Home birth tragedy in North Carolina

When home birth is outlawed...

The recent death of a newborn baby girl during an attempted home birth in Charlotte, North Carolina, highlights just about everything that’s wrong with home birth as it is currently practiced in the U.S.

Though details are still somewhat sketchy, the situation seems to have been one of unlicensed midwives attending an illegal (in North Carolina) home birth. Complications arose, emergency care was delayed (possibly due to fear of prosecution) and a baby died.

The response from those already opposed to home birth has been swift and predictable. In the article, Dr. Amy Tuteur, a non-practicing OB and blogger in Boston who can be counted on to provide the ‘anti’ view on just about any subject related to natural childbirth, predictably blames home birth per se as the culprit.

But what about a legal system that forces a woman seeking a home birth underground and into the hands of questionably competent midwives who practice with little supervision and no link to the larger obstetric community? There are multiple levels of failure in this case, and there’s plenty of blame to spread around.

Home birth is easy to outlaw but impossible to eliminate. There will always be women who will insist on having their babies at home (and as I’ve written previously, there are some sound medical reasons for doing so), and fear of legal consequences isn’t likely to deter them.

So do we work to make home birth in the U.S. as safe as it is in much of Europe and Canada, or do we adopt a “tough luck–you got what you asked for” attitude when a baby dies? I’m a strong proponent of the former

25 Comments

Filed under Home birth, Politics

25 responses to “Home birth tragedy in North Carolina

  1. Hi Mark,

    I very much appreciate your thoughtful post, and your perspective is absolutely the correct one. Well said.

    The only adjustment is to understand that it was not an illegal home birth from the mother’s perspective. A woman may choose any setting for birth and may choose any attendant (or no attendant at all). There is no statute, no permit, no license nor ordinance requiring a woman to seek permission to choose a home birth, or her attendant, in any state in the United States… but in North Carolina the primary care provider serving women seeking the home setting is practicing in violation of the Medical and Nurse-Midwifery Practice Acts (we are in a minority of such states).

    I don’t really care if rates of planned, midwife attended home birth go up, go down or remain constant. It can be an optimal option for some women and not such a good one for others. I care that women are supported in making informed decisions. I care very deeply that women who seek a midwife attended home birth have access to trained, credentialed, licensed and regulated midwives and that the rest of the healthcare team does the best job they can when Plan A turns into Plan B. The only way to accomplish this today is to enact legislation in the remaining 23 states like North Carolina to license and regulate Certified Professional Midwives which enables an adequate supply of trained midwives and provides for regulatory oversight for public safety. Rates of planned home birth are accelerating all across the country and we have to manage our house. In North Carolina, we work to pass H522/S662 (The Midwifery Licensure Act) to achieve this end.

    I so enjoyed working with you at the Summit, Mark. I sure hope we delegates converge again and I look forward to our next meeting.

    Best,

    Russ

    Russ Fawcett
    Vice President, North Carolina Friends of Midwives

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    • Hi Russ,
      Thanks for setting the record straight about the legality of home birth in North Carolina. Though home birth isn’t technically illegal, it’s kind of a moot point–when laws prohibit midwives from attending “legal” home births, it’s a set-up for bad things to happen.

      I certainly didn’t mean to single out the Tar Heel State as the only place something like this could happen. We had a similar tragedy—a poorly trained/equipped midwife, an emergency, and a baby who died—right here in relatively home birth friendly northern California a few years back.

      I agree competely with you on the need for more uniformity in midwifery training and licensure. The Consensus Statements from the Home Birth Consensus Summit, which you and I participated in in Airlie, Virginia, in October, nicely sum up what needs to happen for home birth to become a safe birth option for American women. Statements 2, 4 and 6 in particular address those needs. (For those not familiar with the Summit, I’ll make a link to the Summit statements in my next post.)

      Thanks again for your thoughtful comments – I hope our paths cross again soon!

