A New Life For Midwifery Care


The Big Push for Midwives campaign, launched last week, has some simple yet ambitious goals:

"Our goals are to fully integrate the Midwives Model of Care into the health care systems of our states, to highlight the importance of family healthcare choices and to defend the ability of CPMs [Ed. Note: CPM stands for Certified Professional Midwifery] to provide legal and safe prenatal, birth and postpartum care to families in every state."

Hmmm. Sounds like reproductive justice to me. Substitute "abortion access" for "Midwives Model of Care" , "abortion providers" for "CPMs" , and "abortion care" for "prenatal, birth and postpartum care" and you can see how the underlying issues are essentially the same whether you're talking about abortion rights or childbirth choices.

That is, whether we're talking about provider choices for childbirth or access to abortion, it is not too much to ask that wherever women live in this nation, the options for reproductive healthcare are not effectively criminalized in some states and legal in others.

We may not be there quite yet but The Big Push for Midwives has found a great place to start in advocating for legal certified midwifery throughout the nation.

Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care, has this to say about the campaign:

"Nevermind that you haven't heard the candidates debating a woman's "right to choose" where, how, and with whom she gives birth. Activists are thrusting the issue onto the political agenda anyway, from all sides of the ideological spectrum. Last week in Chicago, a nonpartisan coalition of consumer advocates launched The Big Push for Midwives campaign to license certified professional midwives in every state. Currently these trained midwives, whose competency in caring for normal birth is supported by rigorous study, cannot obtain a license in several states, which forces them to practice underground, which isn't good for anybody.

These activists are pushing against a strong, well-funded medical lobby that has a professional interest in keeping midwives marginalized – most recently this lobby flexed its muscle in Missouri, the only state where midwifery is a felony. But the research data, as well as other countries that are caring for women and babies better than we are, show that midwives should be supporting normal labor and deliveries (the majority), while MDs should be caring for the complications, emergencies, and women with risk factors. This "division of labor" also happens to be far more cost-effective than our current system, which bleeds more cash for less care than any other in the world. The bottom line from a public health perspective: home-birth midwives should be legitimate care providers, not criminals."

Why the need for such an active "push" across the country? CPMs are being strong-armed by a major mainstream medical group seeking to actively stop them from practicing the care that's been shown to improve maternal and newborn outcomes in the United States.

In 2005, the American Medical Association (AMA) passed a resolution that states:

"RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice."

The resolution arose from the above-mentioned Scope of Practice Partnership (SOPP) formed by the AMA and other physician trade organizations that targets health care professionals that are not (gasp!) doctors in order, according to The Big Push campaign, "to obstruct expansion and to restrict the licensed scope of practice of other healthcare professionals."

Let it be said that there are certainly physicians this partnership and resolution do not represent. In Washington state, along with a handful of other states, CPMs are licensed and some work in partnership with hospitals and OB/GYNs when necessary. However, to my knowledge, no physicians have objected to the big-brother SOPP and resolution or stand in solidarity with the campaign or midwives attempts not to be shunted to the sidelines of the health care industry.

Common sense says that restricting access to a full-range of health care providers, especially those known to improve health outcomes for maternal and newborn health, is not healthy for women and babies.

The Big Push For Midwives is hoping to change all of that by reaching out to local midwives, policymakers, consumers and advocates in participating states and working with them on the advocacy, communication and fundraising strategies to effect change on a grassroots level.

The good news is that awareness is growing. Pregnancy and childbirth have been integrated into the celebrity-coverage fold. The recent release of the Ricki Lake produced documentary, The Business of Being Born, on the realities of hospital based maternity care and Lake's advocacy on behalf of natural, home-birth is evidence of this growing awareness that this kind of activism is not only sorely needed but bound to happen.

How far to the fringes can we push women's health care options before women strike back? We've seen the barriers to a full range of care for pregnancy and childbirth grow with each passing year. It's the same with abortion care.

Midwives are banding together and saying no more. How powerful we could be if we understood how intertwined all of our reproductive health experiences really are – menstruation, childbirth, miscarriage, abortion, menopause – and how intertwined the care we receive should be. Then, our advocacy on behalf of ensuring that our options to the care we want, the providers we desire, and the access we deserve would be unmatched.

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To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

  • http://www.physiciansformomidwives.org invalid-0

    Dear Ms. Newman,
    Thank you for linking midwifery and home birth with the rest of reproductive freedom. It has always seemed absurd to me that my reproductive freedoms ended the minute I decided that i wanted to give birth.

    You say “no physicians have objected to the big-brother SOPP and resolution or stand in solidarity with the campaign or midwives attempts not to be shunted to the sidelines of the health care industry.” I am one such physician. I have been standing up for midwives for nearly 20 years as we have striven to legalize midwives in Missouri. I attend births in a birth center and at home. I am not alone among physicians–I have begun an organization called Physicians for Missouri Midwives. There are similar organizations in South Dakota and North Carolina, and rumblings in Illinois. Perhaps soon there will be a national organization.

