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Thoughts on the AMA Homebirth “Ban,” Ricki Lake, and Midwifery

June 19, 2008

Just my initial thoughts on the birth-related resolutions that came out of the American Medical Association this week. I’m still kicking these around. I don’t want to get into the much bigger issues of homebirth safety, reproductive choice, or why the AMA felt these resolutions were necessary in this post, but am attempting to clarify my thoughts (and maybe yours!) on what the recent AMA resolutions may actually mean.

The AMA did what?
First, the AMA did not “ban” home birth. The AMA did recommend for adoption an amended resolution (205) on home birth, as follows:

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging of the concept that the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

While their policies and resolutions may guide their activities, these do not become the “law” in your state – birth is typically regulated on a state-by-state basis, with policies differing between states. The original resolutions mentioned developing “model legislation.” The amended versions refer to supporting state legislation, which is about the only way the AMA could effectively advocate in this area.

Aren’t they just saying that certain types of trained professionals should be the only ones to attend home births?
Not exactly. There were also two resolutions on the table (204 & 239) that were combined and adopted as amended. They stated that the AMA should “support state legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing and/or medical boards.”

The resolution also asks that the “American Medical Association only advocate in legislative and regulatory arenas for the for the licensing of midwives who are certified by the American College of Nurse-Midwives.”

In other words, the AMA is formalizing in the form of a resolution the notion that CNMs and CMs recognized by the ACNM should be the only legally practicing midwives, and that “lay” midwives (there is a lot of term confusion here, but CPMs, direct-entry, that type of thing) who are not regulated by a nursing/medical board (because they are not doctors or nurses by training/certification) should not be allowed to be licensed to practice under state regulations.

Several states already make these types of midwives illegal (or legal), and some states have not yet passed legislations making them il/legal. This resolution does not specifically address home births, although these unofficial midwives typically are the ones attending home births, while CNMs tend to practice in birth centers and hospitals rather than homes. These non-CNM providers typically do not have hospital privileges.

In effect, encouraging states to explicitly make non-ACNM-certified midwives illegal would probably reduce the pool of available homebirth providers in a given state considerably, even though this particular resolution doesn’t specifically address home births.

How can legislation ban home birth?
No state, to my knowledge, has made it illegal for women to give birth at home or in a non-medical environment. State legislation also doesn’t typically just express a feeling on something like birth – legislators want to *do* something. If the AMA is not going to support legislation criminalizing women (and I’m guessing they’re not), then their approach would be to support legislation that makes it illegal for providers to (charge for) attend(ing) home births. This would presumably take the form of “practicing medicine without a license” (for non-traditional providers) or sanctions/potential loss of license for CNM/MD/licensed providers who elect to attend home births.

Again, the AMA itself cannot make states do this, but state supporters of such legislation can look to the AMA and say, “See, the AMA says…” I wonder to what extent this would reduce the pool of women actually wanting and having home births vs. increasing tension between women and their healthcare providers (such as claiming an “accidental” home birth or avoiding healthcare altogether) and unassisted births.

If you want to know whether this ends up having any real effect, you need to watch for legislation in your own state.

What does Ricki Lake have to do with anything?
Ricki Lake recently did a film, “The Business of Being Born,” which prominently featured home birth (including her own). The AMA’s resolution on home birth, in it’s original version, specifically referred to Lake in the portion of the document that is intended to outline why the resolution is needed. This was removed prior to recommending that the resolution be adopted, but stated, “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as ‘Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.'”

In other words, if Ricki Lake jumped off a bridge, every other woman’s gonna want to jump, too. It’s sort of unseemly to call her out individually as somehow responsible for all the women who make this choice, not to mention insulting to women who decide that a home birth is their best personal choice. To assume that women are making these decisions just because “Ricki Lake said…” – well, it doesn’t think too highly of women, and yet it doesn’t do anything to educate them if you believe that Lake’s film is inaccurate or doesn’t present the whole picture with regards to choice of place for birth. It also doesn’t do anything to address the reasons why some women choose home birth in the first place.

Ricki Lake (along with Jennifer Block and Abby Epstein) has issued a response via the Huffington Post. There are a ton of other blog posts on this topic, so I suggest you browse around in this Google blog search.

39 Comments leave one →
  1. June 19, 2008 10:20 am

    Isn’t there another midwifery certification? Seems like I remember from our research that there were CNMs and another cert that I don’t recall. Does that fall under the label of ‘lay’ midwife?