      Mark

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    • You do not speak the truth Russ. Passing H522/S662 is NOT the only way (nor should it even be considered a way) to ensure women access to licensed, credentialed, experienced midwives. Certified Nurse Midwives are legal in ALL 50 states – AND we have the training, experience, credential and in many states, license, to attend home births. There’s something else we have as well…the education that is comparable to midwives in every other developed country as well as an almost 100 year history attending women and babies in this country. There are currently 11 CNMs that are practicing homebirth legally in North Carolina – from Asheville to Wilmington. I happen to know AT LEAST 20 more CNMs that would open a homebirth practice tomorrow if they could do so without the requirement of an MD signature on their licensure. LIFT that requirement – and women will be well taken care of by Certified Nurse Midwives within the home setting. I guarantee it.

      Deb

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      • Deb,
        About the MD supervision–is the issue keeping CNMs from doing home births in North Carolina the difficulty in finding a doctor to provide supervision, or that the supervision itself is onerous? Or something else?
        Thanks,
        Mark

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      • Hi Mark,
        The issue here in NC is duo fold.
        Firstly – we are one of six remaining states in the country that have MD supervisory language written into our rules/regs for licensure. This is problematic on a number of levels not the least of which is the fact that it requires the MD to “sign their life away” to back up a CNM. I can tell you that if I were an MD – not so sure I would do it unless that CNM worked across the hall from me ;).
        New York and Vermont changed their regulatory language this past year. In those states and others, CNMs can practice without an MD signature on their license however they are required to have a very detailed transport plan in place for emergencies as well as a professional responsibility to practice within their scope of practice, and consult, collaborate, and transfer care appropriately
        Secondly – and this goes to back to the first issue – there are only three or four (can’t remember exact #) MDs that will currently sign the approval to practice license for Certified Nurse Midwives here in NC. They practice in the Asheville are, High Point and Raleigh. The physician who signed my approval to practice (CNM license) as my back up is Dr. Henry Dorn. An amazing OB/GYN who has a thriving private practice in High Point. Henry is currently being required to testify before the North Carolina Medical Board due to the fact that he is currently backing up seven of eleven CNMs that are practicing homebirth here in our state. There is no requirement that our back up physician for licensure purposes needs to be within a certain distance of us. We are actually required to have a PRIMARY and SECONDARY back up MD. The secondary back up MD is for the purpose of handling the back up when the Primary MD is unavailable. It is RIDICULOUS language.
        I live in Chapel Hill, NC. I moved here in 2006 and took a job as faculty at UNC within the Division of Midwifery. I left that position in 2010 to open my own practice doing homebirth and GYN. I approached two MDs about back up – the first was located only 25 min from my practice site. She was willing to do it – until she read the regs – and it completely turned her off for liability reasons. I then approached Henry – who practices an hour from my practice site. He was willing to sign my license. I then approached the MFM department at UNC Chapel Hill and asked that they support me for local cases – consults, collaboration, referrals, transfers of care and transports – since I knew that they would be my main resource. They agreed and I am so very grateful to them for this. They were also supportive of my getting hospital credentials but the hospital credentialing department denied me due to ACOG’s stance on homebirth. However, despite the very professional, seamless and appropriate plan I have in place with UNC, my practice could fold within a few months if Henry Dorn is ordered to stop backing up CNMs. This is just sad. I can only hope that the medical board will come to understand that Certified Nurse Midwives are the ideal caregiver for home birthing clients and will continue to support Dr. Dorn and what he is has been willing to do that very few others have been willing to do.

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      • Do you think there is sufficient nurse-midwife-power in NC (and nationally, if you know those figures) to accomodate the demand for home birth, if barriers to doing so were removed? How many annual home births are there in NC?

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      • We completely support the efforts of North Carolina affiliate of the American College of Nurse Midwives to remove mandatory supervisory requirements from CNMs in North Carolina and agree that North Carolina consumers need more CNMs serving women in all settings. We have steadfastly maintained this position since 2008 when in the House Select Committee on Licensing Midwives we advocated for the independent practice of CNMs in addition to licensure for CPMs. Improving access to CNMs as well as providing legal access to CPMs are both essential for increasing safety and access to care for NC mothers.

