Friday, January 2, 2009

Jennifer Block "Pushes" Obama for better maternity care...Should she?

In the LA times, Jennifer Block, has a featured editorial discussing the state of maternity care in the US and our need for better recognition, funding and education about and for midwifery. I agree with all of that. It is a terrific editorial and I welcome the discussion that comes from it. What I don't welcome is the incessant push by many, midwives, homebirthers, doctors and well meaning organizations, for all midwives to be licensed and regulated.

For one thing, NARM, the National Association of Registered Midwives, who grant licensing in this country, do not provide a regulated, peer based checks and balances for their midwives. They have a grievance policy that allows clients to file a complaint against their midwife and mediation to work through problems, but NARM does not actually discipline licensed midwives. What this means is that once you have your certification, you can pretty much practice any way you like. You can use cytotec at a homebirth, for instance, and unless a birthing woman has a complaint against that practice, other midwives can do nothing about this. What does this mean for the birthing community?

I think it is a well known observation that women can have the most horrible birth, go through every intervention in the book, have a terrible time healing from episiotomies, stitches, catheter placement issues, and the humiliation they experience at many hospital births, but as long as they are sent home with a beautiful little baby, they tend to lay to rest the mistreatment they experienced during the birth and instead focus on the positive: loving and raising their child. Because of this, and often because of the guilt they feel over focusing on lingering birth trauma instead of their baby, many woman choose or neglect to be activists against their doctors, hospitals or maternity care in general. They don't write letters, they rarely prosecute and often times they don't even open up about their feelings for fear that friends and family will think them selfish or unreasonable. Afterall, they have a baby, they are alive, why should they care about the birth?

I think the thing to realize here is that terrible births don't just happen at the hospital. Just as there are unpleasant doctors, there too, are unpleasant midwives. It is often not about their training, but about their personalities, or their lack of sensitivity. We are all human afterall and not meant to be right for each and every other human, but there are also some actions at homebirths that are inexcuseable. They are not okay in the hospital, but really not okay at home, considering the lack of emergency management that is possible. A midwife should not ever use cyctotec to augment labor. A midwife should not cut umbilical cords before they have stopped pulsing, especially not if the baby needs resuscitation. A midwife should not strip membranes, or artifially rupture membranes or augment labors with herbs and homeopathics without and really good, research backed reason. Finally a midwife should not do multiple cervical checks, especially after the membranes have ruptured. These practices are good sense, but not common sense and NARM neither suggests nor enforces that certified midwives follow any guidelines or protocols other than their own. NARM is only there to register midwives, not regulate them.

So, what is the difference between a Certified Professional Midwife who has apprenticed for 3 years, finished their studies and is now practicing compared to a Lay/or unlicensed midwife who has apprenticed for 3 years, finished their studies and is now practicing? The difference is the $1400 that the CPM paid to sit for two different exams and the letters after her name. They are probably practicing in similar ways, perhaps with a senior midwife still overseeing their work. They are accountable only to themselves and the clients they work with and depending on the state they practice, maybe a governing state body, but NARM, does not continue to be a part of their lives except for a very vague peer review that can be done without much concern and an annual membership.
Now you tell me, why should we certify? I have many reasons why we should not, and many more reasons why I don't think states should be involved, let alone the US government, but why should we certify?


midwife of the plains said...

Hello Birthright~
I, too, am an AAMI enrollee. :)
The whole pushed issue is complicated. I believe most folks involved do have good intentions for the homebirthing community. Over the many years I have been practicing (both in my apprenticeship and my own private practice), I have given the CPM issue much thought.
I live on the border of Kansas and Missouri. As you probably know, Missouri passed a bill legalizing CPMs after many many years of hard struggle. In other words, CPMs attending births in Missouri are no longer worried about arrest when they attend a birth. Right there is a "push" for me to get certified. And a difference between me and my CPM sister midwives. I am so fortunate to be a part of a lovely supportive midwife community w/ many different midwives who practice in many different ways. I have felt respected and supported by my sisters in this tiny pocket. I collaborate w/ CNMs, CPMs and DEM (or lay).
I do agree that introducing interventions at a homebirth is a slippery dangerous and rather steep slope. But that, for me, is another topic. :)
Regulation and accountability are 2 issues I would like for all of us. Because homebirth is still chosen by a small (albeit growing) minority, accountability is often in the form of word of mouth and references, even for the homebirth CNMs.

I believe I have asked you before??? But can you email me w/ other contact info. I have folks contacting me from just too far away and I am in need of midwifery contacts in other parts of Kansas.
Where do you live in Kansas? I would love to broaden the Kansas midwifery community. I believe you can find my email on my blog.


I do agree ceri

tie-dyed doula said...

haShine on!