tag:blogger.com,1999:blog-3467497842297723172024-03-19T06:55:29.134-04:00Safer Midwifery for MichiganA space to share stories, seek support, and ask questions related to midwifery care in MichiganMWShttp://www.blogger.com/profile/04125751490256911705noreply@blogger.comBlogger158125tag:blogger.com,1999:blog-346749784229772317.post-21569577766687284272014-10-19T21:28:00.000-04:002014-10-19T21:28:09.393-04:00Tandem Care ~ Home Birth in Sheep's Clothing<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>There's a new term in town aimed at <i>marketing </i>home birth as a safe option...</b><i> </i></span></span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>"It’s called 'Tandem Care<span style="font-size: small;">'</span>, and it was developed by Lansing-area obstetrician Dr. Nancy
Herta. It’s a little-known alternative for local mothers who want to
attempt a home birth with a midwife but still want to have access to the
latest medical developments," explains a recent article published in<b> <a href="http://npaper-wehaa.com/citypulse#2014/10/08/?article=2349099" target="_blank"><u>Lansing's City Pul</u><u>se: "Born This W</u></a><u><a href="http://npaper-wehaa.com/citypulse#2014/10/08/?article=2349099" target="_blank">ay"</a>.</u></b> </i></span></span> <br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">I've read <span style="font-size: small;"><span style="font-size: small;">City P<span style="font-size: small;">ulse's</span></span> arti<span style="font-size: small;">cle many times over, and I<span style="font-size: small;">'m still confounded as to what about <span style="font-size: small;">"Tandem Care" makes birth outside the hospital one bit safer than traditional home birth</span></span></span></span></span></span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">...access to the latest medical developments? Well, if we consider what Dr. Herta herself explains in the article regarding her self-made term "Tandem Care", I'm not sure what medical advice she really offers these dual clients. </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"> <i> </i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><i>"...my system is still not the
best. I can’t go into homes. I can’t even give direct advice to midwives
— I have to phrase it as hypothetical situations.”</i></b></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">City Pulse reporter Allan Ross explains further the relationship between doctor and midwife when he says, <i><b>"</b></i><i><b><i>Herta maintains
recommendation-free communication with the midwife."</i></b> </i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Recommendation free? <span style="font-size: small;">Dr<span style="font-size: small;">. Herta can't even</span></span> give direct advice to the midwives in which she has so willingly "partnered" to offer this <i>safe</i> alternative to home birth<span style="font-size: small;">.</span> What's the point? </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">I wonder why exactly it is Dr. Herta isn't able to advise or make professional recommendations. Perhaps because she carries malpractice insurance, notably unlike the midwives she's supporting, and the aforementioned insurance company likely understands how dangerous it is to take responsibility for practices taking place that are unregulated, and without <i>true</i> medical back up. </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><br /></b></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Perhaps if we look more closely at what <span style="font-size: small;">Tandem Care entails we'll se<span style="font-size: small;">e <span style="font-size: small;">how it imp<span style="font-size: small;">roves safety</span></span>...</span></span></span></span><b><span style="font-size: small;"> </span></b><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="font-size: small;">Naturally I ask mys<span style="font-size: small;">elf, w</span></span>here did the term "Tandem Care</b><b>" come from? </b> </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Dr. Herta shares in the Pulse's article, <i>“I
invented the term tandem care, but it’s not a new idea,” </i>Herta said<i>.
“It takes the place of the European model, (which is) no-intervention
midwife-driven birth centers attached to hospitals...”</i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
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<span style="font-size: large;"><b><span style="font-family: Georgia,"Times New Roman",serif;">Whoa. Wait just a minute...<i>"takes the place of the European model...birth centers attached to hospitals..." </i>What?!? This is where I take tremendous pause to carefully consider what Dr. Herta is claiming. </span></b></span></div>
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i> </i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">First, the E<span style="font-size: small;">uropean model of midwifery requires midwives to be <i><span style="font-size: small;">highly</span></i> educated<span style="font-size: small;">...<u>so much so that most US home birth mid</u><span style="font-size: small;"><u>wives (na</u><span style="font-size: small;"><u>mely CPMs like <b><a href="http://safermidwiferyformichigan.blogspot.com/2014/06/danger-audra-post-cpm.html" target="_blank">Audra Post</a></b>) </u><span style="font-size: small;"><u>are not qualified to even practice in any other first wor</u><span style="font-size: small;"><u>ld country. </u> CPMs <span style="font-size: small;">do NOT meet <span style="font-size: small;">the International <span style="font-size: small;">Confederation of Midwives standards for education<span style="font-size: small;"> and training. <span style="font-size: small;">Second, Herta herself even mention<span style="font-size: small;">s the idea of birth ce<span style="font-size: small;">nter<span style="font-size: small;">s <i>attached to hospitals</i>. She is describing what would be ideal,<span style="font-size: small;"> t<span style="font-size: small;">ruly integrated, <i><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/06/what-is-collaborative-care-model.html" target="_blank">col</a></b></i><span style="font-size: small;"><i><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/06/what-is-collaborative-care-model.html" target="_blank">laborative care</a></b></i> where midwives work <span style="font-size: small;">tog<span style="font-size: small;">ether with doctors in a setting where emergency care is readily av<span style="font-size: small;">ailable. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">The problem<span style="font-size: small;"> you ask?? Th<span style="font-size: small;">e problem is that Dr. Herta is <i>marketing</i> herself as working w<span style="font-size: small;">ith highly educated midwives<span style="font-size: small;">, like those in Europe<span style="font-size: small;">, which is<span style="font-size: small;"> completely in<span style="font-size: small;">accurate. She is also misleading fam<span style="font-size: small;">ilies <span style="font-size: small;">by telling them <span style="font-size: small;">her self-titled "Tan<span style="font-size: small;">dem Care<span style="font-size: small;">" model is as safe as a <span style="font-size: small;">birth cente<span style="font-size: small;">r attached to a hospital in Europe, when in fact she<span style="font-size: small;"> (the doctor) is not present <span style="font-size: small;">during labor, not present at delivery, does not show up to<span style="font-size: small;"> care for patients if or when they do tran<span style="font-size: small;">sfe<span style="font-size: small;">r to the hospital, and assumes zero responsibility for any type of counsel or outcome. Instead, Dr. Herta offers a few prenatal <span style="font-size: small;">visits in which sh<span style="font-size: small;">e cannot actually counsel, and hands patients off to the<span style="font-size: small;"><span style="font-size: small;"> unlicensed, unregulated, uninsured midwives</span> doing home birth to mo<span style="font-size: small;">nitor labor and <span style="font-size: small;">deliver the baby</span></span>. <b> <a href="http://safermidwiferyformichigan.blogspot.com/2012/06/hospital-is-only-12-minutes-away.html" target="_blank">The hospital is still several minutes away</a>.</b> There is still no immediate medi<span style="font-size: small;">cal care<span style="font-size: small;"> present. <b>So how, please someone tell me, is this on</b><span style="font-size: small;"><b>e bit different </b><span style="font-size: small;"><b>than home birth??</b> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>What exactly does "</b><b>Tandem Care" really of</b><b>fer?</b> </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">To be frank, Tandem Care <i>benefits the midwives,</i> who through OB partnership have access to labs, ultrasounds, and screenings that they otherwise don't have. There is no arguing that MI midwives need access to these things independently. The problem is that most MI home birth midwives are not licensed, nor do they obtain <b><a href="http://acogpresident.org/?p=1189" target="_blank">educational traini</a></b><b><a href="http://acogpresident.org/?p=1189" target="_blank">ng</a></b> that even comes close to international standards set forth by the International Confederation of Midwives. They are not AMCB certified so earning licenses and further access to labs has been challenging for them, and rightfully so. In addition, <span style="font-size: small;"><span style="font-size: small;">M<span style="font-size: small;">I </span></span>midwives cannot obtain their own p<span style="font-size: small;">rescriptions<span style="font-size: small;">. Under Dr. Herta's T<span style="font-size: small;">andem Care mod<span style="font-size: small;">el, unlicensed, uneducated midwives can fill pre<span style="font-size: small;">scriptions under her name and <span style="font-size: small;">administer them without overs<span style="font-size: small;">ight. </span></span></span></span></span></span></span></span></span></span><span style="font-family: Georgia,"Times New Roman",serif;">Dr. Herta is attempting to utilize loopholes as well as her p<span style="font-size: small;">rescriptive privilege</span>, to allow midwives access to labs<span style="font-size: small;"> and presc<span style="font-size: small;">ri<span style="font-size: small;">pti<span style="font-size: small;">ons </span></span></span></span></span><span style="font-family: Georgia,"Times New Roman",serif;">without taking any real responsibility for the outcome of negligent care with which she is<span style="font-size: small;"> </span>heavily associated. </span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Well as the saying goes, if you pat my back, I'll pat yours....Home birth midwives who encounter cautious, unsuspecting parents-to-be, easily suggest Dr. Herta's "Tandem Care" as a solution to their safety concerns. </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"> <i> </i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>"When Gaëlle and I said we were concerned about doing a home birth
completely outside the hospital system <span style="font-size: small;">...</span><u> <a href="http://safermidwiferyformichigan.blogspot.com/2014/06/danger-audra-post-cpm.html" target="_blank"><b></b></a><b><a href="https://www.blogger.com/blogger.g?blogID=346749784229772317" target="_blank">Audra Post</a></b></u><a href="http://safermidwiferyformichigan.blogspot.com/2014/06/danger-audra-post-cpm.html" target="_blank"> </a>
told us about tandem care and put us in contact with Herta. ~ Allan Ross <span style="font-size: small;">from City P<span style="font-size: small;">ulse</span></span></i><i> </i></span></span><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Ironically,
Dr. Herta and area home birth midwives are working in tandem...selling
"Tandem Care" as some sort of bridge between hospital and home birth
when in fact all of the important components of a truly integrated model
of care are absent. <i> </i>It's flat out <u><i>fraudulent</i></u>, misleading, and dangerous for families.<i> </i></span></span><br />
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<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">Sure<span style="font-size: small;"> Hert<span style="font-size: small;">a's involveme<span style="font-size: small;"><span style="font-size: small;">n</span>t <span style="font-size: small;">provides more </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>access to labs, but what good does <span style="font-size: small;">that really do if neither care provider believes that risk factors matter<span style="font-size: small;">, that everything is a variation of normal, or <i>"...that </i><span style="font-size: small;"><i>high risk pregnancy doesn't nece</i><span style="font-size: small;"><i>ssarily mean a high risk delivery</i><span style="font-size: small;"><i>," </i>as Dr. <span style="font-size: small;">Herta put it. There might be paper work that gets "pre-registered" at the hospital, but anyone can do that as it is <span style="font-size: small;">standard protocol<span style="font-size: small;"> </span>and readily av<span style="font-size: small;">ailable on Sparrow's website. </span></span></span></span></span></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i><br /></i></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><i>What tandem care DOES NOT offer families...A safer alternative to traditional home birth!</i></b></span></span><br />
<br /><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>The Truth Every Mother Deserves to Know... </b><i><br /></i></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Midwives are telling clients
that Dr. Herta is their "back-up physician." The reality is that Dr.
