Thank you for this response Jennifer.  I couldn't agree more!!

Christina Harris, RN
Federal Way, WA

On Jan 3, 2008 7:37 PM, <[log in to unmask]> wrote:

>
>  Those who live outside
> the US would likely find our laws governing midwifery quite confusing,
> as do many Americans. Just as in every other part of the world, the
> traditional caregiver at birth has been a midwife, trained in an
> apprenticeship model by other midwives (or sometimes the role just fell
> in to her lapb/c there was no one else to do it). The practice of
> midwifery has evolved in varying ways in different parts of the world,
> but what tends to be consistent is that midwifery is the standard of
> care almost everywhere except in the US, although the degrees of
> medicalization and of education certainly vary widely.
>
>
>
> In the US, when medical doctors undertook their smear campaign to
> discredit midwives (this is well-documented historically, even in their
> own texts), birth moved rapidly into hospitals and became routinely
> attended by OBs. The near-demise of midwifery as it had always been
> practiced created an opportunity for the new profession of
> Nurse-midwifery (nurses who receive further training in midwifery in
> amedicalized
> setting--although some certainly take it upon themselves to train in
> other settings) . While midwives had been primary care providers, not
> in? any way "below" physicians, CNMs cannot practicew/o the back-up (and
> therefore the control and consent) of a physician. While many CNM's practice
> quite autonomously and have extraordinary faith in women's bodies and birth,
> many in the birth community recognize that the practice in the US is much
> more accurately described as "med-wifery", due to the medicalized training
> that is not grounded in faith in normal birth. Further, b/c
> CNMs may lose their malpractice insurance if they practice outside of
> the medical model, their freedom to make decisions may be vastly
> limited.
>
>
>
> In the US, midwives who are not CNMs were traditionally referred to as lay
> midwives, but during the late 80's
> there was an organizational shift that brought midwives together under
> one credential--the CPM, or Certified Professional Midwife. Some
> midwives have not chosen to go this route, but many have. In some
> states, all midwives who are not CNMs are banned by law, in others,
> they are so terribly restricted, that they cannot practice effectively,
> in others they have excellent legal protection and in others there are
> no laws at all. CPMs are extremely well-trained and competent. The
> attempts to ban their practice are not meant to protect the public, but
> are a sideways attempt to ban homebirth (in many states only CPMs or
> other lay midwives attend homebirths), and to control the choices that
> women are able to make. In study after study, homebirth has proven to
> be SAFER than hospital birth in the US. This is clearly a threat to
> OBs, who charge a lot more money than midwives and whose role depends
> upon the fear that women have of the supposed inherent risk of birth.
> If women come to view birth as inherently safe, what is the need for
> the OB as primary care provider?
>
>
>
> In the US, many doctors who support homebirth are threatened or lose
> hospital privileges. This happened in my community where the family
> practice docs who were performing back-up for the CPMs were threatened
> with loss of privilege if they continued to support homebirth. This is
> very, very common. Personally, I had three homebirths with CPMs, with
> no back-up and that is exactly as I wanted it. I take exception to
> anyone suggesting that midwives should be banned who do not adhere to a
> medical view of birth. I am a strong advocate of the apprentice model
> of training. Is it any different from IBCLCs "apprenticing" as LLLLs?
> Haven't we all said that some of the best IBCLCs have no medical
> background? I am an IBCLC with no medical background and I consider
> myself to be extremely competent.
>
>
>
> One always has to consider the political climate in such situations
> before jumping to conclusions. Very few who would advocate for
> elimination of "lay midwifery" have any idea what they are talking
> about. To argue that CNMs fill the role of midwifery for all women is
> flatly incorrect. There is a world of difference between most CNMs in
> the US and most CPMs. Elimination of CMPs simply lowers the bar and
> makes normal birth less of a possibility for anyone.? Health care
> freedom is not generally valued in the US, but there is a movement
> afoot to secure such freedoms. There is a very real
> counter-movement in the US by the AMA to name almost any health care
> activity,
> "the practice of medicine", so as to either eliminate or control it.
> IMO, consumers have the right to receive care from anyone they choose,
> no matter what the credentials, so long as there is honesty in
> disclosure of education, experience, etc. Anyone who cares to know
> about these issues can do the research. The information is readily
> available and it is truly disturbing.
>
>
>
> Do I think this is OT? No. Birth practices define feeding behaviour and
> support practices. The only reason I have any idea about the physiologic
> norm is b/c
> I have seen so many babies born at home or undrugged in hospital--it is
> my frame of reference for what is possible for all dyads and informs my
> care of my clients in every way.
>
>
>
>
>
>
> Jennifer Tow, IBCLC, CT, USA
> Intuitive Parenting Network LLC
>
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>
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>
>

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