    • Homebirth Advocate permalink
      November 25, 2011 10:55 pm

      LM? Grand Midwife?

  2. June 19, 2008 10:29 am

    W, there is CM (certified midwife) where the provider was not a registered nurse first but went through a program accredited by the ACNM – this is recognized as legal in a few, but not all, states. There are CPMs that fall under a midwifery organization (rather than a nursing one), and they tend not to have the same legal rights or hospital privileges. “Lay” is typically self-study or apprenticeship with no formal training. It’s rather confusing, given the closeness of the acronyms.

  3. June 19, 2008 1:59 pm

    Well written. thanks. I’ve linked it from my blog so my readers can become more informed.


  4. David permalink
    June 19, 2008 3:05 pm

    I’m not opposed to homebirth, but I dislike fundmentalists of every flavor. We’d ideally like our child to be born at a birthing center on the same campus as a full hospital. Since that’s not available in our area, we’re at a hospital birthing center. “Catching” the baby will be a CNM/NP who is a partner in an OB/Gyn practice (her partners are MDs).

    Why in a hospital birthing center? In case of that unlikely chance that there’s something wrong for mother or child that cannot be addressed at home.

    I’m having a hard time seeing anything controversial or sneaky about the AMA’s position here. I’m delighted that our CNM is also an RN and an NP with lots of formal training and would immediately reject as a caregiver a midwife trained through self-study.

    The OBs I know are not greedy bastards seeking to protect their bottom line. They’re dedicated professionals who really want what is best for their patients. Maybe I’m just lucky to know especially great OBs and to be at a hospital where the C-section rate is way below average (probably because many births are midwife-assisted).

    I have a copy of The Business of Being Born at home and plan to watch it tonight.

    • homebirth advocate permalink
      November 25, 2011 10:20 pm

      I’m curious what your Caesarian rate is? I’m always very glad when I hear about US hospitals who are Pro-Midwifery.

  5. June 19, 2008 4:05 pm

    David, it’s excellent that you were able to make a choice that mostly suits your family and the available providers/facilities. I think you’re right that there’s nothing really “sneaky” here – the purpose of the post was to try to explain what did happen, after reading several (IMHO) semi-misinterpretations (added: not malicious or deliberate, just not quite on target). The AMA continues to oppose home birth and non-CM/CNM midwives (and formalizes through these resolutions an intent to support legislation that put barriers to those things in place), and some women continue to want those options to be available to them regardless (and do not want them to become illegal).

    Of course, I never claimed that OBs are all “greedy bastards seeking to protect their bottom line” (and specifically noted that I wanted to talk about what the AMA did and not take on the huge discussion of provider type, safety, choice, etc. in this one post). Different people have different risks, different tolerances for risk, and different priorities, and must make their personal choices weighing these among whatever options are available in their location/price range.

  6. June 19, 2008 4:23 pm

    David, just a follow-up – I think perhaps you were responding to the Huffington Post piece with regards to “greedy OBs.” At first, I thought you thought I had said something along those lines. I should have given you more credit than I did initially! (feels like jerk) 😉

  7. David permalink
    June 19, 2008 6:37 pm

    Oh, your characterizations were fine. Those on the HP were not. I should have been clearer to which I was referring. No worries, Rachel. 🙂

  8. Meg permalink
    June 19, 2008 10:18 pm

    I find it sort of strange that Midwives only need to have their AA to be a midwife.

    • homebirth advocate permalink
      November 25, 2011 10:24 pm

      I find it strange that they need any training at all in issues NOT related to the pregnant mother, birthing process and post natal and maternal care.

      does your mechanic need an AA for you to feel safe about them fixing your tire or changing your oil??