    Elizabeth Allemann, MD

  • http://homebirthdebate.blogspot.com invalid-0

    This is fundamentally a public safety issue. The question: Is it safe to license a second class of midwife with less education and clinical training than any other midwives in the industrialized world? The answer:

    1. This is NOT about having midwives in the US. We already have midwives (certified nurse midwives) who are among the best trained midwives in the world.
    2. This is about creating a SECOND class of midwives with less education and training.
    3. No other country has a second class of midwives.
    4. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world.
    5. Direct entry midwives are NOT trained for out of hospital birth, since no special training is required. The many taxi drivers, police officers and family members who deliver babies each year could tell you that. The only thing that requires training is dealing with unanticipated complications, and this is precisely what direct entry midwives lack.
    6. Direct entry midwives are not “specialists” in out of hospital births. They are restricted to out of hospital births because they are considered unqualified for birth centers or hospitals.
    7. Direct entry midwives are not “specialists” in normal birth. Claiming to be a specialist in normal birth makes as much sense as a meteorologist claiming to be a specialist in good weather.
    8. Homebirth carries an increased risk of preventable neonatal death in the range of 1-2/1000 ABOVE the neonatal death rate for comparable risk women in the hospital.
    9. To date there is not a single study that shows homebirth to be as safe as hospital birth. There are studies that claim to show that, but they do so by comparing low risk women at homebirth with high risk women in the hospital.
    10. This is not about “choice”. Any woman can choose to have a homebirth. This is about licensing of health care professionals who do not have the necessary education and training.
    11. The insurance industry will not write policies for homebirth or charge extraordinary premiums because their data indicate that homebirth carries an unacceptably high incidence of bad outcomes and big payouts.
    12. There is no uniformity in direct entry midwifery credentials. There are many different credentials with differing education and training requirements. Direct entry midwives cannot agree among themselves what baseline training is required.
    13. Direct entry midwifery credentials were created by direct entry midwives without input from medical or public health sources. These credentials are the “seal of approval” of some DEMs in regard to other DEMs. There is no independent objective basis for these credentials.
    14. The Midwives Alliance of North America (MANA), the group that collected the statistics for the BMJ 2005 study, has collected statistics for the years 2001-2006, but refuses to release them to the public. They will only be released to individuals or groups that can prove they will use them for “the benefit of midwifery.” The public has a right to know these statistics.
    15. There are no statistics at all for long term outcomes of homebirth with direct entry midwives. We have no idea (nor do they) about the incidence of brain damage, oxygen deprivation or birth injuries.

    The bottom line is that we already have well educated, well trained, highly competent midwives in the US. We are being asked to license a SECOND class of midwives with less education and less training than any other midwives in the industrialized world.

  • invalid-0

    Thank you for an intelligent article on women’s healthcare choices.

    Thank you for making a distinction between “direct-entry” and “lay midwives” and Certified Professional Midwives. As a student in pursuit of the latter (in a recognized program ending with a Bachelor’s Degree plus 2 years of clinical training which, by the way, my state is paying for) I can assure you that Certified Professional Midwives are a class of maternity caregivers whose time has come.

    As “Dr. Amy” says above, we already have one kind of legal midwives: the real-life equivalent of mini-doctors. They do no abide by the Midwives Standard of Care, but are rather tied to the medical model of childbirth by default.

    Thank you again, for an intelligent article on the subject linking reproductive freedom to childbirth. Seems that too, is an idea whose time has come.

    Kelly, student midwife

  • invalid-0

    Thank you, Dr. Allemann! I am thrilled that there is such an organization and am grateful to you as a leader in this effort. I do know, as I state in the article, that there are certainly physicians who support midwifery and who work in a complementary way with midwives. I just did not know of any who were actively opposing the AMA’s declarations. Thanks so much for the information and for your wonderful work.

  • invalid-0

    It’s true that in many American states there is no legal recognition for the best care providers available for women wanting a home birth. That is why everyone should immediately write their state legislators and demand licensure of certified professional midwives. Stand with your home birthing sisters. We need you. Hold us up and help us maintain the integrity of our own bodies as we bring new life into this world! I can see that organized medicine’s hack (aka Dr. Amy) has already made the rounds here. Don’t fall for her twisted lies. The fact remains that women who decide to give birth and then choose to stay home for the blessed event and want a qualified care provider who wont’ face jail to attend her birth, need certified professional midwives. (whew that was a long sentence! I hope it makes sense.) The fact remains that actual public health experts recognize the safety of certified professional midwives. The fact remains that this small group of women need the solidarity of this larger movement, and we might just make all birth more humane in the process! You can visit http://pushedbirth.com or http://www.thebigpushformidwives.com for more information — or http://www.cfmidwifery.org to contact your own state organized to get involved.

