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Wednesday
Feb022011

Is The Big Push for Midwives an Oppressive Campaign?

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By Jill Arnold

 

I shared a status update from The Big Push for Midwives Campaign on our Facebook page:

Via The Big Push for Midwives Campaign: ” So, we’re getting good news from Mississippi, North Carolina, Iowa, Ohio, Indiana, South Dakota, Colorado, Nebraska, Michigan — our PushMap is just gonna get bluer and bluer (in a good way!) this year. Keep sharing stories from your statehouse adventures, Pushers!”

 

Here are the 151 comments that followed:

 

The Unnecesarean

That’s not without a TON of grassroots/ legal work that nobody ever sees. Keep it up and thank you!

Sunday at 7:57am

 

Jen

I hope Michigan stays like it is. All midwives are free to practice here. Changing the laws will add more rules and regulations I fear.

Sunday at 8:02am

 

Sabrina S.

Illinois needs to change its ways. We are underground here, but still home-birthing with midwives!http://scrambledmommybrain.blogspot.com/2011/01/james-sullivan-peschkes-birth-story.html

Sunday at 8:06am

 

Katherine M.

TBP is not a good thing. It’s going to hurt more women than it will ever help.

Sunday at 8:06am

 

Katie B.

I have VERY mixed feelings about TBP—I don’t think it’s cut and dried in either direction. :/

Sunday at 8:09am

 

Laurel

What are Louisiana laws on mid-wives?

Sunday at 8:11am

 

Jen

Laurel, you can go to mana.org and find your state. Looks like they license CPMs there.

Sunday at 8:15am

 

Katie S.

Laurel- they do, but the state is making it very hard to continue practicing for all but a few midwives. It’s almost as crooked as the rest of the state :(.

Sunday at 8:40am

 

J

Those of you on this thread who don’t want regulation- just stick with your midwife. She doesn’t have to get licensed she can stay underground and you all can enjoy all the benefits of an unregulated health care provider: infection, dangerous practice and unscrupulous behavior. I also suggest you start seeing unlicensed dentists, and surgeons too since you’re into unregulated health care providers.

Sunday at 9:08am

 

Rebecca

Jen, as far as I know there is no law in Michigan allowing all midwives to practice. Until there is, it is only a matter of time until someone gets prosecuted for practicing medicine or nursing without a license. If I’m wrong about this, please cite the law you’re referring to and I will gladly eat my hat!

Sunday at 9:21am

 

Julie ‎

@J- So you’ve seen an unregulated HCP? Can you tell us your experience please?

Sunday at 9:22am

 

Jen

Having letters after your name doesn’t make you good at what you do. When you choose someone to care for you, you do research and find one that fits. Unscrupulous behavior? Really? Infection? It sounds like you are coming from a place of hate and ignorance.

Sunday at 9:24am

 

Katherine M.

‎@J - amazing. None of the underground midwives I and my friends know have any of those problems you mentioned. However, the LICENSED ones do, and they also have a very high (for midwives) c-section rate, induction rate, no informed consent rate and “risk out” rate. Yeah, I’ll stay with my underground midwife thanks. If I hadn’t had her, I never would have been able to have my HWBAC. Unlicensed does NOT mean uneducated. I’d bet my life (and obviously did) that my midwife has MORE education and MORE experience than the licensed ones in my state, k thanks.

Sunday at 9:28am

 

Jen

This feels like a witch hunt all over again. *sigh*

And yes, midwives are free to practice here in Michigan. The only law states that you can not practice medicine without a license. Since WE ALL KNOW that birth is a natural event and most don’t require intervention and medication, we can provide women with this care. We do not (by definition) care for high risk moms.

Didn’t doctors try to irradicate midwives 200 years ago with these SAME tactics? Talking about unscrupulous behaviors and infection? Watch out lades… it’s a witch hunt.

Sunday at 9:37am

 

The Unnecesarean

A consumer-driven witch hunt? Interesting construct.

Sunday at 9:49am

 

Rebecca

And by “we all” do you mean prosecutors? Because they’re the ones who arrest midwives and charge them for practicing without a license. That midwifery is not the practice of medicine (or nursing) is not a given in state law, unless specifically carved out. I’m not saying I disagree with you, but that argument does not hold up in court.

For those interested in learning more about the myths related to “alegal” midwifery practice, please read this:http://fromcallingtocourtroom.net/

Sunday at 9:53am

 

Katherine M.

The witch hunt is going to come from midwives turning in other midwives because they’re not licensed yadda. The whole thing is midwives attempting to “fit in” to a medical system when they shouldn’t be IN the system at all. Pregnancy is, most of the time, NOT a medical issue. When there IS a medical issue, then go to an obstetrician. That’s what they should be there for. Otherwise, keep birth unmedical and OUT of the system!

Sunday at 9:54am

 

Jen

I disagree. I believe that it is driven by those working as “midwives with degrees.” If it wasn’t, why aren’t ALL midwives included instead of just CPMs?

Sunday at 9:55am

 

Steff Hedenkamp

Stay underground by all means. But do recognize with eyes wide open the paradigm in which we currently co-exist in the US is one that calls for licensure/regulation of health-care providers. Midwives do not stand as some special group for whom regulation somehow does not apply. Opt out if you must, stay down down deep underground, but don’t fight the rights of moms and families who want their state to join the 21st century, bring midwifery up from behind the cloak and dagger, so they can have the ability to find their midwife in the yellow pages, to ensure she has the qualifications they want, backed up by a license from the state. Seriously, stay underground by all means, but stop trying to pretend that licensure is something you can shout down with comparisons to the shameful acts of obs to annihilate an entire profession 100 yrs ago. Remember that we have to INTEGRATE midwives into our states’ maternity-care systems, and that WILL NOT happen without licensure.

 

Jen

So let me get this straight Steff. You’re trying to protect ME by making me and other traditional midwives conform to YOUR rules. I don’t see any legislature working on this by themselves so it’s your push, right? Your agenda? The PUSH towards being able to advertise in the phone book?

We ABSOLUTELY ARE a special group. Because we DO NOT PROVIDE medical care. We provide holistic care to moms who are low risk. I agree with Katherine. This is going to be a witch hunt that comes from within… those who want to PUSH OUT traditional midwives.

Sunday at 10:42am

 

Rebecca

No, I don’t think Steff said that anyone is trying to force traditional midwives to become CPMs or to get licensed. Some just want to make licensed midwifery among the options that families can choose. This does not mean that traditional midwives can’t continue to practice outside of the system and outside of the law, if that’s what they and the women they serve prefer.

Sunday at 11:19am

 

Jen

But that’s exactly what you’re doing. In Michigan, we are ALL legal as long as we are not practicing medicine. Essentially you will make us ALL ILLEGAL with your push. So yes, it’s either join you or get arrested. Does that sum it up?

Sunday at 11:24am

 

Katherine Hemple Prown

The case law on this issue is settled, which is why we no longer hear about midwives being prosecuted for practicing medicine without a license. Almost all cases now end in plea bargains since no attorney in their right mind would recommend going to trial because the courts have consistently found that, in the absence of a law defining the practice of DEM, exempting it from the medical and nursing practice acts and providing for regulation under civil administrative law—as opposed to criminal law, which otherwise applies—DEMs are practicing medicine and/or nursing without a license, which in most states are felonies.

That’s simply for routine maternity care and births. In the event of a death or injury, DEMs in states without licensure are also subject to prosecution for involuntary manslaughter or reckless endangerment, and those who carry or use Pitocin and similar meds are subject to additional charges of the unauthorized possession or use of prescription medications.

The medical practice acts in all 50 states were intentionally written—and aggressively promoted by the medical lobby—with the specific purpose of defining all types of health care as the practice of medicine, with the intent of giving allopathic providers a monopoly and making everyone else, not just midwives, but homeopaths, naturopaths, bonesetters, and a whole range of traditional practitioners, illegal.

The only professions that survived the AMA’s campaign to carve out a monopoly for themselves were those, like chiropractors, for example, that successfully passed exemptions to state medical practice acts and lobbied for regulation under civil—as opposed to criminal—law via licensure. Other professions were driven underground, marginalized out of existence, and/or subject to ongoing harassment and criminal prosecution.

And it’s not just unlicensed providers who are subject to harassment and prosecution, but a disturbing new trend involves home birth parents losing custody of their babies for giving birth with unlicensed midwives. There have been four cases in the last year alone that I’m aware of, one of them involving a state legislator whose wife had a home birth.

This is just one among many reasons why the Big Push is a consumer-driven campaign, not a midwife-led campaign. Many of us (including me) have personal experiences with our midwives being prosecuted in unlicensed states and watching their numbers dwindle to the point where our only choice remains to have a UC or give birth in another state.

Sunday at 11:43am

 

Rebecca

As I’ve been trying to say, “As long as we are not practicing medicine” is valid so long as the prosecuting attorney agrees with your definition- which could be forever, or you could get arrested tomorrow. ALL CAPS indignation notwithstanding. Do you carry pit or oxygen? Who defines “low risk”? What happens when you transport to hospital or transfer to an OB? What happens if there is a bad outcome?

I understand the desire not to rock the boat if things have been going well for a while in your state. But look around, at Illinois and Ohio, for example, which have both seen home birth families charged for using unlicensed midwives, and even lost custody of their babies (in IL regained it later).

I respect your position, but I disagree as a citizen working for better government that the status quo is acceptable. And as an attorney (licensed to practice my profession), I can tell you that your assessment of your legal status is dangerously incorrect.

Sunday at 11:46am

 

Katherine M.

Who is responsible for the midwives being prosecuted? i.e. WHY are they prosecuted to begin with?

Sunday at 11:49am

 

Katherine Hemple Prown

Most prosecutions—as well as investigations and cease and desist orders from state agencies—are generated by complaints from hospital personnel in the aftermath of a transport. Of those, a significant number, if not the majority, involve appropriate transports that ended with a healthy mother and a healthy baby.

Sunday at 12:00pm

 

Jen

So licensure will make you invincible from getting sued and miraculously make it so parents won’t get their kids taken from them? It’s worked so far for OB doctors, right? I’ve read where a mom refused antibiotics and immunisations and get CPS called on them. There is no such thing as a magical letters that prevent people from suing you or calling Child Welfare.

Sunday at 12:37pm

 

Rebecca

Sued? No, no one is invincible from getting sued. We’re talking about midwives and families being criminally prosecuted, which is different. When you get sued, it is by a private party such as a family who was harmed by the negligence of a midwife. The penalty for getting sued and losing is having to pay money. Prosecution means being charged with a crime. The penalty for being found guilty of a crime can include jail.

So while OBs get sued for negligence, or even just for bad outcomes, they almost never get charged with a crime like manslaughter or reckless endangerment (though I’m sure some folks think they should be).

No doubt that child protective laws are increasingly being used in a punitive fashion against women who make their own decisions in maternity care, in or outside of the hospital. This is unacceptable but in no way made better by midwives remaining unlicensed.

Sunday at 1:18pm

 

Katherine Hemple Prown

Getting sued and being criminally prosecuted are two different things. Anyone can be sued for many different reasons, but only people who have been accused of breaking the law can be criminally prosecuted and face prison time for it. Unlicensed midwives in every state are breaking the law and are subject to criminal prosecution as a result.

In states that offer licensure, unlicensed midwives face the lesser misdemeanor charge of practicing midwifery without a license, as opposed to states without midwifery licensure, where the charges would be the felony practice of medicine and/or nursing without a license.

In every state you are required to hold a license in order to perform the acts that midwives routinely engage in during the course of their work. The issue isn’t whether you need to have a license to practice legally but which professional licenses are available in your state in order for you to practice in accordance with the law.

The truth is, however, that states that offer midwifery licensure rarely prosecute unlicensed midwives because the assumption is that when licensure becomes available, everyone will get it. It really doesn’t occur to most people that members of a profession would hold philosophical objections to licensure and choose to practice without it.

The parents who lost custody of their children after a home birth were charged with endangering them by hiring an unlicensed provider to attend the birth, not by giving birth at home. I have yet to hear of a case where parents were charged with endangerment for choosing to give birth at home with a licensed provider.

Sunday at 1:24pm

 

Jen

Lots of great scare tactics ladies. Bravo. We have everything from infection, unscrupulous behavior, dangerous practices, criminal prosecution, our clients risking custody of their children and a threat to stay underground “or else.” Sounds like a true dictatorship. Lots of “this is for your own good” talk. We have all seen what happens in hospitals when “committees,” insurance groups and ACOG start telling the masses how to practice. What happened to autonomy? What happens to women’s choices when the “committee” deems breech and twins high risk? All this possible loss just to be able to put your name in a phonebook and the ability to bill insurance companies? Tsk Tsk. No thanks. Perhaps you should learn how to just breathe and not push. Pushing is for bullies.

Sunday at 2:14pm

 

Renee

I am in Michigan, and I had a homebirth with a licensed CPM. I know CNM’s can also practice in the hospital, birth centers and in the home in Michigan as well. I’m confused as to what is meant by no laws in Michigan allowing midwives to practice? Are we talking about reimbursement? Ability to be insured? I do need to read a little more up on this, and will do so tonight… but just wondering if I could have clarification as to what is meant by this comment.

Sunday at 2:15pm

 

Renee

My CPM does have pitocin, cytotec, oxygen, self inflating bag and masks. I had a hospital available for back up and an OB available for back up.

I do wonder why CNM’s and CPM’s are fighting. Midwifery experienced a great amount of back lash and hatred from OB’s @ the turn of the 20th century. We are still suffering for it. We need to not fight, but know that we both have the same end goal, the same passion for the normal progression of pregnancy/labor/birth. If we ALL (CNM’s, CPM’s, CM’s, etc and OB’s) work in collaboration, we can decrease the cesarean rate, induction rate, vac/forcep rate… and promote a happy, healthy outcome for all moms and babies.

