of the 14 year old girls opting for birth without sedation. But I don't have the pulse on that whole scene, so should sit in the corner and be quiet....

ah thanks guys.

Yes well East Ender lol, Im a hippie dippie then if thats the case 🙂

Honestly I know America is different when it comes to births. The UK is different in that it respects womens choices to birth without a doctor - even though there would always be one available. Midwives are the most skilled health care practitioner to deal with a pregnant lady and her newborn over here. In america and st thomas alike, it seems that women want a doctor? or is it the fact they dont have a choice?

Besides all the contraversies, I would love to set up a birth centre, and know this is going to be very very hard. I will have a green card, but will have to live on the island for 4 years prior to getting any type of scholorship - do you know if you can just buy your place at a college without getting a scholorship? and do you have to be on the island for a certain amount of time before you can study?

I would love to know what mums want in the VI, whether its cuture to have a hospital birth or whether actually it seems like they have no choice in the matter. East Ender with regards to the adolescent mothers, i do mean teens. And again i think its different over here...its more likely the older women to want epidurals etc. i have alot to learn from the VI and you ladies.

I wouldnt be a CNM, as I would not practice as a nurse - no chance. A CPM most likely. Any advice???

I am hopping over to you guys next may so hopefully can see for myself what ur all saying.

Setting up a business in the USVI is just like setting up a business in any state in the union. You will need the proper licenses, permits, and, most importantly, the right to work. I'm not sure what you mean by "buying a place" in the university? If you meet the entry requirements, you can certainly pay tuition and study there. That can happen immediately, assuming you have either a green card or a student visa.

Setting up a business in the USVI is just like setting up a business in any state in the union.

Well, kinda sorta. It's quite a bit more expensive though.

And getting the license from DLCA takes weeks or months.

Right. My point was that she will need all the licenses, etc. that she would need in one of the states.

Most American women, although there are exceptions, want to give birth in a hospital with a board certified Ob/Gyn physician, and bring on the drugs!! The mainland has lots of options for those who desire them, but I'm not sure about the USVI. I've never heard of a teenager who turned down an epidural. Here, it seems to be the older moms (not OLD - just not teenagers) who want to try natural birth. And the degree of 'natural' varies. For many, 'natural' is still in a hospital with a doctor - just no pain meds.

greenie: So you don't currently have a green card? And are you asking about scholarships to the university here for your studies? I do not think that UVI has a midwife course of study. You can check here: http://www.uvi.edu/sites/uvi/Pages/Home.aspx

If you have never been to the Virgin Islands, I would suggest a vacation here first. The culture is very different and as I said, I don't see the teenagers here who are having babies as very involved in their birthing plans. I may have a cynical view though.

EE: Not cynical. Realistic. They're about as involved in the birthing plan as they were in the birth control plan. Exceptions exist, of course.

When my son was born 9 years ago, the St. Thomas hospital didn't even HAVE epidurals! (and it didn't matter how much you begged :D) I'm not sure when they started offering them, maybe 4 years ago???

At the risk of being jumped on...I will give you some of my observations about pregnancy and childbirth. First of all, I don't see any negative stigma attached to a teen birth here. It is pretty much the opposite. Teen births are very common here, and so are large families. Also, among a lot of my West Indian and long time Transplant friends, it is usually the norm when you get pregnant to go sign up for every government program that you can get into. WIC, Food Stamps, Medicad, Subsidized housing, etc. Then your pregnancy and birthing options follows suit. You take the services that the government will pay for. Most cases, that means a hospital birth with whatever drugs they will give you.

With my current pregnancy, I've had friends ask why I haven't signed up for these programs. First of all, if I can't afford a pregnancy, how on earth do I expect to afford a child? Not to mention, I don't qualify without completely lying on applications (which I have found a lot of people have no problem doing). The expected cost to have a hospital birth on St. Thomas, less "supplies" is about $6,000. That price doesn't include any medications, complications, or other supplies. Prenatal care will run you in the neighborhood of $3,000. So, if everything goes perfectly, you can expect the medical costs of pregnancy and child birth to cost around $10,000. That's a lot of cash! If I had the option for a birthing center birth, I would do it. It would keep costs down for people like me who don't use the government to pay for it and don't have insurance.