        When I say that the only way to fully manage planned attended home birth is to license and regulate CPMs, it is the only way to fully meet the consumer demand. In the best states in the US for credentialed midwives, where CNMs do not need a mandatory supervisory contract to be permitted to practice and attend home births, it remains the CPM that is the primary care provider. In the U.S. with over 10,000 CNMs we see ~2/3 of home births attended by CPMs (about 2000 credentials have been issued since 1995). So, in making priority decisions related to assuring access to trained, credentialed, licensed and regulated midwives for home birth, the priority has got to be the CPM.

        Simply put, after H522/S662 passes, there will be ~30 North Carolina CPMs licensed and regulated who can attend ~900 births per year and this is the priority. This will ensure North Carolina midwives meet the training requirements set forth by NARM, and offer North Carolina consumers more choice of safe and regulated midwives. We will be happy to endorse and support the needed changes to the Nurse-Midwifery Practice Act as put forth by NCACNM whenever it is considered. I think it would be terrific to maximize access to CNMs for the home birth community, but no state has enough to meet the need.

        We fully support the right of all North Carolina mothers to make the best birth setting choice for her, and we support the mother’s right to choose her care provider. All North Carolina mothers deserve access to hospitals, birth centers, and the home birth option with a trained, credentialed, licensed and regulated midwife.

        Russ

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  2. Here’s an editorial piece I wrote for the Charlotte Observer that answers your questions above, Dr. Sloane.

    Best,
    Deb O’Connell CNM, MS

    To the Editor:
    Your recent article on homebirth (“Report awaited on baby’s death” 12/31/2011) begs the question of why there are so few Certified Nurse Midwives practicing homebirth in NC when studies show that CNMs have better outcomes than doctors or non nurse midwives for births attended at home or in the hospital.
    The most recent CDC data (2007) shows that planned homebirth with a non nurse- midwife has a neonatal death rate that is more than eight times higher than with a certified nurse midwife (0.34 v. 2.62 per 1,000 births). That same study showed that CNMs have the lowest neonatal mortality rate of all providers for home and hospital births. Comparing home birth to hospital births, a 2009 Canadian Medical Association Journal study showed that planned homebirth with registered midwives have very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital births with a midwife or a physician.
    Studies show that the issue is not the safety of homebirth, but rather the risks associated with having your baby attended by an unlicensed, uneducated, inexperienced lay person calling herself a midwife.
    Certified Nurse Midwives are masters- degreed, university- prepared professionals. CNMs that choose to do home birth have had experience in hospital management of high and low risk pregnancies and thus have the knowledge, experience and training to recognize when a normal pregnancy turns abnormal.
    I have 12 years’ midwifery experience, have attended over 900 births, thousands of labors, and have worked in a University faculty practice and community hospital midwifery practice. I own my own homebirth practice, carry malpractice insurance, am a member of the local Chamber of Commerce, take continuing education classes, stay current on licensure and certification and precept Duke and UNC- Chapel Hill Nursing and Midwifery students. How do we increase the number of CNMs like me doing homebirth? Eliminate the supervisory language that is required for nurse midwives to practice midwifery in North Carolina. North Carolina’s midwifery law requiring a medical doctor to supervise a certified nurse- midwife is antiquated and limits women’s access to CNMs. Only five other states still require supervisory language for nurse-midwifery licensure.
    Nurse midwifery is the gold standard for midwifery care in the United States and eliminating supervisory language for midwives is a major first step to protecting the health of babies and their mothers choosing homebirth.
    Deb O’Connell CNM, MS

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    • Hi Deb,
      Thanks for your comments. My daughter is headed for a career as a CNM, so I know that what you say about the quality of training CNM’s receive is very true. The opportunity to deliver babies and to serve as a women’s health care provider can make for a rewarding career. Yours is a highly-skilled profession.