Sunday at 2:23pm

 

The Unnecesarean

Jen B. wrote: “What happened to autonomy?”

Where in this thread is anyone trying to say that women must give birth with a certain kind of care provider? Steff clearly wrote that those who wish to remain underground can remain underground and maintain the status quo if they choose to. I, too, support every woman’s right to give birth with the midwife or doctor (or neither) of her choice.

This is a consumer-driven effort to license and regulate midwives, so it’s just bizarre to me that you see it as a bullying dictatorship. How specifically will your practice change if the state has licensure? Will you not still attend the births of clients who think you’re the best birth attendant for them? Will you lose income? I’m not getting why it would matter to you if you choose to remain unlicensed, so maybe you can clear that up for me.

Sunday at 2:39pm

 

Melanie

I wish midwives were easier to get in Ontario… There seems to be a severe shortage here…

Sunday at 2:48pm

 

Jen

Jill, as Rebecca wrote: “This does not mean that traditional midwives can’t continue to practice outside of the system and outside of the law, if that’s what they and the women they serve prefer.” I don’t work outside of the law and I am not “underground.” Apparently this will change if the push goes through. THIS is how my practice will change. I hope that’s clear. Unlicensed = unlawful.

Income? Pfft. I didn’t become a midwife to get rich.

Sunday at 2:49pm

 

Janet

Can I ask what the licensed mws sought by the Big Push can offer in terms of HBAC and HBAMC? Regulation seldom results in women with scars being supported to birth at home so I would like to hear how midwives are making sure all women are able to access their services. Thanks. : )

Sunday at 2:59pm

 

Katherine Hemple Prown

Unlicensed midwives in Michigan aren’t practicing outside of the law, they’re practicing in violation of it. Whether that law is currently enforced is another question, but it’s a law that is identical to those in multiple other states that have been used to convict midwives of practicing medicine and/or nursing without a license.

Sunday at 3:07pm

 

Jen

Can you please tell me how I am violating the law.

Sunday at 3:20pm

 

The Unnecesarean

Katie, thanks. OK, so Michigan midwives are all currently practicing in violation of the law. With the licensure option, some will have the option to practice in within the law (pardon my non-lawyer explanation), but they might have to make concessions (like no VBAC) to do so. Others, like you, Jen, will not get licensed, presumably, and can remain as you currently are in violation of the law. The question I have is how things will change for you if you remain the same.

Sunday at 3:25pm

 

Rebecca

Michigan law defines:

(a) “Practice of nursing” means the systematic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.

(d) “Practice of medicine” means the diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts.

Do any of these things? Take heart tones? Carry pit or oxygen? You’re breaking the law. Full stop.

Jill- we’ve seen states gain licensure without the restrictions you suggest, for example Virginia.

Sunday at 3:34pm

 

Tuesday

Ohio is all set to push a bill through that will make all midwives not liscensed unlawful…in a state that put a midwife on probation but ALLOWED her to continue to practice, that has midwives registered to sign birth certificate info…i fail to see how clearly making non-licensed midwives unlawful benifits any but the select midwives who want this. over and over i talk with misinformed consumers who have spoken with midwives who assure them this bill will make midwives legal, without informing them that it will make a lot of us unlawful.

Sunday at 3:47pm

 

Jen

Is this for real? I “treat” my son’s “ailment” and “complaint” of a skinned kneed by the “device” of a band-aid and “advise” him to tie his shoes. Apparently we’re all guilty. QUICK mothers…get your parenting license in order to treat your children or you’ll be in violation or Michigan’s laws. *rolling my eyes*

Sunday at 3:50pm

 

Jen

P.S. Because of an attorney general’s decision in 1939 that midwifery was not the practice of medicine, midwifery is still legal to practice in Michigan.

Sunday at 3:52pm

 

The Unnecesarean

Janet, it sounds like in some states depending on the bill, nothing changes for VBAC moms, where as women without scars can access the services of a licensed midwife. I think where I get lost in some of the rhetoric (not in this thread) is whether people are arguing for all women, including those with previous c/s to be able to work with the licensed midwife of their choosing (out of fairness, it seems) or whether they’re arguing for no licensing at all because they believe that licensing midwives takes away the choice to VBAC at home (if that’s what the bill stipulates).

I *think* a lot of the complaints about the IL bill were the former… that it’s not fair for the option to work with a licensed midwife to be extended to some and not all, particularly in light of the fact that the c/s rate is over the top. This argument is based on the belief that licensure is something desirable to which all women should have access, not just some.

The other criticism was just that licensing shouldn’t happen because _____.

It sounds like you’re in the first camp… licensing is good as long as all women have access to a licensed midwife. Otherwise, it’s unfair. Is that right?

Sunday at 3:54pm

 

The Unnecesarean

Tuesday, you just explained what I was trying to figure out. So the wording of the Ohio bill doesn’t just license those who wish to be licensed, it also explicitly states that all non-licensed midwives are “unlawful”?

Sunday at 3:58pm

 

Janet

Our current maternity services are all run by people who are licensed and regulated in some way. Nurses, hospital midwives, doctors, all licensed and regulated. We perceive that system to be broken and somehow we think that extending that licensing and regulating will then serve women’s needs?

Sunday at 4:10pm

 

Rebecca

Jill, states are not keen on so-called “voluntary licensure,” whereby only the professionals who feel like it get licensed and the others are free to practice legally. It doesn’t fly for doctors, dentists, plumbers, or barbers. Midwives aren’t exempt from this general structure & function of public health law. I’m not trying to be a jerk here- states have the power to regulate professions and to exclude unregulated practitioners (via the 10th amendment).

Jen, yes the sections of the law I cited are real. The difference between the example with your own child and the example of midwifery practice is that midwives hold themselves out as providing these services to the general public in exchange for money (though the money part doesn’t matter that much).

It sounds like folks are banking on a decades old AG’s opinion (not a law, an interpretation of the then-current law and practice) and/or the fact that midwives can sign birth certificates without being sent a cease and desist? If I’m a lawyer defending with that, I’d say beg for a plea bargain and move to another state where you can get yourself a license.

Sunday at 4:11pm

 

Jen

It sounds like CPMs aren’t so keen on voluntary licensure. Because, why would anyone get certified if there is no law governing it. You NEED a law governing it, regulating it for your CPM “status” to mean anything. I give my statistics out to my clients. I also tell them in writing and verbally that I am not practicing medicine, I don’t diagnose any conditions nor do I carry any drugs or anything requiring a prescription. I am upfront about everything. You are single-handedly making it UNLAWFUL for 1/2 of the midwives in this country to practice what they love. Maybe someone else should start a group against the push.

Sunday at 4:23pm

 

The Unnecesarean

‎”You are single-handedly making it UNLAWFUL for 1/2 of the midwives in this country to practice what they love.”

Where does the 1/2 figure come in?

I’m still not getting how licensing those who wish to be licensed makes those who do not “unlawful.” Is it written into the bill?

Jen, what would the anti-Big Push group advocate for?

 

Katherine Hemple Prown

Family members are exempt from the medical and nursing practice acts in every state, otherwise parents everywhere would be subject to prosecution!

However, non-family members who provide the same services to other people, ranging from recommending dietary changes to taking temperatures, are not exempt from medical and nursing practice acts. If they engage in the activities enumerated in those laws and they do not hold a license to practice medicine or nursing, then they’re breaking the law, period.

FYI, the MI AG’s Opinion predates the current medical practice act and has been void since the late 1970s.

Sunday at 4:48pm

 

Jen

Jill, I just came up with 1/2. There are many DEMs working right now. And it is impossible to know the exact number. However, if the laws come to our states where it isn’t regulated, DEMS would become illegal. I don’t know how else to put it. It is NOT unlawful for a DEM, traditional midwife or lay midwife to practice in Michigan. We are not in violation of any laws. If a midwife carries pitocin, yes, she is in violation of the law because legally midwives in Michigan can not carry prescription drugs nor administer them. If the big push comes to michigan, ONLY CPMs will be legal. CNMs are nurses and are already governed. DEM, TM, Lay Midwives would BECOME illegal because they are not included in the bills. Therefore, the forementioned midwives must BECOME CPMs in order to practice legally. The bills do NOT encompass all midwives. Just the “select” group of CPMs throwing all others who were previous legal would then become illegal. I hope that was clear. I don’t know how else to say it.

Sunday at 4:52pm

 

Susan M. Jenkins

Let’s clarify a few points here:

Jen, in Michigan, you are not practicing within the law, you are presenting in violation of the medical practice act and/or nursing practice act, as Rebecca explained. Rebecca is an attorney. She just took and passed the bar exam. Do all of you believe that Rebecca or I should be permitted to practice law without a license, just because we act in good faith and believe we know what we are doing?

What about your baby’s pediatrician, folks? Should she or he be allowed to practice without a license because she or he loves babies and trusts mothers?

Unlicensed midwives in Michigan have been fortunate for many years because the enforcement mechanism has had some quirks that resulted in a reluctance to prosecute on behalf of the state powers that be. A bill has been introduced already, NOT by the Big Push or any Michigan midwife or consumer group, by by the State government, that would fix that mechanism. The Michigan State Medical Society began talking talking about cracking down on unlicensed midwives a few years ago. It is only a matter of time until someone gets arrested.

In Ohio, in 2007, two midwives were arrested. Arrested. The home of one, where her office was located, was searched and her computer and all her client records were taken. The prosecutor wanted her computer so he could track down other midwives. That was 3 1/2 years ago. I talked to the midwives it happened to. They had to hire lawyers to fight criminal charges.

The Ohio bill you mention simply substitutes “unlawful practice of midwifery” for “unlawful practice of medicine,” which means it’s an improvement in the situation for unlicensed midwives, not a step backwards.

The Big Push isn’t about really about protecting midwives or protecting CPMs — it’s a consumer/midwife movement to protect consumers. Those consumers who don’t want to use a regulated midwife are free to find unlicensed unregulated midwives who continue to practice in violation of the law.

Jill, thanks for posting our status report and hosting this discussion. It is by no means the case that HBAC will be lost just because a licensure/regulation law is passed. The Big Push wants to work with VBACtivists so that all parties are at the table when the Medical Society raises this issue or legislators ask about VBAC. ICAN members can help out state groups answer the questions that legislators might have about home VBAC.

Sunday at 5:10pm

 

J

‎@ Jen: So this is all included in the informed consent you give your clients correct? You don’t carry pitocin, would that also extend to methergine in the case of a pph? Can you explain to me and anyone else here wondering how you handle that without lawful recognition to carry that life saving medication?what do you do just explain the legality of your practice to them instead?

Sunday at 5:10pm

 

Jen

‎”I have never for one second understood the rationale of licensing midwives for it is THE TROJAN HORSE. If we buy into the idea that midwives need to be regulated or licensed we not only are saying that midwives can be dangerous and SOMEBODY (guess who?) needs to watch them…..BUT WE ARE SAYING THAT BIRTH IS DANGEROUS AND THAT SOMEBODY OTHER THAN THE MOTHER NEEDS TO BE IN CHARGE!” ~ Carla Hartly

“Midwifery needs strong, outspoken, autonomous women to articulate a vision of birth with dignity for all women. Unfortunately, such voices tend to belong to women who are “outside the system.” Once women are in a legalized system, they are silenced. They can be coerced to give unnecessary pharmaceuticals to women and babies (oxytocin, erythromicin, vitamin K) and they become good corporate citizens. The real respect and admiration that comes from knowing that you are true to yourself is missing. Professional bodies do not protect the public, they protect the professionals.” ~ Gloria Lemay

Sunday at 5:14pm

 

J

ha ha ha ha ha ha ha! That’s plain funny.

Sunday at 5:22pm

 

Rebecca

Adding my thanks to Jill for hosting this dialogue, which has been very civil!

If anyone is still around and wants to take the next step into the legal weeds, I’ll add that midwives in a number of states have tried to defend themselves from prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).

Sunday at 5:55pm

 

Valerie

‎”if the big push comes to michigan…”

Oh, please. You make it sound like Godzilla attacking Tokyo. I admire the courtesy and grace you have been shown by posters like Katie, Rebecca, and Susan. Unfortunately, I don’t feel so courteous.

I have been involved in midwifery politics/legalities for over thirty years. THIRTY YEARS. And what I used to see as correctable naïvete, I now see at little more than willful stupidity. I spent over twenty years as a homebirth midwife. I am an RN and have worked in labor & delivery. I am now an Illinois attorney. This isn’t exactly my first time at the rodeo. I have seen all these ridiculous “arguments” before. And while Carla and Gloria sell a lot of stuff, and certainly know a lot about self promotion, they don’t know shit about the law or how it works in the United States. You would do better to listen to the attorneys who, just in this thread, have given you far better advice than the refrigerator-magnet aphorisms you quoted above.

Oh — and about the legality of midwifery in Michigan? It isn’t. Legality isn’t somehow magically conferred just because the state is momentarily ignoring your practice and your presence. If you want to know the law (and if you still think you are practicing legally in Michigan, you clearly do NOT know the law) listen to lawyers, not Carla and Gloria.

Sunday at 6:03pm

 

The Unnecesarean

A reminder to keep it civil, please… Thanks.

Jen wrote: “I hope that was clear. I don’t know how else to say it.”

I get the gist of what you’re saying now. I wasn’t wanting to browbeat for details… just trying to figure out exactly how it plays out on paper.

Sunday at 6:07pm

 

J

Susan, are you a practicing lawyer? J, are you a practicing midwife?