On St. John, you can't have a birth in a clinical setting. Unless you go to the clinic at the last minute and they can't make you keep it in that is!!! If you have a baby at the clinic on St. John, the first thing they do is rush you to the hospital in St. Thomas. It's just procedure. I would LOVE to have the option of having a birth on St. John, and I think many St. Johnians feel the same way. For us, it's either a home birth, or a birth on St. Thomas. Our clinic is not equip to handle births or newborn care. And if there is a problem, it becomes a real problem because the hospital is on another island.

And East Ender...I didn't mean hippie dippy in a bad way either 🙂 Before I found myself on St. John, my impression of a Midwife was a granola eating, hairy armpit, flowers in the hair, kind of lady 😀 I have a new understand and respect for this wonderful group of women who dedicate their lives to such an amazing process!! To me, they provide far superior overall care to a pregnant woman. Doctors tend to treat "conditions", midwifes tend to care for people. My midwife once told me that she feels like the protector of fetuses. She loves people before they are even people, how cool is that!

julie: I don't really have a horse in the race, but your observations are pretty much in accordance with mine. I would add that I think there medicine here is very paternalistic. "Oh, whatever my doctor says, that's what I'll do." The physicians feed into it, also. "Just do what I tell you to do." Things like advanced directives are not done on a regular basis because "I want the doctor to do everything." If you aren't paying for anything, why would you worry about decisions?

As I said, cynical...

I know what you mean. It's difficult to explain my observations without them sounding pretty negative. I'm talking about my FRIENDS here... and as shocking as I first found their attitude towards it all, I've come to learn that my opinions about it all are the ones that are against the norm in the place I've called home for the past 11 years.

I have to say, I am super thankful that my only option with my first pregnancy was midwife care. I don't know if I would have gone that route if I had lived in the states or if I had insurance. I've found that the level of total care with a midwife is a lot better than the care I've received from any doctor. Since I have to foot the entire bill, I almost have more choices than other people. I don't have anyone telling me who to see, when to see them, what tests to get, etc. I pay, I decide. You wouldn't believe the ruckus I caused at Schneider hospital when I insisted on checking out 5 hours after I gave birth. They usually want to keep you two more days. My son was born at 4am, I was checked out of the hospital by 9am, and was on the noon barge back home. I couldn't WAIT to get out of there!!!

Roadrunner,

Epidurals in St Croix are not the norm, especially for our local teen population. I agree that they have no plan, especially for their birth, but most do not get epidurals. Epidurals are available and used by some.

I am not familiar with the hospital on St. Thomas, but I am very familiar with The Governor Juan F. Luis Hospital Labor and Delivery in St. Croix and I can assure you that the staff of 6 Certified Nurse Midwives (CNM's) and 3 Registered Midwives (RM's) go above and beyond the call of duty.

GreenShell,

I am not sure how far you are in the midwifery program, but check with the USVI Board of Registered Nursing. They do license Registered Midwives so it is not that far fetched to license a CPM. Just be patient and very respectful when calling. Also keep in mind that it takes 4-6 months to obtain a license from the Board of Nursing at best.

SMCCNM

With UK credentials, you might qualify as a registered nurse midwife and do hospital deliveries. Your licensure is not through DCLA but through the board of Nurse Licensure. Call them to ask for details, or call Amie Bannis 772-7349 on Labor and Delivery during the daytime. (You are going to the wrong island, by the way. St. Thomas has too much partying, too much traffic, is too expensive, and has two suns.) St. croix is the gentler, friendlier, more earthy-crunchy . Think about it!

People here are very warm to midwifery. Both islands have a rigorous midwifery program and if you qualify, you will be welcomed. Coming from the UK you probably already speak West Indian!

"(You are going to the wrong island, by the way. St. Thomas has too much partying, too much traffic, is too expensive, and has two suns.) "

:S

You must have been partying hardy when you were here, if you saw two suns...

Maybe "two suns" is a rating system, as in, "I give St. Thomas two suns out of a possible five."

Hippy Dippy?
haha! wow.

@greenshell22 hey I was wondering if you are there now and how much do you charge are you in st.Thomas or st.John wanting to have a home birth