Herta shares in prenatal care that doesn't legally offer any real recommendation or advice. She is not present at the labor or delivery. In fact, if your home birth goes wrong and you transfer, you won't see her at the hospital either unless she happens to be on call that night. Chances are you'll see another doctor, one you've never met, right smack dab in the middle of an emergency in which hopefully they can save you and your ba<span style="font-size: small;">by. <b> </b></span></span></span><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><b>What <span style="font-size: small;">Dr Herta and </span>and local midwives are selling is a false sense of security, home birth in sheep's clothing. "Tandem Care" is light years away from the safety of European models of Collaborative Care. </b></span></span></span><br />
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<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="font-size: small;">Full Article: </span></b></span></span>
<a href="http://npaper-wehaa.com/citypulse#2014/10/08/?article=2349099" target="_blank"><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>City Pulse<span style="font-size: small;"> <span style="font-size: small;">~</span></span> Born This Way</b></span></span></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-44849546723975793252014-09-28T14:56:00.000-04:002014-09-28T14:59:25.179-04:00Time to Talk to Your Legislators! <div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;">With elections fast approaching, it's time to start talking to your State Representatives and Senators. Legislators like to hear directly from their own constituents, and your voice matters! </span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;">Friends of Michigan Midwives continues to push for dangerous legislation in sneaky ways. We prefer to take an honest, clear, and direct approach. </span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;">We've put together a printable brochure to help you with talking points, and to share a clear message...Safety First. </span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;">The strongest message will come from printing and personally meeting with your legislators. If you're unable to do so, emailing them with a personal message that clearly states you're a constituent in his or her district, and attaching the brochure is the next best thing. Thank you for taking action on an important issue.</span></div>
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><b><br /></b></span></div>
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><b>Click <a href="http://www.michiganvotes.org/Find.aspx" target="_blank">HERE</a> to find contact information for your State Representative and Senator. Call, Email, and/or visit them in person. </b></span></div>
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><b> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><b><a href="https://drive.google.com/file/d/0B-fHuhVMhvpoWlV5MWJiZGNJcU0/edit?usp=sharing" target="_blank">Brochure for Legislative Action</a></b></span></div>
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif; font-size: small;"><b>(Email or Print and Deliver!)</b></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-30240676850846950082014-08-04T09:31:00.000-04:002014-08-04T18:38:43.495-04:00Midwifery Laws State-by-State<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Midwives are permitted to practice in out-of-hospital (OOH) settings in 28 states. The Big Push for Midwives publishes information on their website regarding legality and licensing of Certified Professional Midwives (CPMs). The Big Push has one goal, and that is to increase the number of states that recognize CPMs. </span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">The Big Push wants the public to believe that legalizing CPM practice confers safety. What licensing and legalizing CPMs often does is legitimize CPMs, allows them to bill insurance, but does not increase accountability and safety standards for out of hospital birth.</span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">We would like to emphasize that licensing and legalizing CPMs does very little in certain states toward creating accountability, safety and true professional practice among midwives. In some states, midwifery is legal - but licensing is not required. There is hardly a difference between the practice of midwifery in these "legal" states than there is in Michigan, where CPMs and lay midwives are completely unregulated. </span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<b><span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><b>We believe there are multiple legal protections that must be written into a responsible midwifery licensing law in order to make OOH birth safe, and encourage accountability among midwives. Many of these provisions work together - it is not enough to have one provision in place. </b> </span></span></span></b></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Who cares if it is mandatory to have a license to practice midwifery, if there are no restrictions on scope-of-practice? (See Washington, Wisconsin, Tennessee for examples)</span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Who cares if licensed midwives are restricted to low-risk births, but licensure is purely voluntary? (See Utah, Minnesota, Oregon). </span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Who cares if the practice of midwifery is "legal" but there is no licensing what-so-ever available, and therefore no scope of practice standards, or guidelines in place? (See Maine, Missouri)</span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><br /></span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">When considering licensing in Michigan, we urge everyone who cares about safety in the out-of-hospital setting to think about which provisions provide true protection for families, and which serve only to legitimize midwifery and increase their income through third-party payers. </span></span></span><br />
<br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Safer Midwifery for Michigan's position on the practice of OOH midwifery: </span></span></span><br />
<br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">1)<a href="http://safermidwiferyformichigan.blogspot.com/2012/04/top-10-reasons-why-hb-5070-will-do-more.html" target="_blank"> </a><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/04/top-10-reasons-why-hb-5070-will-do-more.html" target="_blank">Licensing</a>:</b> a license should be mandatory in order to practice midwifery</span></span></span><br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">2) <b><a href="http://safermidwiferyformichigan.blogspot.com/2012/05/what-were-seeking-is-your-midwife.html" target="_blank">Malpractice insurance</a>:</b> all midwives should be required to carry malpractice insurance</span></span></span><br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">3) </span></span></span><span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/11/what-were-seeking-safety-protocols-for.html" target="_blank">Defined scope-of-practice</a>:</b> OOH births attended by midwives should be limited to low-risk only</span></span></span><br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">4) <b><a href="http://www.safermidwiferyformichigan.blogspot.com/2012/06/what-is-collaborative-care-model.html" target="_blank">Integrated system of care</a>: </b>Midwives should be integrated into the health care system through authority to treat, prescribe and admit patients and/or through collaborative agreements with physicians</span></span></span><br />
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">5) <b><a href="http://www.safermidwiferyformichigan.blogspot.com/2012/06/what-were-seeking-standards-for.html" target="_blank">Education</a>:</b> the minimum level of education for midwives should be at the graduate level. The American Midwifery Certification Board sets standards for graduate level training of Certified Nurse Midwives, (CNMs) and the direct-entry equivalent, Certified Midwives (CMs).</span></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f3f3f3;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span></div>
<div dir="ltr" id="docs-internal-guid-0d4c58f9-9c6c-187e-ae6c-58748bff7fa0" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="background-color: #f3f3f3;">How do other states meet Safer Midwifery for Michigan’s criteria for safe OOH midwifery?</span></span></span></span><br />
<span style="background-color: white;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="background-color: #f3f3f3;"> </span> </span></span></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">State and year licensed or legalized</span></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">License required to practice midwifery</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Requires malpractice insurance</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Limits OOH birth to low-risk only</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">(no VBAC, twins, breech)</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Requires integration into health care system/</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">collaboration</span></b></div>
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<b><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Minimum standard of education is AMCB program</span></b></div>
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<span style="color: #b4a7d6;"><a href="http://www.scdhec.gov/Health/FHPF/HealthFacilityRegulationsLicensing/HealthcareFacilityLicensing/FacilitySpecificInfo/Midwives/" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">SC (1976)</span></a></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
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<span style="color: #b4a7d6;"><a href="http://www.azdhs.gov/als/midwife/" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">AZ (1978)</span></a></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.newmexicomidwifery.org/images/uploads/LM_Rule.pdf" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">NM (1978)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-color: rgb(0, 0, 0); border-left: 1px solid rgb(0, 0, 0); border-right: 1px solid rgb(0, 0, 0); border-style: solid; border-width: 1px; padding: 7px; text-align: center; vertical-align: top;"><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Family%20Health%20Services/4106.shtml" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">DE (1978)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.gencourt.state.nh.us/rsa/html/XXX/326-D/326-D-mrg.htm" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">NH (1979)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.healthy.arkansas.gov/programsServices/familyHealth/WomensHealth/Pages/LayMidwifery.aspx" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">AR (1983)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.dshs.state.tx.us/midwife/default.shtm" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">TX (1983)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO </span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.lsbme.la.gov/sites/default/files/documents/Rules/Individual%20Rules/Midwife%20Practitionrs.pdf" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">LA (1985)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://apps.leg.wa.gov/RCW/default.aspx?cite=18.50" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">WA (1991)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://montanamidwives.org/pdf-law/" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">MT (1991)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.op.nysed.gov/prof/midwife/midwifeqa.htm" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">NY (1992)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://cdn.colorado.gov/cs/Satellite?c=Page&childpagename=DORA-Reg/DORALayout&cid=1251632299138&pagename=CBONWrapper" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">CO (1993)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.mbc.ca.gov/Licensees/Midwives/" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">CA (1993)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.oregon.gov/OHLA/DEM/Pages/issue_responses.aspx" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">OR (1993)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.floridahealth.gov/licensing-and-regulation/midwifery/index.html" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">FL (1995)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://commerce.alaska.gov/dnn/cbpl/ProfessionalLicensing/Midwives.aspx" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">AK (1999)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://mmgstandards.org/faq/210-what-is-the-minnesota-law-on-traditional-midwifery" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">MN (1999)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<br /></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.leg.state.vt.us/statutes/fullchapter.cfm?Title=26&Chapter=085" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">VT (2000)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://tnmidwives.org/documents/tennessee-midwives-association-practice-guidelines" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">TN (2000)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.njconsumeraffairs.gov/chapters/Chapter%2035%20Subchapter%202A%20Midwifery.pdf" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">NJ (2002)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.rules.utah.gov/publicat/code/r156/r156-77.htm" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">UT (2005)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<br /></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.dhp.virginia.gov/medicine/advisory/mw/Default.asp" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">VA (2005)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.dsps.wi.gov/Default.aspx?Page=ab573095-015f-4c21-b476-850e3711e543" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">WI (2006)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://www.missourimidwives.com/resources/Legislative" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">MO (2007)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://mainecpms.org/?page_id=17" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">ME (2008)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<br /></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://ibol.idaho.gov/IBOL/BoardPage.aspx?Bureau=MID" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">ID (2009)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO </span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://plboards.state.wy.us/Midwifery/ApplicationInstructionsForms.aspx" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">WY (2010)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #b4a7d6;"><a href="http://thestatehousefile.com/new-law-allows-non-nurse-midwives-to-practice-in-indiana/11904/" target="_blank"><span style="background-color: transparent; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">IN (2013)</span></a></span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEircebTaVmgfQ4TeHnRKUPOdu75jaa4vej_q554NjV0DefbUWYUf6hxwHavLkxnT2XhApGVnvFAbmC4vvH1t6u3yqIKS7Q4IDfGRrgZx_oBC7Bi-0xJkAL4UaV73k70IT2QwhSgSXn8OEjt/s1600/smSMM.jpg" /></a></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">NO</span></div>
</td></tr>
</tbody></table>
</div>
<br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Links:</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Arizona Health Department</b>, Midwifery scope of practice of by state, VBAC, multiple, breech in non-hospital settings. <a href="http://www.azdhs.gov/als/midwife/documents/committee/additional-resources/state-laws-chart-vbac-br-mg.pdf">http://www.azdhs.gov/als/midwife/documents/committee/additional-resources/state-laws-chart-vbac-br-mg.pdf</a></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>The Big Push for Midwives</b>, CPM legal status by state. <a href="http://pushformidwives.org/cpms-by-state/">http://pushformidwives.org/cpms-by-state/</a></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Lansing State Journal</b>, Midwife Laws state-by-state, <a href="http://www.lansingstatejournal.com/interactive/article/20120503/NEWS01/120502001/Midwife-laws-state-by-state?nclick_check=1" target="_blank">http://www.lansingstatejournal.com/interactive/article/20120503/NEWS01/120502001/Midwife-laws-state-by-state?nclick_check=1 </a></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Midwives Alliance of North America</b>. About Midwives: State by State.<a href="http://mana.org/about-midwives/state-by-state" target="_blank"> http://mana.org/about-midwives/state-by-state</a></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Safer Midwifery for Michigan</b>, State Laws and Licensing. <a href="http://www.safermidwiferymi.org/issues/state-laws-licensing">http://www.safermidwiferymi.org/issues/state-laws-licensing</a></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-42209017596312295182014-06-23T09:53:00.000-04:002014-06-25T22:23:36.483-04:00Dear Michigan Legislators<span style="font-family: Georgia,"Times New Roman",serif;"><b>Dear Michigan Legislators,</b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">I have an important story to tell about a tragedy that could have been prevented had Michigan laws been up to date. You have the power to make them current and protect families from experiencing the same unnecessary harm. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">My baby died three years ago as a result of severe trauma during out-of-hospital birth at a freestanding birth center. Two of the midwives attending his birth were licensed. One was not. His birth should have been considered high risk. Proper assessments should have been taken. We should have been referred to a physician. None of those things happened. Instead we were reassured by our midwives that delivering at the freestanding birth center would be safe and ideal. Instead he was entrapped for over 7 minutes. <br /><br />After a very traumatic birth and nearly two weeks in the RNICU, our baby passed away. We sought accountability at the state, criminal, and civil levels only to be told that there were no laws to which these people could be held accountable. The Attorney General issued sanctions for the two licensed midwives...who still continue to practice today, one without her license, because in MI you don't need to have a license to be a midwife. The unlicensed midwife walked away without any consequence because the state can't do much about unlicensed care givers who are considered "a-legal". Civil court found one midwife to be grossly negligent, issuing a 5 Million dollar judgment. All of them filed bankruptcy to discharge the civil lawsuit. The judgment itself didn't matter much more than the paper it was written on though, because they didn't carry malpractice insurance, nor are they required to do so. The worst part? We found that we were not alone, that many other babies had been injured or died in the care of the same midwives both before and after our son. How is it they are still allowed to practice? </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Michigan is one of only a few states to have no laws addressing midwifery outside hospitals. It's not a subject to be taken lightly. With a shortage crisis in maternity care, and misleading cultural movements, more and more women are seeking alternative care in our state. For 30 years North Carolina has required midwives to have an AMCB certification, an education, and a physician back up. 30 Years! Michigan? No laws or standards whatsoever. None. Not even today. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Legislators, you have a responsibility to protect the people of Michigan. Whether Republican or Democrat, you have ethical obligations to do the right thing. This is not a subject that can be ignored. It's only a matter of time before a family sues the State for not protecting the people. Several dangerous bills on the subject of licensing for midwives have been proposed in recent years. Unfortunately, these bills would do more to protect midwives than the families they serve, and would indeed do nothing to improve safety. We need you to take action and draft responsible legislation that would improve safety for out-of-hospital birth. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Primary Areas of Concern:</b></span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Anyone can call herself a "midwife" in the state of Michigan, regardless of her educational background, experience, or track record. </span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Anyone can open "birth center" in the state of MI. </span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">No malpractice insurance is required of a midwife who practices outside a hospital, or a birth center not affiliated with a hospital. </span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">You don't need a license to be a midwife or run a birth center. </span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Midwives with both criminal and civil history are continuing to deliver babies due to lacking laws in Michigan. In fact, they purposefully come to Michigan because they can get away with it here. </span></li>