  • invalid-0

    I find it quite ironic to find the elusive “Dr.” Amy on this blog. The continual copying and pasting of her 15 point mantra from blog to endless blog is indicative of her hatred (or jealousy) towards any maternity care provider other than an OB. But, when asked what her credentials were on a previous list, she declined to provide that necessary information. At least we know CPMs are trained, skilled and have the credentials to provide counsel to our blogs. I ask again, “Dr.” Amy what state in the US claims you to be one of their licensed physicians? AMA doesn’t list you as a member or non-member. If we are to take your advice seriously, we would like to know your current professional status. In addition, what do you find most intimidating about skilled, educated, competent and experienced CPMs providing care for the women you inform on your “Ask Dr. Amy” website? Have you considered that perhaps some women might like to enjoy the beauty and gift of normal childbirth without fear of unnecessary medical interventions that so many physicians rely upon?

  • invalid-0

    This is both a public safety issue and a reproductive choice issue. (Sound a bit familiar?) When women have no access to licensed health care providers, they seek underground care.

  • http://homebirthdebate.blogspot.com invalid-0

    “reproductive choice issue”

    Reproductive choice is an important issue and therefore, you should not demean it by linking it to substandard midwives receiving licensure because their supporters want them to get it. This is not about “choice”. This is about direct entry midwives trying to make more money by qualifying for insurance reimbusements.

    No one has yet offered a compelling public health reason for why the US should license a second, inferiorly trained group of midwives. No other country has a second class of midwives and CPMs have less education, less training and less experience than ANY midwives in the industrialized world. Indeed, Canada has recently insisted that to qualify for licensure, direct entry midwives must upgrade their education and training.

    I’m not aware of any constitutional right to insist on licensing the incompetent. Are you?

  • invalid-0

    Thank you for your wonderful article! This is about safety and about choice. We can easily make both a reality by simply licensing the only health care professional who is specifically trained in the home setting, the Certified Professional Midwife! CPM’s are not a “second” class of midwife, as “Dr” Amy likes to put it. They are definitely First Class! Write your legislators today and tell them you want a safe choice for all women!

  • invalid-0

    On behalf of The Big Push for Midwives Steering Committee, I want to thank you for calling attention to our national campaign to license Certified Professional Midwives in every state, as well as DC and Puerto Rico. And it’s exciting to see at least two posters urging others to get involved!

    If you’re interested in advocating on behalf of licensing CPMs in your state, please check the following link on our
    website. It’s a list of state organizations and their various discussion lists and websites, where you can find out more information about how to get involved (and please do so before you contact your state legislators!)

    http://thebigpushformidwives.org/states.aspx

    If your state isn’t on this list and you’d like to get involved, please email me at kprown at prodigy dot net and I can point you to additional resources.

    Many thanks!

  • invalid-0

    Wow. Those “substandard,” “incompetent” midwives sure have duped a whole lot of women into supporting them! Not to mention quite a few doctors and a whole bunch of state legislators as well. This in spite of the fact that organized medicine consistently throws a whole lot of money at convincing them not to.

    FYI–DEMs can get insurance reimbursement in states where they remain unlicensed, and licensure doesn’t automatically qualify them for reimbursement.

    Delivering babies for anywhere from a few hundred to a few thousand dollars (depending on the family’s financial status and the state) is hardly a lucrative deal, insurance reimbursement or not.

  • http://homebirthdebate.blogspot.com invalid-0

    “Those “substandard,” “incompetent” midwives sure have duped a whole lot of women into supporting them!”

    Not really. In 2005, the most recent year for which we have data, only 0.24% of women chose homebirth with a DEM and that number has not changed for the last quarter century. Less than 1/4 of 1% is a fringe movement, not “a whole lot” of women.

  • invalid-0

    Dr. Allemann,

    Thank you for speaking out about how doctors feel about the practice of midwifery. I couldn’t be more pleased that there is a physician group in support of homebirth midwives.

    It is not the individual physicians, in general, who are hostile to the midwives. Most of the physicians who interact with the midwives are very open and helpful. They give a pat on the back and tell the midwife she is doing a great job. They often give their home and cell phone numbers and ask her to call anytime if she needs anything.

    It is only the the leadership of the physicians community that has been adamant that they will not support midwifery nor support a physician who is friendly toward midwives.

    The American College of Obstetricians and Gynecologists (ACOG) made a broad statement against all out-of-hospital birth in 2006. It is based on supposition, not on scientific research. Interestingly, they did not make this statement public on their website (it was members-only) and did not issue a press release.

    There will never be a study ‘rigorous’ enough to please ACOG because:

    a) they won’t participate in a study that involves homebirths or comparison of outcomes with midwives, and

    b) and it’s not really possible to do a prospective double-blind study (the ‘gold standard’).

    So they’ve set up a nice little catch-22 there.

    As I’m sure you know, the friendly physicians cannot publicly say that they are supportive because they could be blacklisted or have their licenses disciplined or taken away. It’s wrong to allow the medical lobby to bully not only the midwives and their own physicians, but the legislature and the families as well.

    If the medical lobby wants to talk about safety, challenge them to find a valid scientific study showing that homebirth is unsafe. They cannot. They have produced neither of these. The best they seem to do is to have “Dr. Amy Teuter” blogging their canned responses to every midwifery and homebirth webpage she can find. Her posts and website are insulting to women.