Rebecca, thank you for your information thus far. While I still do not agree, I respect your point and will contact my lawyer in the morning regarding this important issue. Clarification is definitely needed.

Sunday at 6:14pm

 

The Unnecesarean

Rebecca wrote: “I’ll add that midwives in a number of states have tried to defend themselves from prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).”

This is what freaks me out from a client/woman/consumer perspective. My belief is that a woman should be able to choose the birth attendant, if any, that she wants to work with. In states without licensing, adding licensing would add another choice for her— a licensed CPM and, ideally, VBAC wouldn’t be out of their scope of practice.

Listening to Rebecca makes me realize I’ve been in a bubble regarding the autonomy defense and out-of-hospital birth. I’ve focused so much on the coerced and court-ordered cesareans that I haven’t really delved into this. I have some serious reading to do.

Sunday at 6:20pm

 

The Unnecesarean

Jen, I’m following up on Rebecca’s posts, too. Thanks for your comments and civil debate. Feel free to touch base with anything interesting you find out this week.

Sunday at 6:23pm

 

J

‎”And while Carla and Gloria sell a lot of stuff, and certainly know a lot about self promotion, they don’t know shit about the law or how it works in the United States. You would do better to listen to the attorneys who, just in this thread, have given you far better advice than the refrigerator-magnet aphorisms you quoted above.”

AMEN valerie, amen amen amen and from reading about ALL the cases where midwives were and are prosecuted and lose not only their identity and profession as midwife, but a whole bag full of money, I highly doubt either midwife would aid in your defense $$$$ wise if YOU were on the receiving end of a prosecutor’s scope.

Sunday at 6:26pm

 

Jen

Valerie, I am reading about the case against Yvonne Cryns. She was a CPM, right?

Sunday at 6:48pm

 

Valerie

Yes. Yvonne was (and I believe, still is) a CPM.

Sunday at 6:57pm

 

Janet

‎@ Jill.

“This is what freaks me out from a client/woman/consumer perspective. My belief is that a woman should be able to choose the birth attendant, if any, that she wants to work with. In states without licensing, adding licensing would add another choice for her— a licensed CPM and, ideally, VBAC wouldn’t be out of their scope of practice.

Listening to Rebecca makes me realize I’ve been in a bubble regarding the autonomy defense and out-of-hospital birth. I’ve focused so much on the coerced and court-ordered cesareans that I haven’t really delved into this. I have some serious reading to do.”

YES! That’s exactly it! Look to other countries to see how women have lost the right to determine their own care, their own births, who they invite and whether or not they’re just being forced back into hospitals for caesareans.

In Australia midwives are being reported for simply taking on women seeking HBAC, before they’ve even birthed, without any adverse outcomes. Transferring, as noted above, is the time when hospital staff will maliciously report midwives despite them clearly acting safely in supporting necessary transfers, and even though the family involved are perfectly happy with the care and there has been no adverse outcomes.

I currently have a client seeking HBA2C with twins. There’s NO WAY she’d be allowed to birth in a hospital, no. way. But can she find midwives to take her on? There’s maybe two or three in our whole state who would because the others have now retired or joined the “collaborative” schemes which means they work for obstetricians now and HBAC is off the menu. HBAMC is considered practically criminally negligent.

The hospital she initially began going to early in her pregnancy have already scheduled her cs: 32 weeks. Yes, 32 weeks. In case TTTS occurs. Is there any sign of it? No. Does that matter? No. Will they support her to birth? No, it’s not allowed. Maybe a vba2c, maybe twins, (and a jolly big MAYBE indeed) but no way at all with both. Shouldn’t that be up to the woman to decide, we cry? Hell yes. And yet is it? Hell no.

Remember if the state doesn’t like your birth choice you also risk being reported and having your children removed. This is happening in Australia to homebirthing families now. The thing with one birth choice being removed is that all choices are then made null and void because they ain’t choices at all. Someone else’s choices presented to me are not my choices.

Putting this anti-birth, anti-woman, anti-midwifery campaign in an international context is essential. All those ACOGs, RANZCOGs and their fellow travellers are working together. So we need to be smart and watch them all.

I’ll be very pleased to hear your thoughts, Jill, after you’ve done the reading.

Sunday at 7:04pm

 

Janet

‎”I’ll add that midwives in a number of states have tried to defend themselves from …prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).”

That so beautifully sums it up. Women have no right to autonomy and no right to decide who attends their births.

I don’t see this as a good thing in any way. No one is regulating my body, thanks.

Sunday at 7:08pm

 

Jen

Janet, that’s why I see the push as covering the certified midwife, not helping the birthing mothers.

I was reading this earlier: http://www.surveyusa.com/ArchivedArticles/suntimes0605.htm

Sunday at 7:18pm

 

Rebecca

Janet and Jill, I hope that my comment did not imply that I agree with those courts! The point was to show that women’s rights don’t confer a midwife with rights to practice legally in the eyes of US law.

I became a lawyer in order to defend women’s autonomy, even and especially when pregnant. Part of being good at that is understanding and recognizing the current law for what it is. I’m sensitive to the “master’s tools will never dismantle the master’s house” line of reasoning, but the law does and is regulating our bodies whether we like it or not.

Sunday at 7:21pm

 

Valerie

I agree, Rebecca. That was certainly one of the reasons I became a lawyer, and I have had the privilege of advising midwives and parents throughout the U.S. As you know, however, we don’t win cases by screaming about the “unfairness” of the law. What wins cases and *changes* law is understanding the law and why it is what it is. It is also critical to understand that the states have the right to regulate those who provide health care services to citizens. It is only by understanding what the law IS that we can begin to work to change it to what we want it to be.

Sunday at 7:40pm

 

Janet

Please don’t be patronising. Just as we don’t need to be obstetricians to understand caesareans, we don’t need to be lawyers to have a grasp of human rights and the law. No one’s “screaming” or talking about “unfairness” here. Birthing women can grasp just fine what rights they are accorded under any given law and which they are not. We can also see how it plays out in reality on our bodies.

Sunday at 7:45pm

 

Katherine M.

Perhaps, instead of pushing for licensing of midwives, we should be pushing for legality of midwives. Once licensing is brought into the picture, midwives will be required by the state to have malpractice insurance (because the state will be who licensed them, and who can ultimately be held liable if someone gets sue happy). Once insurance companies are involved, midwives will be told by the insurance companies whom the can and can not treat. They already do so to licensed midwives. Anyone with “high” blood pressure - risked out to OB. Anyone with a c-section -risked out to OB. Anyone with “high” sugars, the most times inconsequential and misdiagnosed, but dreaded GD - risked out to OB. Anyone spilling ketones during pregnancy (not considered “normal” by OBs) - risked out to OB. Anyone over a certain weight - risked out to OB. Anyone over a certain age - risked out to OB. Anyone whose baby is over a certain weight (by ultrasound) - risked out to OB. Anyone with twins - risked out to OB. Anyone with breech - risked out to OB. Anyone who goes over 40 weeks - risked out (and that group gets large based on the immovable, infallible wheel calculator based on an “average” of 28/14 day cycle/ovulate paradigm). Anyone with a previous preterm baby - risked out to OB. Do we see a trend here? I spill ketones during pregnancy. As a normal part of my pregnancies. I had a c-section. I’m considered very overweight and unhealthy by any doctor and OB who looks at me (they don’t listen to the fact that I used to weigh 400lbs and weigh half of that now). They assume, because I’m “fat” to their standards, that I have GD during pregnancy, and because I MUST refuse to take their stupid GD test (I had bariatric surgery, I’m not even allowed to LOOK at that kind of concentration of sugar, not to mention I am physically unable to ingest the amount of liquid in the time frame they want me to) they try to send me to diabetic nutritional counseling and tell me to eat more fruits and veggies and yadda yadda (which I am also not allowed to do because of the bariatric surgery…I must concentrate on protein, and any room that’s left over after consuming the amount of protein I must - which, btw, OBs and licensed midwives tell me to get 70grams of protein per day and yell at me when I have a LOT more than that, which is ridiculous seeing as I’m supposed to consume upwards of 100 grams NOT pregnant because of the surgery, is allowed to go to fruits n veggies). I’m now considered part of the “advanced maternal age” group. I birth babies over 9lbs. My cycle is 32 days long, ovulating on day 19. I had a preterm birth with the baby dying (exact reasons known, without a doubt). I had abdominal hernia surgery with mesh implanted. This, technically, makes me much more suited for birthing babies because I literally have abs of steel. The licensed midwives COULD not and WOULD not see me for any part of my pregnancy after my c-section (which they caused) because of their insurance policy dictating to them that I am “high risk”. Now…granted. I have a TON of things going on. Women with ONE thing that I’m dealing with get risked out and sent to OBs. But let’s be gracious and say we have a midwife who listens about say…a longer than “average” cycle and is willing to “fudge” the dates so it “looks” like an “average” cycle. What about women like me? With two or more things on the list of “high risk” things? We will continue to be thrown under the wheels of “LICENSURE for LEGALITY”. Get rid of the licensure caveat and I will stand behind the push. Legality for midwives. Women have brains. They can and should ask for references, ask about a midwife’s stats, ask about her education, yadda. They should OWN their births AND their pregnancies. Realize that, if something goes wrong, it was meant to go wrong, and it wouldn’t have mattered where you were, it still would have happened. There are no “what if’s” in life. You can’t turn back the clock and say “IF she’d been at the hospital x y z wouldn’t have happened”. No one can know that because she wasn’t there and it did happen. Where has common sense and the ability to think for ourselves and own our decisions gone? Oh wait. The Doctors took it from us over several generations of telling us that we “can’t” birth babies, we “need” drugs, we “need” hospitals “just in case”. You think they’re doing this for OUR good? Not on your life. They do it for THEIR pockets. As they always have and always will. I was told by doctors that I would NEVER be able to have a vaginal birth. They lied. I was told by doctors that I would NEVER be able to breast feed my child. They lied. I was told that my body was simply (!!!) and totally broken. THEY LIED. I had a vaginal birth with NO help from them. No problems. My midwife did nothing other than encourage me (HAH…nothing…her encouragement was invaluable and SUCH a difference from the other midwives from my sons birth). So it should be. It should not be able to be considered “practicing medicine” to take someone’s BP and show someone how to hear a heart beat. Period.

Sunday at 7:56pm

 

Katie B.

Which is exactly why I have such mixed feelings about this.

Frankly, I’m appalled by this statement: from J- “Those of you on this thread who don’t want regulation- just stick with your midwife. She doesn’t have to get licensed she can stay underground and you all can enjoy all the benefits of an unregulated health care provider: infection, dangerous practice and unscrupulous behavior.”

This is not the least bit civil, nor is it accurate.

I have had 2 homebirths and one homebirth transfer in 3 different states. The 2nd birth was in a state in which midwives were “allegal.” My midwife was not dirty, dangerous, or unscrupulous. To the contrary she made a homebirth possible for my baby who certainly would have not done well in a hospital setting.

How disheartening that someone has concerns—mine are more with the law as it exists, how it is carried out, and what happens after midwives are licensed, rather than licensing in general—or that someone doesn’t agree, and people just start mudslinging.

One of my biggest concerns has to do with how midwives are protected after being licensed when they actually do commit an error. Where I am now, a midwife in our state committed several grave errors which led to the death of a baby. She was completely protected by the midwifery board and by the state, and the family had no justice.

As it is, even though midwives have been legal here for quite some time, families are still reported to CPS for being homebirth transfers, for refusing eye-ointment for goodness sakes. But that is WITH legal-to-practice law.

I know midwives practicing here WITH a license who refuse to carry pitocin or oxygen.

Midwives in my area have become increasingly medical. Doctors in my area have become essentially ONLY surgeons. It’s a very difficult situation everywhere, but it is here even in a licensed state.

Sunday at 8:09pm

 

Melanie Hughes

Good point about risking out to OB’s Here in ontario Midwives are licensed and there are a lot to times that they are not allowed to attend home births here that they are everywhere else it seems..

VBAC’s pretty much have to go to the hospital, or transfer to an OB.

But there are VERY few midwives her to begin with…

Truthfully I think the C-section rate would be much lower and breastfeeding rates higher if there were more midwives!

I would take a midwife over an OB anyday. With an OB you are lucky if they spend more than 5min with you at a prenatal… Where as midwives spend up to an hour and provide education as well…

OB’s have a place - with high risk pregnancies(where there are REAL medical issues, not minor issues often overcome)…

Sunday at 8:14pm

 

Janet

I agree, Katie.

The least scrupulous operators with the highest infection rates and least accountable practitioners in birth are obstetricians in hospitals. The first “collaborative” midwife in my state is notorious for dumping women and keeping their money and then reporting them to child services. She has full protection from the law and is a collaborating buddy with the head of the AMA. How is that ok? She works within the guidelines the state has implemented and women have no come back.

How about someone does something about the dangers of obstetric practice which can be clearly demonstrated to be not in the best interests of women and babies?

Sunday at 8:27pm

 

Valerie

‎@Janet: Is it really “patronizing” to suggest that a lawyer might have a bit more knowledge and understanding of case law and legal analysis than someone who is not a lawyer? If we “don’t need to be lawyers to have a grasp of human rights and the law,” why do we see defense fund websites and pleas for legal fees whenever a midwife is arrested? Why should she not just go to court and take of it herself? If “birthing women can grasp just fine what rights they are accorded under any given law…” why do we still see people using the word “alegal” as though it had any real legal meaning related to midwifery? Why on this very thread have we seen people arguing that the practice of midwifery is legal in Michigan?

You may not need to be an obstetrician to understand cesareans, but you do need to be one to DO a cesarean. And while I knew quite a bit about laws relating to midwifery on the numerous occasions I was a defendant (before I went to law school), I was mighty glad to have a lawyer defending me in court.