</ul>
<ul>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Home birth has increased 20% during the past 10 years, and 116% in Kent County alone, according to an article from <a href="http://www.wzzm13.com/story/news/health/2014/05/06/home-births-rise-michigan/8760821/" target="_blank">Grand Rapids</a> last month. Home birth has reached a 40 year high in our state, yet we have no laws governing the practice of those delivering babies outside hospital walls. </span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><br /></b></span>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>How to Improve Safety: </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Draft responsible, bi-partisan legislation to address the <i>safety issues</i> with out-of-hospital birth<b>. Licensing midwives alone will not improve safety. </b></span><br />
<div class="block block-block contextual-links-region">
<span style="font-family: Georgia,"Times New Roman",serif;">
</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span>
<br />
<div class="block block-block contextual-links-region">
<ul>
<li>
<span style="font-family: Georgia,"Times New Roman",serif;">Require a Minimum Standard of University Level Education, and AMCB Certification for all Midwives</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Define a Clear Scope of Practice for Out-of-Hospital Birth, Name Risking Out Criteria</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Only Allow Licensed Midwives</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Only Allow Licensed & Accredited Birth Centers</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Define Safety Protocols for Out-of-Hospital Birth</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Define Safety Protocols for Transfer of Care, Referral, and Consultation</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Require Liability Insurance for all Midwives</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Require Ethical, Board-Issued Informed Consent</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Create A Balanced Board to Offer Oversight (Doctors, and Midwives) </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">
Establish Mechanisms for Accountability</span></li>
</ul>
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<span style="font-family: Georgia,"Times New Roman",serif;">Thank you for taking the time to learn more about this important issue. I sincerely hope you will reach across the aisle to protect Michigan families from further unnecessary heartache. </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">Sincerely,</span></div>
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<div class="block block-block contextual-links-region">
<span style="font-family: Georgia,"Times New Roman",serif;">Sara Snyder</span></div>
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="mailto:safermidwiferymi@gmail.com">safermidwiferymi@gmail.com</a> </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">Safer Midwifery for Michigan: <a href="http://www.safermidwiferymi.org/">www.safermidwiferymi.org</a></span></div>
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>PS. If any reader would like to add that they are a constituent to the opening paragraph, and phrase this letter as one in your own voice, it would be tremendously helpful for you to send it to your own legislators and follow up with a phone call. Thank you for helping to improve safety in birth options for Michigan families. </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Visit <a href="http://www.michiganvotes.org/Find.aspx" target="_blank">Michigan Votes</a> for Legislator Contact Information. </b> </span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-43187923886686098872014-06-19T12:20:00.002-04:002014-06-19T12:28:44.113-04:00Danger: Audra Post, CPM<div class="field field-name-field-c-section-rate field-type-text field-label-inline clearfix">
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<span style="font-family: Georgia,"Times New Roman",serif; font-size: large;"><a href="http://safermidwiferyformichigan.blogspot.com/2014/03/w-t-f.html" target="_blank">Willow Tree Family Center's</a> Provider Directory proudly features: </span></div>
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<h4>
<i><span style="font-family: Georgia,"Times New Roman",serif;"> </span></i></h4>
<h4>
<i><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://willowtreefamily.com/practitioner/audra-post" target="_blank">Audra Post, CPM </a></span></i></h4>
</div>
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</div>
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<span style="font-family: Georgia,"Times New Roman",serif;">Naming her stats as follows: </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">C-Section Rate: </span></div>
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<div class="field-item even">
<span style="font-family: Georgia,"Times New Roman",serif;">6%</span></div>
</div>
</div>
<div class="field field-name-field-vbac-rate field-type-text field-label-inline clearfix">
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;">VBAC Rate: </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">77%</span></div>
</div>
</div>
<div class="field field-name-field-transfer-rate field-type-text field-label-inline clearfix">
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Transfer Rate: </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">17%</span></div>
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>What is conveniently missing from this list of made up statistics? </b></span></div>
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</div>
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<span style="font-family: Georgia,"Times New Roman",serif;"><b>Her death and injury rate of course.</b> </span></div>
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</div>
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<span style="font-family: Georgia,"Times New Roman",serif;">Knowing for a fact of two deaths and two serious injuries in the past three years, one being my own son, this is one dangerous midwife. Not to mention that Audra also filed bankruptcy to avoid any accountability in civil litigation over wrongful death, in which another midwife attending the same birth was found to be $5 Million dollars worth of negligent. Given that she carries no malpractice insurance, and accountability for CPMs in our state is non-existent, families are left to just accept that the negligence continues. Audra hopes that it continues without prospective clients knowing the truth behind her statistics.</span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">Perhaps Audra should name how many of her transfers were too late. Perhaps her cesarean rate should be higher, and just maybe more babies would be alive. </span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">The icing on the cake is that Audra Post, CPM openly advertises <i>Additional Pregnancy Services</i> such as, "</span><span style="font-family: Georgia,"Times New Roman",serif;">Support for breech positions," but she fails to explain that the only breech delivery she's ever attended, ended with the death of the baby due to severe birth trauma after he was entrapped for over 7 minutes in his mother's body. So what exactly does "Support for breech positions" really mean? </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"> <i>Audra, what on earth are you thinking? Have you forgotten us? Have you </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> forgotten the horror that was Magnus's birth? I haven't. I was there and I know </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> exactly how tragic it was. I remember vividly how long 7 minutes of being </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> entrapped really feels, and the 45 minutes it took neonatologists to revive him. I </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> remember a baby who never opened his eyes until he died because of you and your </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> esteemed colleagues. Perhaps you should rethink your skill set before another </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> baby dies that doesn't have to. Obviously his death must have been my fault, or </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> better yet my body's fault. Perhaps you think the stars just didn't align that day </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> and he "wasn't meant to live" as your partner so bluntly put it. How about </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> severely negligent care that missed many red flags? How about incompetent </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> midwives that had no business attending a high risk delivery like that outside the </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> hospital? You had a serious role in his death, his death that should have been </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> prevented had you done your job well. It is appalling and utterly disgusting </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> that you would advertise yourself to have the ability and confidence to </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> "support breech positions." Thanks for trying to <b><a href="http://www.safermidwiferyformichigan.blogspot.com/2014/06/not-buried-twice.html" target="_blank">Bury Magnus Twice</a></b>. I won't let </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> you get away with that. You've perfectly illustrated the need for this campaign.</i></span></div>
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<b><span style="font-family: Georgia,"Times New Roman",serif;">Families, please be wary of statistics like these, of midwives like this, of facilities such as the Willow Tree Family Center that clearly advertise dangerous providers with ugly disclaimers voiding them of any responsibility. </span></b><span style="font-family: Georgia,"Times New Roman",serif;"> </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Women deserve safe care options, not someone who manipulates the truth, can't see the danger in her own actions, and "barters and trades" as a payment option for her services. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Find an educated, licensed, and insured midwife who works ethically withing a system of care that will allow you to bring your baby home at the end of your birth experience. </span></div>
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-346749784229772317.post-24447205685948849682014-06-16T09:40:00.001-04:002014-06-16T09:40:06.909-04:00Not Buried Twice<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/CRhkZKUNyMY" width="560"></iframe>
<br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">When we lost Magnus, for months I thought we were alone. We soon learned his death was preventable and that other babies had died and been injured under the care of the same midwives. It was then we knew we had to find a voice. We posted our story on <a href="http://hurtbyhomebirth.blogspot.com/2012/01/magnuss-story.html" target="_blank">Hurt by Home Birth</a>, reported our experience to the state, the police, and civil attorneys. We went to the media so other families would know not to seek their care. Our story needed to be told, our voices needed to be heard. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">We found out we were not alone. Not by a long shot. Over the past three years I have come to know many, many families whose babies died preventable deaths, or were severely injured in the hands of home birth midwives. There was no one for these families to report to, no one to hold those responsible accountable. Lawyers wouldn't represent these families because without malpractice insurance they would not get paid for their endless hours on the case. Their own professional organizations (NARM and MANA) turned a blind eye. With no state laws or licensing requirements, there was little the police and state could do. And now? Well, now those midwives are nearly all still practicing. More babies have died. More babies have been injured. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>I participated in the Not Buried Twice Campaign because the message is so important. </b>Families deserve to know the other side to choosing home birth or freestanding birth centers. They deserve to know that it doesn't always work out, and that when it doesn't, it's always the fault of the parents for making that "choice". Every loss family I know has a <i>preventable</i> loss story to tell. <u>These are babies that would not have died in hospitals.</u> These are families that were misled, manipulated, and thrown out like yesterday's garbage for speaking out about negligent care. I know too many mothers in this video personally. Far too many. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">These families do not represent "a few
bad midwives" or a couple of mothers who couldn't process their grief. They represent a fundamentally broken home birth system in our country, and their voices are aimed at raising awareness. The reputation of home birth should very concerning, and discussed so that safety issues can be addressed and the option
as a whole can become something families can rely upon safely. Home birth in the United States is vastly different from home birth in other first world countries where midwives are highly educated and work <i>within</i> a system of medical care. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">And although some midwives are advising clients more and more to have high risk deliveries at home (HBAC, VBAC, Twins, Breech, etc), it's also low risk pregnancies with preventable, tragic outcomes. <b>"It's
some midwives making unethical choices, it's other midwives making
ignorant choices. At the core, it's a philosophy driven movement and
it's clear that clinical and educational standards fall by the wayside." ~ Doula Dani. </b> </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">MANA and
Midwifery Today are marketing experience and convenience at the expense
of safety. They have appalling standards for education and training.
Their own statistics show home birth to be far more dangerous that
hospital birth in terms of neonatal death rates, and they don't want our
voices to be heard.</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">I still believe truth prevails. In the case of out-of-hospital birth, it's truth I wish I had known many years ago. It's truth I lived and still live with every day. It's a truth that I don't wish upon any mother or baby. <b>The truth about home birth in the US is that it is not nearly as safe as it could be, not nearly as safe as any other first world country.</b> This is truth that will continue to grow and spread if the issues that perforate the already fragile state of home birth are not addressed. As more and more women consider out of hospital birth, lacking safety standards, dismal educational standards, and inevitable loss will absolutely become more apparent. The Not Buried Twice video is raw truth. These mothers have nothing to gain, but want their voices heard so that safety in home birth can be improved, so other families don't learn the truth the way we did. </span><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
