What's a "midwife?" Please let the ACNM know.

This week, the birth blogosphere was abuzz with news that the American College of Nurse-Midwives has changed its position statement on midwife certification and its definition of what a midwife is.

Essentially, what it boils down to is that the ACNM will not recognize a midwife unless she has received her academic and clinical training in a formal education program. The North American Registry of Midwives is the national agency which certifies professional midwives. After a midwife has met conceptual learning objectives and gained significant clinical experience with out-of-hospital births and prenatal care, she can become a Certified Professional Midwife. There are a number of formal education programs in which an aspiring midwife can enroll; however, an aspiring midwife can obtain her theoretical and conceptual learning through apprenticeship, under the guidance of wise, experienced and mentoring midwives. It's probably the oldest, most traditional form of learning there is.

There are many paths to learning, and it makes sense that the art of traditional midwifery honors learning through apprenticeship. NARM certification is rigorous; it recognizes different paths to learning, and ensures quality practice and standards of care through its certification process. Additionally, its standards for certification are used by the 26 states that regulate midwifery, states in which CNM's, OB's and CPM's practice collaboratively in a variety of birth locations.

It is curious that in its definition of a midwife, the ACNM wishes to split the midwives certified by NARM into separate camps, legitimizing one and squeezing out the other. It is particularly disheartening in the 24 unregulated states like Massachusetts, where the only opportunity to learn midwifery is through apprenticeship. What gain does the ACNM have in only recognizing some CPM's?

NARM has created a petition asking the ACNM to reconsider its statement and respect the knowledge and diverse training that those who hold the CPM carry. At this writing, the petition has over 1160 signatures. Please take a few moments to sign the petition, taking action to protect birthing choices, which includes access to qualified, trained, experienced Certifed Professional Midwives.

(this has been cross-posted on the Massachusetts Friends of Midwives blog)

Faced with a doctor gap, more hospitals turn to "Laborists" to deliver babies

Please click on the title above to read a Boston Globe front page article, published 2/22/09, about how hospitals are dealing with a shortage of OB's. This is exactly the reason why we need more birth choices, particularly in Massachusetts. Midwives, both CNM's and CPM's, can ease the burden on L&D units by creating more birth center births and homebirths, as they do in most countries around the world! The midwives would be able to attend more births, and the OB's could care for the much smaller percentage of births that actually need obstetrical intervention.

I come from a family with a number of doctors, so I have a very personal understanding of the pressures MD's face because of liability and soaring malpractice insurance costs. Because of my family, I'm also not as quick as others are to blame OB's for the medicalization of birth. But imagine if birth in this country were not driven by fear -- the OB's fear of being sued and watching a life time of work go down the drain for themselves and their families; the expectant parents' fear that the totally normal and healthy process of birth will go utterly awry unless it is interfered with; the mothers' fear when they go post-dates, because they can't spare precious maternity leave days waiting around for labor to begin.

So who is benefitting from the 15 minute prenatal visit, from theVBAC bans, from the c-section rate that is nearly 40%? Who is dictating all these policies? This really is a call for a reform of the insurance and medical malpractice industry and how it has burdened health care and effectively damaged our understanding of birth.