Natural Allies

I wonder how many of us know about the grassroots struggles of Certified Professional Midwives in the country, or exactly who a CPM is, and what they do. In terms of what CPMs provide to whom, and their having to battle against an industry establishment who ought to be championing them, the parallels to community acupuncture are pretty remarkable, and are worth all of us taking a look at.

I'm not the best one to write about this. I'm trying to get up to speed; and, I'm offering some links and an invitation that you do too. I'd like to invite a direct entry midwife to write something here soon.

My wife and I are expecting in July. We knew we wanted to have a homebirth, and actually had started a relationship with a home birth midwife as a prerequisite to our trying to get pregnant. But, as we got further into pregnancy land, we began seeing just how hard these traditional care providers have to fight to be able to do the oldest and most natural job in the world without ending up in jail or otherwise entirely shut down.

In most states in the country, CPM's status has been declining in proportion to the role that the AMA plays in dictating licensing and credentialing and determining CPM's relationship to hospitals. In many states, CPMs have to work basically undercover.

When my wife and I were talking to lots of midwives, we were warned by all of them about their relationship to hospitals, how it's been whittled to none, and how, in the very tiny chance of our having to transfer last minute to a hospital, we'd basically have to be on our own, since they are effectively illegal.

I should say quickly that none of these women reported this as a complaint to us. Nor, did they act powerless in the face of this oppressive situation. They were laying out the landscape for us so that we could work together to think of creative solutions, while showing that the situation is simply unacceptable and that a huge part of their jobs happen to be remedying this situation.

Find out about their fight here, from an organization called The Big Push for Midwives: Legislation not Prosecution.

Like community acupuncturists, CPM's believe there could be an educating and licensing process that adequately prepares them for the important work they do, without turning their profession over to the techno/medical establishment, and without racking up the kind of debt that would make giving low cost care impossible.

Certified Professional Midwives are licensed and qualified traditional midwives, who help birth babies in non-medical settings. They provide a continuity of care from the point of a woman's or family's decision to have a baby through pregnancy and birth and for at least several post-partum months. Their model of care is the same as that of the midwives in most countries in the world who have both lower c section rates and lower infant mortality than in the U.S.

This from the Big Push for Midwives:

Certified Professional Midwives (CPMs) serve a disproportionate number of low-income, rural, immigrant and uninsured families. Regulation and licensure of CPMs ensures that there are enough well-trained midwives to meet the demand for out-of-hospital birth and to provide safe and affordable maternity care for underserved populations.

CPM licensure protects and defends the rights of American women and families by:

  • Providing a mechanism for families choosing out-of-hospital birth to verify their midwife's training, skills and educational credentials
  • Ensuring adherence to evidence-based practices and providing for transparency and accountability
  • Ensuring continuity of care and offering liability protection to physicians who collaborate with midwives
  • Providing access to:
  • A family-centered model of maternity care that offers individualized education, counseling, screening and pre-natal care
  • Continuous hands-on assistance during labor and delivery
  • Minimal use of costly technological interventions
  • Support of the physical, psychological and social well-being of mothers and families throughout the childbearing cycle
  • Ensuring that every family can choose their birth provider and setting based on their religious, cultural and philosophical beliefs
  • Ensuring the availability of qualified and experienced out-of-hospital maternity care providers in the event of an emergency that makes hospital care inaccessible (e.g. a hurricane or other natural disaster, or flu epidemic). Access to out-of-hospital maternity care is in keeping with the mission of the National Working Group for Women and Infant Needs in Emergencies to ensure that the health care needs of pregnant women, new mothers, newborns and infants are adequately met during and after a disaster situation.
Here's some more about who CPMs are.

Please look around the website of The Big Push for Midwives to find out about what's going on. I think it's incredibly important, both on it's own, and as perhaps an indication of how important taking a stand against the Fist Professional Doctorate is.
This story was posted on March 12 2009 by korbenp.
Tags: fpd midwives

Comments

  • March 12 2009 at 1:29 PM
    tatyana writes:

    ...

    thanks korben good connection here. and CONGRATS to you and your family!

    i wanted to mention the movie “The Business of Being Born” - i thought it was a good exploration of the childbirth “industry” and some sobering data.

    my partner’s daughter was supposed to be delivered in a birth center by a midwife - they planned a water birth. instead, she was born in the backseat of her grandmother’s volvo on the way to the birth center. she was just ready and came out… her grandmother, who was driving the car at the time, had gone through two complex and traumatic hospital births with her own kids. she says that seeing the ease and natural-ness of her granddaughter’s birth was one of the most healing experiences of her life.

    -tatyana

      0 likes
  • March 12 2009 at 3:15 PM
    Rianoth23 writes:

    Thanks!

    Thank you for this post. I am a doula and I have done a midwifery internship overseas. Both my sisters used midwifes in their births and I am a huge supporter of midwifes and homebirth. Throughout history women have supported each other through childbirth and I have seen a superior  quality of the care in the midwifery community. It is very important for the holistic community to stick together. 

    Great info!  

      0 likes
  • March 12 2009 at 9:28 PM
    River Jordan writes:

    we shall overcome institutional greed

    Korben and Amy - Congratulations. I sent an email to our family’s midwife (asking her to comment) who ultimately decided to move to Canada due to various events which unfolded after the birth of our daughter. 