</b><span style="font-family: Georgia,"Times New Roman",serif;">This video reminds me of every baby I know that should be alive today and thriving uninjured. They deserve to be named because they represent truth in its purest form:</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Magnus</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Brody</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Mary Beth</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Sophia</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Shazaad</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Wren</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Kate</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Raphael</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Gavin Michael</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Vylette</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Clara Edith</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Ligia</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Abel</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Sheppard </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Angela</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Zen</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Aquila</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Bryce</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Alia</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Henry</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Kailya</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Aminah</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Esperanza</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Charlotte</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Ben</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Miranda</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Sam</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Thomas</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Grant</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Celia</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Kaylee Jean</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Natalie</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Griffin</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Avery</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Shirdam</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">There are 100's more I cannot name, and more listed in the documents below. The list is already far too long. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> </span><br />
<a href="https://docs.google.com/document/d/1jwCT9IfozLRzpJiDSnuxtHqRXWn-vZPOSpmrxjlTa4w/edit" target="_blank"><span style="font-family: Georgia,"Times New Roman",serif;">Home Birth Deaths</span></a><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="https://docs.google.com/document/d/1BPhhz1U77rfHjqepKnWt2WqzWeFdXZQ80zY9L9OAh84/edit" target="_blank">Home Birth Injuries</a></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">This list doesn’t account for the families that won’t speak because
fear, and grief overwhelm them.<span style="mso-spacerun: yes;"> </span>Many of
their home births involved things like cord prolapse, eclampsia, extended ICU
or RNICU stays, numerous missed cardiac problems, ABO incompatibilities, meconium
aspiration, sepsis from retained placentas, and on, and on.<span style="mso-spacerun: yes;"> </span>This also leaves out many injuries, 3000cc
blood loss, transport of babies to the RNICU, pelvic floor injuries from
prolonged labors, and cerebral palsy to name a few.<span style="mso-spacerun: yes;"> </span></span><b><span style="font-family: Georgia,"Times New Roman",serif;"> </span></b><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">In short, the Not Buried Twice video is a small piece that should ignite an important conversation, and further a demand to change American home birth for the better. </span></b><span style="font-family: Georgia,"Times New Roman",serif;">We cannot improve safety and standards if we cannot first discuss and acknowledge that there is a monumental problem with home birth in this country...one that is getting worse as more and more families look for alternative options. </span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Please watch and share this video so that others may know there are severe concerns with out-of-hospital birth in its present state in the US. </span></b><br />
<br />
<br />
<u><b><span style="font-family: Georgia,"Times New Roman",serif;">To learn more about why the Not Buried Twice Campaign started, check out: </span></b></u><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"> <a href="http://whatifsandfears.blogspot.com/2014/06/not-buried-twice.html" target="_blank">What Ifs and Fears are Welcome Blog: Not Buried Twice </a></span></b><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="https://www.facebook.com/notburiedtwice" target="_blank"><br /></a></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="https://www.facebook.com/notburiedtwice" target="_blank">Not Buried Twice Facebook Page</a></span></b><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<u><b><span style="font-family: Georgia,"Times New Roman",serif;">Other Related Links: </span></b></u><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://midwife101.wordpress.com/2014/06/13/my-thoughts-on-home-births/" target="_blank">Midwife 101: My Thoughts on Home Birth</a></span></b><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">(Written by an aspiring midwife) </span></b><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://whatifsandfears.blogspot.com/2014/06/not-buried-twice.html" target="_blank">Grounded Parents Blog: Why the Fight for Birth Safety Matters</a></span></b><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://bostonwed-murakami.blogspot.com/2014/06/the-home-birth-natural-child-birth-and.html" target="_blank"><br /></a></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://bostonwed-murakami.blogspot.com/2014/06/the-home-birth-natural-child-birth-and.html" target="_blank">Married to Medicine Blog</a><a href="http://bostonwed-murakami.blogspot.com/2014/06/the-home-birth-natural-child-birth-and.html" target="_blank">: The Home Birth, Natural Child Birth, and US Hospital Birth Debate Part II ~ What I Would Want to Know About Out-Of-Hospital (OOH) Birth. </a></span></b><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.skepticalob.com/2014/03/introducing-the-not-buried-twice-facebook-page.html" target="_blank">Skeptical OB: Introducing Not Buried Twice</a></span></b>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-346749784229772317.post-27958666828293770832014-03-27T01:02:00.001-04:002014-03-27T01:02:42.195-04:00Wait, I thought we were discussing waterbirthThis last week, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly published a position statement regarding waterbirth. <br />
<br />
<a href="http://pediatrics.aappublications.org/content/early/2014/03/18/peds.2013-3794.abstract">Immersion in Water During Labor and Delivery</a><br />
<br />
In short, it states that immersion in water during labor poses little risk of harm and appears to have some benefit, but that safety of delivering a baby underwater "has not been established."<br />
<br />
OK - so midwives - of all stripes - are up in arms over this rather bland, cautionary statement. Apparently midwives believe waterbirth is their exclusive purview, and are taking this statement as an attack on midwifery.<br />
<br />
The resounding tack is to change the subject by proclaiming that obstetricians have no right to scrutinize waterbirth when obstetrics is rife with non-evidence based practices.<br />
<br />
From MANA's Facebook page: <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkQNY4775DB4NbyNj5whV1f2Vh9Z_UXdjFsLQ8BS3r8bPuBCf-v0lUzP5N7JkpFoG4L5PXt8KUJmaBTc0XT_si46XbhfAAS1WqJraewMw01d9q3NGsEr1UV_iI1M1IPbpNl_CfqFOc6-od/s1600/wtrbrth.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkQNY4775DB4NbyNj5whV1f2Vh9Z_UXdjFsLQ8BS3r8bPuBCf-v0lUzP5N7JkpFoG4L5PXt8KUJmaBTc0XT_si46XbhfAAS1WqJraewMw01d9q3NGsEr1UV_iI1M1IPbpNl_CfqFOc6-od/s1600/wtrbrth.jpg" /></a></div>
<br />
<br />
An excerpt from an <a href="http://www.birthcenters.org/webfm_send/137" target="_blank">email</a> to ACNM membership: <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyXFCcb4amnayntpEDFGgSwj9xkz4O8rOy8f7TZ9fh1O2xAP33OqY5QZyB67o7wurG78I9pZJuIqPrPSDZNxaUkHBeMTAa_pUUtbZ9u5Tv17ONU_ehyphenhypheng6RpQyHD0yaSEVhtyBgFi-y9jK8/s1600/ACNMwtrbirth.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyXFCcb4amnayntpEDFGgSwj9xkz4O8rOy8f7TZ9fh1O2xAP33OqY5QZyB67o7wurG78I9pZJuIqPrPSDZNxaUkHBeMTAa_pUUtbZ9u5Tv17ONU_ehyphenhypheng6RpQyHD0yaSEVhtyBgFi-y9jK8/s1600/ACNMwtrbirth.jpg" height="273" width="640" /></a></div>
<br />
<b><i>Wait, I thought we were discussing waterbirth...</i></b><br />
<br />
The question comes up - why are midwives so loathe to engage in any self-reflection? Why are midwives afraid to examine their practices and critically evaluate them for safety and effectiveness? Why are midwives changing the subject when their own practices are being scrutinized?<br />
<br />
If midwifery is what it says it is - <i>safe, effective care for low-risk women</i> -and does what it says it does: <i>provides high-quality, personalized maternity care</i> - why the defensiveness? Why change the subject? Safe and sound practices should hold up to scrutiny. <br />
<br />
Why aren't midwives clamoring to answer these questions:<br />
Is there evidence of increased risk of aspiration at waterbirth?<br />
Is there evidence of increased rates of neonatal infection at waterbirth?<br />
Is there evidence of increased rates of difficult management of complications (ie shoulder dystocia) during waterbirth?<br />
Is there evidence of increased rates of umbilical cord avulsion during waterbirth? <br />
What are the safest parameters for waterbirth?<br />
When is waterbirth contraindicated?<br />
<br />
And will the ACNM include in their position statement recommendations about the following practices that are currently offered to women under midwifery care in the US:<br />
<br />
These are "controversial contraindications" to water birth according to water birth 'expert' Barbara Harper of <a href="http://www.waterbirth.org/" target="_blank">Waterbirth International</a>:<br />
<br />
<b>Meconium staining</b> "meconium washes off the baby in the water"<br />
<b>Maternal HIV, Hepatitis A, B, C infection</b> "HIV is susceptible to warm water and cannot live in that environment"<br />
<b>Maternal GBS colonization </b>"There is no evidence that GBS positive cases should be asked to leave the water."<br />
<b>Maternal herpes outbreak during labor</b> "it is safer to deliver in the water due to the dilution effect of the water."<br />
<b>Breech vaginal birth</b> "a perfect environment for a hands free vaginal birth"<br />
<b>Multiple birth</b> "labor in water for multiples is well documented and recommended."<br />
<b>VBAC </b> women attempting VBAC in water "have a much higher success rate in giving birth vaginally"<br />
<b>Shoulder dystocia:</b> "there is mounting evidence that providers find it easier to assist a shoulder dystocia in the water."<br />
<b>Placental delivery in water:</b> "there is no reason not to allow the birth of the placenta in the water"<br />
<br />
~ Barbara Harper (c) 2006 <a href="http://www.waterbirth.org/assets/documents/Guidelines%20for%20safe%20Water%20use.pdf" target="_blank">Guideline for a Safe Water Birth</a><br />
<br />
To be clear, Barbara Harper is stating that the above indications are NOT contraindications to underwater birth and, in some cases, is asserting the superiority of water birth in these higher-risk circumstances.<br />
<br />
If these things are being recommended by a "water birth expert" you can bet they're happening with midwives at planned deliveries in the US. Spend a minute Googling, and you'll find ample photographic evidence of these practices. <br />
<br />
So no, ACNM, now is not the time to examine what OB/GYNs are or are not doing in hospitals with regard to c-sections, epidurals and whatever-all-else is happening that doesn't fit into the midwives' ideal model of care. It's time to examine what midwives are doing, and to address some of the reckless and negligent practices being promoted as "safe" and "evidence-based" without supporting scientific evidence. <br />
<br />
We're looking forward to that position statement. <br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-22283674190306820602014-03-10T20:37:00.002-04:002014-03-10T20:37:48.825-04:00W T F ?!?<span style="font-family: Georgia,"Times New Roman",serif;">In the world of social media, the implication behind the letters WTF are well known. The irony of these three little letters could be no more appropriate in considering the latest from the Willow Tree Family Center. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span> <span style="font-family: Georgia,"Times New Roman",serif;">Willow tree might ring a bell. We wrote about the new family center back in April of last year, in the post entitled <a href="http://safermidwiferyformichigan.blogspot.com/2013/04/open-letter-to-willow-tree-family-center.html" target="_blank">"<b>An Open Letter to the Willow Tree Family Center.</b>"</a> The concept of this new center is essentially to provide an open space where care providers can offer pregnant women their services and house resources for families. Sounds nice right? </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">In our open letter to the founders last year, we urged them to carefully consider the ethics of the care providers who functioned within their facility, and moreover to consider the ethics of the care providers they named on their website offering unsuspecting families their services. As it turned out, the response received indicated they didn't like the affiliation with the <b><a href="http://www.lansingstatejournal.com/article/20120813/NEWS01/308130041/Greenhouse-Birth-Center-considers-closing?nclick_check=1" target="_blank">Greenhouse Birth Center</a></b>, and asked that we remove our original title, "Greenhouse Birth Center Reincarnated". Politely we obliged, but in looking at the newly revealed website of care providers the title wasn't far off the mark. In fact you could say it was <i>dead</i> on. I wish I could say the founders of the Willow Tree Family Center are more concerned with safety and ethics than they are with their image. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The Greenhouse Birth Center closed its doors in 2012 after the death of our baby, Magnus Snyder and numerous other accounts of deaths and injuries in the hands of the midwives working there. After fund raising efforts to support legal fees for the center and midwives that didn't bother to carry <b><a href="http://safermidwiferyformichigan.blogspot.com/2012/05/what-were-seeking-is-your-midwife.html" target="_blank">malpractice insurance</a></b>, the majority of the GBC board moved on to raise money for a new endeavor, and hence the Willow Tree Family Center was born. The questionable care that took place at GBC was highly publicized. The founders at Willow Tree were notified in our open letter that many of the midwives and other types of care providers they were considering were in fact involved with dangerous practices. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<b><span style="font-family: Georgia,"Times New Roman",serif;">The response? </span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>A handy little "<a href="http://willowtreefamily.com/practitioners" target="_blank">Provider Directory</a>"with a convenient disclaimer absolving themselves of <i>any </i>ethical responsibility whatsoever for having provided the public with such a classy list of care providers:</b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><br /></i></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><i> "Disclaimer: This Provider Directory is a compilation of providers who
have indicated </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> that they provide services related to pregnancy, birth,
women and children. Willow </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> Tree Family Center does not guarantee the
accuracy or validity of any of the </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> credentials listed, nor do we
recommend nor endorse the competence or expertise of </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> anyone listed.
Willow Tree Family Center shall not be responsible, directly or </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> indirectly, for any damages or loss caused or alleged to be caused by or
in connection </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> with the use of or reliance on any provider in this
Provider Directory. Willow Tree </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> encourages consumers to verify the credentials of providers and interview providers </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> to find the care that
is right for each family."</i></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">The unsuspecting public may wonder why such a disclaimer might be necessary. <u><b>The answer...because the founders of the Willow Tree Family Center absolutely knew about everything that happened at Greenhouse Birth Center, and they worked hard to consult with lawyers to ensure they covered their own asses. </b></u></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">The language is precise and purposeful. <b>To translate for families considering the care providers on this list, these people don't want to be held liable when babies die.</b> They know darn well babies have died, and been injured many times over in the hands of the people listed on their website, yet chose to name them anyway as a provider in our area. The kicker is that they conveniently excuse themselves on any responsibility in doing so.</span><br />
<br />
