Tova Siegel caught the 'birth bug' after being involved with Le Leche League 28 years ago, after the birth of her first child. She certified as a childbirth educator with Informed Birth and Parenting 12 years ago. She has retired from delivering babies, and is now an ACNM Board Certified Nurse Midwifedoing well-woman gynecology. This is her journey into midwifery.

"Nursing was a way to get what I wanted" (which was to become a midwife). ... I hate the identification of myself as a nurse. I think someone can be a wonderful midwife without being a nurse. But at that time, this was the only way to practice midwifery legally in California. But I feel there has to be standards, to guarantee safety and to make it a credible profession."

The question as to whether she would become a nurse-midwife or a direct-entry midwife was clear to Tova. At that time direct-entry midwifery was not legal in California, and so she decided to become a Nurse Midwife.

Tova obtained a position as a student nurse worker at Cedars Sinai Medical Center in West Los Angeles where she worked for 18 months (or 3 semesters). She worked one shift per week while in school and "learned a tremendous amount" from other nurses, residents and doctors. She was given her own patients, started doing procedures and was "essentially functioning as a nurse".

At Cedars, her method of managing labors earned her respect and her homebirth awareness made her "a more sensitive and compassionate nurse". Hospital administrators received letters of praise from parents who were very pleased with the support she gave. Tova also offered education to the staff nurses on "things they had never heard of like exhale pushing."

Tova passed her nursing board examinations in June, 1989 and became a Registered Nurse. She had considered getting her nurse-midwifery training through "Method 6"--a way a RN could become licensed in California as a Nurse-Midwife --but decided against it, as she would not have been able to practice in other states and would not have been accredited by The American College of Nurse Midwives (ACNM).

Tova began the Apprentice Academics Midwifery Home Study Course designed by direct-entry midwife Carla Hartley, but found she did not have the discipline needed to work at this self-paced program; and found that "it was not in-depth enough" for her. She did take and sponsor the Informed Birth and Parenting Birth Assistant Training created and taught by Karen Parker (now a CNM), and learned a great deal from it.

In January 1989, Tova applied to the University of Southern California Nurse-Midwifery program, having completed her B.S.N. and received her labor and delivery nursing experience---prerequisites for the program. Initially, she was rejected. USC said she needed more labor and delivery nursing experience, so she stayed at Cedars Sinai Medical Center one more year. Tova was finally accepted and entered the USC Midwifery Master's Degree Program in January 1991 and graduated December 1991.

When asked how she managed to cope with the hospital training given her homebirth perspective, Tova is honest that it was difficult at times, but says she "gained a new perspective". As a childbirth educator and labor support person, Tova admits she was "very cavalier and always minimized the physician's judgment".

Through working in the hospital, she came to realize that "birth is not always perfect and serious emergencies--life threatening ones like shoulder dystocia-- can kill babies". While she admits a lot of times unnecessary c-sections and "violations of the woman's being" occur, she truly believes that the place where the woman feels the safest is where she will give birth the easiest. Tova says she no longer feels the need to try to "beg or convince women to breastfeed, if they don't, that's their right", she says. Tova feels that as a result of her hospital-based training she has "become more accepting in an unconditional way."

When asked how she dealt with doctors or nurses she witnessed doing things to mothers or babies that she felt were unsafe, Tova says, "As a nurse, I had little power", and she needed to "follow orders or get fired". But at Cedars, she could choose her patients and she chose the physicians she wanted to work with.

The women who wanted to give birth "their way" had supportive doctors, Tova says, and "the women who gave up their power had very authoritarian doctors." She learned to inform women of their options, offer education if they requested it and let them make their own best decisions.

Tova says "nursing was a way to get what I wanted" (which was to become a midwife). "I think nursing as a profession needs revamping, which they are trying to do. I hate the identification of myself as a nurse. I think someone can be a wonderful midwife without being a nurse. But at that time, this was the only way to practice midwifery legally in California. But I feel there has to be standards, to guarantee safety and to make it a credible profession."

Now that direct-entry midwifery is legal in California, when asked if she would choose the nurse-midwifery route again, Tova says, "I'd choose the route that got me there the quickest".

It's good to know that Los Angeles' women are benefiting from a Nurse-Midwife who has the perspective and background that Tova Seigel does. Her persistence, commitment to excellence and making a difference are an inspiration to all aspiring midwives; especially those with children at home who think that the nursing school route is too difficult to manage while caring for a family. Tova says, "the world needs more midwives".

Tova previously worked as a Certified Nurse-Midwife at County USC Women's Hospital and taught residents and midwifery students. Currently, Tova has started a full-scope private practice, Women's Health Connection, doing family planning, well-woman gynecology and primary care. Now a grandmother, Tova delivered her twin grandchildren at Cedars Sinai Medical Center and two other grandchildren at home! She no longer offers prenatal care or delivers babies, but she does offer well-woman gynecology services.

To reach Tova, go to her website:Women's Health Connection, or E-mail her at: .