    We want homebirths and healthy babies. That is obvious. And the women are doing the research into the subject on their own and making the best choice for themselves and their babies.

    Thank you so much for giving a voice to physicians who support those choices!

  • invalid-0

    I have to agree with Dr. Amy, this issue is not about safety. If it were about safety, Midwives would never have been outlawed in the first place. This is about money, pure and simple. In the words of one Missouri legislator, “I’m concerned about the money this might take away from my OB’s.” Midwives are money hungry? Let’s look at an example:
    Eight years ago, I gave birth in a hospital with an OB. She was present for approximately 30 minutes during the birth. The cost for that 30 minutes and one follow up visit: $5000.
    Six years ago, I gave birth at home with a Midwife. She was present for approximately 18 hours (including labor, birth, and four hours after). The cost for prenatal visits, birth, postpartum follow-up: $2500. Hmm…she definitely was raking in the dough wasn’t she?
    In addition, three years ago I called my local Midwife (who, at the time had 500+ births under her belt, including my two brothers) to find out how much she would charge. Her cost: $1000 and some dance classes (I am a trained ballet dancer).

  • invalid-0

    My mistake! So really, we’re just talking about a small, fringe group of misguided women who need to be protected from their own bad judgment. Thank you for the clarification.

    I’m curious, though, to know how you explain the votes of hundreds of state legislators and governors on behalf of licensing CPMs, even in the face of massive amounts of campaign cash from the medical lobby telling them to vote against it. Why would they vote on behalf a small, fringe group of women with no money over the interests of a multi-billion dollar industry with legions of highly-paid lobbyists flush with cash?

  • invalid-0

    What is the compelling public health reason to license certified professional midwives? Excellent question!

    The number one public health reason is that in many areas of the United States, there is an extreme shortage of licensed homebirth maternity care providers. Thousands of women choosing homebirth can not find a licensed provider.

    Dr. Amy, what is the your answer to the low-risk women who will not go to a hospital for childbirth and have zero access to a licensed maternity care provider? Will you go to their home?

    I guess the answer to my last question is no because you believe that no one should birth at home because homebirth is outside of your safety belief system.

    Does your personal belief system extend to all women? Do you think women choosing homebirth are undeserving of a licensed provider?

    Do you think women should be forced to birth in hospitals? What about Amish women? Should we be acting as Big Brother and telling entire communities of women where they should birth? Or should we just tell them that they can birth at home but if they make that choice, they do not deserve licensed care providers?

  • invalid-0

    To Dr. Amy?

    Are you aware that certified professional midwife credential is accredited by the National Commission for Certifying Agencies (NCCA)?

    I wonder if you are strongly opposed to any other allied heath certification program recognized by NCCA?

    http://www.noca.org/NCCAAccreditation/AccreditedCertificationPrograms/tabid/120/Default.aspx

  • invalid-0

    So, Dr. Amy, “choice” is only relevant if it agrees with your opinion? Otherwise, it is demeaning? That’s the kind of paternalistic “informed consent” that characterizes the Medical Model of Care, and is why many women are choosing to birth with a Certified Professional Midwife. You have posted the same, stale rant on blog after blog and in newspaper after newspaper for several years, now. Your statements have been proven to be incorrect, yet you continue to post the same misguided and slanderous remarks about credentialed midwives who are well trained and who have excellent statistics. Get your facts straight, and learn something for a change.

  • invalid-0

    Another public health reason for licencing CPMs is neonatal screening. What happens when a woman gives birth at home and she has no care provider? Do the baby’s get screened? With licensing, fewer mothers will homebirth alone. That means that more homebirth moms will have a professional present to make sure that their babies get tested.

  • invalid-0

    I would be interested to see a comparison between the training of *Dutch and British* midwives to CPMs. To the best of my knowledge, those midwives are not required to be nurses first, nor has any good study proven conclusively that it is necessary to be a nurse AND a midwife to provide quality care.

    The CPM is accredited by the same organization that accredits the exams for the IBCLC, LCCE, and CNM, and that is reassuring to this consumer.

    That CPMs could practice in hospitals because they are substandard is preposterous. Do hospitals typically have chiropractors or massage therapists on staff?

    I’m reminded of a lawsuit that Big Medicine lost a couple of decades ago, when they sought to marginalize and eliminate the chiropractic profession. I see some antitrust action going on here, and as a consumer am inclined to view the Dr. Tutuer’s theoretical but unproven mantra with suspicion.

    I’d put more stock in Dr. Tuteur if she actually said something that made sense, like “let’s work toward implementing a maternity system like Holland’s or England’s, where *homebirthing families have access to qualified care providers.* ”

    The way to do that would be to ensure that midwives are not under a doctor’s thumb, and they collaborate when necessary.

  • http://homebirthdebate.blogspot.com invalid-0

    “I would be interested to see a comparison between the training of *Dutch and British* midwives to CPMs. To the best of my knowledge, those midwives are not required to be nurses first, nor has any good study proven conclusively that it is necessary to be a nurse AND a midwife to provide quality care.”