      Having said that, I think a certain amount of caution is in order when analyzing home birth studies. Comparing neonatal death rates between CNM-attended births and those attended by “non nurse-midwives” may not be the fairest assessment of the risks involved. While CNMs are a relatively homogeneously-trained group, “non nurse-midwives” can include anyone from well-trained CPMs (Certified Professional Midwives) to those women sometimes referred to as “lay midwives”—women whose formal training in obstetric care may be limited to what hands-on experience they have managed to acquire. Comparing the outcomes between those two groups isn’t really fair to all groups of non-CNMs.

      The Canadian experience you mentioned is instructive. Janssen and colleagues in British Columbia (references below) showed that well-trained CPMs working in an integrated maternity care system can have excellent birth outcomes, both in home and in hospital. The Canadian system is one the rest of us would do well to study.

      I agree with you. Good outcomes depend on the skill and training of the people attending births in any setting, and the infrastructure and collaboration that exist (or don’t) when emergencies arise.

      Take care,
      Mark

      Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee Sk. Outcomes of planned home births with registered midwife versus attended by regulated midwives versus planned hospital birth in British Columbia. CMAJ 2009;181(6):377-83.

      Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 2002;166(3):315-23.

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      • With all due respect, Mark, the CPM credential is an American credential.
        Please refer to the below link to see the legal status of midwifery in Canada.
        http://www.cmrc-ccosf.ca/node/19
        Midwives in Canada are University-trained (as they are in every other developed nation). Their training is similar to Certified Nurse Midwives with training in the management of both high and low risk pregnancies as well as hospital and out of hospital experience.
        I have read both the Janssen articles and I do not see where either of these articles supports or infers that CPMs working within an integrated maternity system can have excellent birth outcomes.
        Certified Nurse Midwifery is the gold standard of midwifery here in the United States. We have close to a 100 year history and our profession began with attending women/babies within their homes. Homebirth is the SAFEST when attended by a Certified Nurse Midwife who is practicing within her scope, is licensed and credentialed.

        Best,
        Deb

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      • Department of corrections/mea culpas:
        You are of course correct, Deb. The training of the registered midwives in Canada (who are not CPMs) is similar to that of CNMs in the U.S. and as such the studies I cited do not necessarily apply to the situation in the U.S. The studies do though speak to the importance of an integrated maternity care system in home birth safety.
        Mark

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      • Ida Darragh, CPM, LM

        Actually, there are 90 CPMs in Canada. There is a mechanism where someone with a CPM credential can challenge the University requirement, and with a few extra courses specific to Canada get the license there. The primary difference is that in Canada, midwives must be prepared to work in hospitals, birth centers, or homes. The additional training provides them with the skills to attend hospital births, which is not part of the CPM training.

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  3. Ida Darragh, CPM, LM

    Your comments are mostly on the mark, Dr. Sloan. The problem lies with a health care system that forces home birth families to seek underground midwives for home birth. There are three midwifery credentials that are accredited by the National Commission for Certifying Agencies, and North Carolina only licenses midwives who hold one of those credentials. Ms O’Connell is correct that removing antiquated supervisory language is one solution to the problem of restrictions to care. The other solution, mentioned by Mr Fawcett, is the licensure of Certified Professional Midwives. CPMs are licensed and providing excellent care in 27 other states, including all of the states neighboring North Carolina. When midwives with recognized credentials are allowed to practice legally, the families choosing home birth will have many more available caregivers and the state will have a system of accountability and regulation for those who are offering those services.

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    • Thanks, Ida. I’ll be addressing the legal end of things in an upcoming post.
      Mark

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    • Ida –
      Please show me where CPMs are providing “excellent” care. It’s certainly not in Oregon, Colorado, or Virginia where they are LEGAL. Also, why hasn’t MANA released their statistics if CPMs all over the country are providing such “excellent” care??? They should be shouting it from the rooftops – yet they are silent.
      Deb

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      • Hello Deb,

        It is a false rumor that the Midwives Alliance is “hiding the data.”