Sunday at 8:29pm

 

Janet

Your comments pretty much speak for themselves, Valerie. No need for me to respond to that.

Sunday at 8:31pm

 

Kenneth

‎@Janet Please don’t be patronising. Just as we don’t need to be obstetricians to understand caesareans, we don’t need to be lawyers to have a grasp of human rights and the law. >>

My guess is that same people who discount the value of lawyers analyzing the law are the same people who think that midwives shouldn’t have to prove adequate training or minimal skills to attend births. But like it or not, EVERYWHERE in the US, states have the right to regulate professions where the presence of the right provider is the difference bewtwwn life and death. And any midwife who believes that her presence at a birth makes no difference in the outcome is in the WRONG profession.

Sunday at 9:20pm

 

Kenneth

‎@Jen Janet, that’s why I see the push as covering the certified midwife, not helping the birthing mothers.>>

Personally, I think that laws which make sure that a birth attendant meets a minimum standard of training and skills benefit both midwives and ESPECIALLY birth parents. I don’t want any babies or mothers lost to incompetency, regardless of whether they are attended by doctors or midwives.

Sunday at 9:26pm

 

Katherine M.

How does licensing cause someone to “prove” their training? All it does is “prove” they can pass a test. Ultimately, NO one is able to change the outcome of anything. If a midwife is a midwife because she wants to “save” the baby or mother, or to “deliver” babies, she is in the wrong profession, she should be an obstetrician.

Sunday at 9:30pm

 

Janet

So why do hospitals have such poor outcomes, Kenneth? Everyone in there is licensed, registered, proven to be qualified. And yet their outcomes are appalling. What is licensing doing for women in that scenario? What is insurance doing for women in that scenario?

Sunday at 9:31pm

 

Kenneth

‎@Katherine M.  How does licensing cause someone to “prove” their training? All it does is “prove” they can pass a test. Ultimately, NO one is able to change the outcome of anything. If a midwife is a midwife because she wants to “save” the baby or mother, or to “deliver” babies, she is in the wrong profession, she should be an obstetrician.>>

Congratulations, you have eliminated the rationale for all licensure in all states. Now if only state legislatures and courts would adopt your reasoning, we’d have nothing to worry about. Other than kids and mothers dying at the hands of self-proclaimed midwives with next to no training. But they only have to worry about CIVILl liability in your framework and since midwifery isn’t a profession, there is no expectation of making any money anyway. Problem solved.

Sunday at 9:35pm

 

Kenneth

‎@Janet So why do hospitals have such poor outcomes, Kenneth?>>

Licensure doesn’t guarantee that everyone is competent, it just provides a framework to make people accountable without criminally prosecuting them. I don’t have a high regard for the purely medical approach to birth but I have even less regard for midwives (and birth parents) who are closed-minded and arrogant enough to think that a doctor’s involvement is unnecessary under any circumstances. Part of the job of a midwife is to know when the situation is beyond her limits and scope of practice.

Sunday at 9:44pm

 

Katherine M.

No one is saying that doctors don’t have their place. Nor midwives. Who on here has been close-minded and arrogant?

Sunday at 10:02pm

 

Jen

Kenneth, I think you’re being a little over ambitious here. We absolutely need doctors. No one said otherwise.

Also, midwives don’t practice without others knowing about it. If someone tried to become a midwife without any training, the community would out them. You dont’ just “become” a traditional midwife. You go through the process just as you would if you were a CPM but you choose not to be tested by NARM. Is the midwife I trained with (15 years of experience, over 1500 catches, with no infant or maternal losses) less qualified than a fledgling midwife who just took her exam….JUST because she has “CPM” after her name?

Sunday at 10:23pm

 

Bonnie

But ….and this is so important to remember….childbirth is generally NOT a medical event, pregnancy is NOT a medical disease, but a natural condition.

Sunday at 10:42pm

 

Renee

So, I’ve done some reading and I guess I was misinformed when I believed this was a CNM vs. CPM thing. Looks like it’s more of a CPM vs. all other unlicensed midwives thing, right?

I did not know my CPM was practicing illegally (in Michigan……). She does have medications (as I mentioned before) so I guess I’m curious as to how she got them. She also does collaborate with physicians (kind of).

I’m going to go off topic here…

I am in a master’s program now for CNM, and my goal is to open a birth center with the option of homebirths available.

I knew it was not easy for a CNM to do homebirths, but I was willing to put in the work and fight for the cause b/c it’s an important one. From reading, it sounds like CPM is synonomous with “out of hospital midwife”. Does this mean the Push could make it even more difficult for CNM’s to practice in the home setting?

Also, is there a place for CNM’s in the Push for Midwives campaign? I love midwifery, and while I know a lot of the homebirthing momma’s don’t have the same regard for us (CNM’s)… I know there is a place for us in traditional midwifery.

Monday at 2:03am

 

Melanie

As a mom I think that we need to have BOTH in-hospital and in Home Midwives! They are lots of women who for whatever reason want/need to birth in the hospital. They should have an alternative to the OB in lower risk pregnancies. I think the OB’s should be left for consults when required and Truely “high risk” pregnancies. VBAC’s, twins, and women in generally good health should be seen be midwives if possible. It would cut the c-section rate and improve maternal outcomes… The insurance companies should be interested in pursuing safer births, not just money… Face it C-sections are big money for hospitals - and they are very dr freindly(no waiting around for the baby to come). But a 1 in 3 cs rate is not in anyones best interest…

Monday at 5:16am

 

Susan

In NJ, midwives are legal to practice, but unless you want to birth at home, there’s no alternative to a hospital. :(

Monday at 6:08am

 

The Unnecesarean

Melanie, I mostly agree with you. I would add that I also trust women to make their own decisions for their bodies, including seeking medical care from an obstetrician for a low-risk pregnancy if that’s what they feel they need.

There is a hospital chain here that consistently has lower c/s rates than all of the others thanks to their secret weapon— midwives routinely handling “low-risk” women.

Monday at 6:11am

 

The Unnecesarean

Bonnie wrote: “childbirth is generally NOT a medical event, pregnancy is NOT a medical disease, but a natural condition.”

It would be nice if this was universally true. The word “generally” means that sometimes it is a medical event. I’m wondering how you propose states would regulate (per the 10th amendment) affairs relating to when it is a medical event and should be attended to by a (licensed) health care provider.

Monday at 6:28am

 

Valerie

‎@Jen — the problem is that some people DO “just becomed a traditional midwife.” If you have never come across a “midwife” who shouldn’t be a midwife, then you haven’t been around long enough. Not every midwife is as ethical as you are; not every midwife is as conscientious as you are. The fact is that some women do read Spiritiual Midwifery, see a couple videos, and decide that they are now midwives. And “the community” may know it, or it may not. And even if it does, how many mothers and babies were damaged before the alleged “midwife” was outed?

I wonder if you would feel the same way about “traditional physicians” or “traditional lawyers.” Should we dispense with licensing them because we can count on “the community” to out them?

Like it or not, the CPM does at least promise a minimum standard of training, as well as a mechanism for filing a complaint against a midwife who is incompetent.

Monday at 7:17am

 

Valerie

‎”I’m wondering how you propose states would regulate (per the 10th amendment) affairs relating to when it is a medical event and should be attended to by a (licensed) health care provider”

And that is really the bottom line, I think. The states have the right to regulate those who provide health care to citizens. One can ignore that; one can complain about it or (as I have seen elsewhere) criticize it as some sort of insidious plot to control women and families. But the states HAVE THE RIGHT TO REGULATE (OR FLAT OUT PROHIBIT) MIDWIVES. It seems to me that midwives are better served when they help to shape that which will regulate their practice, rather than allow the state (aidied by medical societies) to create the rules.

Monday at 7:23am

 

Bonnie

If you believe that doctors are all competent or safe or going to help you have a birth YOU WANT just because they have a license, you could be very disappointed. There are doctors who are UNSAFE. Their are doctors who are drug addicts, unstable, seriously ill, or mentally unstable, just as there may also be midwives just as impaired. It is up to women to choose their providers CAREFULLY. And if they find themselves being dismissed or mistreated…..CHANGE caregivers immediately.

Monday at 7:40am

 

Bonnie

as the word “generally” used to describe childbirth as NOT a medical event, there are many analogies. But consider this: Eating is not generally a medical condition but if one chokes on one’s food things can change dramatically. Does this mean we need to eat in a Hospital, just in case?

Monday at 7:44am

 

Valerie

I don’t believe anyone has said that licensure promises competence, safety, or “a birth YOU WANT (sic).” What licensure promises is legal practice. It also guarantees a minimum standard of competence, and a way for consumers to seek disciplinary measures against an incompetent midwife.

Of course, some doctors are unsafe! Just as there are some nurses, some lawyers, and some nail technicians who are unsafe. The difference is that with those licensed professionals, the consumer has a mechanism by which to submit a complaint. But what if a mother or baby is hurt by an unlicensed midwife? What are the options?

Monday at 8:07am

 

The Unnecesarean

Bonnie wrote: “Eating is not generally a medical condition but if one chokes on one’s food things can change dramatically. Does this mean we need to eat in a Hospital, just in case?”

I’m very familiar with risk analogies and am someone who prefers the care of midwives and will never give birth in a hospital unless I have a medical situation that requires it. The care I received in the hospital (first child) and out of the hospital (second child) was night and day.

What I was trying to do was move this beyond the rhetorical and into the practical (for my own education, really). This analogy builds a case against routine medical intervention for pregnancy/birth, but it doesn’t speak to out-of-hospital pregnancy care. Thanks to our 10th Amendment, states will find a way to have a say in midwifery care. Women (clients/consumers) and the public are also stakeholders in this process and want accountability for malpractice (to be considered separate from the earlier “sue happy” comment which implies that families are seeking revenge for maloccurrence). The typical midwifery arrangement is that there is a contractual, monetary obligation to provide some kind of care related to the health of the pregnant woman and infant.

Is it worth clarifying that I am personally very sensitive to the radical, anarchical mindset that helping usher babies into the world shouldn’t be commoditized and should be an act of love between two or more human beings? I get the beauty of the theory and the practice. It seems that some circles carry this out with confidence. Somewhere at the crux of this (among many other things) is a fine line between birth as a natural, social event and birth as an event which requires a watchful eye, possible assistance and for which money will exchange hands. Once it crosses into the latter, it will inevitably be subject to scrutiny by society and the state, rendering the former “underground” to some extent. So is The Big Push for Midwives really the oppressor here?

Monday at 11:00am

 

Jen

If a midwife has articles of incorporation in the state of Michigan, is she still in violation of the law?

Monday at 12:55pm

 

Jen

Valerie, I agree that in Michigan “anyone” can call themselves a midwife. It is up to the consumer (as it is with anything else) to do their research. You can’t just “assume” that your midwife is competent. I’m sure many VBAC moms who weren’t successful wished they would have asked their OB about his or her success rate. I give mine out and so do other midwives in this area. We also tell our clients what our experiences are, even if they forget to ask. I think the worst thing you can do as a midwife is to lie or misrepresent.

Monday at 1:00pm

 

Heather

Renee, good question. I am a CNM, and I would like to be able to open a homebirth practice in the near future. I became a midwife so that I could be “with women”. I get very disheartened about how some people view CNMs. Nobody is perfect. When I was looking at options about becoming a midwife I chose to be a CNM so that I could be licensed in any state. So, I too would like to know if the big push would make it harder or easier for CNMs to do out of hospital birth? I know here in my state (NY) with the passage of the MMA it seems that it would be much easier for me to open a homebirth practice now.

Monday at 1:55pm

 

Valerie

‎”If a midwife has articles of incorporation in the state of Michigan, is she still in violation of the law?”

You aren’t serious, right? RIGHT??

Let’s make believe that I write up articles of incorporation for…oh, I dunno…”Valerie’s Medical Clinic and Tattoo Parlor, Inc.” and send it off to the Illinois Secretary of State along with a check for $150. In due time they send me back some very nice papers declaring that I am now an Illinois corporation. Of course, I am neither a licensed physician nor a licensed tattooist, but my paper proclaims me a corporation, so everything must be hunky dory, right? My point is this: you cannot incorporate an illegal entity and believe that the entity is now transformed into something legal. The Secretary of State confers corporate status, NOT LEGALITY.

One of the things I have heard repeatedly over the years is “I sign birth certificates — I must be legal.” Or “I do PKUs and send them to the state — I must be legal.” Different state agencies can do a variety of things that can make a midwife think that she is legal, or at least not illegal. But the folks who work in those state agencies do the jobs they are assigned to do, and they tend NOT to investigate — or even be aware of — the legality of the people sending in the forms. I signed birth certificates and sent in PKU forms right up until the day the sheriff showed up at my door with a subpoena. And the signed birth certificates ended up as evidence at my trial.

I imagine that articles of incorporation might make equally good evidence.

Monday at 2:06pm

 

Jen

It was only a question Valarie. No need to be snarky.

Monday at 2:31pm

 

Valerie

The thing is this, Jen — all through this thread you have been proclaiming how “midwives are free to practice in Michigan,” and how that legality was somehow conferred by an AG opinion from 1939. If it is not illegal to practice midwifery in Michigan, why the question about incorporation?

Monday at 2:40pm

 

Jen

As soon as my lawyer gets back with me, either with answers or a number to someone else, I’ll be able to sift through the facts and information. If anyone is interested in groups and organizations who oppose this push, I will be posting a list later tonight.

Monday at 2:56pm

 

Rebecca

I’m going to agree with the substance of Valerie’s answer here. There might be an argument to be made that corporations can do whatever they please in the U.S., but articles of incorporation don’t insulate individuals from getting in trouble for their own unlawful conduct.