<i><b><span style="font-family: Georgia,"Times New Roman",serif;">Need more precise examples:</span></b></i><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Consider Audra Post, CPM, </b>midwife extrordinare attended the botched delivery of our son, watched him born without breathing, even drove me to the hospital hours later so we could spend two weeks wondering if he would live. She was named in our lawsuit that followed, and filed <a href="http://safermidwiferyformichigan.blogspot.com/2012/09/no-liability-insurance-just-file.html" target="_blank"><b>bankruptcy</b> </a>to dismiss the case from civil court. Weeks later she opened a new business, her own home birth midwifery practice, backed up by the other two midwives who attended our son's birth. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Nothing harmonious about that, and yet her name appears on the Willow Tree Family Center's directory as if nothing ever happened. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Consider Heather Paris, Childbirth Educator </b>and<b> Mitzi Montague-Bauer</b>, <b>Doula</b>, both former owners in part of the Greenhouse Birth Center. Also both of whom played a timely part in convincing me that it would be a good choice to trust the midwives (Audra Post, CPM, Shelie Ross, CNM, and Clarice Winkler, CNM) to deliver a 10+ pound frank breech baby outside a hospital. Also both of whom know every detail of the shady events and afterward lies that took place surrounding Magnus's birth. How do I know this...because I told them personally by phone in the weeks after his death as I tried to sort out what had happened in my own grieving mind. <u>And finally, both of whom NEVER bothered to tell me they were part owners in the very business venture they were "recommending" for our care. </u> </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Yep, they are both listed in the Willow Tree Family Center directory too, and had a hefty role in "town hall" type meetings that brought the creative idea of a reincarnated center to life. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Consider Dr. Nancy Herta, OBGYN,</b> and "Consulting Physician" for the Greenhouse Birth Center. Dr. Herta provides advice when the midwives call upon her for consultation or referral. In MI, there is no definition for what this role entails. So even when a client is sent at 37 weeks to her office for a patient-requested ultrasound that reveals a breech baby, there are no established guidelines for what is actually assessed in that ultrasound, other than what the <i>midwives </i>requested. Dr. Herta never reviews the case, supposedly never looks at the ultrasound, and doesn't advise the midwives providing the care. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">When bad things happen, it's easy to say she didn't know about it. Another great example of self-absolution of any ethical responsibility. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">I don't know every provider named in the WTF Center's directory, nor do I care to. <b>Considering the reputation of those I do know, I would caution every family to think twice about the lack of ethical thought and responsibility that went into creating this public listing of "resources".</b> I would also caution every provider on that list to carefully consider the company you keep. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">In knowing who created the WTF Center, the motives behind the effort, and the providers they support in their attempt at "holistic, family-centered care", it is imperative that Lansing Area families understand who it is hosting this gathering place of questionable professionals. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> </i></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-13198315103580330652014-02-25T18:42:00.000-05:002014-02-25T20:58:24.989-05:00Safer Midwifery for Michigan Website Debut<span style="font-family: Georgia,"Times New Roman",serif;">For those who regularly read our blog, you've likely noticed a lag in the frequency of our posts. Going back to teaching full time, having a baby, selling a home...and writing content for a website will do that to a girl. The good news? The website is ready for it's long awaited debut. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">For those who know my story, who know Magnus, and who know my passion for education ~ this website is our healing project. It represents our contribution to moving midwifery closer to being the reliable, accountable practice it claims to be, the practice families deserve. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Please take a moment to read this letter to our visitors that explains the founding purpose behind our website. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="https://docs.google.com/document/d/1fu4qBAfOXGzavJAf05x31Qc26JkuZZyqB7qc5haxGZ0/edit" target="_blank"><br /></a></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="https://docs.google.com/document/d/1fu4qBAfOXGzavJAf05x31Qc26JkuZZyqB7qc5haxGZ0/edit" target="_blank">Letter from the Founder</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">You can also visit the "<b><a href="http://www.safermidwiferymi.org/about-us" target="_blank">About Us</a></b>" page to learn more about our Mission, Vision, Values, and Goals as an advocacy group. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The full website can be found at: <b><a href="http://www.safermidwiferymi.org/">http://www.safermidwiferymi.org/</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">To all of those who have offered our family countless hours of support, and those who have supported the idea of our website from its infancy,<i><u> thank you.</u></i>...two small words that don't begin to express the enormity of our gratitude. I hope you find our work useful, and are able to share it with those whom it will help to make more fully informed decisions regarding midwifery care. We hope it is a resource that will be shared far and wide. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">As always, feedback welcome. We'd love to hear your ideas. </span><br />
<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-7092089274964981922013-10-31T17:41:00.003-04:002013-11-04T07:27:17.299-05:00Legalization without regulation - midwifery in MissouriRecently we became aware of the tragic death of a baby at planned home birth in Missouri. A Missouri CPM took on the care of a woman expecting twins, and one of the twins died due to a cord prolapse during the birth. You can read this story here:<br />
<a href="http://dreahlouis.blogspot.com/2013/10/the-midwife-from-hell.html">http://dreahlouis.blogspot.com/2013/10/the-midwife-from-hell.html</a><br />
<br />
Midwives practiced underground for many years in Missouri, the practice of midwifery was explicitly illegal, and any midwife openly practicing was arrested and investigated for breaking the law. Read <a href="http://www.babble.com/pregnancy/my-illegal-home-birth-giving-birth-at-home-was-weird-magical-and-a-felony/">this story</a> about how not only midwives, but clients used to conceal the identities of their midwives when planning home births.<br />
<br />
<a href="http://www.ourbodiesourblog.org/blog/2008/06/missouri-supreme-court-ruling-makes-midwifery">In 2007, Missouri <i>legalized</i> the practice of midwifery</a>. But as of today, midwives practicing home birth in Missouri <u>do not have licenses</u> - the state has virtually no oversight or regulations over the practice of midwives.<br />
<br />
The law stipulates that if one holds the <a href="http://narm.org/">NARM</a> credential, one may legally practice midwifery.<br />
<br />
This is very, very little oversight or regulation of a 'profession' that holds the lives of women and their children in their hands. <br />
<br />
Presumably, the legalization of midwifery in Missouri allows midwives to attend any and all births that they deem appropriate for OOH care. Like a twin birth.<br />
<br />
<blockquote class="tr_bq">
<b>And when a birth ends tragically with the death of a baby in a state with no licensing, what is the recourse for the midwife? </b><br />
<br />
<b>Is her license reprimanded?</b> <u><i>No, she has no license.</i></u><br />
<b>Does a professional board evaluate the midwife's practice?</b><u><i> No, there is no professional board.</i></u><br />
<b>Do her malpractice insurance premiums increase?</b> <u><i>No, she is not required to carry malpractice insurance.</i></u><br />
<b>Does she lose her credential from NARM? </b><i><u>Possibly, </u></i>though NARM appears to be <a href="http://safermidwiferyformichigan.blogspot.com/2012/04/narm-no-accountability-renegade.html">more interested in promoting midwifery than disciplining dangerous midwives</a>.<br />
<b>Or does she keep on practicing like nothing ever happened</b>, because the state allows this, because there is no oversight?</blockquote>
<br />
We've heard the nonsensical argument from some Michigan midwifery advocates that <i><u>legalization</u></i> of midwifery should be pushed for, not licensing. We believe Michigan women and their families deserve better than a state-sanctioned free-for-all in the realm of midwifery where any form of risk-factor (breech, twins, VBAC, post-dates) can be "supported" in the out-of-hospital setting, and legally attended by midwives who can wash their hands of the responsibility when there is a bad outcome. <br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-42094106553020324552013-08-07T08:11:00.001-04:002013-08-07T08:11:34.934-04:00 Certified Professional Midwife Credential<span style="font-family: Georgia,"Times New Roman",serif;">Some may read our blog and draw the conclusion that we do not "like" or support Certified Professional Midwives." Please know that is not the intention. We do not aim to be inflammatory or derogatory toward CPMs. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">For Safer Midwifery for Michigan, the bottom line is a clear, an appropriate standard for education and training is absolutely critical. <b> Research from around the world points to a high level of education as one of the key factors in positive birth outcomes outside the hospital.</b> You can visit recent posts about the Education of Midwives Around the World, <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank">Part I</a></b>, and <a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world_22.html" target="_blank"><b>Part II</b></a> to further understand this research, and how it highlights glaring disparities between educational standards for midwives in other countries as compared to the US. Notice in these links that other first world countries have much higher standards, most requiring a university level education for the women delivering their babies. What about the USA? The <i>minimum</i> standard for a CPM's education is only recently (2012), a high school diploma. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">The problem with the CPM credential lies in credibility and severe inconsistencies among providers who carry the credential. While there may be some CPMs who are highly educated, there are far, far too many who are not, and they are all thrown in the pot together. Scope of practice is undefined at best, </span><span style="font-family: Georgia,"Times New Roman",serif;">purposefully leaving it up to the midwife herself to determine along the way.<b> </b></span><span style="font-family: Georgia,"Times New Roman",serif;"><b> </b>For example, check out <b><a href="http://narm.org/accountability/informed-consent/" target="_blank">NARM's "Shared Decision Making Statement"</a></b>. The end result is a variable pool of midwives, some who are highly educated, and those that are not with a smattering of skills in between. Some are even rushing through the training with a careless preceptor so they can be "grandfathered in" when licensing legislation does pass. <i>For a little history lesson about the CPM credential, and the importance of educational standards, visit our recent guest post by <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world_29.html" target="_blank">Judith Rooks, CNM.</a></b></i></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">The American College of Nurse Midwives said it well in a <b><a href="http://www.midwife.org/siteFiles/legislative/ACNM_re_Minimum_Educational_Stds_for_Midwives_7_09.pdf" target="_blank">letter</a></b> sent to members of Congress in 2009: </span><br />
<br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> </span><span style="font-family: Georgia,"Times New Roman",serif;"><span class="">"Until the CPM community has developed a uniform process
to ensure that all </span></span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span class=""> CPMs have graduated from an accredited program,
Congress should not recognize </span></span></i><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span class=""> this class of provider in its entirety."</span></i> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">We sincerely understand the desire and need for a credential that offers reliable care for the out-of hospital client, but in what world is an apprenticeship process acceptable for delivering babies? Especially when there are other routes to professional midwifery credentials that require a graduate level of education, like the <b><a href="http://www.safermidwiferyformichigan.blogspot.com/2013/07/certified-midwives-examining-cm.html" target="_blank">CM credential</a></b>, or the CNM. Or what about states that provide provisions and appropriate licensing for all three credentials like the state of <b><a href="http://cfmidwifery.org/states/states.aspx?ST=NY" target="_blank">New York</a></b>? </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span class="text" id="_ctl0_CfmContent_longStatus"><b>Education Requirements for Licensure in NYS:<br />
</b><br />
All midwives, regardless of credential or educational background must meet certain criteria to be eligible for licensure in NYS:</span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span class="text" id="_ctl0_CfmContent_longStatus"><br />
-- Bachelor's degree (doesn't matter what subject) -- which you already have.<br />
-- Midwifery education at a NYS approved midwifery school*<br />
-- Can demonstrate competency in particular areas relating to well-woman
care and pharmacology (see http://www.op.nysed.gov/midwif.htm check
under education) <br />
<br />
<u><b>All midwives must take and pass the AMCB certification exam which is
designed for CNMs or CMs, but which all midwives in NYS must take (the
NARM exam is not accepted here). </b></u><br />
<br />
** Several MEAC schools have been deemed acceptable by NYS. CPMs using
the PEP process can become licensed, but they must then go to a
midwifery school and have a bachelor’s degree. Several CPMs have become
licensed in NYS by attending the distance learning program at the
National College of Midwifery and obtaining a BS in midwifery.</span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">(These guidelines and standards for education are in line with<b> <a href="http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Planned%20Home%20Birth.aspx" target="_blank">ACOG</a></b> and <b><a href="http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Issues-Guidelines-For-Care-of-Infants-in-Planned-Home-Births.aspx" target="_blank">AAP's</a> </b>recent statements on planned home birth.) </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Some are uncomfortable with any kind of comparison among credentials, CPM, CM, and CNM. I would ask them, how is a healthy conversation about the safety of midwifery, and educational standards possible without discussing the difference among them? Somehow that is misconstrued as breaking the sisterhood, or damaging the image of midwifery. I have to say, nothing is more damaging to midwifery than continued unsafe practices, preventable deaths, and injuries that are ignored, and the multitude of issues that continue to go unaddressed ~ even outright ignored. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Our advocacy group believes that women and families deserve transparency. They deserve to know, discuss, and understand the differences between<b> </b>these credentials, and how it impacts their care. Lines between these credentials have been purposefully blurred to the public, allowing dangerous midwives to practice under the same hat as those who practice responsibly. Need an example? MANA's <b><a href="http://www.mana.org/about-midwives/what-is-a-midwife" target="_blank">"What is a Midwife?"</a></b> leaves out all the important details about educational standards and the differences in scope of practice among various types of midwives. They make it seem as if their training is on par with the rest of the world, even citing an International definition of "midwife"...all while the minimum standards for CPMs don't even meet International educational standards. It's misleading, confusing, and leaves women feeling scammed when the unthinkable happens. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">It's time for frank discussions about what our standards should be for education and practice of all midwives in this country and state, and the public deserves to have a say. It's not about leaving anyone out, insulting any one body of midwives, or being divisive. It's about establishing a minimum bar for education and standards for practice that are appropriate, with safety and outcomes at the forefront. It's about supporting midwives in reaching that bar if they aim to provide excellent care for mothers and babies in any environment, home or hospital. It's about taking the time to get a sound education and offer women choices they can rely upon. We've said all along, the state of midwifery cannot improve if it cannot accept and address its shortcomings. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Instead of getting offended, lets get the difficult conversations started, and move toward real progress. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-45364923350871729732013-07-29T08:56:00.000-04:002015-09-18T15:45:27.156-04:00"Certified Midwives" Examining the CM Credential<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><i>What is a Certified Midwife? </i></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">A <a href="http://www.midwife.org/The-Credential-CNM-and-CM">Certified Midwife </a>(CM) is a health care professional who holds a credential in midwifery from the American Midwifery Certification Board. Certified nurse-midwives (CNMs) are the most prevalent type of midwife in the US and are certified by this same board.</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The standards for education for CMs and CNMs are identical. Both must be educated in a graduate degree program, are trained in the same competencies, and must pass the same certification examination.</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">By credential, certified midwives are qualified to independently manage low-risk pregnancies and deliveries, provide routine well-woman care and screenings, diagnose and treat health conditions, and prescribe medications. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><i>How is a certified midwife CM different than the CPM or CNM?</i></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Educationally, the only difference between CMs and CNMs is that CMs do not have degrees in nursing. It is an equivalent credential to the CNM. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The differences between CPMs and CMs are that CMs must be trained at a graduate level, CMs are integrated healthcare providers working alongside physicians, nurses and other healthcare providers, CMs are qualified to attend births in any setting, CMs are trained in pharmacology and prescribing medications.</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The differences are so important, we felt a graph would be helpful: </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
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<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; font-size: 14.0pt; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">CPM</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Graduate degree
required</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Training in medical
pharmacology required</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Skilled in providing
care in all birth settings</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Providers of
gynecology and well-woman care</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Qualified to
prescribe birth control and other medications</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Trained with in
the health care system among physicians, nurses, and other healthcare professionals</span></b></span></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" valign="top" width="90"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></b></div>
</td>