  9. Susan permalink
    June 20, 2008 11:33 am

    A few necessary clarifications. Certified Professional Midwives (CPMs) are not “lay” midwives, they are professionals who are certified as CPMs by the North American Registry of Midwives (NARM), a certification body recognized by the same certification-accreditation body that recognizes the American Midwifery Certification Board, which certifies CNMs and CMs. Laws to license and regulate CPMs have been enacted in 24 states, while only 3 states license and regulate the CM credential. Check out the website of Citizens for Midwifery or NARM for details rather than rely upon what was written in this blog. Once a health care provider group is licensed by state law and certified, its members are no longer appropriately referred to as “lay,” which connotes non-professional health care providers.
    Also, although the AMA can hardly “ban” home birth on its own, Resolution 205 explicitly calls for it to draft model legislation and to support the passage of such legislation — whether at the state or federal level — that would disfavor home birth or birth in an unaccredited birth center (even when the birth center is licensed by state law). What form would that legislation take? One can only wonder, but legislation either requires something or prohibits something. The AMA could be drafting bills that ban home birth outright, that exact some sort of penalty on women who have home births (report her to the local child welfare agency, perhaps? charge her with child abuse?), or it could seek to prevent state or federal or private health care payors — Medicaid, Managed Care Organizations, etc. — from paying for home birth.
    Resolution 205 is not about legislation to make CPMs or any other type of midwife illegal, because Resolution 204/239 deals with midwives. So, why add another resolution talking about home births specifically if the intention was legislation regarding midwives. Also, don’t you find it unfortunate that the AMA is talking about physician control of all midwives, over CNMs and CMs. ACNM’s official position is opposed to physician control of CNM practice and ACNM encourages its members to work for legislation that frees CNMs from physician control. Check out the ACNM website. In most states, CNMs are regulated by the Board of Nursing, not medicine. No profession should be regulated or controlled by another profession and the autonomy of birthing women should not be restricted by state or federal laws.

  10. June 20, 2008 12:33 pm

    Thanks Susan! I started typing about the NARM before and got interrupted.

    Rachel, I have to say I disagree with your interpretation of the AMA resolution. I agree with Susan that is explicitly encourages state legislation saying childbirth must only occur in a freestanding birth center or in a hospital. This echoes the ACOG position statement, but as far as I know, the ACOG does not encourage legislation. Legislation would ban the practice. I am all for regulation, but I believe homebirth is a safe choice and I believe choosing homebirth should fall under the spectrum of informed consent and reproductive rights.

    I wish I had more time to put into this right now, but I don’t. I think that the practice of midwifery and homebirth is threatened on a state level in many areas of the United States, especially so called lay midwifery. As far as I know, midwives in most states already have to be backed up by a physician to a certain extent. Most states also have strict laws about certification and training. I don’t like the tone of some of the comments about midwives being unskilled. Most of the world is lucky to have an unskilled midwife to show up to their births. I am sure there are women in China and Myanmar that would love to have the unskilled midwife without an AA to show up and help them deliver their child. Let’s keep things in perspective, here.

  11. June 20, 2008 12:49 pm

    Thanks for commenting, Susan, although you’ll find that many of the issues you raise have already been addressed in the original post.

    I was certainly using a kind of shorthand with “lay” as a stand-in for “assorted types of midwives without formal medical/nursing training.” Yes, the CPMs are regulated by a midwifery body and may object to being called “lay,” but for the purposes of this discussion (about what the AMA actually did), the AMA effectively lumps CPMs and lay midwives together in resolution 204 (presumably because neither group has a nursing background, although AMA does effectively say that the CMs that ACNM recognizes are okay with them). “Direct entry” or “non-nurse” may have been a more appropriate shorthand, although that continues to run into the problem of the CM exception.

    Also, the “draft model legislation” language was removed from the resolution in favor of the “support state legislation” language, as noted in the original post.

    I’ve noted the same issues you raise about legislation needing to *do* something. I find it highly unlikely that states would criminalize women who give birth outside of hospitals or birth centers, for a number of reasons. As I explained, my prediction is that the AMA would support legislation that prevents non-CNM/CM midwives from advertising and charging for services and being paid by a client or otherwise reimbursed for attending home births. I have not suggested that I necessarily think this is appropriate, but it is my prediction about the form such legislation would take. My own state’s law says, “The general assembly recognizes that midwifery is a profession in its own right and that it is not the practice of medicine,” and so I suppose AMA would advocate against legislation that frames midwifery in such a way.

    Your question about why they would make a resolution regarding home birth if the intention was solely to regulate midwifery is a good one, and one worth thinking further about, I think. As I mentioned, laws preventing providers from receiving fees for attending home births would effectively reduce the ability of the non-CNM/CMs to practice, which may be part of the rationale.

    I do find the language regarding “appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing and/or medical boards” to be problematically vague. I’m not sure how they would expect to “oversee” midwifery practice, and the lack of explanation on this point is bothersome. Yes, there is usually a physician involved as a back-up provider, but I don’t see that this arrangement necessarily justifies the hierarchical structure proposed.

