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Midwifery Regulation….. Do We Really Understand??????

Nebraska, the Good Life.... or is it? When it comes to homebirth and access to midwifery care, some may disagree on the good life. However, before we jump on the bandwagon of regulations for legal midwifery, maybe we should stop and think about what that truly means.

Most women don’t realize that not all midwives are created equal. In fact, there are three main types of Midwives:

CNM- Certified Nurse Midwives are advanced practice Registered Nurses. They must graduate from nursing school and then attend a midwifery school through the American College of Midwives. These midwives are regulated by their state laws regarding CNM and registered nurse regulations. In Nebraska, CNM must be under a supervision of a doctor and cannot attend home births.

CPM- Certified Professional Midwives are midwives who have attended an accredited MEEC (Midwifery Education and Accreditaion Council) midwifery school and who meet the requirements set forth by NARM. These midwives are also regulated by their state laws and/or the regulations (standards) of NARM. In Nebraska, these certifications are not recognized. However, in other states a CPM’s may own independent practices, but are still under regulations by the state and/or NARM. Some CPM may entered through a PEP process as well, Entry-Level Portfolio Evaluation Process.

Tradition Midwives- These midwives are called many names like Tradition, Lay, or Direct Entry Midwives. They may or may not have any formal schooling and have gained their knowledge through apprenticeship. This is how ancient midwifery was and is taught in many cultures. They hold no official certification in midwifery and they are not regulated by the state or other accredited organizations.

I mention the word “regulation” quite a bit. What are regulations? If you look up the definition this is what you’ll find:

“a rule or directive made and maintained by an authority”.

So what authority is over Licensed Midwives? Shouldn’t it be the pregnant woman who hired her????

In Reality, licensed midwives are accountable to the state and to their certifying organization. Depending on your state, many midwives are restricted in the following ways:

Many licensed midwives cannot:

  • Deliver a baby before 37 weeks gestation

  • Deliver a baby after 42 weeks gestation

  • Deliver a breach baby

  • Deliver a still birth

  • Deliver a baby estimated under 5lbs. or over 10lbs.

  • “Let” a mother go past 12 hours after waters open with stalled or no labor

  • “Let” you control all you maternal care

They may:

  • Be required to have all routine testing, exams and ultrasounds, regardless of evidence of that practice

  • Require the mother to have vaginal exams

  • Be more hands on

  • Require testing and exams on baby right after skin to skin hour

  • Require the placenta to be delivered in a certain amount of time.

Now this is not a discussion of whether licensed midwifery is “bad” or not. Some women may genuinely want more hands on intervention or a midwife who answers to a third party organization. However, many women think they are having a holistic way of birthing by hiring a licensed midwife, only to find that their midwife is bound by medicalized regulations.

This blog post is to inform you as the mother, so you can make an inform choice for yourself.

One question many people ask, “Well, isn’t regulation a good, so we don’t just have anyone practicing midwifery?”

  • Just because you have licensure/certification behind your name, doesn’t make you a good anything. It’s like doctors, nurses, or anything else. You have good ones who really love what they do and work with you, but are still bound by regulation. And you have bad ones, who don’t take the time and follow medical practice no matter the circumstance.

  • If they hold credentialing, at the end of the day, they DON’T work for you, they work for the state or for their credential organization.

  • Should the state really have authority over your birth?

  • And the biggest question “Why are we asking for the state’s permission? “

So feeling hopeless in our pursuit of legalized midwifery, we may think “At least it’s a step.” But is it a step in the right direction???? I recommend this article…. HERE

So what is the answer??????

Up until 100 years ago, birth was not seen a medical event. We need to recognize that in 95% of cases Birth is NOT a medical event and therefore midwifery (who take care of normal birth) has no place in medical practice laws. Kansas laws have a great example.

“In March of 1996 the Kansas Supreme Court ruled unanimously in favor of Michelle Ruebke and the practice of midwifery stating that "midwifery is separate and distinct from the practice of medicine." The court generously referred to "the historically separate practice of midwifery" and it's use of "traditional and time-honored techniques" as "not the practice of medicine or surgery even if some of these techniques fit within the technical definition of the practice of medicine or surgery." Additionally, the court wisely pointed out, "In their ordinary usage, the terms in KSA 652802(a) used to define the healing arts clearly and unequivocally focus on pathologies and abnormal human conditions. Pregnancy and childbirth are neither pathologies nor abnormalities."

We need to separate the practice of midwifery from medical practice. We need freedom for all midwives to practice according to what their clients, the mothers, truly want out of their midwifery care. Whether that would be care in a hospital, birth center, or at home.

This must start with you, the birthing mother, demanding the care you want and need for you and your baby. Take back Responsibility for your own BIRTH!!!!

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