Before I begin, I feel it's really important to say I am not anti-midwife, not even anti-CPM. I am against the way things are at the moment and am for increasing the standards for all CPMs/DEMs and believe it will only help home birth in the United States. I felt I needed to clarify before you started this post.
Sara Larane Savel, answering a thread about Michigan’s introduction of Senate Bill 1208 which would, among other things, limit midwives to those that are Registered Nurses first, not permit breech births or other complicated cases out of hospital and require them to carry malpractice insurance, created this piece she calls “Midwives: Bringing it On Themselves.” I rarely quote entire posts, but this was so spot on, I can’t help but write it all out for you here. I’m going to interject between her points. She says:
“As a Michigan tax payer, I support strict regulation of homebirth midwives if they are to receive Medicaid reimbursement and be covered by insurance. The truth of the matter is that the midwifery movement has brought this situation on themselves.
Sara was once an avid home birth advocate, in her words, “Before I got pregnant and had a baby, I was convinced that I was going to have an all natural midwife assisted birth. I knew lots of women who successfully homebirthed with lay midwives, and was close to a retired DEM. I knew all the catchphrases about birth being a normal event, about doctors being cut happy, and rambled on about the Dutch ad nauseum.” Like me, she became disillusioned by the Natural Birth Community (NBC) and has chosen to speak out about her discoveries. Her list of reasons CPMs/DEMs are in such negative light right now includes:
- Not transferring high risk clients to obstetrical care.
This happens all the time and is something I’ve done (not done) myself. I attended a twin home birth and the births of women with very large babies. It took a really out-of-range woman to get herself risked out. I’ve watched as midwives have taken and kept high risk women over and over again.
2. Describing many high risk conditions as "variations of normal" in order to promote an agenda that all birth is "as safe as life gets" regardless of the medical needs of individual mothers and babies.
Exactly. Saying that breeches and twins are “variations of normal” is absurd. Breeches and twins come with unique sets of complications that are anything but “normal.”
3. Refusing to set concrete and consistent educational standards for classroom and clinical training.
This has to be one of the most confounding parts of CPMs… why they can’t come up with standardized education requirements is baffling.
4. Refusing to require hands on clinical training in emergency births.
While there is some hands-on training, there isn’t nearly enough. I believe there should be some rehearsing at each monthly Peer Review or more frequently if your Peer Reviews are further apart. I believe different groups of midwives and students should work with each other in these scenarios so each woman gets an idea of how the other person works during an emergency because we never know who we might end up with at a birth. However, the midwives/apprentices that work together the most should practice so much each knows the others’ body memories and actions without thinking. I believe these scenarios should include shoulder dystocias, surprise breeches and twins (including calling 911!), postpartum hemorrhage, neonatal resuscitation, the umbilical cord falling off, a partial release of the placenta, placental fragments still inside the mom, mom freaking out, TTN, fetal distress, hypoglycemia in the newborn, calling EMS and role playing that scenario as well as giving report to EMS and RNs and OBs at the hospital. (I’m sure there are more I’m missing. But the Big Three [PPH, NR and shoulder dystocia] are often the only ones addressed. That has to end.) I believe the more experienced midwives should lead the charge to educate the less-experienced women and insist on these scenarios any time midwives, apprentices and students are in a group together, even if it is a social setting. Spend 20-30 minutes before or after a gathering to practice some scenario. In my experience and in talking to midwives, students and apprentices around the country, this aspect of midwifery care is sorely lacking.
5. Fighting every attempt to hold midwives accountable.
This is confounding! When a midwife does something wrong, for goodness sake, instead of holding a rally for her, hold her accountable via Peer Review and legally if necessary. What is with supporting all midwives merely because “there but for the grace of god go I”? It’s ridiculous and extremely unfair to the women who lose their babies or have their child damaged by an inept midwife… even if it was an accident. Sure, accidents happen, but we hold OBs accountable for accidents. Why aren’t we doing the same for midwives?
6. Fighting every attempt to regulate midwives.
Another confounding aspect of CPMs, insisting that all midwives receive the same education and skills training via the same mechanisms. It does suck there aren’t schools around the US for women to attend in person, but at least the ones that are out there could be similar in their classes and information imparted. That CPMs are permitted to take classes via mail from a variety of schools is just weird. At the least, they could all be MEAC-accredited schools, even though MEAC isn’t the be all and end all for the education of midwives in America.
7. Unconditional support for midwives under investigation or on trial when a baby dies. Creating a culture of animosity against mothers who speak out against dangerous midwives.
Mentioned above. And it is just awful mothers who’ve lost babies in home births are made to feel like crap for speaking out. We expect and encourage women to speak out about their hospital births… usually in the negative to validate the home birth culture… but any time a mom speaks negatively about home births, she is suspect and considered a troll or one of Dr. Amy’s minions. That has got to stop! Women who’ve suffered through their home birth experiences have every right to speak up just like women who’ve suffered hospital birth experiences. We would never consider silencing a woman telling her hospital trauma story. Why do we do that with our troubled/pained home birth mamas? It’s simply not fair.
8. Not speaking out against dangerous midwives. There is an intrinsic code of silence in the midwifery community. Even when they think a midwife is at fault, they will stand in solidarity with her because they mistakenly believe that prosecuting dangerous killer midwives in some kind of medieval persecution. The concept of midwifery is more important than ethics, safety, integrity, or human beings.
Again, mentioned above and agree 100%. I do think a large part is the “there but for the grace of god go I” mentality, but midwifery is still seen as a calling and with that brings an entire (often unspoken) spiritual aspect to the profession and it seems like heresy to speak out against the women who are a part of the group. It is disgusting to me how dangerous midwives are spoken about in behind closed doors yet are allowed to continue their path of destruction with women and babies. What about the protection of our clients? Don’t they deserve to know who is and isn’t operating within the standards of care and who flagrantly flaunts the boundaries of safety? Isn’t there a space between lying and slander? I believe there has to be.
9. Double standards:
These are brilliant.
- Saying that birth is as safe as life gets, and then switching to the statement that birth is inherently risky when something goes wrong.
- Blaming mothers for not doing "research" or "trusting birth" when a midwife fails to do her job.
- Using scare tactics to keep women from going to the hospital or seeking obstetrical care, then blaming the mother for not transferring when something goes wrong.
- Telling women that "babies die in hospitals too" when it is actually a midwife error that caused a homebirth loss, and had the mother been in the hospital the death would likely have been prevented because of the availability of technology.
- Wanting to be considered "professional" birth attendants, yet refusing to hold to consistent standards of education, scope of practice, oversight, regulation, and ethics.
- Wanting to receive Medicaid and insurance reimbursements but refusing to hold liability insurance.
- Saying they are not health care providers and do not practice medicine, yet want Medicaid reimbursement.
- Claiming to support women yet abandoning them if they speak out against dangerous midwives.”
I couldn’t have said this better myself.
Sometimes things we write take on a life of their own. Sara told me she scribbled these words down in a 15 minute break while her three-year old was watching Bob the Builder. Inspired, Sara… absolutely inspired. I wish I’d have said these words myself. Thank you for allowing me to share them here.