Jen, thanks for continuing to ask questions and seek clarification. I’d be very curious to hear what your attorney has to say about these matters.

Monday at 2:57pm

 

Patrice B.

To whomever posted that NH has voluntary licensure, Here are the facts from NARM : ‘The New Hampshire law is not voluntary. You must be certified by the council to practice midwifery. NH is like a lot of the early states: they didn’t require the CPM credential because there was no CPM credential. But, the states list the kind of supervised experience you must have (NH is slightly higher than the CPM in numbers) and ALL states require the NARM exam. NH also has reciprocity so a CPM can move there and get a license. So, essentially, the CPM is required whether you document it through the state process or through NARM.’

Monday at 3:02pm

 

Patrice B.

For whomever asked why licensure should be based on the CPM credential, from NARM : That’s because it has to be based on something. You can’t get a license just by asking for it. You have to have some training and supervised experience, and you have to pass a test, in EVERY state. If you don’t use the CPM, then you are just letting the Health Dept or the legislature set the requirements. With the CPM, it is practicing midwives who have set the requirements. There is really no benefit to letting the state make up the licensure requirements. The docs will be very involved in it, and they know nothing about home birth. When people ask that the CPM not be required, what do they proposed to substitute for it? Who is going to set the requirements? The CPM credential is by far more midwife-friendly than something made up by the state. Also, NARM has a process already in place for the evaluation of knowledge and skills. Again, you can’t have the health dept staff making up the test. It won’t be valid or reliable, as they have no experience in home birth.

When someone wants to have licensure without using the CPM, how will they determine that a midwife is competent enough to be licensed?

There is no other home birth credential, and this one is created by and for midwives with full respect for the autonomy of the mother to make decisions about her care.

Monday at 3:04pm

 

Katherine Hemple Prown

Just to clarify, the Big Push for Midwives has no interest in telling states what to do about their midwifery laws. We’re a resource for state groups that decide to launch legislative campaigns to license CPMs. Groups come to us, we don’t go to them.

We support autonomous practice for all legally practicing midwives (and really have no official position at all on those midwives who choose to practice without a license). So to answer Heather’s question, we also support efforts, like the MMA, to increase autonomy for CNMs, and a number of us worked to help pass that legislation.

Monday at 3:26pm

 

Christa

Thanks so much to all the lawyers that are posting here. My knowledge and experience is in caring for birthing women….that’s what women seek me out for. Likewise, when I want information on what the law says and how it can affect me, I want to hear it from someone that has spent years studying and working with it…and we have lawyers right here sharing their expertise about laws regarding midwifery and how it impacts us. Thank you so much!

I understand both sides of the legislative aspect and sometimes have mixed feelings about it myself. But I haven’t seen any of the people that are anti-legislation propose any kind of acceptable alternative. Saying “we just want things to be how they used to be” is not a solution to the problem. Nor is saying that just because someone has not been prosecuted in our state yet that means it’s not going to happen. We just have to look at what’s occurred in surrounding states to know that’s not the truth. We all want to live in an idea world, but the truth is, we don’t. Our society is completely different then it used to be. We’re not in Kansas anymore Toto.

Monday at 4:54pm

 

Renee

‎@ Katherine, just a question…

I asked my CPM if it would be better for me to let my nursing license lapse and just go the CPM route. She told me no way, to go for the CNM. I thought it was just she figured since I was on the way there anyway to just go through with it cause it doesn’t matter. Now, I think it was b/c she’s not legal in Michigan. (and of course I want to be legal)

If “the Push goes through Michigan”… Would it then be better for me to be a CPM? (as a home birth midwife)

Monday at 11:30pm

 

Renee

BTW, even though my program does not require home birth experience, they do encourage it.

I am seeking out homebirth CNM’s. It’s not easy… but I feel strongly enough about it, that I am willing to leave Michigan for several months to get the experience. *crossing my fingers I will not have too*

Monday at 11:32pm

 

Heather

Thank you for the info Katherine, and thanks for your help with the MMA!

@ Renee, you may also want to consider a birth center. I looked high and low for a homebirth CNM to do clinical with. However, my school required that anyone who was precepting had malpractice insurance. I could not find anyone doing homebirth (close to me) who had malpractice insurance. I ended up doing almost all of my clinical at a free standing birth center, and a little in the hospital.

Tuesday at 4:17am

 

Jen

I just had an amzing hour and 1/2 long conversation with Carla Hartley. Everything she said made sense and it was a relief to know that someone is getting things together to fight this push. One of the things she said is that CPMs are not doing any of this for the mothers and babies. They are doing it for recognition, money, some sort of status, to eliminate lay midwives. Mothers are not saying that midwives are dangerous, CPMs are….just as doctors said midwives were many years ago. This is nothing short of midwives against midwives. Midwives who want status and “power” over anything… including the rights of mothers to CHOOSE their provider. Very eye opening. Gail Hart, Gloria Lemay, and dozens of other midwives she named would become illegal if the push goes though. Are you telling me that a midwife who has the minimum requirements of births who can pass a test is more qualified than them? PULeeease. If anyone wants to read Carla’s notes, please message her. She is very willing to share.

I talked to my lawyer today and he is looking into the laws in Michigan. Also, if you want to stand against the push, I will post some links and e-mail address later. I wrote them down while talking with Carla and I want to make sure they are right before posting.

Tuesday at 5:25pm

 

Valerie

You know, Jen, I really have tried to be courteous on this thread. Believe it or not, I have tried to be as polite as possible, in spite of the misinformation and goofiness that has been posted.

So when I ask you how Carla is able to speak with such authority about CPMs and their motives, please understand that I am truly baffled. I have been a CPM. I was part of the initial group that was surveyed in the early 1990’s when the CPM credential was still being developed. I know a LOT of CPMs, as well as a lot of students who are seeking the CPM credential. So when Carla — through you — declares that CPMs are in it for status, money, power, recognition, it is hard to know whether to laugh at such idiocy or to stand back in awe at one of the biggest straw men arguments I have ever seen.

Do you know what a straw man is, Jen? A straw man argument occurs when a person ignores another’s actual position, and instead substitutes a distorted version of that position. In other words, instead of attacking what CPMs truly believe and feel (if there is indeed any such generalization!), Carla attacks what SHE BELIEVES them to be. Sooo…Carla says that CPMs “are not doing any of this for mothers and babies.” All CPMs? They are doing it for “recognition, money … status…to eliminate lay midwives.” All CPMs? C’mon, Jen. You really don’t believe that this is “eye opening,” do you? Do you really think that Carla has some sort of inside track on the motives and thought patterns of every CPM? I have been a part of midwifery politics and legalities for over thirty years, Jen, which I suspect at least matches Carla’s experience with those same issues. And I can assure you that I have yet to meet ONE midwife who believes that becoming a CPM is going to give her recognition, money or status. As to “eliminating lay midwives”…well, if you are going to use the term “lay midwife”(which is to say, a midwife who does not become a nurse before she learns midwifery — most prefer the term ‘direct-entry midwife’) at all, it also applies to CPMs. All the CPMs I know (including myself) became CPMs as a way to validate their education and experience. Even in states where it doesn’t buy them legal permission to practice, the CPM credential does imply a baseline level of knowledge. If there is anything that constitutes “midwives against midwives,” I would suggest that it is this kind of straw man attack on midwives who don”t fall into line with anti-regulation ideology. As has been mentioned by others, you can have your own opinions, but you don’t get to create your own facts. And the facts don’t exacly support your nasty generalizations about CPMs.

As to “the push” riding into Michigan on a fire-breathing dragon and cracking some sort of regulatory whip over unrecognized, impoverished, status-less ‘lay midwives, (You should have become CPMs so you could become rich and famous like the rest of us), do you really have to be reminded that “the push” is a consumer-driven advocacy group? The Big Push has no power to force any legislation on anybody.

Finally, to respond to your horror at the thought that experienced midwives might have to follow the regulatory rules if they want to become licensed…uh, yeah. Pretty much. Even celebrity midwives don’t get a pass if everyone else is required to pass a test in order to practice legally. And YES — in the absence of that, they would be ILLEGAL.

Tuesday at 8:09pm

 

Jen

You’re right Valerie, I should have said CPMs like you.

But then, you’re not a midwife are you. Why did you feel the need to “validate” your education and experience? For whom? You? Other midwives? Some sort of “edge?” You could simply tell a client your stats and experience. Was it important to the moms you served? Did they ask to see your credentials? Be honest. I’ve never been asked… not even to see my NNR or CPR cards. We need to educate the MOTHERS on how to pick the right midwife. We don’t need to take that away from them. You “hope” that VBACs will still be allowed to birth at home. You “hope” that twins and breeches will be “allowed” to birth at home. But what if you and the others who are for the push make it illegal for them to birth at home because someone deemed it “high risk?” What do you tell those moms? “Well, we wanted to be in the phonebook. Sorry about your luck. But HEY, guess what, your insurance company would have totally pay us too. We fought for that!!”

This push has been going on for years and for a while I ignored it. I’m so glad Jill posted this because I had no idea what was all involved with this. I thought it was just about CPMs and I was so wrong. It involves all midwives but more importantly, it could end a mother’s choice on who attends her birth and where. If a couple decides to birth without assistance, would they go to jail because it wasn’t with a CPM? Would CPMs have an obligation to report DEMs who attend births? To me, this is so very sad. No one owns birth except the mother. (I know I know…here comes your arguement about “we’re not realllllly taking birth away from the mothers. We aren’t telling people that they can’t birth with whomever they want. We are simply getting CPMs legal. If they birth with a Traditional Midwife, that’s their choice. *shrug* …. and here’s the fine print: But they WILL be breaking the law because only CPMs will be legally allowed to.

I really don’t care how you spin it.

Stay tuned. I’ll be back with more info and links later.

Tuesday at 8:43pm

 

LeTara

Valerie.. I do believe you would argue with a fence post..lol .. I too once thoguht as you do now.. then i was deemed” high risk” I made an educated decision to hire a DEM .. who had realized that in promoting licensure in her state, she had in fact created a monster… she turned in her licensed and now is busier than all of the CPMs and LM’s in her state .. simply b.c she does not allow the rules and regs to “Weed” out women… I would have most definitely had a c/s had i not found her.. and when my CPM dropped me this time it was my DEM who was there for me… I have apprenticed with a CPM and attended births w/ a DEM .. there is a MAJOR difference in care…. your body must obey, it must comply, or you are deemed unfit to birth… my body is NOT unfit.. it birth’s beautifully, and thank goodness there are women strong enough to help those of us that the law seems to disregard… I know of mw’s who BARELY passed the test… yet they carry the same cert. as those who did well and passed with flying colors.. i do not trust the CPM cert. it is BULL if you ask me.. as a student mw I was quite unimpressed with the standards and am VERY glad to have found AAMI .. the standard of education is very high.. there is no passing with 75% .. there is pass or fail.. you know your stuff or you don’t.. I spent 12 years contemplating midwifery and the midwife i want to become.. and i was saddened by the values of the CPM cert… and the philisophy it seems to convey… who cares if an OB is legal or not.. cerified or not.. if he cuts you open unnecessarily it is WRONG…. if a mw does something you arent ok with it is WRONG… it comes down to that .. right and wrong… who gives a damn if they are legal, certified, someone just sitting in a corner observing! If the woman wants that provider there.. it is her RIGHT! no one elses business! we need to focus on educating women to find a provider that best suits them… and encourage them to look inside themselves… not towards someone else simply b/c of a piece of paper…If i go to jail for doing what is right.. so be it! If i go to jail for being careless and taking on the responsibility of the birth that should be with the parents.. then i deserve it! end of story…

Tuesday at 11:03pm

 

Valerie

‎”But then, you’re not a midwife are you.”

I could ask the same thing of you.

“Why did you feel the need to “validate” your education and experience?”

Because we don’t tend to be objective when judging our own abilities, and it is helpful to have one’s education and experience compared to a standard CREATED BY MIDWIVES. That is what the CPM credential is about. And in the 1100 births I attended, quite a fewvamilies actually did want to know my level of education and experience. But even if they hadn’t, are you really saying that sharing that information is only important if the client asks for it? Kind of the midwifery version of Don’t Ask, Don’t Tell?

” But what if you and the others who are for the push make it illegal for them to birth at home because someone deemed it “high risk?”

Think back to civics class, Jen. I “and the others who are for the push” don’t make ANYTHING illegal. Your state legislature will make or not make that law. You trust women to choose the best birth attendant — don’t you trust the voters of Michigan to make (through their choice of legislators) the best law?

“and here’s the fine print: But they WILL be breaking the law because only CPMs will be legally allowed to”

And here’s the headlines: THEY ARE ALREADY BREAKING THE LAW. What licensing CPMs will provide is another choice for birthing women. Aren’t you all about choice?

Wednesday at 12:56am

 

Valerie

Valerie.. I do believe you would argue with a fence post..lol ..”

lol. Uh. Yeah, that’s it. lol………lol. lol. lolololol. Yeah, ok.

” i do not trust the CPM cert. it is BULL if you ask me”

I didn’t, actually, but believe what you wish. No one is stopping you from having and expressing an opinion. But as I mentioned in an earlier post, you don’t get to have your own facts. Like it or not, state licensure based on the CPM is rapidly becoming the standard for direct-entry midwifery practice in the U.S.

By the way, you might want to review the definition of “straw man argument.”

“who cares if an OB is legal or not.. cerified or not”

So would you see an unlicensed physician? How about an unlicensed lawyer? How about if the next bridge you drive over is designed by an unlicensed engineer — ok with that?

” If the woman wants that provider there.. it is her RIGHT! no one elses business!”