<td style="border-bottom: solid #595959 1.0pt; border-left: none; border-right: solid #595959 1.0pt; border-top: none; mso-border-alt: solid #595959 .5pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 166; mso-border-left-alt: solid #595959 .5pt; mso-border-left-themecolor: text1; mso-border-left-themetint: 166; mso-border-right-themecolor: text1; mso-border-right-themetint: 166; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: .95in;" valign="top" width="91"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid #595959 1.0pt; mso-border-alt: solid #595959 .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-themetint: 166; mso-border-themetint: 166; mso-border-top-alt: solid #595959 .5pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 166; padding: 0in 5.4pt 0in 5.4pt; width: 342.9pt;" valign="top" width="457"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><span style="color: #404040; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-themecolor: text1; mso-themetint: 191;">Self-purported
“experts” in out-of-hospital birth</span></b></span></div>
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<span style="color: #404040; font-family: Wingdings; font-size: 14.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: #404040; mso-style-textfill-fill-colortransforms: "lumm=75000 lumo=25000"; mso-style-textfill-fill-themecolor: text1; mso-symbol-font-family: Wingdings; mso-themecolor: text1; mso-themetint: 191;"><span style="font-family: Arial, Helvetica, sans-serif; mso-char-type: symbol; mso-symbol-font-family: Wingdings;">YES</span></span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><i>How are CMs and CPMs similar? </i></span></span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Neither CPMs or CMs are required to have a degree in nursing.</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">CMs
and CPMs are not licensed in every state. The state of Michigan does
not currently recognize either the CPM or the CM through licensing. </span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>But the differences between CPMs and CMs are vast and striking</b>. Why are so many states '<a href="http://pushformidwives.org/cpms-by-state/">pushing</a>' for licensure of such poorly-trained midwives as CPMs, when there already is a high-quality, non-nurse credential? Why, when every state already recognizes and licenses CNMs, is it so difficult to enact licensing for the CM - an equivalent credential? Why, when it comes to midwifery licensing, should we reinvent the wheel - and an inferior wheel, at that -and license midwives with minimal training, minimal oversight, and minimal (<a href="http://safermidwiferyformichigan.blogspot.com/2012/04/narm-no-accountability-renegade.html">or non-existent</a>) standards of practice?</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><i>What we'd like to see in Michigan: </i></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">We would like to see Michigan take the lead on this very important issue, and <u>license <b>only</b> the most qualified and highly-skilled midwives</u> for women and their families, CNMs and CMs. We would like to see Michigan's nurse-midwifery programs, the <a href="http://www.nursing.umich.edu/academic-programs/masters-programs/nurse-midwife">University of Michigan</a> and <a href="http://www.nursing.wayne.edu/msn/nmwcurriculum.php">Wayne State</a>, create pathways for training midwives who would become CMs in our state, and we would like to see not only the <a href="http://michigan.midwife.org/">Michigan Affiliate of the ACNM</a> but also the <a href="http://michiganmidwives.org/">Michigan Midwives Association</a> openly support improving the educational standards of midwives in our state by endorsing and promoting the CM credential. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-346749784229772317.post-91112270209698221892013-07-19T10:40:00.000-04:002013-07-19T10:40:03.650-04:00Considering Home Birth? <span style="font-family: Georgia,"Times New Roman",serif;">Our country affords many freedoms, among them the right to birth where and with whom we choose. In a state like Michigan where there are currently no regulations or laws surrounding midwifery, that freedom is widely interpreted. But what about the rights of consumers to be "<b><a href="http://safermidwiferyformichigan.blogspot.com/2012/07/freedom-to-be-fully-informed.html" target="_blank">fully informed</a></b>", and what exactly does that mean? It seems that many home birth advocates tell mothers to "educate themselves", and defend their cause when things go awry with reprimands about the mother's responsibility to make an educated choice. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">In a state with no defined scope of practice or licensing measures for out-of-hospital midwives, it's extremely difficult for consumers to access information that would allow them to<i> fully educate</i> or <i>inform themselves</i> before making the choice to have a home birth or birth center birth. Being fully informed means families are told about the good, the bad, and the ugly as they pertain to home birth. It means a woman is told by her care provider directly & honestly the benefits of home birth, <i>and</i> the inherent risks that come along with it. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">All too often I meet mothers, usually those whose birth stories don't have happy endings, who were only told about the benefits of home birth. They feel duped, embarrassed, like they somehow were fooled by an illusion of promises that turned out to be anything but empowering. </span><span style="font-family: Georgia,"Times New Roman",serif;">These mothers have not been informed, they have been misled. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">There will also forever and always be those mothers who choose home birth despite the risks that come with it, and fully knowing what they are risking. And there are mothers who do not fully understand the choices, and more importantly the consequences that can be associated with making the home birth choice. I fully accept a woman's right to choose home birth, but the one caveat is that she deserves to know a few key facts. Then, if knowing these facts, she still makes the choice for home birth, then the choice and responsibility can truly be her own. </span><span style="font-family: Georgia,"Times New Roman",serif;">The
problem comes when mothers choose home birth with their heads full of
misguided information and misleading propaganda...blinded by the woo as some might say. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">And so with these mothers in mind, those who weren't fully
informed about the important factors to consider before choosing home
birth, here is a list of things to consider...</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Facts You Should Know When Considering Home Birth</b></span><br />
<ol>
<li><span style="font-family: Georgia,"Times New Roman",serif;"> "<b><a href="http://safermidwiferyformichigan.blogspot.com/2013/05/american-midwife-certification-board.html" target="_blank">Planned home birth</a> is associated with a twofold to threefold increased
risk of neonatal death when compared with planned hospital birth.</b>" ~ <b><a href="http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Planned%20Home%20Birth.aspx" target="_blank">ACOG </a><a href="http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Planned%20Home%20Birth.aspx" target="_blank">Statement on Planned Homebirth</a></b><br /> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Requirements for licensing vary widely by state.</b> This includes minimum standards for education, scope of practice, collaborative agreements, and insurance requirements. Some states have NO regulations, others some, and still others more thorough guidelines. Know your state laws well, and consider heavily the impact they have on safety in practice. <i>(MI is a state that has no regulation what so ever.)</i> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Credentials and educational training vary greatly too.</b> <u>Look for a midwife who is certified by the <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/05/considering-home-birth-check-out-these.html" target="_blank">American Midwifery Certification Board</a></b>. </u> The only type of midwives who are AMCB certified are Certified Nurse Midwives and Certified Midwives. CPMs, DEMs, or lay midwives do not typically meet the educational standards for this important certification. There are exceptions for CPMs in states like NY where state law has required CPMs to further their education and pass the AMCB exam to earn a license to practice. In other states CPMs are licensed without the added educational requirements. Certification by AMCB demonstrates a high degree of competency, and is a more reliable hallmark of educational training than licensing alone. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Outcomes for home birth are greatly impacted by several factors.</b> Among the most critical are a high degree of education and training (In the US that means an AMCB certified midwife), working within a fully integrated health system, and practices regarding consultation, referral, and transfer of care.</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Not all women are good candidates for home birth. </b></span><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;">Risk factors matter a great deal when considering where to have your baby, and they matter even more if you're considering an out-of-hospital birth. </span>Research has shown time and time again that home birth is intended for LOW RISK pregnancies...yet somehow story after story of baby deaths and injuries are surfacing, revealing they were high risk to begin with according to modern medical standards. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Assessments matter in order to ensure your pregnancy is and stays low-risk.</b> If your midwife disregards important <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/01/the-delicate-relationship-between.html" target="_blank">assessments</a></b>, she is "trusting birth" more than she is assessing and monitoring your risk factors. </span><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;">A
good midwife will value assessments so she can be informed, and she can
keep you informed about whether or not your pregnancy becomes high risk
at any point. She should have very clear guidelines for what defines
high risk, and what situations "risk out". </span></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Not all "<a href="http://safermidwiferyformichigan.blogspot.com/2012/05/what-were-seeking-defining-birth-center.html" target="_blank">birth centers</a>" are safe. Looking for a birth center? </b>Look for one that is<b> </b><a href="http://safermidwiferyformichigan.blogspot.com/2012/06/are-freestanding-birth-centers-safer.html" target="_blank"><b>affiliated with a hospital</b> </a>with licensed, insured midwives providing the care. At the very least, choose a birth center that is accredited by AABC. <b><br /></b></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Most midwives practicing
outside of a hospital DO NOT carry <a href="http://safermidwiferyformichigan.blogspot.com/2012/05/what-were-seeking-is-your-midwife.html" target="_blank">malpractice insurance</a>.</b> Midwives like to claim that<a href="http://safermidwiferyformichigan.blogspot.com/2012/06/ask-midwife-should-midwives-carry.html" target="_blank"> <b>they can't afford it</b></a>. Insurance protects both the consumer
and the midwife. The former by providing specific safety guidelines
for practice, and protecting those who are victims of negligence. The
latter from lawsuits that could be life altering. </span></li>
<li><b><span style="font-family: Georgia,"Times New Roman",serif;">Just because a midwife is covered by Medicaid, does not mean she is a safe care provider. </span></b></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Just because a midwife tells you home birth is safe, and that she has never been responsible for a baby or mother's death, doesn't mean it is true. </b> When there is no oversight and no public track record, there is no way to actually know the truth. You have to decide whether or not to take your chances. </span></li>
</ol>
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">What Factors Contribute to the Best Outcomes for Out-of-Hospital Birth?</span></b><br />
<ol>
<li><span style="font-family: Georgia,"Times New Roman",serif;">An educated, licensed midwife</span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">A low-risk pregnancy and health status of mother and baby</span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">A professional, collaborative relationship between the midwife and local physicians and medical providers</span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Routine prenatal care and testing in accordance with professional medical guidelines</span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/05/what-were-seeking-informed-consent.html" target="_blank">Informed consent</a></b> leading to a clear knowledge that certain conditions
are more dangerous in out-of-hospital settings - and not indoctrination
into 'trusting birth' at all costs. A provider should be honest and open
about what cannot be handled in an out-of-hospital setting. If the
client is led to believe that all complications are handled better at
home with a midwife, or if those 'scary' complications only happen in
hospitals, then they are being misled. </span>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
</li>
</ol>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Other Important Thoughts </b></span><br />
<ol>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Cesareans are not the worst outcome. </b> A baby who is injured or does not survive birth is the absolute worst outcome, especially when that death or injury was fully preventable. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/06/what-is-collaborative-care-model.html" target="_blank">Collaborative Care Models</a> are on the rise.</b> Want a natural childbirth? You have options, many of them. Look for a collaborative care model where midwives work as part of the fully integrated health care system. This means the midwife delivers in a hospital or in a hospital-affiliated birth center. (Not to be confused with a freestanding birth center.) Many collaborative care midwife groups have their own practices. You'll have the most highly educated midwives in the country, with emergency care seconds away should you need it. You'll have licensed, insured care providers working within a defined scope of practice. </span></li>
</ol>
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<br /><span style="font-family: Georgia,"Times New Roman",serif;">Any mother
planning a
home birth who goes around touting that it is safe or as safe as a
hospital birth does not have, or fails to acknowledge the facts. A mother who claims her
unlicensed
midwife is safe, cannot <i>really</i> know without the data on her outcomes to
back it up. A mother who tells you she is educating herself and
choosing not to do any of the prenatal assessments because they are
unnecessary or harmful has fallen hard for the fallacy of trusting
birth. Whatever your choices may be surrounding birth, take time to understand the benefits<b>, the risks, and their subsequent consequences </b>before making the decision to have your baby at home. </span><br />
<ol>
</ol>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-346749784229772317.post-57467740944799430472013-07-05T21:51:00.003-04:002013-07-05T21:51:52.766-04:00Freedom to Choose<span style="font-family: Georgia,"Times New Roman",serif;">Since this week marks our Nation's birthday and celebration of the many freedoms we enjoy, I thought it was the perfect time to approach the topic of freedom to choose when and with whom we give birth. Is it a basic human right? Is it about the safety of the baby? No matter where your opinion falls on this highly debated topic, one thing is certain, that no matter what choices we make they should undoubtedly be genuinely informed of all risks and benefits. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">I find this subject tends to be addressed like a one way street. The moment the word "regulation" comes up in discussion surrounding midwifery, home birth advocates start screaming, "don't take away my <i>choice</i> to birth where and how I please." The tone of those same voices shifts though with the slightest mention of <i>elective</i> cesarean. Judgment fills the room, sucking all the oxygen out. The discussion then becomes less about <i>choices</i> and more about quoting the cesarean rate as being too high. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>But is there a time when an elective cesarean has its place? Is it not the right of the woman and her care provider to make those choices?</b> Take the woman who was sexually abused for example, or </span><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;">the mom whose natural birth left her so injured that it took years to heal</span>. </span><span style="font-family: Georgia,"Times New Roman",serif;">Do </span><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;">these women not have a say in how they give birth during subsequent
pregnancies? Where do we draw the line and how shall we write the
rules? </span></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><span style="font-family: Georgia,"Times New Roman",serif;">What about </span><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;"></span>the former loss mom who already endured NCB and intervention-free birth in all its tragedy</span>? That was my story. An elective cesarean saved my emotional sanity. It also re-established my trust in care providers taking good care of me. After the worst imaginable tragedy resulting from natural, out-of-hospital childbirth and incompetent care, an elective cesarean gave me peace of mind and a way forward. It was my choice to make with my doctor and for that I am immensely grateful. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;"></span>If a woman truly has the freedom to choose where and how she gives birth, then every home birth advocate should also support a woman's right to elect a cesarean. They should support and appreciate the life saving measures a cesarean can offer period, whether elected or emergency. </span><br />
<br />