    I think this discussion is important, and I think the autonomy of women issue you raise is extraordinarily important, and is the most interesting to me personally. It wasn’t the goal of this post – I simply wanted to clarify and think through what the AMA did and what it might mean – but the autonomy/choice issues are huge and definitely worth exploring.

  12. June 20, 2008 1:04 pm

    Hilary, I think we were typing at the same time. The interpretation issue is definitely one I want to think about more – the form the legislation would take. I think they plan on supporting legislation that would prevent providers from attending home births. After reading some comments that the “AMA banned homebirth,” I wanted to clarify in the original post that the AMA doesn’t actually have the capacity to do such a thing – state legislations do. Therefore, keeping an eye on your state legislators is where the rubber really meets the road, so to speak. Again, I don’t think they’re right (the autonomy issue, again), but they aren’t the ones who would ultimately make the law. So you and I agree, that they are explicitly encouraging states to make home birth illegal – but they don’t have the power to do it themselves. I believe states would do so by regulating providers rather than criminalizing women. I also think such a move may result in an expanded underground of midwifery and/or unassisted birth which would be precisely contrary to what the AMA claims to want to achieve when they talk about what is and is not “safe.”

    Another thing I haven’t heard discussed that I’m thinking of now is that legislation could take the form of encouraging hospital/birth center birth through some type of incentive rather than making attended home birth more difficult to achieve, but I suppose that’s unlikely.

    Perhaps I wasn’t clear enough in my original post, that I was not agreeing or disagreeing with the AMA, as there are too many points to consider in one post, but wanted people to realize that if you want your voice to the contrary heard, it needs to be heard by your state legislators, because the AMA is certainly being heard by them, and will be referred to by them when a related bill comes up.

    Sort of off-topic: I think I love my blog commenters most when they’re disagreeing with me in a civil way and challenging me to think about things. I won’t always agree with you, but I’m glad you show up and but words on the screen. Thanks, ladies.

    PS-And Hilary, of course you’re right that most women do not have the privilege of choosing between hospital, hospital with midwife, birthing center, home, and the like. The AMA approach sort of assumes that people can afford hospital care, even aside from the question of wanting it. Everybody else, see Hilary’s post on the topic.

  13. June 20, 2008 1:43 pm

    Thanks for linking to me. I am so happy with this discussion, and I am glad you are enjoying it, Rachel. I am deep in discussion about birth practices, including this topic that I started a thread on, in a discussion board centered online class for my MPH on Culture and Health. I am so stoked!!! I was in so many arguments online at once, I hope I have taken the time to be civilized and evidence driven in most of my arguments. I was happy to see, when I checked back, that I wrote that the AMA is trying to ban home birth. When you see the chilling effect that the position statement on VBACs by ACOG had on the rate of VBAC attempts in the US, a combined position statement by the AMA and ACOG with an intent of model legislation thrown in there tends to make me quake in my boots a little.

    I am going to post a copy of the post from my class discussion board on the topic on my blog, too. Come check it out!

  14. June 20, 2008 6:20 pm

    There are two branches of midwifery in the US. Certified Professional Midwives (CPMs) are trained to provide maternity care in out-of-hospital settings, while Certified Nurse Midwives (CNMs) are trained as hospital-based providers.

    The credentialing bodies for CPMs and CNMs—the North American Registry of Midwives and the American Midwifery Credentialing Board—are nationally accredited certifying agencies authorized by the National Commission for Certifying Agencies (NCCA) and the National Organization for Competency Assurance (NOCA), which oversee the credentialing process for allied healthcare professions in the US.

    In its lobbying and PR efforts, organized medicine has confused the issue by misleading the public and policy makers into believing that midwives credentialed as specialists in out-of-hospital maternity care are, by virtue of the setting in which they work, “lay” midwives.

    As a result, many people are surprised to learn that CPMs are not only legitimate healthcare providers, but are the only healthcare providers whose education requires specialized training in out-of-hospital settings. Likewise, people are often surprised to learn that CNMs do not undergo training in out-of-hospital settings.

    Fewer than 1% of CNMs in the US deliver babies outside of the hospital, and those who do want to provide such care undertake additional training. Although this last point may seem counterintuitive, it actually makes sense. A midwife delivering a baby for an Amish woman in a house with no running water or electricity needs to have a different, though complementary, set of skills than a midwife delivering a baby in a hospital where all of the bells and whistles are readily available.