Yeah, now there is a legal argument. “It’s just NOT YOUR BUSINESS, you nasty old state, you!”

Wednesday at 1:13am

 

Katherine M.

Your likening midwives to doctors is just not correct, Valerie. You go to a doctor because you’re SICK. You go to a lawyer because there’s a legal PROBLEM. Pregnancy is neither a sickness nor a problem. It is a natural human state.

@Heather - There you have it in a nutshell. Your program REQUIRES midwives to have malpractice insurance. Malpractice insurance won’t allow VBACs and a host of other things.

@Valerie - “…Like it or not, state licensure based on the CPM is rapidly becoming the standard for direct-entry midwifery practice in the U.S.” THIS is what I argue against. Instead of TBP going in and helping to make licensure the “standard”, why aren’t they going in and pushing to get the state OUT of what they shouldn’t be in? “It’s just NOT YOUR BUSINESS…” Well guess what. It’s NOT the states’ business, and energy would be better spent getting laws into place that state that it’s NOT THEIR BUSINESS! Pregnant women should NOT be a business, nor should anyone other than the pregnant woman and whomever SHE chooses have any right to dictate to her what she can and can not do!! It seems like so many people are saying “Standard of care, standard of care” but what they’re REALLY saying is “Women aren’t SMART enough to do research on who they’re choosing to be at their birth, so WE must step in and show them who is and isn’t good to be at a birth”. Well THANKS for making MY CHOICE illegal. Why is it YOUR right to make MY CHOICE illegal? Oh right. I forgot. Because the state knows best and god forbid there be an unlicensed, able to serve whomever she chooses because she’s not regulated by INSURANCE companies and MEDICAL BOARDS and everyone else who wants to make MONEY off of the pregnant women, more educated and experienced than the licensed midwives in my state, FANTASTIC midwife running around being with women during their births. Saints preserve us!

Wednesday at 6:07am

 

J

“Pregnant women should NOT be a business, nor should anyone other than the pregnant woman and whomever SHE chooses have any right to dictate to her what she can and can not do!!”

Great, then ask your midwife to work for free.

Wednesday at 7:00am

 

Katherine M.

She does when needed.

Wednesday at 7:26am

 

Jen

J, you haven’t contributed a single thing to any of this discussion. You’re not a midwife, not a lawyer….what are you? Ohhhh….a consumer.

I DO now believe that this is a consumer push. Look around…there are NO midwives on this thread pushing for licensure. At best, they have mixed feelings about it. Those for the push are are lawyers (or disbarred lawyers with shady backgrounds), working for midwife schools like Aviva with an aggenda, a former unlicensed midwife, turned nurse turned lawyer who rolled another midwife under the bus (Yvonne Cryns…search on wikipedia for trial info)…these are the “consumers” who are for the push. Where are the homebirthing moms fighting for this? I can show you MANY MANY who don’t care about licensure. I work with the Amish. Do you think they care? If I called all my clients and my preceptor’s clients, do you think they’d care? Are they standing up in protest against midwives who aren’t CPMs? I can tell you they aren’t. You can stand here and lie about how it’s “good for everyone” but the truth is, is that it’s only good for CPMs…..and those who stand to make a lot of money from this…namely NARM.

Wednesday at 7:28am

 

The Unnecesarean

Katherine M. wrote: “Your likening midwives to doctors is just not correct, Valerie.”

This line was interesting to me. I learned in this thread that some people believe that CPMs are working through The Big Push to systematically oppress/oust the lay/traditional/unlicensed midwife. The basis for part of this argument is that CPMs are behaving as doctors did “100 years ago” and trying to squelch out midwifery. It’s likening of midwives to doctors.

Wednesday at 7:29am

 

The Unnecesarean

Don’t let this discussion degrade further. Walk away if you can’t resist using offensive words like “idiocy” and “stupidity” and if you can’t rely on anything more than personal attacks and unsubstantiated claims of hidden agendas to support your points. It’s not worth it to be a total jerk.

Wednesday at 7:32am

 

Katherine M.

Yes, but that’s NOT what midwives SHOULD be. That’s how many of them are behaving, but it’s not how they SHOULD be behaving. Midwives SHOULD NOT be considered or looked at as doctors! They’re trying to make themselves more legitimate in the medical professions’ eyes, and in doing so, they’re making themselves more and more “medicalized”, turning themselves into the very thing that almost killed midwifery 100 years ago.

Wednesday at 7:33am

 

The Unnecesarean

Jen B.: Can a thread on a Facebook page define an organization’s agenda? I see several midwives on this thread— yourself included— but just because more midwives haven’t shown up to “push for licensure” means nothing. It’s one random Facebook post that’s several days old, which generally means that the only people hanging around are the handful who are still chatting.

Wednesday at 7:39am

 

Katherine M.

btw, my use of capital letters is not meaning to shout…I realize it looks like I’m upset, but I’m using capital letters for emphasis, not shouting)

Wednesday at 7:41am

 

The Unnecesarean

Katherine, I think that summed up your position very well. There is a specific definition of “midwifery” that I wasn’t aware of. Is there a formal description anywhere of what constitutes true midwifery as opposed to other forms of midwifery? I think that would help people to understand what you and Jen are advocating.

If you have time to send/post something, I’d appreciate it. Thanks.

Wednesday at 7:43am

 

J

Jen, people have been fairly nice to you considering your obvious lack of respect for the people who have lived through this and actually been developers of direct entry midwifery for thirty years now. NARM as Valerie has pointed out was developed by midwives for midwives so that is another point that you should depart from. The oppressors oppressing themselves- is that your fallacious argument? I am literally loving that your argument has FINALLY degraded.

When you say what are you a consumer to me, its almost like I want to push the applause sign. Yes, I am a consumer, I AM THE ONE who needs and wants a midwife.We are the ones who literally are here to pay you and every other midiwfe in America to do their job, their profession, their vocation. Let’s do some midwifery Math here- where I am, the average home birth costs between 3500.-5000. and given that the midwife would do 1-2 hours prenatals for 10 months + a birth that can last anywhere from 3-48 hours + a post partum, plus more visits if needed- we are talking about roughly 10.00-12.00/hr. which doesn’t even factor in supplies, travel, medications, or time away from family/on call. So stop. Just stop Jen, You have shown your cards which I knew you would at some point. This IS about you- your ability to practice unhindered, unemcumbered by accountability from the state. Your because I told you so- I’m qualified and you didn’t ask- is not appropriate. I have every right to know as a birth consumer that you are qualified that is all that state sanctioned midwifery does. I could choose you or anyone else and know that if it ended with a midwife who was not qualified, they would have to improve or possibly have to end their practice. Yes, it is shutting the barn door after the lambs have sprung, but as someone here wrote, we have tried other systems and they do not work.

Do you even know that in places in America there are no maternity services at ALL? Do you realize that if a parent wants to have a baby home birth is their only option and I am not talking the Amish population here. This is not a social event, this is not a rite of passage, midwives who see this as a calling deserve to get paid for it and also get paid as authors, lecturers, instructors and anything else they want. This is not a quashing of midwives or them relegating themselves to the level or training of a doctor- there is case law where midwifery has been adjudicated as NOT the practice of medicine and this issue will I am sure continue to be challenged in the courts as laboring mothers are presented with less and less birth options. (inductions, no VBACs in hospitals, c-sections that are unindicted.)

People do not take kindly to paying people engaged in “illegal enterprise”. This is where midwives in states with licensure can CHOOSE to either up their game, or stay below the radar and serve the populations that will continue to use their services despite their lack of licensure.

As far as Aviva is concerned- I hope you looked at our school’s website- what’s our agenda? Mothers and babies ? The promotion of holistic midwifery and community based skills based learning? Is that so egregious? Lactation and doula support for mothers? We want every family that chooses midwives, doulas, and lact. consultants- trained through us to know that they are astutely trained in all aspects of normal childbearing. We also want them to know and how to implement any emergency procedures related to birth and when to seek consult. We are creating a path for Mothers and their families who do not want a hospital birth pure and simple.

Obviously we can all do what we want with regard to birth- and our birth choices, hospital, home, etc. As someone remarked if you are a true libertarian when it comes to health care then great- just stay on that path see only unlicensed, uncredentialed providers. At least understand that the general birthing population doesn’t always see it that way and ethically providers have a duty to fully disclose this along with risks/benefits- such as: “I do not as a habit carry pit, lidocaine, or methergine, so understand if the unthinkable happens, you assume the risk for this home birth. If you are saying that and people are signing on for that I say go with G-d, and good luck ultimately with this.

Lastly, Jen I am looking forward to the links you post regarding an anti-push for midwives movement because nothing will speed licensure in Michigan along any faster than a group of health care professionals who openly oppose it. Again, go-with G-d and good luck with that.

Wednesday at 8:06am

 

Jen

Jill, it’s common sense. NARM is the only who tests midwives. As it stands now, Midwives in unregulated states like Michigan can choose to be tested or not. Even if they got their certification, they are still considered “lay” midwives because michigan does not recognize this brand of midwifery. Say the licensure goes through (due to efforts by the push)…now ALL midwives who want to remain legal have to take NARMs exam. Who makes money on that? Not the midwife. They have to pay thousands when it’s all said and done…..and keep paying every year if they want to stay certified. You don’t see that as an aggenda? If you were NARM and people only had you to go to for licensure, wouldn’t you push for it? ….and maybe even raise the cost once everyone is sucked in? Aviva institute stands to make money as well. Aren’t they the ones who help midwives become CPMs in LEGAL states. If the states write new laws with help from the push, Aviva now stand to gain more money helping other midwives get their CPM.

Jill, talk with Carla. Truly. Get a different view of this. Even if you don’t agree with her, at least hear the other side. Get ALL the views because this will effect mothers who want a HBAC. We’ve both heard stories about how a mom successfully had a vaginal birth after multiple c/s….who wouldn’t otherwise have had them if they were under doctor’s care. Will CPMs be “allowed” to attend these women at home? Someone saying, “Well we hope that VBACs are included” isn’t very reassuring. We already know that doctors don’t typically deliver breech babies…because they don’t have the training. Midwives do because my preceptor does them, her preceptor did them, and so on. We learn from each other and from our experiences. What if this PUSHES out breech home birth? (Footling breech will always be a transport regardless, just had to say that incase any one wanted to pick up on that and run with it.) This is why I’m against this. Because it takes the rights away from the mother. If a HBA2C becomes high risk, the push has taken their right to birth at home….unless they want to be investigated, unless they want to put their midwife at risk of prosecution.

Wednesday at 8:08am

 

Valerie

“I am literally loving that your argument has FINALLY degraded.”

And the indication that it has indeed degraded is Jen’s need to resort to personal attacks. There is another logical fallacy beyond straw man arguments, Jen — ad …hominem. People who have nothing of substance to contribute resort to personal attacks as a substitute. I trust you are not representative of all those with ideological differences.

It is unfortunate that Jen….shall we say….peed in the sandbox.

Wednesday at 8:34am

 

Rebecca

Seems to me that this has been a ideo(logical?) argument the whole time. I hope that these midwives also disclose to potential clients that their assessment of legal status is based on Ms. Hartley’s philosophy and opinion. If so, with my last breath I will stand up for a woman’s right to choose to engage your services. What I can’t do is change facts about the law in order to fit with someone’s philosophy.

I defend a woman’s right to autonomously choose an off-the-grid birth with an unlicensed provider. It simply is not consistent with the principle (or definition) of autonomy to make such births the only out-of-hospital option and proclaim that women are freely choosing it.

If anyone has some legal theories like Katherine Potter has proposed that would successfully push the state out of the regulation of public health and safety, I am all ears. There is a new facebook group, Legal Advocates for Birth Options and Rights (LABOR), that I’m sure would be thrilled to host such a discussion amongst attorneys.

Wednesday at 9:01am

 

Jen

Sure, point the finger to me. If you want to talk about attacks, we’ve seen here how J made very personal attacks about traditional midwives having unscrupulous behaviors (ha, that still makes me laugh) and spreading infections. And those who don’t want to be CPMs (via the push for legislation) will have to work “deep underground…with eyes wide open” or some such nonsense.

This started out as DEMs protecting what they feel is right, their views, their definition of how they help mothers and babies ….and it turned very quickly with one comment from J. (scroll up if you don’t believe me) People have a right to know who and what they are up against. These so called personal attacks arent’ attacks at all. I google. I read. It’s all out there for anyone to read.

As I said, I am waiting to hear back from my lawyer. I’ll report back with what I learn. I need clarification. It’s not wise for anyone to take advice from those with an aggenda. Do we vaccinate our kids because doctors, the CDC and big pharma recommend it? Of course not. We do our own research. They are trying (or have in some areas) to make vaccines manditory, taking the choice and rights away from the parents. I see the push along those same lines. (I don’t need a long winded analogy, thankyouverymuch.)

Wednesday at 9:26am

 

J

yawn…..

Wednesday at 9:56am

 

The Unnecesarean

Like I said, sometimes it’s time to walk away before something degrades into petty bickering. Substantial arguments or nothing, please.

Wednesday at 10:44am

 

The Unnecesarean ‎

“Jill…Get a different view of this. Even if you don’t agree with her, at least hear the other side.”

Thanks, I will. How does it differ from what you’ve articulated here? Do you mind posting some links to articles or manifestos to help clarify?

“Jill, it’s common sense. NARM is the only who tests midwives. … Who makes money on that?”

Wouldn’t it also be considered common sense that people might have a material interest in promoting an anti-licensing agenda? Probably not the best argument to fall back on. Everyone has an agenda in this world.

“If a HBA2C becomes high risk, the push has taken their right to birth at home….unless they want to be investigated, unless they want to put their midwife at risk of prosecution.”