    All European midwives are trained to work in the hospital. In the UK and the Netherlands, the same midwives can also work at home. They have a longer education, no pseudoscience classes like homeopathy, extensive training in hospitals, extensive experience identifying and managing complications. The UK has a homebirth rate of only 2%. According to the National Institute for Health and Clinical excellence, a British watchdog agency, homebirth has an increased risk of neonatal death in the range of 1-2/1000 compared to hospital birth for low risk women.

    The Netherlands has a higher homebirth rate though it has been falling steadily. It currently stands at approximately 30%, though in major cities, it has fallen to 10%. Midwives are the primary caregivers, but they are governed by detailed risk criteria. Patients who do not qualify for homebirth cannot have a homebirth (and there are quite a few qualifications). The criteria for transfer to the hospital are also very detailed. In addition, there is an elaborate transport system that exists throughout the country (it is a small and densely populated country) to be sure that patients can be transferred rapidly in homebirth emergencies to a facility that expects them, and where their midwife is trained to work.

    American DEMs have much less education, training and experience than European DEMs. They have no training in hospital management and therefore, they have no direct experience with identifying and managing complications. There is more than one credential for DEMs and the requirements are arbitrary. They were made up by DEMs themselves. The bottom line is that the ONLY people who think DEMs are qualified are DEMs themselves.

    “That CPMs could practice in hospitals because they are substandard is preposterous.”

    They would be considered substandard and not allowed to practice in any hospital in the industrialized world, not just the US.

  • invalid-0

    It’s funny that she doesn’t answer most of the questions directed to her, but just repeats the same old stuff time and time again.

    Give it up, Amy.

  • invalid-0

    Anyone with experience working for women’s birth choices already knows not to take “Dr.” Amy seriously, seeing as she’s proven herself to be so biased and un-evidence-based that nothing she says can be considered credible. She’s just out to discredit homebirth, and no amount of reason, research, or intellect can combat her head-in-the-sand approach. You can’t reason with crazy.

    Come on, folks. Don’t feed the trolls!

  • invalid-0

    Dear Dr. Amy,
    I find it interesting that you deem CPM’s to be substandard to the Royal College of Midwives in the UK or to the Midwives in the Netherlands. It is true that their midwives do train in hospital first. However I know of MANY of my sister midwives who have received their CPM here, then gone on to move to the UK, the Netherlands, Australia, New Zealand, Spain, Iceland and a few other countries where their training was considered COMPARABLE and all that was required of them was a written exam! So if these other countries you hold up as the standard don’t consider the CPM credential to be inferior to theirs, how can you?

    Monique
    very tired of hearing Dr. Amy’s same old same old time and time again….

  • invalid-0

    Do I deserve the option of a licensed home birth provider vs. an underground network of unregulated prvoders or not? Is the medical paradigm to hold ultimate control overy my body and my baby’s birth? This is my body and my child. I know what’s best for my child. Currently women are “allowed” to make other, riskier choices in pregnancy and childbirth so long as they fit into the medical paradigm (i.e. so long as those choices benefit doctors or their wallets or big pharma). I support a full range of reprodctive rights. The whole enchilada.

    The one major choice that usually is thought of for the term “reproductive rights” is

    1) Do I continue this pregnancy?

    If the answer is yes, then I have tons of choices I have to make:

    Where will I give birth?
    What type of care provider will I hire (if any)?
    Will I opt for an amniocentesis/chorionic sampling?
    Will I be pharmacologically induced or augmented?
    Will I have a prenatal ultrasound?
    Will I have a vanity ultrasound?
    Will my ultrasound include video?
    Will I eat a healthy diet?
    Will I keep my body well hydrated with lots of good fresh water?
    Will I allow my labor to start on its own when the baby kicks out the labor starting hormone?
    Will I schecdule my baby’s birth?
    Will I have anesthesia for my baby’s birth?
    Will I have an iv for hydration in labor, or will I eat and drink what I want?
    Will I push my baby out standing up? Or squatting? Or on all-fours? Or on a birth stool? Or lying down with my knees pushed way back by other people?
    Will I walk and move around while I’m pusing to wiggle the baby out, if necessary?
    Will I allow a medical staff to tell me what position to get into, when to breath and how long to push?
    Will I schedule a c-section?

    At what point does the state stop making these decisions for me?

  • invalid-0

    This Dr. Amy character apparently cuts and pastes the same lies — verbatim — all over the internet. I just googled and found the exact same list on other blogs, newspaper article comment sections, etc. She has about 2 or 3 standards lists, none of which has a single reference or seems to make sense when I have dug up source material to check her elusive claims.

  • http://homebirthdebate.blogspot.com invalid-0

    “Do I deserve the option of a licensed home birth provider ”

    No, you don’t deserve to decide who gets licensed, and I’m not sure why you think you do. Licensing is not a popularity contest. It to ensure that providers are competent to practice midwifery. American DEMs are undereducated, undertrained and inexperienced. Unless and until they upgrade their standards to the level of midwives everywhere else in the industrialized workd, they are not qualified to be licensed. Canada has insisted that their direct entry midwives meet the higher European standards for competence. The US should do nothing less.