<br />Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-346749784229772317.post-90479078816049473802013-06-27T13:10:00.001-04:002013-06-27T17:54:39.418-04:00"Take Responsibility for Your Pregnancy and Birth!"<span style="font-family: Georgia,"Times New Roman",serif;"><b>We welcome a guest post today from an anonymous midwife, who takes research and serving mothers safely very seriously. </b><i><b><br /></b></i></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><b>“Pregnant women need to educate themselves and take responsibility for their births.”</b></i><br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Women receive this advice, and admonition, from many quarters, but it does not usually mean what you would think it does. It does not usually mean to educate themselves about their risks in pregnancy and childbirth, or how to know when intervention may be necessary. What it usually means is to trust your midwife, and not to trust the doctors, nurses, hospitals, or medical advice. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">If your pregnancy and birth are completely normal and you don’t have any risk factors, that advice may work fine. But, what if your midwife tells you how to handle a condition or situation that seems contrary to your instincts and intuition, contrary to evidence based practices, or without safety at the forefront? If women are told to take responsibility for their births then they should know when it is time to trust themselves that they may know more about about their pregnancy, labor, birth, and newborn than their midwife or doctor does.<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Midwives attending women planning a home or birth center birth frequently quote the World Health Organization (WHO) which recommends that the cesarean section rate should not be higher than 10% to 15%. However, WHO also has many excellent midwifery educational publications that midwives may not be using, including<b> <br /><br />Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice </b>(<a href="http://www.who.int/maternal_child_adolescent/documents/924159084x/en/">http://www.who.int/maternal_child_adolescent/documents/924159084x/en/</a>)<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">The overview for this publication describes the contents:<br /> <i><br /> “This guide provides evidence-based recommendations to guide health-care </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> professionals in the management of women during pregnancy, childbirth and <br /> postpartum period, post abortion, and newborns during their first weeks <br /> of life. It is a guide for clinical decision-making. It facilitates the collection,<br /> analysis, classification and use of relevant information by suggesting key <br /> questions, essential observations and/or examinations, and by recommending <br /> appropriate research-based interventions. It supports the early detection of <br /> complications and the initiation of early and appropriate treatment, including <br /> timely referral, if necessary.</i><br /><br />In other words, where ever midwives are providing evidence based care, this is what they should be doing. The Institute for Clinical Systems Improvement (ICSI) also publishes two interactive healthcare guidelines. The first is for <b><a href="https://www.icsi.org/_asset/13n9y4/Prenatal-Interactive0712.pdf" target="_blank">Routine Prenatal Care</a></b>, and the second is <b><a href="https://www.icsi.org/_asset/br063k/LaborMgmt.pdf" target="_blank">Management of Labor</a></b>. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><u><i>Routine Prenatal Care</i></u> pertains to the care of all women who are pregnant or are considering pregnancy, and the labor management guide is for all women who present in labor, including preterm labor. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><u><i>Management of Labor</i></u> provides algorithms (charts) for decision making during labor, birth, and the newborn period.<br /><br />The Hesperian Foundation publishes a number of books and guides for developing or low literacy countries, including<b><u> </u></b><i><u>Where There is No Doctor</u></i>. An excellent guide for pregnant women, simply written is <i><u>A Book for Midwives</u></i>. You could purchase the entire book as a download, but the Hesperian Foundation has made the chapters available<b> <a href="http://hesperian.org/books-and-resources/" target="_blank">here, for free</a></b>. The medical advice used in the book has been recently updated to reflect WHO guidelines for safe, evidence based care during pregnancy. This is the care your midwife should be providing using the best evidence available. <br /><br />If labor is progressing normally, watchful waiting and careful attentive monitoring are required. If your labor varies, or something feels wrong to you, your midwife should assist in assessing the situation and transfer you to the hospital. A Cesarean is not automatic when you transfer to the hospital, but more careful monitoring may necessary to be sure you and<br />baby are safe and healthy. Cesareans are also not the worst possible outcome should the need arise. A safe and healthy mother and baby in end is what most mothers care most about. At times we become so entranced with the "experience" of birth, we lose sight of what matters most. </span><span style="font-family: Georgia,"Times New Roman",serif;"><b><br /><!--[if gte mso 9]><xml>
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<br />
<i><b><span style="font-family: Georgia,"Times New Roman",serif; font-size: small;">Links for each of these guidelines
is included above, but they are summarized in the two tables below.</span></b></i><br />
<span style="font-family: Georgia,"Times New Roman",serif;">
<br />Safer Midwifery for Michigan has already discussed what should be included in <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/01/routine-care-during-pregnancy.html" target="_blank">Routine Prenatal Care</a></b> at each visit. <b>The remainder of this post will describe the conditions that mean you should trust yourself that the pregnancy is no longer completely normal. </b> Unfortunately this list of signs and symptoms have been taken from the birth stories of loss moms. Women whose babies died or were permanently injured because the midwives caring for these moms either didn’t know that these were signs of complications or did not believe the mothers. <b>If these things occur, please find answers.</b><br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Sometimes there are other explanations, but minimizing your symptoms and hoping they will go away is not the same as knowing these things are not problems. Trying to manipulate the symptoms does not mean they didn’t occur. Using a different thermometer to get a lower temperature doesn’t mean you didn’t have a fever. Resting on your left side for 10 minutes before having your blood pressure retaken, and getting a lower number the second time, doesn’t mean you don’t have high blood pressure. It only means your midwife has found a way to get a lower number so she doesn’t need to make the diagnosis of hypertension or possible pre-eclampsia. Or, that she doesn’t need to transfer you to the hospital.<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Although some midwives may say this chart is medical management and such precautions are not necessary with a normal pregnancy, if these things are happening with your pregnancy you need to know that they may be signs of complications or impending complications.</b> The midwife may tell you that she has seen this before, and everyone was fine, meaning it’s no reason to go to the hospital. <b>Dismissing or minimizing your concerns does not make the problem or the risks go away, and it may put you or your baby in danger if ignored.</b> A skilled, knowledgeable, and competent midwife will take your concerns seriously and will help you find answers. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Remember how often your midwife told you that she was an “expert in normal birth”? That she was also excellent at catching complications before things got serious, and would transfer you to the hospital if complications occurred? The situations in these charts are some of the red flags they were talking about. Is she living up to the expectations you had for the care you thought you would receive?</span><br />
<br />
<br />
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<div align="center" class="Body" style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Times; font-size: 14.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt;">Care
During Pregnancy</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Times; font-size: 10.5pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt;"></span></i></b></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="Body">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background: white; border-collapse: collapse; margin-left: 5.0pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-table-layout-alt: fixed;">
<thead>
<tr style="height: 12.0pt; page-break-inside: avoid;">
<td style="background: #B0B3B2; border: solid black 1.0pt; height: 12.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div align="center" class="Heading2" style="text-align: center;">
<span style="font-size: 10.0pt;">Sign or symptom</span></div>
</td>
<td style="background: #B0B3B2; border-left: none; border: solid black 1.0pt; height: 12.0pt; mso-border-left-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div align="center" class="Heading2" style="text-align: center;">
<span style="font-size: 10.0pt;">What it could mean</span></div>
</td>
<td style="background: #B0B3B2; border-left: none; border: solid black 1.0pt; height: 12.0pt; mso-border-left-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div align="center" class="Heading2" style="text-align: center;">
<span style="font-size: 10.0pt;">What may happen next</span></div>
</td>
</tr>
</thead>
<tbody>
<tr style="height: 66.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 66.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Bleeding,
15-42 weeks</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Placenta
previa or abruption. </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">May
be a minor problem and could resolve on its own. However, you should have an
ultrasound so you have better information for making decisions. The bleeding
may occur on and off but may recur during labor. The bleeding you are seeing
is almost never all the bleeding occurring, as the baby’s head may act as a
cork at the cervix. </span></div>
</td>
</tr>
<tr style="height: 99.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 99.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Severe
pain in abdomen or uterus</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 99.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Any belly pain with fever can be a sign of womb infection. </span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Constant belly pain in late pregnancy may mean the placenta is coming off the
womb wall. </span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Strong, constant belly or side pain in the first 3 months may mean that this
is a tubal pregnancy. </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 99.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
severe pain may be caused by an infection or problem not related to
pregnancy. You may have a kidney stone, appendicitis, or a problem with your
gall bladder.</span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Any
of these things may cause problems for you and for the baby including the
baby coming much earlier than it should.</span></div>
</td>
</tr>
<tr style="height: 33.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 33.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Severe
nausea</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 33.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">You
should be concerned if you can’t keep water, or any other fluid or food down.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 33.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
the mother is unable to keep fluids down and stops urinating,</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">get
medical help immediately. She may already have severe</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">dehydration,
which is very dangerous.</span></div>
</td>
</tr>
<tr style="height: 99.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 99.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Large
amount of uterine (baby) growth</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 99.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">May
be twins.</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">May
be that your pregnancy is farther along than you think. </span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Could
be a very large baby or an excessive amount of amniotic fluid.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 99.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
you decided not to have the glucose test at 24-28 weeks, you may have a
missed diagnosis of gestational diabetes or diabetes that was present before
pregnancy. </span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">A
very large baby may make it difficult for the baby to get in the best
position for birth and lead to shoulder dystocia.</span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">An
excessive amount of amniotic fluid makes it easier for baby to float in the
uterus which increases the risk for a cord prolapse or a baby that is breech,
sideways, or otherwise in a poor position for birth.</span></div>
</td>
</tr>
<tr style="height: 55.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 55.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Less<span style="mso-spacerun: yes;"> </span>uterine (baby) growth than expected</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 55.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Pregnancy
may not be as far along as you or your midwife think, but baby may also be
smaller than expected because the placenta is not working correctly.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 55.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Babies
who are not receiving enough nutrients because the placenta isn’t working
well will usually have problems with low blood sugars when they are born,
which can lead to trouble breathing and maintaining their temperature. Low
blood sugars can lead to brain damage that becomes permanent.</span></div>
</td>
</tr>
<tr style="height: 66.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 66.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Fever</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Can
have a number of causes from an infection you have to an infection the baby
has.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">You
should try to find the reason for any fever. If your midwife can’t help,
seeing your family doctor might. It may be a kidney infection, but could also
be an infection of the amniotic fluid, or<span style="mso-spacerun: yes;">
</span>of the uterus. These infections require antibiotics. Untreated
infections may lead to<span style="mso-spacerun: yes;"> </span>the baby’s
death from sepsis (severe blood infection).</span></div>
</td>
</tr>
<tr style="height: 165.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 165.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">High
blood pressure, headache, dizziness, or blurred vision , especially with
generalized swelling</span></div>
<div class="Body">
<br /></div>
<div class="FreeForm">
<br /></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 165.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Usually
associated with preeclampsia.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 165.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
Brewer diet does not prevent or treat preeclampsia. Urine dip sticks are not
an accurate way of finding protein in the urine. Preeclampsia labs need to be
done and a 24 hour urine performed. Anytime the headache doesn’t go away with
your usual remedies, you should have it investigated further at the hospital.</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">When
a woman has high blood pressure during pregnancy, it is harder for her blood
to bring food to the baby. The baby then grows too slowly. Very high</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">blood
pressure can also cause the mother to have kidney problems, bleeding in the
womb before birth, or bleeding in the brain.</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">High
blood pressure can also be a sign of pre-eclampsia. Pre-eclampsia can cause
premature birth, bleeding, convulsions, or even death for the mother.</span></div>
</td>
</tr>
<tr style="height: 66.0pt; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 66.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Blood
pressure elevated</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Usually
associated with hypertension, and pregnancy may make the high blood pressure
more obvious. </span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Can
also be associated preeclampsia.</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 66.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">(See
headache with swelling above)</span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Women
with pre hypertension or chronic hypertension are at greater risk for
developing preeclampsia, but this may also indicate a need for lifestyle
changes to prevent the development of chronic hypertension within a few
months or years.</span></div>
</td>
</tr>
<tr style="height: 154.0pt; mso-yfti-lastrow: yes; page-break-inside: avoid;">
<td style="border-top: none; border: solid black 1.0pt; height: 154.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 115.95pt;" valign="top" width="155"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Labor
doesn’t start by 42 weeks</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 154.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 151.05pt;" valign="top" width="201"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Baby
is in a bad position, the head is in a bad position and can’t apply the
appropriate pressure to the cervix to assist the start of labor.</span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">It
can also be related to chronic medical problems like under functioning
thyroid (hypothyroid).</span></div>
<div class="Body">
<br /></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
labor doesn’t start on its own, then the family should ask themselves how
long they are willing to wait, and whether waiting<span style="mso-spacerun: yes;"> </span>will make the birth more likely to occur. </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 154.0pt; mso-border-left-alt: solid black 1.0pt; mso-border-top-alt: solid black 1.0pt; padding: 5.0pt 5.0pt 5.0pt 5.0pt; width: 271.65pt;" valign="top" width="362"><div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">As
long as baby if moving the same number of times each day it is fine to wait
for the baby past your due date. </span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">However,
at approx. 41 weeks a biophysical profile (ultrasound) should be done to
check the amount of amniotic fluid and how well baby is doing with waiting.
