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Guest Post: Licensing Midwives

My dear friend Colleen Scarlett, LM, CPM in Miami, FL wrote a comment to my "Dandy Commentary Continued" post, but it's so fantastic, I needed to make it a blog post itself. Here, she says exactly what I wish I could say. Whatever she says below, hear me saying, "Me, too!"... because I am.

"I'm trying to understand the logic behind not licensing midwives. What I hear, when you get past the rhetoric, doesn't make sense to me.

When I hear "Licensing limits who we can take care of!" I hear, "I want to be able to take on high-risk cases!" Because, having a license has allowed me to take care of any woman who CAN be expected to safely birth at home, including women on Medicaid and with insurance. While yes, women expecting twins, breeches, and who have hypertension or diabetes cannot be taken care of at home, SHOULD we actually be doing that? And, aren't low income women especially deserving of midwifery care? Do they KNOW what low income women go through seeking out a provider? Or how they're treated like cattle once in the obstetric system? Or does freedom of choice only apply to the middle- and up class? There's a reason why the vast majority of women having home births are white, middle class, and college educated.

When I hear, "Licensing midwives doesn't honor the traditional paths into midwifery!" I hear, "I can't be bothered with devoting time, money and effort into midwifery school,.....I want to start as soon and as cheaply as possible!" The fact that someone can "self-study", catch a few babies, sit a ridiculously easy exam, and call herself a midwife makes me cringe. The fact that a midwife can start practicing and not know how to start an IV or suture makes me want to scream.

When I hear "It's the woman's responsibilty to make the right choices for herself and family!' I want to scratch my eyes out. Yes, she IS responsible, but SO. ARE. WE. We are ultimately responsible, for her health and safety, and for her baby's. We need to be able to provide her with good, safe care. We need to be able to work with the system, not against it. We can kick and scream about how horrible the obstetric system is til we're blue in the face, but it sure is nice to know they're a few miles down the road when the shit hits the fan.

I LIKE being licensed. I LIKE being able to have take Medicaid and insurance, because more women can choose a home birth without denying herself and her family, or stressing about paying their bills AND me.

I like being able to have a lab account, and a nifty lockbox on my office door, and I like being able to run labs and cultures in my office or at a clients home, and not having to send her to a clinic or doctor.

I like being able to call a back up OB and know a prescription is being faxed over to the client's pharmacy of choice.

I like being able to order, and adminster, IV antibiotics for GBS+ women, and not having to pretend GBS is no big deal because I don't know how to give an IV or because it's illegal for me to have them.

I love the fact that I can carry pitocin, and methergine, and O2, and sutures and Xylocaine. I love that I don't have to pretend herbs are just as effective in stopping a hemmorhage, or that seaweed is an acceptable alternative to suturing.

I like being able to walk into a hospital with a client in labour, with her chart in my hand, and I like being able to give report without fear of prosecution. I like the fact that in the rare instances of emergency transport, I don't have to make up a story for the EMTs, or clean up the evidence before hiding in a closet before they arrive. I like being able to ride in the ambulance with her, and monitor heart tones. And honestly, the EMT's would rather have some one that knows how to take care of a labouring woman, because Lord knows, they don't know jack about catching babies, and would seriously rather not have to contemplate that during a transport.

I like not having to wait, agonizingly, until she's a train wreck before I make the decision to transport.

Maybe those who try to convince everyone to "trust birth" are trying to deflect the attention away from what DEM's are lacking.......education, skills, legality, access to medications.......perhaps those who try to convince others that midwifery without collaboration with the obstetric system is more "authentic" or "traditional", to make up for the fact that they have no access to it? Some sort of delusion that all you need for a safe birth is enough trust, and if something goes wrong, it's actually the WOMAN'S fault, for not trusting, for having fear, for not speaking up, for not listening to her instincts.

I know when I first started my midwifery education, I was enamored with the concept of the "Traditional Midwife", the Mountain Granny with her herb garden, teas, tinctures amd poultices, her gnarled hands with years of oral tradition and apprenticeship under her ample apron, her basket of knitting by her rocking chair while she patiently waited for the baby to come. But then I grew up.

Our amazing tradition of midwives, our Martha Ballards, our Anne Hutchinsons, Miss Mary Coleys and our Gladys Miltons, our Ina May Gaskins, have given us centuries of knowledge and skills, our philosophy that birth is natural, woman and family centered, and that skilled hands can save lives. But none of these great women EVER balked at the idea that more education, training, and skills were a good thing. And the beauty of learning from our past is that we can intergrate, learn, and apply our knowledge. That we can continue to learn, and grow, and provide increasingly better care to our women and babies.

I can't imagine that traditional midwives, all over the world, would NOT want to have access to hospitals, doctors, medicines, clean instruments, IVs, and the support of their governments health care system.......we have become so distant from the reality of childbirth, how many of us actually KNOW (not know OF, actually KNOW) a woman or baby who died, from a preventable cause, during or right after birth? How many of us go into our pregnancies filled with dread that we may not make it? We take it for granted that we, and our babies, are going to be just fine BECAUSE we have, maybe too much, access to modern medicine.

In the blog post ("Why state licensure is not the answer for midwifery"), an article ("Her Home-Birth Battle") is linked about a Massachussetts baby who died from GBS sepsis. I can't help but wonder, if the midwife was licensed and regulated, would she have screened the mother for GBS according to Mass. Department of Health and ACOG guidelines? Would she have had a back up OB, because the mother was a VBAC? Would she have sent her in for biophysical profiles and non-stress tests every 2-3 days when the pregnancy went post-dates? Would she have administered prophylactic antibiotics when the mothers membranes ruptured 3 days before labour started? Would she have been required by her laws and rules to transfer this mothers care to her back up OB when she began to show signs of infection? If she had, most likely this woman's baby would have been born alive.

I keep hearing, "Licensing does not make better midwives!" and it's true. I know some LMs who lack skills and judgement. And while I don't think licensing per se is going to make a better midwife, I think across the board, standardized education that meets, not just the minimum, but NECESSARY skills. Unfortunately, for the less than motivated, that means going to 20 births and reading some books is not going to cut it.

I love the profession of midwifery, I love our tradition, our philosophy, our dedication....I would really like to see us around for a long, long time."

Goddess, I love you, Colleen. Thank you for speaking my mind. You're the best!