  • invalid-0

    Dr. Tuteur,

    Is homeopathy etc. a required course for ALL CPMs or simply an elective? I thought vaccines worked by exposing the body to a tiny bit of harmful substance to stimulate immunity, if that is true, homeopathy makes sense.

    I would like to see a side-by-side COMPARISON, not your commentary.

    The bottom line is that consumers are insisting on competent providers for HOMEBIRTH, similar to England and Holland’s system. Whether or not homebirth rates are declining in Europe is not germane to this discussion.

    If that means further standardization of midwifery certification (that all midwives are trained in hospital AND HOME management), so be it.

    If that means implementing a consultancy and transport system, SO BE IT.

  • invalid-0

    My husband and I don’t have children yet, but we both think that homebirth with a midwife is a *very* appealing option.

    It’s nice to see people talking about this!

  • invalid-0

    this campaign exists though it has clearly put Dr. Amy Tuteur on the defensive.

    Dr. Tuteur, your opinions are just that – opinions. You provide no links to studies or other articles, you cite no real statistics that provide clear evidence that home or birth center labor and delivery facilitated by a certified professional midwife for a low-risk pregnant woman is less safe than a hospital birth presided over primarily by nurses.

    I am thrilled that there are so many women who have spoken up in this comment thread. I think people like Dr. Tuteur are clearly afraid of informed women and their families making up their own minds about what kind of birth they want to have and with whom.

    By the way, I certainly do not shun "modern medicine" or hospital care or OB/GYNs. I had both of my children in a birthing center of a major hospital in Seattle presided over by my certified nurse midwife (and doula). However, the amount of unnecessary medical intervention that occurred with my first brought me to this place of clarity and awareness so that with my daughter's birth I knew exactly what I wanted and needed. Her birth was an entirely different experience.

    Thank god for the availability of a full range of care and options for women in this country who can afford to access. If you fall into a higher risk category while pregnant, if you need a c-section, if you require emergency care that only an OB/GYN can provide, thankfully many women in this country have the financial means to access this kind of care. Of course, there are still millions of women for whom high-quality hospital care with an OB/GYN is just a dream. Lack of insurance effectively bars them from this kind of health care. And in many instances, if the woman is low-risk, a CPM at home or at a birth center can be a much less expensive option.

    I'd love to know how often Dr. Tuteur has visited the Seattle Midwifery School by the way? Other training facilities around the country? Amazing how much you know about the education and training.

    Finally, this large-scale study done of low-risk home births with CPMS as compared with low-risk in-hospital births tells a very different story than Dr. Tuteur's:

    http://www.bmj.com/cgi/content/full/330/7505/1416

  • http://homebirthdebate.blogspot.com invalid-0

    “I am thrilled that there are so many women who have spoken up in this comment thread.”

    Do you really think that will make people forget that you cannot (and they cannot) address even one of the 15 reasons why DEMs are not qualified to be licensed?

    Let’s be honest here. You did not know the information I presented before I presented it, and you do not know how to refute it. Instead, you prefer to ignore the facts and pretend that the issue of homebirth safety is a popularity contest.

    “Finally, this large-scale study done of low-risk home births with CPMS as compared with low-risk in-hospital births tells a very different story than Dr. Tuteur’s:

    http://www.bmj.com/cgi/content/full/330/7505/1416

    Yes, the famous BMJ study by Johnson and Daviss which does NOT show homebirth to be as safe as hospital birth. Johnson and Daviss ACTUALLY showed that homebirth has a neonatal death rate almost TRIPLE that of hospital birth for low risk women. Can’t find that information in the study? That’s because Johnson and Daviss left it out. Instead of comparing homebirth in 2000 to hospital birth in 2000, they compared homebirth in 2000 to hospital birth extending as far back as 1969. They had to go back three decades before they could find hospital data that would make homebirth look safer by comparison.

    Moreover, Johnson and Daviss neglected to mention some serious conflicts of interest. Johnson and Daviss are long time public advocates of homebirth. Johnson was the former Director of Research for the Midwives Alliance of North America; Daviss, his wife, is a homebirth midwife. The study was performed in collaboration with MANA, and was funded by a homebirth advocacy foundation (they do acknowledge the foundation funding in the fine print at the end of the paper). So Johnson and Daviss, long time homebirth advocates, collaborating with MANA, funded by a homebirth advocacy foundation performed a study that was supposed to show that homebirth is as safe as hospital birth. Instead it showed that homebirth in 2000 had a neonatal mortality rate almost triple that of hospital birth in the same year.

    Of note, MANA has continued collecting homebirth statistics from 2001 to the present day. MANA has publicly announced that the statistics are available to midwifery organizations that can prove they will use them for the “advancement of midwifery”. Even then, they must sign a legal non-disclosure agreement promising not to share the data with anyone else. It does not take a rocket scientist to figure out that the data almost certainly shows homebirth with a CPM to have a higher rate of neonatal death than hospital birth, and probably far higher than what the literature already shows.