        MANA has a large and uniquely detailed dataset on midwife-led births occurring primarily in out-of-hospital settings. The data is accessible to researchers who are interested in conducting studies on the outcomes and practices associated with midwife-led births. The Midwives Alliance invites researchers to apply for access. (The application form and further details can be found on the Division of Research website at mana.org/DOR.)

        MANA’s Data Access Policy is careful and fair, allowing qualified researchers to study our data when their research questions match the kind of information we collect. This is the way large databases are usually managed. MANA collects data; it does not conduct research. So in order for our data to be utilized, researchers must study it. And indeed, researchers are currently using our database, and several others are in the application process. And we welcome all qualified researchers!

        As to the safety of homebirth with skilled midwives of all types (CPM, CNM, CM, LM and RM), not only has homebirth been proven safe in numerous studies in the US and abroad, but homebirth is on the rise in the US with a 26% increase noted between 2004-2008, and rising.

        It is important that we evaluate homebirth not so much via anecdotal information, but rather, using the best evidence available. This kind of evidence exists. Please refer to an annotated bibliography with citations and critical appraisal of original studies on homebirth available at .

        After a careful review of the literature you will note studies on out-of-hospital births consistently show similar perinatal outcomes, including rates of perinatal mortality, to hospital births. Most studies also document fewer interventions, fewer severe lacerations, fewer operative births, fewer lower Apgar scores, fewer babies requiring resuscitation, and increased rates of breastfeeding for the homebirth groups. The issue is no longer about the safety of homebirth. Research has proven that with a skilled attendant homebirth is as safe as birth in the hospital setting.

        As Mr. Fawcett pointed out in an earlier post, a woman in the United States does not need to seek permission to choose the place of her birth nor her birth attendant. As an American, those choices are inherent in her reproductive rights. I also agree with you Deb that supervisory language restricting CNMs should be removed from state statutes so that women’s rights can be fully honored and nurse-midwives can practice to their full scope.

        I encourage consumers and professionals alike to make use of the wealth of solid literature on homebirth. I also welcome qualified researchers to review the application materials for using MANA’s database, available online at http://mana.org/pdfs/DORHandbookForResearchers.pdf

        Geradine Simkins, CNM, MSN
        President, Midwives Alliance

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  4. Jeremy Galvan

    I as a Home Birth consumer and advocate believe very strongly in my ability to conduct research and make an educated decision about not only the Doctor I choose for my family, but for the Midwife who attends the birth of my children.

    As a Paramedic I respect the idea that birth outcomes can be related to the skill of the provider however I would caution anyone from implying that the Midwife and his/her training is always at fault in a bad outcome. Sometimes having all the training in the world doesnt make any difference. I as a Certified and Licensed Paramedic have had many occasions where I arrive onscene to find a very alive person… only to be doing CPR as I am walking in the door at the Hospital. Its not my training or skill level that is in question, but sometimes nature wins. My license allows the Board to review my case and make sure I followed all the rules I am supposed to follow. If the board finds I broke no rules but they could improve something… having licensure in place is what allows for a state wide change to my profession and the care we give.

    When it comes to Home Birth educated people are doing the research and choosing CPM’s to assist them. People like my wife who is college educated, and myself a licensed Paramedic chose a CPM for a number of reasons. She was very experienced, came with excellent recommendations, and lived close to us. The closest CNM available was over an hour away. That was unacceptable to us. In addition my state has over 200 Nurse Midwives licensed and only 5 who will do home birth. That profession although very qualified to manage a Home Birth is not interested in serving families in that way. Maryland passed a Law allowing CNM’s to do home birth without OB permission. It hasnt changed anything here.

    I believe in Education, training and re-certification. Licensure sets a standard that the state can enforce. Without it, there is no standard and it makes it difficult to ensure certain standards are being met when Home Births are chosen.