    For this reason, CPMs are also essential first-responders during natural disasters, pandemics or other events during which hospitals become inaccessible or unsafe for laboring women.

    As far as other differences between CPMs and CNMs go—CNMs have a broader scope of practice, which includes well-woman care and, in many states, prescriptive authority. The CPM scope of practice is limited to the childbearing year and to healthy women experiencing normal pregnancies and does not include the ability to prescribe medications. CPMs are trained as experts in risk assessment and transfer care when women develop health conditions or risk factors that make them inappropriate candidates for out-of-hospital birth.

    CNMs are licensed and regulated in all fifty states, whereas CPMs are licensed and regulated in just under half the states, with legislation currently pending in 20 states. The states that have opted to regulate out-of-hospital maternity care use the CPM credential as the basis for licensure. In the remaining states, consumers are left to navigate a “buyer beware” system in which the education, training and scope of practice for out-of-hospital midwives is unregulated and there is no mechanism in place, short of criminal prosecution, for screening-out genuinely “lay” providers.

    In 2005 the BMJ published the largest study to date on out-of-hospital deliveries managed by CPMs. The study found that out-of-hospital birth for healthy women using CPMs results in outcomes equal to those of low-risk women giving birth in hospitals, but with much lower rates of preventable and costly interventions.

    The study also included demographic data on women who choose out-of-hospital maternity care. The medical lobby likes to dismiss them as well-heeled, pampered and self-centered women who are in it for the “experience.” However, what the data actually shows is that CPMs care for a disproportionate number of low-income, rural and uninsured women, as well as women who choose home birth because of their religious or cultural traditions.

    In its resolution, “Increasing Access to Out-of-Hospital Maternity Care Services Through State-Regulated and Nationally Certified Direct-Entry Midwives,” the American Public Health Association (APHA) concluded that births to healthy mothers experiencing normal pregnancies can occur safely in various settings, including out-of-hospital birth centers and homes. The resolution further noted that births attended by midwives in out-of-hospital settings significantly reduce the costs of maternity care.

    In its resolution, “Expansion of Reproductive Freedom to Include Access to the Midwifery Model of Care,” the National Organization for Women (NOW) supports the right of women to choose midwives as their maternity care providers and to choose the setting in which they give birth.

    ACOG is also out-of-step with its British and Canadian counterparts. The professional organizations representing obstetricians in Canada and Great Britain actively promote out-of-hospital maternity care and encourage their members to collaborate with midwives who work in all types of settings.

    By contrast, ACOG not only opposes out-of-hospital birth, but actively discourages its members from working with CPMs. In states where CPMs aren’t licensed and regulated, the physicians who work with them are subject to disciplinary charges for aiding and abetting the unlicensed practice of healthcare.

    For all these reasons and more, ACOG and the AMA are on the losing side of this battle.

    • July 4, 2011 12:57 am

      Thank you, Dr. John for your intelligent articulation of the FACTS.

      We only wish more doctors were so dedicated to real change in our maternity care system.

    • Homebirth Advocate permalink
      November 25, 2011 10:59 pm

      If you are a physician of medicine, Dr. John, Please keep preaching the word to your colleagues.

  15. June 20, 2008 6:58 pm

    “CPMs care for a disproportionate number of low-income, rural and uninsured women, as well as women who choose home birth because of their religious or cultural traditions.” – John, that’s definitely an access and cultural competence issue that I think is important to remember. I personally know women who have chosen out-of-hospital births because of their religious traditions, and I believe they would do so again even if the legal situation prohibited it – their choice, of course.

    Just as a point of clarification, are you affiliated with the Big Push for Midwives campaign? I noticed you had linked to them.

  16. June 21, 2008 11:42 am

    Oooh, the “trying” was only supposed to be italicized – whoops!

    I wanted to add that I do know of midwives being arrested. There are ways to selective enforce illegal or allegal midwifery practices. I know of a midwife here who was arrested in an actual sting operation. She had invoked the ire of a local physician who was sued for malpractice for a homebirth transfer of hers. One that was technically illegal – I think a VBAC with no doctor consult. (Yes, that would be definitely breaking the law here. The doctor does not have to be present for the birth, but there needs to be a consult prior to the home birth, I am pretty sure.)

