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April 11th, 2013 11:07 AM #21Senior Member
- Join Date
- Mar 2013
- Pacific NW
FWIW, there's a term that's been bandied about in midwifery communities for years. It started as an insult and now it's something akin to a slur. "Medwife." You can ascertain for yourselves what it's meant to imply: a midwife who, in the eyes of other midwives, rely too much on allopathy and medical intervention, who is "insufficiently committed to natural birth processes."
I believe in choice. That's why I want to be a midwife. I want to help women who want to have their babies at home exercise that choice. But I also believe in sanity and sense. My own birth was extraordinarily traumatic; if my mother had been at home, one or both of us would be dead. Out-of-hospital birth is a great option for some, but it is not appropriate for everybody, and it is critical that we screen those people. So my patients are getting ultrasounds. My patients are getting bloodwork. My patients are being screened for gestational diabetes and group beta strep. If someone has a problem I can't handle, I'm referring them on to their friendly neighborhood obstetrician. If they don't agree to these things, that's their choice, and that's fine - but in that case, I'm not the midwife for them. Taking a chance on the life of a mother or baby is not acceptable. If that means people want to brand me a "medwife," by all means.
Last edited by shyshutterbug; April 11th, 2013 at 11:16 AM.
April 11th, 2013 06:28 PM #23Senior Member
- Join Date
- Apr 2011
You sound a lot like the midwife I had for my son - she was definitely licensed (or certified?) - anyway, she has been in practice for a very long time. She delivered my brother 25 years ago and she delivered my son who is 4 and I am pretty sure she is still practicing, anyway, point is, she was very much "mothers choice", whether that be home birth, hospital birth, epidural, natural - it was entirely up to you and she supported and advocated for you in the hospital. My birth did not go as planned because I, being young and stupid, did not realize I was in labor and got to the hospital close to 8cm dilated. I had a shot of nubane (sp?) I don't think it worked, I still felt everything, I did have localized anesthetic because she did an episiotomy (at my request via my birth plan - I plan to tear naturally next time). In all honesty, I did not like her personally (our personalities did not mesh) but I believe she is a good midwife and did not turn me off potentially using another, though it would likely be in a clinic setting with OB's as well as midwives.
I think your approach to it is very sensible and safe, personally.
April 11th, 2013 08:16 PM #25
If berries from other countries are reading this thread and are confused, I'd like to explain the US midwifery system.
The first type of midwife is a CNM, a Certified Nurse-Midwife. This is a midwife who first earned an RN, then or concommitantly earned a bachelor's degree in nursing, and completed a 2+ (now mostly 3) year Master's degree in midwifery. They are very well respected health care practitioners who have close relationships with obstetricians; they have extensive in-hospital training where they see and diagnose complications both antenatally and in labor (though they typically do not manage complicated or high-risk patients); they are licensed independent providers who have prescribing privileges (can prescribe medications), admitting privileges (can admit patients to a hospital and be the provider listed as responsible for their care); they are required to pass rigorous licensure exams, meet certain criteria to be eligible (i.e. X # of deliveries, assist/watch X # c-sections/complicated births, see X # prenatal patients). They can bill insurance and are required to hold malpractice insurance. Their license is regulated by the state medical board and they are subject to formal inquiries and disciplinary hearings, including revocation of licensure and even criminal charges. In many respect they are held to the same standards as physicians [though in most US states, they are required to work under the license of a physician].
In most Western countries, including Canada, Australia, and all of Europe, this is the only type of midwife which exists.
In the US there is a second type of midwife, which is a "Direct Entry Midwife." This means the midwife did not first earn a nursing degree, is not required to have a preexisting background in health care, and can train in an apprenticeship model with an existing midwife rather than in a hospital-based graduate-level accredited program. In many US states DEMs are not permitted to practice legally. They are called CPMs (Certified Professional Midwives) or LMs (Licensed Midwives, in the states where licensure is permitted). In many of the 20+ US states where licensure is permitted, it is VOLUNTARY. Unlicensed midwives are allowed to practice in these states. CPMs are NOT health care providers under the same aegis as doctors, dentists, nurse practitioners, physician assistants, etc. Their licensure is under a separate organization, not the medical board, which is called NARM, and they are NOT permitted to work in hospitals (so they attend home & birth center births exclusively; as students they do shadow in hospitals occasionally). The licensure process is very minimal compared to nurse-midwifery [note: many people will surpass these requirements, but these are the minimal standards. And they're voluntary); Oregon, for example, requires only 25 deliveries and 100 total pregnant patients seen for licensure, as well as passing a weekend CPR course. You must also pass a 200-question multiple choice exam.[http://www.oregon.gov/OHLA/DEM/Pages...ation_Process]
To put this in perspective, an average obstetrics resident in an average week on Labor & Delivery would perform at least 25 deliveries as the primary birth attendant. That's only 4/day. In a clinic day, the average patient load is between 10-20/day, given the complexity of the patients and the type of visit. So in a clinic month, they would hit that 100-patient mark in roughly 2 weeks.
Since licensure is voluntary and since many CPMs are not permitted or do not wish to carry malpractice insurance, it is a very, very difficult profession to police. "Bad apples" simply cannot be weeded out, short of facing criminal charges.
Shyshutterbug, I am very curious how people in your program are handling Judith Rooks' recent data review for the state of Oregon.
For those who don't know, a homebirth-friendly nurse-midwife named Judith Rooks was charged with rigorously examining the outcomes for planned homebirths versus hospital births in the state. Oregon is considered one of the more home-birth friendly states in the country; there is an eager clientele, the state permits CPMs to carry a few obstetric-relating lifesaving medications, and CPMs can receive Medicaid reimbursement if they are licensed. Unfortunately she found a NINE-fold (900%) increase in mortality-- not disability or complications, but death-- for the homebirth group.
Last edited by blade; April 11th, 2013 at 08:24 PM.Blade, MD
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April 11th, 2013 09:15 PM #27~Boys~
Jory Leander Atticus, August Eli Benedict, Casimir Mordecai Stewart,
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Julian Remy Charles, Vasiliy Lochlan Michael.
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April 11th, 2013 09:23 PM #29Senior Member
- Join Date
- Sep 2012
- Humboldt, California
Do you know what the outcome was like for homebirths attended by CNMs vs all other types of midwives? Can CNMs even attend a home birth? Seeing as they're supposed to operate under a doctor, and if the doctor is not at the home...Can you clarify how that whole thing works?Proud furmom to:
Pepper, Kuno, Mia, Rosalind, Gwendolen & Cecily
Elysia Maeve~Marina Isolde~Linnea Violetta~Minerva Sophronia~Merida Ianthe~Eleni Finola
Tiernan Hugo~Felix Lysander~Orion Casimir~Caspian Milo~Evander Anslem~Leonidas Gavin
Cosima Helene & Emrys Jasper