    A few facts:
    1. Home Birth is on the rise.
    2. CPM’s are licensed in 26 states and have been for more than 30 years. No state has ever gotten rid of CPM’s once they were legalized.
    3. CNM’s and CPM’s trainings are accredited thru the same organization.

    If CNM’s or OB’s have concerns about Home Birth I would encourage them to focus on licensure as a means of making Home Birth as safe as possible. Suggesting CNM’s be the only Home Birth midwives is not a realistic suggestion as Maryland clearly shows.

    Thank You for comments Dr. Sloan. It is refreshing to hear your words come from an OB.

    Jeremy Galvan
    Maryland Families for Safe Birth

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    • “As a Paramedic I respect the idea that birth outcomes can be related to the skill of the provider however I would caution anyone from implying that the Midwife and his/her training is always at fault in a bad outcome. Sometimes having all the training in the world doesnt make any difference. I as a Certified and Licensed Paramedic have had many occasions where I arrive onscene to find a very alive person… only to be doing CPR as I am walking in the door at the Hospital. Its not my training or skill level that is in question, but sometimes nature wins.”

      I have been saying this for the LONGEST. And I had a homebrith loss myself over 6 years ago. Sometimes things are just out of your control no matter how skilled you are. I support CNMs and I also support CPMs. But on the whole I support a woman’s right to choose who attends her birth and where she births at. Restricting those rights in ANY fashion goes against the very principle of our freedom of choice.

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  5. Rain

    There is no way to deny the fact CNM have better training than CPMs and if you don’t believe that is true you have to at the very least agree they are better regulated and governed. MANA is a joke and CPMs regularly get away with substandard care a CNM or OB would lose their license over. I agree with Deb. CPMs aren’t the answer here at all. Help facilitate OBs to back CNMs who attend home births or lift the restrictions in most states requiring CNMs to practice under an OB and you have competent home birth midwives who can carry pitocin for PPH and resuscitation equipment and oxygen legally! They have training to help them prevent and identify serious complications and they won’t be afraid to transfer or risk women out before it gets to that point. Even perhaps look towards Florida for a good model for an LM system. In a first world country there is no excuse or reason for having CPMs. It’s a waste of time as in their current form the CPMs will never meet the standards set around the rest of the world for home birth midwifery. The other issue we seem to be dealing with in the US is because CPMs have such an “us versus them” mentality they are convincing women to “trust birth”. Convincing women who should not be birthing at home they are simply a “variation of normal”. That cayenne pepper prevents PPH, garlic kills Strep B, babies don’t need oxygen as long as they are still attached to their placenta. This is what really makes the American CPM dangerous especially when an entire community of midwives adopts this cultish behavior as has happened in Oregon.

    I would love to see home birth with a qualified midwife available to all women who qualify for it, but I do not want to see what is happening in the extreme midwifery circles happening in every state. I myself plan on having a home birth but it will be with a CNM or a LM with a nursing background in California. I don’t need someone to help me through a problem free birth. None of us do! A woman can have her baby all by herself in the bathtub if everything is going great. What I want is some one there who can help me and/or my baby if things don’t go so perfectly and that is what a midwife or an OB should be. Someone who allows a woman to birth on her own until a problem arises, but who has tremendous training and skill to help if needed. Trust birth is a dangerous mantra the majority of CPMs, DEMS and lay midwives cling to. Until we have professional who don’t receive training in magical thinking I fear for the future of home birth in the US.