    But, after she lost her license, they set up a sting and had a fake couple call her and solicit her services, she agreed and was arrested. She is now on probation. I agree with her losing her license if she broke the local health law. But, just wanted to let everyone know there is means and a way to crack down on individual midwives if local people get it in their heads to.

  17. June 21, 2008 11:58 am

    I enjoyed your post and the comments. I have written my own response to the “resolutions.”

  18. Elliot permalink
    June 22, 2008 12:24 am

    A women’s youtube response to this in song format..

  19. Northwest Midwife permalink
    June 22, 2008 10:12 pm

    Thank you Dr. John (post #16). Very well said.

  20. June 24, 2008 3:33 am

    There are about 10, 20 or 30 CMs nationwide (okay maybe 50 or 100 but not enough), and they are licensed in only a few states (literally a few). Essentially the ACNM tried to take over direct entry midwifery and failed miserably). What the poster was thinking of is certified professional midwives There are more than 1,400 CPMs, and they almost all do home births, and they are licensed in 24 states.

    A common misbelief is that nurse-midwives will handle home births. Not true (with a few individual exceptions). Only 1% of nurse-midwife attended births are at home, with 2% in free-standing birth centers, and fully 97% of nurse-midwife births occurring in the hospital. Clearly we need to LICENSE AND REGULATE certified professional midwives, not outlaw them, thus marginalizing home birth babies (and their moms), by extension.

    Oh, and to respond to the ever-present myths about “the old days,” why did the childbirth death rates improve in modern times? Because of public health improvements, not obstetrical procedures. Back in the “old days,” people had higher rates of rickets and polio, and many many women had their organs smashed by corsets and far, far too many kids. There was no clean water running out of a faucet,or reliable birth control, and food supplies were spotty. Plus there were no antibiotics to cure infections. Even in those times, midwives got better rates than doctors.

    The fact is that c-sections carry a much greater risk of infections and greater risk of death for mother and baby (and second c-section or more are far riskier than vaginal). The fact is that good sicentific evidence shows “low risk” moms do no better in the hospital than at home. The fact is birth in the hospital is unnecessarily brutal.

  21. June 24, 2008 8:27 am

    Home Birth Advocate, I certainly agree with you that historical health comparisons are extremely difficult – changes in access to care, knowledge about health, techniques, infection control, population changes, etc. all make it more difficult to make direct comparisons.

  22. Petunia permalink
    June 24, 2008 7:09 pm

    I just delivered my third child 6 months ago and had unforseen, major complications. I had what is called Placenta Accretia (part of my pacenta adhered to my uterus) and had I delivered at home I would have died (I had major surgery, blood transfusions and was in ICU for 2 days). There was no way for me or my doctors to know this prior to my delivery. There is a reason 10% of women in third world countries still die from childbirth. People have an idealic perspective regarding how childbirth should go and if they are lucky there are no complications (for them or more importantly for their child). If you have access to a hospital for delivery you should not take the risk of having a child at home for reasons of convenience, “getting back to nature” etc.,..b/c you are being ignorant (and selfish by putting your child at risk)…and if you argue that doctors/hospitals are in it for the money etc. b/c yes they are, they have every right to earn a living doing one of the most stressful and most important professions, after all what is more important in life than your health and the safety of your child??

  23. June 24, 2008 8:31 pm

    Petunia, I’m intrigued by how closely your argument parallels those made by folks who are anti-choice wrt abortion, who frequently accuse women of having abortion for simple “convenience” and call them selfish. This ignores the myriad of reasons why women make these choices and strips them of any autonomy. I firmly believe that having respect for women as full and equal beings involves knowing that they may make bad (or good) choices, may make choices I don’t (or do) agree with, but that these are ultimately their choice to make.

  24. Melinda permalink
    June 25, 2008 11:50 pm

    A wonderful, far-ranging discussion. As a CNM in a state where I am nominally regulated by the board of nursing, perhaps I could shed a little light on some of the issues surrounding CNMs, homebirth, and physician “back-up.” Nevada where I live regulates CNMs as advance practitioners of nursing (APN). In order to even apply for a full-fledged license as a CNM I had to have a collaborating physician signature on my application with a letter from the physician saying that he approved of my protocols for practice and would be reviewing an agreed upon group of my patient records on a regular basis. Looking at the nursing practice act which regulates my practice in Nevada CNMs are generally recognized as knowledgable professionals, but having to have a collaborating physician puts my practice under the influence of the Board of Medical Examiners. That board has adopted regulations (note the board adopted the regulations, the legislature did not tell them to do specifically what they have done) which reguire that a collaborating physician work with no more than 3 APNs, and as a final regulation on the collaborating physician, says that “the collaborating physician is responsible for all medical acts commited by the advance practitioner of nursing.”

