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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