Betsy R wrote:
"The CNM is not only certified and registered, but LICENSED as well, which
is one designation the CPM's do not have."

This is incorrect, and seems to perpetuate some widespread myths about
midwifery.  Certified Professional Midwives in the US are subject to a
licensure process every bit as stringent as what a CNM goes through.  That's
why they can use the words 'certified' and 'professional' before their
title.  There is a difference between a lay midwife, defined as one who has
become a midwife by some route other than a formal training program, and a
certified one, the main difference being the certification, and another one
being, in most cases, the education.  Please note that I am not dissing lay
midwives in what I have to say, as my purpose here is not to argue for or
against licensure or formal training.  I just want to point out that there
is a distinction.
I came to Norway as a nurse (BSN, RN) and went to midwifery school where
nursing was an entry level requirement, but IMO a meaningless one since
nurses here have no mandatory obstetric content in their education, nor are
nurses as such employable in the maternity services except in cases of
extreme staff shortages, and then only temporarily.  I was the only one in
my class who had had any ob experience before midwifery school.  The only
nurses who ever get to touch a pregnant woman are the ones who are either in
midwifery school or have graduated and passed the boards.  I work as an
equal alongside Danish midwives, trained in a direct entry system, not to
mention Dutch midwives, who are the gold standard as far as midwifery is
concerned.  Neither Danish nor Dutch schools accept nurses as a rule, and I
have been told it is because they feel there is so much they need to
un-learn before they can function appropriately as midwives that it isn't
worth the bother.

I can see that this could go completely off topic, so here comes the
BF-related part:
Julia Allison, past General Secretary of the UK Royal College of Midwives,
in her fascinating book (ISBN 0-412-56300-2) based on her study of the
practice of district midwives in Nottingham from 1948-1972, found among
other things that there was a marked difference in the breastfeeding rates
among women who were cared for by midwives in hospital and on the district.
All of them were professionally licensed and formally trained.  The hospital
midwives tended to be nurses while the district midwives were nearly always
direct entry.  This did not reflect restrictions on practice setting
dictated by educational preparation, but a conscious choice of where to work
in both the hospital and district midwife groups.  The district midwives
practiced among women with less money and more children.  The district
midwives appear to have been far more knowledgeable about breastfeeding than
the hospital midwives were, possibly because their practice was more in
keeping with community and physiological norms and less concerned with
applying hospital, or nursing, routines to a process inherently unsuited to
such tampering (my interpretation of Allison's work).   

It is a curious fact that midwives go back at least as far as physicians.
Mentioned in the early part of the Old Testament, they are actually members
of the 'classical' medical community in the truest sense.  In most parts of
the world, the heritage of midwifery has been continuous since that time,
but once again, the US is the exception to the rule.  

Rachel Myr
Jordmor (the word for midwife in Norwegian, which literally translated means
'earth mother' and is a title which may only legally be used by one holding
a current state authorization to practice as a midwife) Stepping down from
my earth mother's soapbox in Kristiansand, Norway

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