    In effect the medical board regulations create vicarious liability for the physician who works with CNMs. For the most part physicians are unwilling to collaborate with CNMs due to the vicarious liability. And because medical societies tend to disapprove of their own members working with anyone who is doing home birth the CNMs in Nevada can’t legally do homebirth, birth center birth, or hospital births because we can’t find a collaborating physician to work with us.

    So in our state, where the non-nurse midwife is not regulated, but there has been a judicial rulling that midwifery is not the practice of medicine, the only non-hospital option open to women is CPM or lay midwife–and yes we do have some who have not availed themselves of the validation of professional competence provided by participating in a certification process.

  25. Melinda permalink
    June 25, 2008 11:59 pm

    A note about the midwife with the “CM” from ACNM. There are now approximately 65 CM’s who have gone through the one direct entry program in the US that is accredited through the ACNM. Those CMs can currently legally practice in New York, New Jersey and Rhode Island. Other states have not been willing at this point in time to license the CM through boards of nursing. There are several states where legislation is being developed or is moving forward on the development of a board of midwifery for the regulation of all midwives.

  26. Kendra permalink
    June 26, 2008 5:21 pm

    I feel strongly about the right to choose birthing at home. My first son was born in a hospital with a CNM. We moved to a different state that regulates Licensed Midwives. I did the research about the safety of hospital birth vs. homebirth. My other six children have been born at home with an incredible L.M. She has delivered over 3,000 babies and never lost one of them. She has successfully delivered babies under extreme situations including two with prolapsed cord. She did a wonderful job at one of my deliveries when our son was born with the cord wrapped around his neck. He is a smart 9 year old today that scores above grade level in his academic testing. She also successfully cared for me when I hemorrhaged after my last delivery.

    Our nation has some of the worst infant mortality rates for an indusrialized nation. At the time of my research we were still placing in the bottom few of 23 nations. The nations with the best results were Japan and the Scandinavian countries that heavily rely on midwife attended homebirths. The Women’s Health Organization was also wary of c-section rates above 10%. Our national average is 25% while my home state is at an astronomical 42%.

    Back in the “good old days” one of the major killers was commonly known as child-bed fever. At the turn of the 20th century it killed 150 women for 1000 births. Learning the advantages of handwashing was an incredible boon to medical science.

    We are so often easily lead by what we think of as “normal.” Most people think of hospitals as safe and sterile. Most women in our nation do labor and deliver in a hospital so that is the norm. I would, however, appreciate people doing some major historical research before they decide that I am “ignorant and selfish.” A good place to start is with Dr. Michel Odent and his documented change of perspective in his French clinic.

  27. Miri permalink
    July 2, 2011 4:51 pm

    We did two documentaries on Homebirth, it might open people’s mind on the subject Homebirth stories at and Birth Dialouge at

  28. Homebirth Advocate permalink
    November 25, 2011 10:54 pm

    For anyone who is FEELING UNSAFE about homebirth and CPM’s or LM’s please read Ina May Gaskins book, Ina Mays Guide to Childbirth.
    The Midwifery Center that she and others founded in the 70’s, called The Farm Midwifery Center, which has taken over 2000 women (some of which would be considered high risk) have statistics that directly coincide with other midwifery practices around the world and from times past when hospital birth was not heard of yet.
    All of the practices, including those on The Farm, have C-section rates below 2% and spontaneous birth rates at around 98%, (which means that there was no induction needed in 98% of the women).

    Other stats from The Farm Midwifery Center include a high success rate for VBAC (in my estimates, probably around 99%), 0% maternal death, 0.39% neonatal death, transports to hospital 4.9%, Emergency transports 1.3%, preeclampsia 0.39%, breech around 3%. other stats can be found in the back of the book.

    I just want you skeptics to know that Ina May and her colleagues started delivering their own babies (and friends) before they were ever Licensed Midwifes. Ina May has used all the births she has ever attended, even before she was a midwife, in her statistics.
    Is that amazing to you? It is ground breakingly phenomenal to me!

    Read and research before you decide. The facts are there!


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