Did The Big Push really take a right away in this hypothetical case? You’re building a case for giving birth “off-the-grid” to avoid investigation (presumably by CPS) and to protect the midwife involved. Are you talking about in the event of a bad outcome (or negligence/malpractice), a transfer or just by giving birth at home?

It doesn’t fit with the CPMs-are-out-to-eliminate-lay-midwives argument, but it seems that the goal of your proposed anti-Big Push campaign is to make sure that all out-of-hospital midwifery is never subject to the scrutiny of the state because you want to be able to practice as you feel best serves women and vice versa. As Rebecca wrote, and I agree wholeheartedly, that with informed consent, “I will stand up for a woman’s right to choose to engage your services. What I can’t do is change facts about the law in order to fit with someone’s philosophy.” You (and Katherine) invoke choice rhetoric, but there is one glaring problem with that—there are large groups of consumers/clients of midwives who want midwifery to exist legally outside of hospitals and in accordance with state law. Does the rhetoric of choice not apply to them as well? Wouldn’t your proposed anti-Big Push group then be oppressing the CPM desiring licensure and the women who want to work with a licensed CPM?

Wednesday at 11:32am

 

Tara Anaturaladvocate

I imagine that it’s highly unlikely that a law would ever pass that would wholesale make illegal birth at home without an attendant. The difficulties in making such a law, and the necessary exceptions (miscarriages? precipitous labors? weather such as much of the nation is currently in?), would make it nearly useless.

I also would like a sincere and rational argument as to how licensure would reduce women’s access to providers and/or force them to use certain providers. If you (generic you, not pointed at anyone in particular) are an illegal midwife (there’s not such a critter as an “alegal midwife”) then your status would remain the same, yes? However, if you are an illegal midwife who has or can obtain CPM status, then you could receive insurance payments, could attract clients who prefer CPMs (or just regulated midwives), and could breathe a little easier. The women who prefer “lay” midwives or are not concerned with licensure will remain your potential clients. You will still remain concerned with legal issues and still not be paid by insurance companies.

The concern I see here is that “lay” midwives may recognize that competition will be tougher in the event that CPMs are recognized in their states. Families will be able to choose from more providers, meaning each one will have to make themselves more attractive. Now, in some cases I have seen this mean that a “lay” midwife will “turncoat” and obtain the CPM status and state recognition. But there are also others who will choose not to, knowing the legal consequences of that decision.

I am, in all cases, a supporter of a woman’s right to choose her own provider and birth place, and I’m just at a loss as to how CPM licensure will reduce these rights, much less how The Big Push (which simply helps organize the work of consumers and volunteers) would be responsible for these losses.

Wednesday at 12:29pm

 

Jen

Jill, the push is the illusion of choice. Talk to Carla.

23 hours ago

 

Katherine Hemple Prown

Why not invite Carla to join the conversation? That way she could engage in a dialogue with those of us who are actually part of The Big Push for Midwives Campaign and see, perhaps, that we’re not really all that scary.

One of the common myths that’s been mentioned here is that midwifery licensure automatically imposes non-evidence based restrictions on practice, which is not the case. The reason for this has to do with the simple basics of how a bill becomes a law.

Legislators won’t vote for bills that contain provisions that enough of their constituents oppose, and we mobilize to fight for and routinely pass CPM legislation that protects access to HBAC, breech, twin, and even footling breech twin births if that’s what the mother and midwife decide. When people mobilize and make their voices heard it is possible to beat the medical industry and its teams of lobbyists intent on keeping midwives illegal.

And it is the medical lobby—not the home birth moms, dads, partners, allies, and friends who are the Big Push—that’s working to limit access to legal midwifery care, often, in states without licensure, in conjunction with the local prosecutor’s office.

Just an FYI, the midwifery and home birth advocates who are part of the Big Push most definitely include the Amish. They don’t want their midwives at risk of getting arrested any more than we do. Here in WI, we had nearly 200 Amish families leave their farms and chores for a long day and night at the state capitol in support of our our bill when it was being voted on. And as a gesture of thanks to the governor for signing the bill into law they turned out in massive numbers the following year to vote for him.

If any of our opponents at the statehouse decide to roll back our law and impose restrictions on HBAC, etc., you can believe the Amish will be showing up in droves to protest.

23 hours ago

 

Jen

Jill, Midwives in AZ can carry drugs but they cannot help women have vbacs. How exactly is that serving women? It is serving NARM and the midwives who want to monopolize midwifery. Why, if we believe that birth is natural, are we trying to make midwifery fit into a medical paradigm??

22 hours ago

 

Rebecca

If some mothers and midwives are organized in Arizona and want to get their rules changed to allow VBAC, I believe the Big Push would welcome an invitation to help them!

In the meantime, all the non-VBAC moms have access to legal midwives who can carry life saving medication without threat of a jail sentence.

21 hours ago

 

Katherine Hemple Prown

AZ also has one of the oldest midwifery licensure laws on the books. The older the law, the more restrictive it is for the very reason that, prior to the establishment of NARM and the CPM, states were left to their own devices when it came to developing educational, training, and testing standards to authorize legal practice for midwives working in out-of-hospital settings.

Also, after nearly 30 years of trial and error, midwifery activists have learned a great deal about how to successfully advance our cause in state legislatures. In the early days, states like AZ didn’t have the benefit of learning from more experienced activists—they were inventing the wheel. Most of the work we do at the Big Push is simply helping states avoid having to reinvent it.

21 hours ago

 

Jen

“how to successfully advance our cause in state legislatures.” Well, if there was an argument about aggenda, I guess it’s solved now.

20 hours ago

 

Katherine Hemple Prown

Yes, and that agenda would be to enable midwives who are trained in the provision of out-of-hospital maternity care to be able to legally serve women who are planning out-of-hospital births.

19 hours ago

 

Katherine M.

If there are consumers (which of course there are) who want midwifery to exist legally outside of hospitals, in accordance with state laws, why not push, simply, to make midwifery legal? Quit pushing for licensure, which will not help all midwives. Push for legality of midwifery period. Leave it up to the consumer then to do their homework and ask the questions of their care provider that they should be asking. If you have a group which is “licensed” and group that is not, would that not lead a person to be a bit more careless about asking questions? I mean…when I go to a doctor, they are all MDs (example only, I know not all doctors are MDs, I just don’t feel like typing every abbreviation here). I know they all have the same letters after their names, so knowing that someone always has to have graduated last in their class, I ask questions and find out more about them and what their stats are. However, if you have a person with MD after their name and a person without, and both are saying they’re doctors, most people would automatically be led to believe that the one with MD after their name is the better choice. This is what I fear will happen with the midwife issue. Instead of women doing their research and asking questions, there will be a false sense of security because “Oh, well THIS midwife is licensed, that one isn’t.”. That already happens in my state. The licensed midwives at the only birth center in the state are the “only” midwives in the state, and heaven forbid you try to mention anyone else, you might as well be suggesting the homeless guy on the corner be present for your birth. BTW, the licensed midwives will NOT do a home birth under ANY circumstances in my state. As such, they have abandoned all the Amish to illegal midwives.

13 hours ago

 

Katherine M.

Please excuse any typos on that post. Working on my phone with a splitting migraine. Goodnight for now!)

13 hours ago

 

Tara Anaturaladvocate

Just “make midwifery legal”? How? By pushing for a blanket “midwifery is legal” law? How do you define midwifery? How do you define a midwife? How do you define what is NOT covered? All of these things would have to be done in order to “make midwifery legal.” All of these things are the same exact things done with licensure.

Also, where would the protections be for women and families? If “midwifery” (being “with woman”? assisting in a birth? what exactly?) is legal in toto, then what about someone who puts out that they are a midwife, but in fact have no knowledge or skills at all…just a convincing fake (as can happen in any field, not just midwifery)?

5 hours ago

 

J

“Quit pushing for licensure, which will not help all …midwives. Push for legality of midwifery period. Leave it up to the consumer then to do their homework and ask the questions of their care provider that they should be asking.”

How much homework is required then if midwifery is legal without midwifery by definition such as CNM, CPM, CM? (CM seldom used by ACNM)

So past the requisite list of questions that a home birth parent will ask- then what? A chart review by a panel of midwives? 10 chart reviews? 20 chart reviews? An audit of all the transfers in the last year, references from clients who are not trained providers of midwifery but clients themselves? Shadow the midwife for six births? sounds ridiculous, doesn’t it. In what other health care field would you have to do this in order to know you are with a skilled provider.

Katherine, the reason licensed midwives will most likely not do a home birth under any circumstances in your state is because they ARE midwives. We are clients. Good midwives know when they are inside and also outside of what is a prudent home birth candidate. Consumers should be in general very weary of midwives who promise the world. Do they step in and assess situations where a doc would suggest a c-section and where a mother can go on and have a normal vag. birth? Yes and they do that is why hb is a viable option for ALL normal pregnant mothers. Midwives are trained to assess, we are not nor should we be. Lastly in this note, Doctors win when home birth remains illegal. What choice does a mother have then? Hospital or gleaning credentials from a provider based on what they can have access to as a provider?…UC?(and I do not dispute that an unlicensed midwife possesses the necessary skills. The NARM CPM confirms this for mothers and their families.)

“BTW, the licensed midwives will NOT do a home birth under ANY circumstances in my state. As such, they have abandoned all the Amish to illegal midwives.”

and should they? We cannot have it all ways, when I see this argument it speaks to the economics again. Is a home birth midwife not entitled to decide whom she sees? does she have to dive on the sword financially or socially in order to be a midwife? (there is a midwife in Manhattan that charges 10,000.) This isn’t colonial America- she can define who are her clients and who are not.

I know as many here have commented that licensure/legality may seem like a “prohibition” of rights, but it opens up legitimate birth options for laboring/pregnant mothers and also an affordable alternative to a standard hospital birth.

4 hours ago

 

Susan M. Jenkins

Katherine, as a practical matter, simply legalizing midwifery — that is, decriminalizing the practice of midwifery by statute and/or getting the legislature to pass a law to officially declare that midwifery will no longer be considered unauthorized practice of medicine or nursing — would be politically impossible. Organized medicine, and often organized brainy, fight tooth and nail against efforts by consumer groups to regulate midwifery. They win over many legislators by claiming that licensed certified professional midwives are unsafe. Can you imagine the field day the OBs and medical society would have, or how skeptical the legislators would be, if the legislation simply allowed midwives to practice without any state oversight? Even if this legislative option may have worked ever in the past, it would be truly impossible today. Really truly impossible. Our state groups are there “in the trenches” and know how difficult it is already to get licensed regulated midwives.

Also, to quiet some of the fears of regulation I perceive on this thread, may I invite you and anyone else who fears regulated midwifery, to check out how well things are going in New Mexico and Texas, where midwives have been licensed for many many years, there is a large thriving community of midwives, no one feels the need to practice outside the law, and consumers have lots of midwives to choose from, and it is easy to find one. Look at the websites of the Association of Texas Midwives and the New Mexico Midwives Association — or, for that matter, the New Hampshire midwives group — and just get a taste for how well it can be done. In both TX & Nm, midwives are licensed by a a government agency, with a midwife-consumer board or committee, and it works really well, and there is a large and increasing number of midwives in both states.

3 hours ago

 

Katherine Hemple Prown

The situation that Katherine is referring to in Delaware (I’m assuming) is a perfect example of bad midwifery laws that The Big Push has successfully fought against. The birth center there is staffed by nurse-midwives, who are required in most states to enter into a contractual relationship with a physician, who of course refuse to sign if the midwife attends home births.

Also, as a practical matter, out-of-hospital clinical training is not a requirement for nurse-midwives, the vast majority of whom practice in hospitals.

Those of us who advocate to legalize midwives who specialize in out-of-hospital birth push hard for autonomous practice and we’ve been successful. And a reason for that is because we are highly mobilized home birth/midwifery advocates demanding our rights to legal providers who can practice autonomously to provide the maternity care services we need.

That’s very different from midwives themselves—a special interest group with no money and no political clout—going to the legislature and demanding autonomous practice for themselves. One reason why nurse-midwives are still fighting to undo overly restrictive legislation is that they don’t have a strong grassroots movement of consumer advocates behind them in the same way that CPMs do.

about an hour ago

 

 

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Reader Comments (25)

Many pregnant women find themselves holding the short end of the stick due to regulations. OBs' SOPs have changed due to liability issues and other factors. CNMs typically have more restrictive SOPs as well. DEMs/CPMs may help a wider cross section of women, but many women with breech babies, twins, and/or uterine scars find themselves having to choose between an unwanted hospital "birth" and unassisted birth.

I was reading a post on another site earlier tonight, and a M.D. was making a big deal about CNMs having undergraduate degrees while CPMs don't have that requirement. I am a clinical practitioner in a completely unrelated field; however, I can attest to the fact that having a degree (or meeting regulatory minimums) doesn't really mean much. My undergrad degree was "something to do" or a "means to an end." I now hold a doctorate in an unrelated field . . . that degree did not contribute in a meaningful way to what I do now.

Just as it does not always take much dedication, smarts, or effort to achieve a minimal degree . . . it does not necessarily take much dedication, smarts, or effort to achieve minimal regulatory standards. What you do and how you do it says much much more.

February 3, 2011 | Unregistered Commenterlabortrials

Oh man. That was fierce.

I think that we are facing two separate issues; making midwifery part of healthcare (sometimes "medical" and sometimes not) and the general problems we women have, in our society, in obtaining bodily autonomy under the law, especially when birth is involved.

I don't think we can protect women's autonomy by refusing to license midwives, though I do understand the fear the posters feel. But IMO larger issues of whether a woman has a right to, for example, birth unattended or with someone unlicensed would actually fall under the same legal area as abortion (oh no, I said that word!) and birth control. Both of which are under ferocious attack in this country right now.