  • invalid-0

    Amy Tuteur writes: “5. Direct entry midwives are NOT trained for out of hospital birth, since no special training is required.”

    This is simply incorrect. Most OBs, and some CNMs, are unqualified for out-of-hospital birth. Many OBs are completely unfamilar with totally natural birth, without any medical management. They would have no idea how to spot the early signs of problems that would warrant intervention or transfer — no way of distinguishing normal variations from dangerous complications. Similarly, some CNMs are very dependent on medical intervention and technology. Unless a CNM or MD has specifically apprenticed in homebirth, s/he should not be attending births at home except as an assistant to a more experienced homebirth midwife.

    For a very clear example of the above, read Ina May Gaskin’s discussions of the “lost knowledge” of vaginal breech delivery and how it endangers moms and babies. This is but one example.

  • invalid-0

    You throw these ideas out with no evidence. You say that they left the information out – so please, for the health and safety of women, show us where the information IS that shows that the neonatal death rate for home birth was triple that for in-hospital birth. And I'm assuming you're comparing low risk pregnancies on both ends?

    Again, Dr. Tuteur, you conveniently throw out these ideas with no links to back it up.

    You write:

    Moreover, Johnson and Daviss neglected to mention some serious conflicts of interest. Johnson and Daviss are long time public advocates of homebirth. Johnson was the former Director of Research for the Midwives Alliance of North America; Daviss, his wife, is a homebirth midwife. The study was performed in collaboration with MANA, and was funded by a homebirth advocacy foundation (they do acknowledge the foundation funding in the fine print at the end of the paper). So Johnson and Daviss, long time homebirth advocates, collaborating with MANA, funded by a homebirth advocacy foundation performed a study that was supposed to show that homebirth is as safe as hospital birth.

    Johnson and Daviss ran this study as advocates of home birth, yes. But why? ACOG is made up of OB/GYNs with plenty of funding – so where are the studies that conclusively prove that in hospital births are safer than home or birthing center births? Here is what ACOG has said:

    Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous.

    Who else is going to run these studies?! The AMA and ACOG have clearly shown they hold tight reins on their power to reign over labor and delivery in this country and haven't done it thus far.

    As for your "15 points" – I didn't address them because most of them show nothing more than your anger at midwifery:

    7. Direct entry midwives are not “specialists” in normal birth. Claiming to be a specialist in normal birth makes as much sense as a meteorologist claiming to be a specialist in good weather.

    This statement shows nothing but your own bias, Dr. Tuteur, and nothing else.

    The very goal of The Big Push for Midwives campaign is to REGULATE and LICENSE midwives around the nation. You may not like midwifery but there are states around this country where midwifery is licensed and regulated and wonderfully, successfully bringing healthy babies into this world.

    As for what MANA's stats show or don't show – it's hard to comment without seeing them. Though I would say that with a well-funded, powerful mainstream medical organization ready to defend their position of power, I'd keep the information close at hand as well.

     

  • invalid-0

    You may think she doesn’t deserve to decide whether or not CPMs get licensed, but the fact is, she does get to decide. Healthcare providers are licensed by state legislatures. So she gets to decide who deserves licensure by going to the elected officials in her state, presenting them with the evidence and informing them about the reasons why giving birth at home with a CPM was the safe and appropriate choice for her and why it’s their responsibility, as her elected representatives, to ensure that she has access to legal providers. It’s called democracy, and it ensures that those of us who actually have to live with the healthcare policy decisions made by our elected representatives have a voice at the table. Without it, we’d be subject to paternalistic and self-serving healthcare policy dictated from on-high by the likes of Dr. Amy and other mouthpieces of organized medicine.

  • invalid-0

    You may think she doesn’t deserve to decide whether or not CPMs get licensed, but the fact is, she does get to decide. Healthcare providers are licensed by state legislatures. So she gets to decide who deserves licensure by going to the elected officials in her state, presenting them with the evidence and informing them about the reasons why giving birth at home with a CPM was the safe and appropriate choice for her and why it’s their responsibility, as her elected representatives, to ensure that she has access to legal providers. It’s called democracy, and it ensures that those of us who actually have to live with the healthcare policy decisions made by our elected representatives have a voice at the table. Without it, we’d be subject to paternalistic and self-serving healthcare policy dictated from on-high by the likes of Dr. Amy and other mouthpieces of organized medicine.

  • http://homebirthdebate.blogspot.com invalid-0

    “You say that they left the information out – so please, for the health and safety of women, show us where the information IS that shows that the neonatal death rate for home birth was triple that for in-hospital birth. And I’m assuming you’re comparing low risk pregnancies on both ends?”

    I’m not sure why you are being so snarky. You clearly have not read this paper so you have no idea what it does or does not show. This is typical of homebirth advocacy; most of what homebirth advocates think they “know” is not even true.

    As it happens, Johnson and Daviss have recently acknowledged that they left the hospital data for 2000 out of their paper and are now back pedaling trying to explain why. On their website Understanding Birth Better, they write:

    “… Since our article was submitted for publication in 2004, the NIH has published analysis more closely comparable than was available at that time, and some have tried to use it as a comparison. While we still do not offer the comparison as a completely direct one, as it is the closest we have and the comparison is occurring regardless of our cautions, we offer the following adjustments that have to be made to provide the comparison of the CPM2000 analysis in as accurate a manner as is possible with the published NIH analysis.”

