Midwife vs. midwife

I am so deeply saddened by the American College of Nurse Midwives’
decision to fight the inclusion of Certified Professional Midwives in
health-care reform. 

I have a lot of respect for the work of
Certified Nurse-Midwives (CNMs), who are trained as RNs and go on to
pursue graduate-level education in midwifery, similar to a
Nurse-Practitioner or ARNP.  Most practice in hospitals under the
supervision of an obstetrician, and they are recognized in all 50
states.  Because of their status as medical professionals, CNMs are
able to both serve women who may never have heard or considered
out-of-hospital birth and receive reimbursement from insurance and
government-funded Medicaid programs.  They provide humanized birthing
care within the hospital, often reducing intervention and improving
outcomes in poor or under-served communities.  They are able to do
this, again, because they are legal recognized throughout the country
and by the federal government as health-care providers.

Certified Professional Midwives are not nurses.  They are, I would argue, health care providers but not medical professionals
For most healthy women, birth doesn’t need to be a medical event, and
what they need is primarily someone to safe-guard and support the
healthy choices they will make when given good information.  CPMs
practice exclusively in out-of-hospital settings, including homes and
free-standing (i.e. not hospital affeliated) birth centers.  They
recieve  the CPM credential after demonstrating that they have an
agreed-upon set of skills which are necessary to facilitate normal
birth and manage the rare emergency.  Their training takes place primarily outside the hospital, allowing them to approach birth from the perspective of normalcy rather than from the perspective of medical emergency.  Unfortuanately, in many states,
CPMs are not recognized health care providers.  Their clients must pay
out-of-pocket for services, their access to medical referral is
limited, and their practice is sometimes tolerated by Attorneys General
who choose not to prosecute them for practiing medicine without a
license.  Thus, though many healthy women could be good candidates for
out of hospital birth, they have never heard of CPMs or are too poor to
pay for their care.  

Health care reform could change all that
If the CPM was recognized as a health care provider by the federal
Medicaid program, out of hospital birth care could spread to women who
now could only be served by doctors and nurse-midwives, and the stage
would be set for incorporation of CPMs into the health care system

I wish the ACNM would rejoice and support this possibility instead of lobbying congress against the expansion of midwifery in the US
Their claim that graduate-level education is required to support a
normal physiologic process falls flat in the face of the broad evidence that CPMs provide safe and competent care to healthy women and babies, and reports of dangerous abuse of intervention by birth attendants who receive the most post-graduate education.

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  • invalid-0

    What you describe is nothing short of despicable politics and turf wars.

    Nurse-Midwives are mid-level practitioners who can diagnose and treat many illnesses. Nurse-Midwives can even prescribe even some of the stronger medications, order narcotics or even anesthesia in childbirth and nurse-midwives still attend with the increased risks of medicated childbirth for both the mother and baby. Nurse-midwives also care for women outside of childbearing and even, for example, manage hormone replacement in post-menopausal women.

    Certified Professional Midwives, on the other hand, practice almost entirely during the childbearing cycle (and non-pharmaceutical birth control). CPMs screen to ensure good health. If there’s something amiss or out of the range of normal, a CPM must refer on to a higher level practitioner, like a nurse-midwife or physician.

    It’s disgusting to me as a home birth mother who has hired both a CNM and a CPM (separate pregnancies), that the ACNM is allowing politics to sway its policies given how vehemently AMA/ACOG fought the ACNM in getting prescriptive authority. The hypocrisy is great, and the ACNM deserve admonition for their political bullying of their sister midwives.

  • invalid-0

    Excellent comments about midwives. Since Midwives, in all settings, provide excellent care, have unsurpassed safety, minimize unneeded interventions, and save money, midwives should be available to all women. Midwives need to get along with each other to advance their cause–which is nothing short of improving the health of childbearing women and their babies. “Can’t we all just get along?”

    Just to be clear–not sure what point you are making about health care providers versus medical professionals, but Midwives ARE professionals.

    Elizabeth Allemann, MD
    Family Physician

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

    As a homebirth mother and midwifery advocate, I, too, am saddened and disturbed by this move by ACNM. When selecting a care provider for my first pregnancy, I interviewed both CPMs and CNMs, and found them to be equally professional, qualified, and competent. The midwife I hired had obtained her CPM and then worked incredibly hard, traveled very far, and spent a ton of money to achieve a CNM credential as well.

    Requiring midwives to attend MEAC-accredited universities will reduce the availability of midwives, plain and simple. There is no evidence supporting the allegation that university-based training results in any difference in outcomes among births attended by trained midwives (CPMs AND CNMs). Eliminating the apprenticeship model of care means less hands-on experience in continuous care. It means that midwives without the financial means or local assets to attend these schools will continue to be prosecuted for providing a valuable, in-demand service.

    This most punishes women doing the kind of healthcare we most DESPERATELY need: rural healthcare providers. In my state alone, only 1/3 of the counties have OB/GYNs. The closest MEAC-accredited university is over 1,000 miles away. Yet we have a vibrant local community of CPMs and wannabe-CPMs who are at risk of going to jail for doing the jobs they are continually called upon to perform by members of their community. Can we not include two modes of training in the definition of midwifery? Can we not value and honor a centuries-old practice that provides outstanding service at a low cost?

    I sincerely hope that ACNM reverses its position. I sincerely hope that CPMs are included in federal and state-level healthcare reform to increase the availability of midwifery to any woman seeking it. My husband and I agree that having our baby at home with a midwife was the best decision we made as a young family and want every family to have this option available.

  • invalid-0

    I had 5 children, natural childbirth, no medications, with both types of midwives. Midwives should be supported in all thier efforts toward assisting in natural childbirth in home settings.
    I am not saying childbirth was easy, IT HURTS and is work but I wouldn’t trade the care I was given for any in hospital experience. I have witnessed several of those as I was assisting other women with their birthing, including some who gave in to epidurals & some who required C-Sections, all but one which I think could have been prevented, had they used a midwife who would have helped the birthing in a way that I believe could have led to a healthy natural birth. I think it’s all about money, so so sad. Just like trying to ban natural remedies because they can’t corner the market.

  • invalid-0

    I am a privileged and lucky woman in many ways: I am educated, healthy, well-insured, and as a midwifery advocate, with lots of knowledge about my birth options. But if I were to become pregnant today, I could not afford the services of a Certified Professional Midwife for a homebirth, despite the fact that midwifery care is the most cost-effective and safest option for healthy women (I’d have to pay out of pocket for a CPM, but choosing a hospital-based provider would be free under my insurance plan). Furthermore, the brave women practicing as CPMs in my state could be charged with a felony for serving me.

    Increasing access to Certified Professional Midwives promotes better outcomes for moms and babies, and real choices for families. CPMs should not be relegated to the underground where they can only serve those who can afford them- whether in money, knowledge, or courage to go outside the system. I am also heartily disappointed that some midwives are fighting for turf instead of for women.

  • http://www.savehomebirth.com invalid-0

    This is about our freedom. It is not about safety or evidence or satisfaction of birthing families. It is about the powerful gaining control over the less powerful. Give them an inch and they become rulers.

  • alison-cole

    I’m grateful for all the wise comments above. Regarding professionalism, I absolutely agree that midwives are professionals. However, we can choose not to practice as medical professionals, because childbirth does not have to be a medical event. For medical intervention, we can transport. I see the role of midwives as supporting wellness in pregnancy and birth, something which is often all too lacking in medical care.