I read a feminist writer several years ago who pointed out that law is based on male physiology and has simply been expanded to include women, without actually acknowledging the uniqueness of women's roles in reproduction. Which is why we had to come up with "privacy" to get abortion legalized; it was not actually a great fit, but it was the closest male experience to what women experienced. Had law been written by and for women from the beginning, these particular issues would have been hashed out years ago and would be largely noncontroversial.

Like abortion, I think birth is something a woman must have decision-making power over simply because it is happening in her body. The law may have a shaky grasp of this idea, but to most women, it's crystal clear.

Obviously I am not a lawyer, but it seems that whatever laws we ultimately have for better birth have to be based on some understanding that in general women cannot and should not be coerced by the state regarding what they do with their own bodies, including the fetus, in pregnancy and birth. Anything else gives the state or other outsiders ownership claims in the woman's body, and that is intolerable. None of the "what if" questions that come up (what if she does drugs, or chooses dangerous birth, or acts against doctor advice, etc. etc.) really override the fact that she owns her own body and has final say. The state will have to content itself with education and access to care for women it wishes to influence.

I am not sure where that leaves unlicensed caregivers, though; seems that you would end up with a system where women can do what they like, but anyone who attends them w/out license is prosecuted; on the other hand, I can't really see it's the state's responsibility to allow unlicensed practitioners just to accomodate those who wish to use them.

Makes my brain hurt, but fascinating all the same.

February 3, 2011 | Unregistered Commenteremjaybee

It seems to me that the issue is whether direct entry midwives are professionals or hobbyists. Professionals recognize that they serve others and therefore have an obligation to meet education requirements, training requirements, and licensing standards. These requirements and standards exist to protect patients.

A hobby, in contrast to a profession, is an activity undertaken for personal pleasure. Obviously, if you are engaging in an activity to satisfy yourself, standards make no difference. You can pursue your hobby without knowing anything about it; you can pursue your hobby even if you are demonstrably terrible at it; you can pursue your hobby purely to satisfy your own personal needs and ignore the needs of others with whom you interact.

Direct entry midwives are, by and large, hobbyists. They like going to births; they describe themselves as birth junkies. They expect to enjoy what they do, and simply dispense with anything they don't enjoy. A college degree seems too hard? Don't get one. Don't have any experience with emergencies? Who cares. Don't want to deal with women who make choices different than yours (like bottle-feeding instead of breastfeeding)? Refuse to take care of them.

If you view delivering babies as a hobby undertaken for your personal enjoyment, it makes perfect sense to object to standards. Standards, by their very nature, limit a midwife's ability to do what she wants, how she wants, when she wants. That's why those most in need of standards are the ones who object to them most. They attend births for personal enjoyment, to get their "fix," and anything that places someone else's needs above their own is anathema.

Ultimately, direct entry midwives are going to have to decide whether they want to join the ranks of professionals or whether they want to be hobbyists. Licensure is the bare minimum for any professional. Only hobbyists object to meeting the standards of a profession.

February 3, 2011 | Unregistered CommenterAmy Tuteur, MD

What I learned as a moderator of the discussion:

There is one way that a midwife should be and that is non-medical.

Midwives should not be licensed and regulated. Instead, efforts should be directed at these two contradictory items:
1. Keeping “the state” uninvolved in midwifery (I guess by a constitutional amendment?)
2. Making midwifery legal. No definition of “midwifery” provided, so presumably anyone who acts as a midwife or answers to “midwife.”

CPMs have an agenda of pushing out all non-CPMs for the power, prestige and financial gain of having letters behind their names.

The Big Push may be a consumer-driven campaign, but it has an agenda—to oppress the non-CPM so those with “CPM” after their name can enjoy power, prestige and financial gain.

NARM is in on it because they get a cut of the money.


All of that was interesting, but this one really got to me:

It is the sole responsibility of the consumer to ask better questions. If something goes wrong, it was because the consumer was “careless” in their questioning of potential midwives. The actual argument was that there are some unlicensed/lay/traditional midwives who might be a good choice for a woman, but she might be misled into believing that, because someone has letters behind their name, they are a better midwife.

This all but says that if a family suffers a tragedy at a home birth, it can be traced back to their being careless in their interviewing process. Since this is offered in conjunction with the contradictory recommendation to both make all midwifery legal and keep the state away from midwifery because it’s not the practice of medicine, it seems that the expectation is that the mother will sacrifice all rights to investigate the maloccurence and hold anyone but themselves accountable for the outcome.

The statement, “[r]ealize that, if something goes wrong, it was meant to go wrong, and it wouldn’t have mattered where you were, it still would have happened” means that the midwife was hired… why? Putting all of the responsibility on the mother to “own her birth” and accept any death or injury as fate is based on the idea that the intervening actions of any care provider would be interchangeable and the same outcome would have occurred.

This is another highly contradictory statement. We learned that women shouldn’t be careless in their interviewing of midwives, because some have better stats, i.e., better outcomes; therefore, some midwives do (an undefined) something better than others. At the same time, anything that goes wrong was meant to go wrong, so the mother needs to accept that no person was responsible—it was fate. But what about that something that Midwife A does better than Midwife B? Do we fault fate or the mother for being a sloppy interviewer if someone dies or is harmed?

February 3, 2011 | Registered CommenterJill

I am not weighing in on the conversation, but I would like to say that accusations of NARM being a profit center are false. NARM spends almost all it earns in fees in implementing the NARM exam. Many midwives have a perception of NARM being like the Princeton Review as a cash cow, but it is handled by a volunteer board like most of the midwifery organizations that just barely financially gets by.

February 4, 2011 | Unregistered CommenterH

A+ emjaybee :) Lots of thoughts here... One of the things that has me confused is the way that some people are seemingly conflating the issue with licensing with that of women's reproductive autonomy. There are some very true and disturbing horror stories out there, but generally speaking, the person a woman chooses to attend her birth is not a basis for action against the woman. Who attends births, holding themselves out as a quasi-medical provider, certainly is a basis for action -- against the provider.

What I have yet to have someone explain to me compellingly, however, is how merely having licensing undermines women's reproductive autonomy (and for the record, the fact that birth is a normal physiological process is not compelling. Birth is not swallowing or pooping. It's a singularly serious bodily process that should be trusted, yes, but respected.) While the woman bears the physical risks, the unlicensed provider bears the legal risk. A woman's right not to be punished for her choice to deliver with anybody, or nobody, is completely separate from midwifery licensing.

Women who choose unlicensed midwives now will still be able to choose unlicensed midwives. The idea that there is such a thing as "alegal" midwives practicing in a state of utopia, is horsefeathers -- at most it's "not currently being prosecuted." It's also worth asking "prosecuted for what" -- practicing medicine without a license, dispensing controlled substances, even manslaughter. These are serious offenses, and all it takes is one bad outcome (probably not even malpractice, just maloccurence).

February 4, 2011 | Registered CommenterCourtroom Mama

Good distillation of the thread, Jill. I think there's one more implication - that if a woman wants ANY medical management (I've heard some midwives say they NEVER carry pitocin because there is NEVER a situation when it is necessary...) she should GTFO and just lay down on the table for a cesarean already. Yikes.

February 4, 2011 | Registered CommenterCourtroom Mama

Thanks for moderating a great discussion that taught me a lot. From my perspective, all any 'celebrity' midwife would need to do not to be illegal is take the test and demonstrate the needed experience, which would probably be easy. I don't get why you wouldn't want to do that. If you're concerned about limits restricting legal homebirth, then for goodness sakes get involved in the process! Help write the law! I have no patience with people who refuse to give their input when asked and then criticize the law when it's passed with other people's priorities in place (this frustration much amplified by my neighborhood organization on a totally separate issue). I know that for me, in Maryland CPMs and DEMs are illegal, and a major consequence is that it makes my husband wary of "underground" CPMs, which, given the scarcity of homebirth CNMs, makes me just hope that we like and can get in with the _one_ I know of in Baltimore. Argh.

February 4, 2011 | Unregistered CommenterWhitney

The thing that seems contradictory to me is that people are opposed to licensing because it might put some restrictions on a midwife's practice (twins, breech, VBAC, whatever), but without licensing, it will never be possible to arrange a transparent and safe transport system for when complications arise. That seems like a basic protection for women who want to accept the risks of planning a birth out of the hospital, but want the assurance of back-up, should something go wrong. But I guess under the "trust birth" ideology, consumers are supposed to understand that if something goes wrong, it was meant to, too bad? Licensing also seems like a way to protect families from the instances Katie Prown was talking about where, in the event of a non-emergent transport, hospital personnel call CPS because they believe the families have acted negligently in hiring unlicensed caregivers to attend their births. One thing i don't understand is how exactly consumers are supposed to "take responsibility" for ferreting out the bad midwives? Checking references will only get you so far---no one gives out the names of references who have bad experiences. And, so I ask a midwife for her stats, how do I know she's telling the truth? Or that she has a record-keeping system that is accurate and trustworthy? I also would like an answer to Jill's question: if the objections are all based on this "trust birth as a natural process" philosophy, then why do women need to pay a midwife to be there? Why not invite some friends and let whatever happen happen?

February 4, 2011 | Unregistered CommenterJennifer

Ok, I am going to (probably stupidly) jump into the fray :-)

To start, I have very libertarian leanings, but at the same time have to realize that we live in the real world and there may be some things that need to be exceptions to that ideology. I *do* see the danger of regulating midwifery, in that as many posters said, if you regulate it, then you allow the state or whomever makes the regulations to determine what can and cannot be offered.

Yet, at the same time, I live in TX and have seen firsthand the benefits of licensed CPMs combined with strong parental rights case law. That is not to say TX is utopia ~ there are many midwives in my town, but a very hostile medical community with a few exceptions, which still makes homebirth a risky option if you have to transfer, and makes midwives more jumpy (IMO) and transfer-prone and less likely to take or support good candidates, even when there's nothing wrong. Moreover, even with strong parental rights case law, that doesn't necessarily stop child services from overstepping their authority, etc. when called, and justice is not always carried out in these cases because family law judges generally don't want to be seen as helping child abusers, whether or not that is really the case (and I would argue that a mother choosing a homebirth with the belief it is best for her and her baby is no child abuser, or neglector...esp if she seeks medical care when something goes wrong). There is no utopia.

However, I've also seen someone locally get taken by a midwife poser who claimed to be from out of state where there is no licensure. The "midwife" saw her for a few appointments, then abandoned her after being paid in full...initially she said she was in the process of getting licensed in TX. Con. artist. So licensure does in a way protect from that form of fraud. There *is* some benefit to it, despite my libertarian leanings :-)

I think the thing that needs to be said is that when the licensure push happens, it's not a good thing to throw women and babies under the bus. Here in TX, many hbmw's do HBACs, HWBACs, etc. The state encourages them to get breech training...not to purposely take on a breech, but in case there is one that turns at the last minute and is a surprise. EVERY care provider should have this training, IMO. Throwing VBAC, breech, and twins/multiples under the bus for licensure *does* take away choice, and IMO will eventually allow the state to regulate everything about your choices. If they can say no to VBAC, when the rate of rupture (what usually enters the discussion) is lower than the rate of just about every other emergency complication that can happen in *any* birth, then who's to say they can't take away choice for moms over 40, or 35, or 30, or whatever age they next determine is "too old"? Or take away choice for fat mamas, or skinny mamas, or what not? Without protecting choice for all women, we end choice for all women (and yes, abortion enters into this...when we start dictating what a woman can do with a wanted or unwanted fetus, to me the other side is necessarily in danger...and I'm only reluctantly admitting that as I really don't like the thought of purposely terminating a pregnancy, ideologically...although I don't want to regulate against it either...not sure where I would fit in the standard debate, I'm a bit of an odd duck there).

Here are my thoughts.

License CPMs in every state...but let the CPMs and moms determine when to transfer. Put the onus on them to make this decision in tandem. It's how it should be in **any** care provider relationship, period.

Encourage ACOG to make homebirth safer by encouraging their members to actively support and respect transfers from licensed midwives, instead of (as many do) treating them like uneducated dolts who want to kill their babies. Being a doctor doesn't make one God, or give one the right to tell me what kind of care to get....but it does obligate them to treat me with respect when I determine that their care is necessary (and likewise, if I determine it is necessary, it obligates me to treat them with respect...goes both ways).

We need to get child services out of the business of persecuting families that don't make mainstream decisions, whether it is in birth, vaccinations, schooling choices, etc. Focus on true abuse, true neglect, not some well you don't do what everyone else does so it *must* be neglect crap. Tearing families apart because they make unconventional choices is flat out wrong. Doctors *and* midwives who turn in families to child services because they make choices that go against their personal beliefs ought to be censured in some way. Child services definitely has a place, but this is not it. As I somewhat stated before, if child services can persecute a family for a homebirth (presumably they would call it medical neglect, since they can only look at neglect or abuse cases), then it's really just a step away for them to persecute women who get abortions. And if you don't agree...look at the mom in (was it Illinois?) who fell down a flight of stairs, ended up miscarrying, and was prosecuted for manslaughter or something like that (may not have my facts entirely straight) because it was a surprise pregnancy and she admitted to care providers she wasn't 100% thrilled to be pregnant so they determined she purposely killed her baby (which was a fetus, technically, at that point).

Anyhow, it's a very nuanced debate, but licensing *can* work well. Strong underlying case law that supports parental rights helps a bunch with this though...in a state that doesn't support parental rights (at least in its case law...no place does it perfectly in every case), I can see how licensure would be more of a tricky issue.

I'm with emjaybee, it makes my head hurt.

February 4, 2011 | Unregistered CommenterAnne
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