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    • Sherry DeVries

      Rain,
      I would like to address your idea of unequal education between the CPM and the CNM. The CNM spends at most one semester in her undergraduate nursing program studying maternity care. In a semester system that would mean somewhere between 15 and 18 weeks. That CNM student then spends 4 semesters full time studying Maternity care. This time frame equals about 1 year and 8 months. The majority of CNM students spends that time within the walls of a hospital setting developing that specific skill set and do not spend any time gaining a skill set in out of hospital birth.
      In looking at the CPM training these students spend between 24 and 36 months or 2 to 3 years learning maternity care. That training time for the most part is spent in the out of hospital setting developing that specific skill set.
      When we look at time of training the time frames are pretty equalized. The extra time the CPM student spends in training is comparable with the nursing student spending time learning fundamental assessment skills.
      It is interesting to me that a CNM who graduates with zero exposure to the out of hospital birth setting feels adequate training within that setting. It would be unthinkable for the CPM to think they have adequate training to help women in the hospital setting. Caring for women in reflection of birth setting requires on the part of the midwife a specific skill set and the training that matches that skill set.
      Your statement “It’s a waste of time as in their current form the CPMs will never meet the standards set around the rest of the world for home birth midwifery.” It is a bit bewildering to me what you are exactly talking about here. If you are speaking of the new ICM standards for midwifery education ACNM has a bit of work to do in the education department as well to meet the minimum requirement of 3 years if we speak purely of midwifery education.
      There is a philosophy that nursing needs to precede midwifery training. The opposite philosophy is that nursing is not midwifery and midwifery is not nursing. When you set one as a criteria to the other you are mixing apples and oranges in relation to education.
      Sherry DeVries CPM, LM, CNM, MSN

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  6. I couldn’t agree more, Rain – thank you.

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  7. Linda McHale

    “Trusting birth”, is not something only CPMs say. It is a mentality that needs to come back to birthing women. Fear of birth has taken us to numbers of C sections and epidurals that are abusive. When American women start to trust their bodies to birth, they will make clear choices about where and with whom they want to birth. Home birth numbers will skyrocket and ALL home birth midwives will flourish. The same way women need to trust birth, caregivers need to believe that women are smart enough to make their own choices. One midwife bashing another does not help women to get the birth they desire. Instead it limits choices and gives the public the impression that all midwives are not safe. Respecting each other in our diversity would be a good way support birthing women.

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  8. As a homebirth mother, a homebirth grandmother, and oh yeah, a homebirth midwife I am not the least bit interested in the bluster around the letters after your name. Anyone can learn the basic skills and knowledge to assist the birth of a baby and provide emergency care when needed and it does not require four years of liberal arts or an advanced degree to learn it. But everyone cannot be a good midwife. Institutions, whether they be schools or hospitals, cannot teach you what it takes to be a good midwife who can create a safe space around a woman so that she can dig deep and birth her baby with confidence. What that takes is the quiet to listen, the time to know a woman, the patience to wait, the faith to believe in birth and in a woman’s ability to birth, it takes the wisdom to enter the room without fear but to act when your fear is founded, it takes intuition, it takes courage, it takes unconditional love. No one’s training is going to make them a good midwife, that comes from within. Birth is birth, it has not changed and the only thing that has changed about women is their cultural warping around birth. Midwifery is about relationships, building a trusting working relationship with women, with families, with communities. Bashing other women (or men) healers because they are different than you is not building, it is destroying. There are no dead babies in midwives’ backyards, no hidden outcomes that warrant this hateful lashing out at CPMs as a threat to humanity. We are doing the work, we are doing good work, we were doing good work before we were CPMs, before we were licensed, before we were professionals. No number of years or degrees will make you a better midwife. When you can embrace the wondrous diversity of midwives which reflects the wondrous diversity of women and families and their unique needs, when you look into the eyes of a newly born wise one and feel honored to be there, then you know you are in the right place at the right time doing the right thing and you have a chance to be the best midwife you can be.

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    • “Midwifery is about relationships, building a trusting working relationship with women, with families, with communities. Bashing other women (or men) healers because they are different than you is not building, it is destroying. ”

      I could not agree with you more.

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  9. Free

    So true, we need to make homebirth safe, and the transfer if needed be respectful.
    I have had two unassisted births. In Australia there are a few independent midwives but confusion over registration. The hospital system is a mess with not enough beds for the increase in births. All around its a prelude to disaster.

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