    They acknowledge that my calculation of the neonatal death rate for low risk births in 2000 is correct:

    “Thus a crude comparison of the comparable rates for non-Hispanic white >37 week babies in hospital in the year 2000 would be about 0.91 neonatal deaths/1000 live births …”

    That is almost exactly the figure I reached in my analysis of the hospital data. Here is what I wrote in January of 2007 in my post Johnson and Daviss study shows death rate more than double the hospital group:

    “Looking at the raw data we find:

    2,824,196 births to white women at term (37+ weeks), see Table 2
    and
    2,602 deaths of white babies weighing more that 2500 gm see Table 6
    for
    a death rate of 0.9/1000.

    The hospital neonatal death rate for white babies at term of 0.9/1000 is not corrected for congenital anomalies, pre-existing medical conditions, pregnancy complications or multiple births.”

    Even now, though, they continue to offer disingenuous excuses for their failure to appropriately analyze the data. Consider this claim: “Since our article was submitted for publication in 2004, the NIH has published analysis more closely comparable than was available at that time”. However, the relevant data was published in 2002, long before their paper was submitted (Infant Mortality Statistics from the 2000 Period Linked Birth/Infant Death Data Set, published August 29, 2002). Moreover, even before publication of the analysis, Johnson and Daviss had the raw data in their possession. They used that raw data from 2000 to calculate the rates of hospital interventions, so they were fully aware of the mortality data at all times.

  • invalid-0

    Amie,

    You mention that in Washington state licensed CPMs work with hospitals and OB/GYNs when necessary. Unfortunately, a DEM – CPM does not necessarily recognize on time (or at all) when she needs the hospital/doc, and disaster ensues.

    I would like to know which hospitals in your (and my) metropolitan area (since you use it as an example) follow this model of providing backup for DEM – CPMs: UW Medical Center? Swedish? Valley? Overlake?

    To those of you who insist on trusting your body, trusting your baby to know when it’s time to born, and trusting your midwife, go ahead – but understand the risk, because it’s there, and it’s a larger risk at home no matter how you try to spin it.

  • invalid-0

    for you which hospitals have doctors who accept patients from midwives when patients need to be transferred to a hospital but I cannot list them for you offhand. I can tell you that there are doctors at Swedish and at Group Health who work with midwives here in Seattle.

    And I don't think anyone is telling you that you should be forced to have a home birth or use a CPM. That's the point. If you don't feel comfortable, of course you should have the right and access to a provider you feel most comfortable with in the setting of your choice.

    Actually, once again the statistics show that home birth is safe but of course there are risks to everything. There are plenty of OB/GYNs that, sadly, put women at risk for dangerous and unnecessary medical interventions that have serious repercussions for mothers and babies. No one said that using a midwife is risk free but nor is in hospital birth.

    The saddest part of your comment, to me, is this:

    To those of you who insist on trusting your body, trusting your baby to know when it's time to born, and trusting your midwife, go ahead – but understand the risk, because it's there, and it's a larger risk at home no matter how you try to spin it.

    I do hope that no matter what kind of provider a woman chooses or where she chooses to give birth, she trusts her own body and her provider. This is not about forcing you – or any woman – to give birth with someone or someplace that doesn't feel right or safe to you.

    But the truth is that one of modern midwifery's contributions to our contemporary birth culture is the ideal that women trust our own bodies! It's not that there aren't dangers and risks. We should all go in with a birth plan, an idea of how we want to birth and make sure that everyone involved knows what you want and need from your labor and delivery of your beautiful baby. But, yes, there are dangers and risks – childbirth can be a risky proposition for women and babies depending on a variety of factors.

    I hope you feel comfortable advocating for yourself with your provider, when (if) you decide to have a baby. Good luck!

  • invalid-0

    I don’t find my comment sad at all! Trusting has nothing to do with a “good outcome” in a homebirth – it’s the good odds and a little luck thrown in that make homebirth seem safe to what really is a very, very small number of women. While homebirth may be relatively safe for low-risk women, it is not AS SAFE as in a hospital because the personnel are simply not there to act as quickly as may be needed to save a baby or mother. Low-risk women suffer sudden emergencies too – that’s why they are called emergencies.

    I personally could never trust a DEM/CPM. I don’t think they are educated or experienced enough, and I have seen what can happen when one of these midwives does not recognize the impending disaster (and then refuses to even accompany the mother to the hospital).

    Believe me , I have no problem advocating for myself or those who I feel need an advocate. That is why I am currently one of just a handful of people working to get at least ONE incompetent midwife’s license revoked. For those promoting homebirth, a dead baby from a midwife’s incompetence is a statistic; for the family of that dead baby it is an unbelieveable grief.

    I have had my children already (2, in a hospital, NATURALLY!), but thanks – you make me feel young again!