    Long story - but as briefly as possible, she was sanctioned by the state DOH who ruled that she delivered substandard care. My wife, daughter, and I attended her administrative trial (for 5 days), and testified on her behalf, but it seems the judge had only ears for what the state DOH prosecutor had to say. I was appalled at what seemed no less than a modern day witch hunt.

    As an example of the institutional bias and discrimination, the state paid an M.D. something like $200 per hour for the duration of the trial to testify against our midwife, and this money came out of the general fund that midwives pay for their licenses (thus essentially gutting the midwifery program which shouldserve midwives, not oppress them).

    The other midwife (we had planned a homebirth also) was very unsupportive when the pregnancy turned out to not be the norm, and we were told our only option was a c-section.

    So we connected with the underground railroad of midwives  and found an experienced and compassionate direct entry midwife who offered us an alternative for a homebirth. In the end, she was crucified for bucking the system.

    I am guessing that acupuncture is tolerated as much as it is by western medicine because we do not encroach upon their turf nearly to the degree that midwives do. But I suppose that could change.

    In any case, the common issue I see is only partly one of monitoring professional education standards so that they are strong, yet equitable, not enriching schools to the detriment of individual practitioners. The larger issue is one of getting the government (which is US - We the People) to monitor its own institutions - so that diversity of treatment options are available, without enriching entrenched industries.

    It’s a big and long term job. I’m really happy to hear about the new midwives organizations, and of course, delighted as always to be part of CAN. 

     

    http://www.communichi.org/

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  • March 12 2009 at 10:39 PM
    tessmcginn writes:

    check out the midwifery system in Holland

    something like 30% of births in Holland are home births.  The midwives are regulated and licensed like any other medical care practitioner.  New Mexico I believe has the largest % of homebirths in the United States and much has been written about their success.

    Both of my children were born at home with no complications.  I feel blessed because the midwives really put themselves on the line if there are…the doctors who may have backed them up in the case of emergency have generally stopped because their liability is so high.  I know many midwives and hardly any I know have managed to escape legal scrutiny.  It’s a tough situation for them and they are by far the bravest people in the medical profession.

    It’s just really hard to go your own way in the U.S.  Dairy farmers who want to sell raw milk to willing customers are finding themselves in similar situations as the midwives.  In Pennsylvania there is a huge case pending on a Mennonite farmer who  had a cow share operation and in one day, the PA regulating body confiscated over $30,000 worth of product and many thousands more in equipment.  He is the father of 10 children.  Organic Pastures in Fresno California had to pull their milk off the shelves because of some kids getting sick though it seems more likely to be from other sources…they also ate spinach that day.

     

    But Jordan is right, the best way to conteract all of that, is to organize and educate.  I am most certain that homebirth is not an option most women in the U.S. would entertain…it goes against the idea that birth is a medical procedure and most women do not accept that for themselves.  But for us tiny minority of people willing to fully accept responsibility for our actions and lay the burden of consequence squarely on our shoulders, we should be able to freely do so.  MIdmifery organizatios themselves could help their case by not allowing underqualified midwives to practice as CPM.  I know of some midwives who really have no business birthing babies because they are doing so with little experience…that is when bravery turns into irresponsible studipity even if their willingness is appealing to desparate clients.  Midwives try to distance themselves from these selfish misguided souls but they are sometimes the reason for the legal onslaught and it’s hard to not also need to defend their brethren when all of their fates are so tenuous.  One midwife can make them all look bad.

    The reality though, is that the most horrible actions by CPMs is a mere drop in the bucket when compared to what goes on inside hospital or birthing center walls.  In some hospitals C-section rates near 45%.  If the C-section rate  gets lower, all the medical estabilshment has to do is publish a study about how unborn babies who weigh more than 7 lbs are a risk to the mother with an unstable pelvic girdle and you can guess the rate of unstable girdles will go up to unprecendented levels.  And no one will even question what the heck an “unstable pelvic girdle” is.

    The legitimacy of midwives will remain in question until we have a stable health care delivery system…no matter what you believe, it’s hard not to question the possiblity of that happening.

      0 likes
  • March 12 2009 at 11:32 PM
    River Jordan writes:

    scare tactics

    Yeah what is an “unstable pelvic girdle”? What I learned is that measuring a women’s pelvic and determining it to be too small for a baby’s head is nonsense, because something happens to the cartilage connecting the pelvis during birth, allowing it to expand. Maybe Unstable pelvic girdle is talking about something else, but it sounds like another scare tactic to me.

    http://www.communichi.org/

      0 likes
  • March 12 2009 at 11:42 PM
    lumiel writes:

    This makes me see red.

    I see this as more than a turf war.  Remember that the patients involved are all women and that the midwives and doulas are almost all women, too.  The issue is about women’s bodies and whose responsibility it is to make decisions affecting these bodies. More dominator culture oppression.

    I’ve been blessed to have had one beautiful home birth and a hospital birth that completely snookered the delivering doctor and ultimately changed his attitude toward unmedicated vaginal delivery (my twins).  This is worth standing your ground for.  And Koren and Amy, Congratulations.  A most blessed expectation for you!  I will be sure to tell many of this website!

      0 likes
  • March 19 2009 at 1:19 PM
    korbenp writes:

    Great article on the cost of being born at home

    More good parallels here to places where we, as health care providers, need to keep confronting our own classism and racism towards removing barriers to improved access for all. 

    http://www.rhrealitycheck.org/blog/2009/03/19/the-cost-being-born-at-home 

    Korben Perry

    Philadelphia Community Acupuncture

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