If the amniotic fluid is very low, there is a greater risk that baby will
inhale meconium when it occurs because there is less fluid to dilute the
meconium. A low volume of amniotic fluid also increases the risk that the
cord will be “pinched” during labor, or that baby may not have gotten enough
nutrients to tolerate labor well.</span></div>
<div class="Body">
<br /></div>
</td>
</tr>
</tbody></table>
</span><br />
<div class="Body">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span>
<div class="Body">
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Times; font-size: 14.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt;">Care
During Labor and Birth</span></i></b></div>
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<span style="font-family: "Times New Roman Bold"; font-size: 10.0pt;">Sign or symptom</span></div>
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<span style="font-family: "Times New Roman Bold"; font-size: 10.0pt;">What it could
mean</span></div>
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<span style="font-family: "Times New Roman Bold"; font-size: 10.0pt;">What may happen
next</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Bright
red bleeding</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">May
be an undiagnosed placenta previa or a placental abruption.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
amount you are seeing is not all there is, and baby has a lot less blood to
lose than you do. </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Very
long labor</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Or
</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Close<span style="mso-spacerun: yes;"> </span>or strong contractions with little progress</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">(Usually
a sign of obstruction either because of the shape of the pelvis or the
position of the baby’s head)</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Once
you reach 4 cms<span style="mso-spacerun: yes;"> </span>(6 cms if you have had
5 or more births) you should be making steady, continuous progress in labor. </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Active
labor should not last longer than 24 hours for a first time mother, and no
longer than 12 hours for a mother having another baby.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
you had a previous Cesarean for CPD, this may be an indication that the
problem has recurred.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">A
very long labor may mean the labor is obstructed. Signs of obstruction
include: </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Continuous contractions.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Constant pain between contractions.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Sudden and severe abdominal pain.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Horizontal ridge across lower abdomen.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Labour >24 hours.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Can
lead to exhaustion for the mom, or permanent, serious damage to the baby.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Worst
case scenario is a catastrophic uterine rupture which puts mom and baby at
risk for dying.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Water
is broken for a long time</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">A
long time is 12 hours without signs of labor beginning</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Consider
going to the hospital, but at all times you should be watching for signs of
infection.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Go
to the hospital immediately if you notice </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Fever >38˚C<span style="mso-spacerun: yes;"> </span>(100 degrees F)</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Foul-smelling vaginal discharge</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Fever</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">A
sign of dehydration or infection.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">All
infections in labor are dangerous for the mom and the baby.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
uterus doesn’t contract well if you are dehydrated. So you have an increased
risk of prolonged labor and a large hemorrhage after baby is born.</span></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
you have an infection, baby probably has an infection too. These can be life
threatening especially for the baby.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Pushing
without progress for longer than 2 hours in first birth, longer than an hour
in subsequent births.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
mother’s genitals should be bulging within 30 minutes of when her cervix is
completely open and she begins pushing.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
the birth is taking too long, go to a medical center. This is one of the most
important things a midwife can do for the mother and baby to prevent serious
problems or even death in women or their babies.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
you have tried different methods for bringing the baby down — better pushing,
different positions, emptying the bladder, rehydration drink, acupressure,
and any other methods you know — and you still see no progress after 1 hour
of good pushing, you should go to a medical center. It is not safe to wait
until more warning signs appear.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Severe
abdominal or uterine pain</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Any belly pain with fever can be a sign of womb infection. </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Constant belly pain in late pregnancy may mean the placenta is coming off the
womb wall. </span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Severe
pain in the abdomen or uterus during labor is usually a sign of the placenta
becoming detached (abruption), the uterus tearing (uterine rupture) or an
infection in the uterus.</span></div>
<div class="Body">
<br /></div>
<div class="Body">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">All
are emergencies and you need to go to the hospital right away. Don’t wait to
see if the pain goes away or becomes worse.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Dehydration</span></div>
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<br /></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Dehydration
can also make a woman feel exhausted. Signs of dehydration:</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
dry lips</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
sunken eyes</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
loss of stretchiness of the skin</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
mild fever (up to 38°C or 100.4°F)</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
fast, deep breathing (more than</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">20
breaths a minute)</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
fast, weak pulse (more than 100 beats a minute)</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
baby’s heartbeat is faster than 160 beats a minute</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Baby
has a slow heart beat when the midwife listens</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
midwife should listen to the baby’s heart beat at least every hour in early
labor, every 30 minutes in active (hard) labor, and with every contraction
while you are pushing.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">These
things can cause the baby’s heartbeat to drop below 100 beats a minute:</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Cord is very short or is being</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">pinched.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The baby is not healthy.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
There is not enough amniotic water.</span></div>
<div class="FreeForm" style="margin-left: 7.0pt; mso-list: l0 level1 lfo1; tab-stops: list 7.0pt; text-indent: -7.0pt;">
<span style="font-family: "Times New Roman"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-text-raise: -1.0pt; position: relative; top: 1.0pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman"; font-size: 10.0pt;">Placenta does not work
well, usually because the mother has high blood pressure or the baby is late.</span></div>
<div class="FreeForm" style="margin-left: 7.0pt; mso-list: l0 level1 lfo1; tab-stops: list 7.0pt; text-indent: -7.0pt;">
<span style="font-family: "Times New Roman"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-text-raise: -1.0pt; position: relative; top: 1.0pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman"; font-size: 10.0pt;">• Placenta is
separating from the womb.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
Contractions are too strong.</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">(This
is rare for a normal labor. But too-strong contractions can easily happen to
a woman who is given medicines or herbs to strengthen labor.) </span></div>
<div class="FreeForm">
<br /></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
the baby’s heartbeat is slower than 100 beats a minute and stays slow until
the next contraction or almost to the next contraction, the baby is in
danger. This is especially true if there are other warning signs, like green
waters or a long labor. The baby could be very weak at birth or have brain
damage.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">You
must go to the hospital so baby can be watched more closely.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">Baby
has a fast heart beat-faster than 160 beat per minute.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">The
midwife should listen to the baby’s heart beat at least every hour in early
labor, every 30 minutes in active (hard) labor, and with every contraction
during pushing.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">These
things can make the baby’s heartbeat speed up to more than 180 beats a</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">minute:</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The mother is dehydrated</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The mother or baby has an infection</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The mother is bleeding.</span></div>
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<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The mother has been in labor for too long.</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">•
The mother’s womb is tearing</span></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">(uterine
rupture).</span></div>
<div class="FreeForm">
<br /></div>
<div class="FreeForm">
<span style="font-family: "Times New Roman"; font-size: 10.0pt;">If
the baby’s heartbeat stays fast for 20 minutes (or 5 contractions), get
medical help.</span></div>
</td>
</tr>
</tbody></table>
<div class="Body">
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<span style="font-family: Georgia,"Times New Roman",serif;"><b>Related Posts: </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2013/01/the-delicate-relationship-between.html" target="_blank">The Delicate Relationship Between Assessment and Safety</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/08/home-birth-story-women-deserve-not-to.html" target="_blank">Women Deserve Not to be Their Own Midwife</a></b> </span><br />
<br />Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-346749784229772317.post-69472986453868484892013-05-26T21:30:00.001-04:002013-05-26T22:28:32.965-04:00On the Horizon for Safer Midwifery for Michigan <span style="font-family: Georgia,"Times New Roman",serif;">While spring has firmly settled in, there is much up and coming for Safer Midwifery for Michigan. We figured it's time for an update post for our readers. Baby Snyder is anxiously anticipated to make her arrival next week!! It's a bit surreal, and as long as everyone comes home alive, we'll be tremendously happy. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">We have many important projects in the works that will continue moving forward thanks to leadership within our advocacy group. The blog will continue as well, but may slow just a bit while we adjust to a new little one in our family. We have several guest posts in the works that will help along the way, and look forward to sharing thoughts on everything from VBACS to the CM Credential, and more. Below you'll find a brief update for our biggest projects...</span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Website</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Thanks to a great deal of generous support, our website initiative is well under way. Our initial ideas are being fleshed out with a designer who has started a prototype. After we have worked through the design process, the implementation will begin. It's a long, thoughtful process to do this job well, and we're grateful for so many collaborators on this project. We don't have a project completion date, but are happy to share we've officially started in the right direction. We'll be working hard on researching, and drafting content this summer. </span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Data Team</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;">With the help of an amazing epidemiologist and the cooperation from the State of Michigan, we have assembled a data team who will be carefully analyzing data on perinatal outcomes, (both deaths and injuries) in the state of Michigan. We'll be looking at out-of-hospital data for deaths and injuries as well as in-hospital data, and considering comparisons by care provider type. At this project's completion, we hope to have a thorough report to share with the public so they can be better informed, and we hope this project will simultaneously inform any legislation regarding midwifery in the near future. Transparency matters a great deal when it comes to safety, and Michigan families deserve to have data to support them in the decision making process. Safer Midwifery for Michigan has assembled a team to look at the data the state has collected, and further analyze it in order to promote transparency. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<b><span style="font-family: Georgia,"Times New Roman",serif;">Collaborative Care Initiative</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;">If you live in or around the Lansing, MI area, you are likely well aware of the lacking options when it comes to the type of care providers in the birth world. We have one CNM who delivers part time at McClaren Hospital, and none at Sparrow. We have worked hard to express to Sparrow Hospital the need for a Collaborative Care Model that includes CNMs as a care provider option in the same facility that houses our area's only RNICU. Sparrow has adopted the Baby Friendly initiative in recent years, is working hard on a more concrete plan for a Collaborative Care Model, and a further develop a plan for facilities that support a focus on natural childbirth. We appreciate the progress this project has made, and look forward to hearing more soon about a potential timeline for how things will proceed. </span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Legislation</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;">We've also worked hard to revise SB 1208, and submit detailed suggestions for change. The two biggest changes we hope to see include altering the language so that it would eliminate restrictions on CNMs practicing in MI, and changing the minimum standard for education to be in line with International Standards. We're hoping for reintroduction in coming months on the legislative front that would offer higher standards for education, a defined scope of practice for midwives practicing OOH in MI, and measures of accountability. We'll be sure to keep you up to date at this project develops, and share ways you can support the effort as they become available. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Stay tuned for more in coming weeks, and as always, thank you for caring about the important issues we discuss here. </span><br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-34345822851667111302013-05-20T08:56:00.000-04:002013-05-20T08:56:37.712-04:00American Midwife Certification Board (AMCB) <span style="font-family: Georgia,"Times New Roman",serif;"><b>ACOG and the AAP recently issued statements regarding planned home birth recommendations. Among them was the recommendation that midwives attending home births be AMCB certified. We couldn't agree more and thought we'd share with you what exactly this means. </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<b><span style="font-family: Georgia,"Times New Roman",serif;">What is the <a href="http://www.amcbmidwife.org/" target="_blank">American Midwifery Certification Board</a> (AMCB)?</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> </span>
<br />
<i><span style="font-size: small;"><span style="font-weight: normal;"><span class="bold" style="font-family: georgia; line-height: 1.2;">"Our mission</span><span style="font-family: georgia; line-height: 1.2;">: To protect and serve the public by leading the certification standards in midwifery" ~ A<span style="font-size: small;">merican Midwifery Certi<span style="font-size: small;">fication Board</span></span></span></span></span></i> <span style="font-family: georgia;"> </span> <br />
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<article><div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">The AMCB provides certification opportunities for Certified Nurse Midwives (CNMs) and Certified Midwives (CMs), the only two credentials for midwives in the US that require graduate school level education. </span></span></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-family: georgia; line-height: 1.2;"><i><span style="font-family: georgia; line-height: 1.2;"> </span> </i></span><br />
<span style="font-family: georgia; line-height: 1.2;"><i>"The
American Midwifery Certification Board (AMCB) is the national
certifying body for candidates in nurse-midwifery and midwifery who have
received their graduate level education in programs accredited by the
Accreditation Commission for Midwifery Education (ACME). </i></span><i><span style="font-family: georgia; line-height: 1.2;">Certification by the <u>AMCB is considered the gold-standard in midwifery certification</u> and is recognized in all 50 states." </span></i> </div>
<span style="font-family: georgia;"></span><span style="font-family: georgia;"> </span> <span style="font-family: georgia;"><div style="text-align: justify;">
</div>
</span> </article><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">What midwives qualify to take AMCB's certification exam?</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Midwives with a graduate level, university degree may take the AMCB certification exam. This includes Certified Nurse Midwives (CNMs), and Certified Midwives (CMs). Regardless of educational pathway, both CNMs and CMs take the exact same certification exam to become certified by AMCB, and must continue education according to standards set forth by AMCB to retain their certification status, every 5 years. </span><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;">What is the Scope of Practice for AMCB certified midwives?</span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> Scope of practice is somewhat determined by state laws that license AMCB certified midwives (CNMs and CMs). It is important to note that CNMs and CMs have an <i>identical </i>scope of practice, both able to attend births in and out of hospitals according to state laws. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Why does AMCB certification matter?</b> <br /><i>"</i></span><span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-family: georgia; line-height: 1.2;"><u>Certification
protects the public by ensuring that certified individuals have met
predetermined criteria for safety in practice.</u> While state licensure
provides the legal basis for practice, most states require AMCB
certification for licensure, and many institutions require AMCB
certification to grant practice privileges."</span></i></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: georgia; line-height: 1.2;">Consistently reliable, high standards for education and practice protect the people. Why would we accept anything less, whether in or out of the hospital? Midwives practicing without AMCB certification have not met the educational or practice standards set forth by AMCB, nor do they come close. </span><i><span style="font-family: georgia; line-height: 1.2;"> </span></i></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>What makes AMCB certified midwives different than CPMs, DEMs, and other midwives & why does it matter?</b> </span><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;"> </span></span><br />
<br />
<span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">I
must explicitly point out that a Certified Midwife is very different
from a Certified Professional Midwife or CPM. CPMs are not eligible for
certification through AMCB. Their educational and clinical requirements are vastly different. <br /><br />This link: <b><a href="http://www.amcbmidwife.org/amcb-certification/why-amcb-certification-" target="_blank">"Why AMCB Certification?"</a></b> offers a thorough comparison between different types of midwives, their education and certifying bodies. </span></span><br />
<br />
<span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">We have recently posted a series on the Education of Midwives around the world here on the Safer Midwifery for Michigan blog. <b>It's important to note that AMCB certified midwives are on par with highly educated midwives serving women around the world. CPMs would not however, be qualified to practice in any other first world country by current educational and practice standards. </b> I would encourage any reader wondering about the differences in credentials to visit these posts to learn more. </span></span><br />
<br />
<a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank"><b><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">Education of Midwives Around the World: Part I</span></span></b></a><br />
<b><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;"></span></span><a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world_22.html" target="_blank"><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">Education of Midwives Around the World: Part II</span></span></a></b><br />
<b><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;"></span></span><a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world_29.html" target="_blank"><span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">Education of Midwives Around the World: Part III</span></span></a></b><br />
<span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;"><br /></span></span>
<span style="font-family: georgia; line-height: 1.2;"><span style="font-family: georgia; line-height: 1.2;">The educational background and training of midwives is directly related to outcomes and safety. One of the most important factors in fostering positive out-of-hospital outcomes is the component of hiring a highly educated midwife. </span></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Which <i>Michigan</i> midwives are certified by AMCB? </b> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">All CNMs, whether practicing in hospitals or outside hospitals are certified by AMCB, and licensed through the State of Michigan. If we had CMs in our state, they too would be certified through AMCB, but we currently don't know of any practicing here. This is likely because our state does not currently license CMs. <br /><br />All other out-of-hospital midwives, (CPMs, DEMs, and other midwives) are not certified through AMCB. These are the majority of midwives serving MI families outside hospitals. (Majority meaning all but two in the entire state.) <b>If you're considering out-0f-hospital or home birth in the state of MI, you deserve to know that your midwife is likely <i>not</i> AMCB certified, university educated, licensed, or functioning within the high standards for practice described for AMCB midwives. </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>The implication? Explicitly stated, MI OOH midwives are <i>not</i> in line with ACOG and AAP recommendations for safe home birth. They are <i>not</i> highly educated as a collective group, nor do they meet this critical component that contributes to positive outcomes. </b> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The statements issued by ACOG, and AAP directly support the notion that home birth outcomes
improve dramatically when attended by highly educated and trained
midwives. This is <u><i>just one important factor</i></u> in providing for the best out-of-hospital care. <b>Please be sure to read about the other critical factors here if you are contemplating out-of-hospital birth or home birth. </b></span><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;"><u>Recommendations & Guidelines</u></span></b><br />
<ul>
<li><a href="http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Planned%20Home%20Birth.aspx" target="_blank"><b><span style="font-family: Georgia,"Times New Roman",serif;">American College of Obstetrics and Gynecology: Recommendations for Planned Home Birth</span></b><b><span style="font-family: Georgia,"Times New Roman",serif;"> </span></b></a></li>
<li><a href="http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Issues-Guidelines-For-Care-of-Infants-in-Planned-Home-Births.aspx" target="_blank"><b><span style="font-family: Georgia,"Times New Roman",serif;">American Academy of Pediatrics: Guidelines for Planned Home Birth</span></b><b><span style="font-family: Georgia,"Times New Roman",serif;"> </span></b></a></li>
<li><a href="http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000251/Home%20Birth%20Aug%202011.pdf" target="_blank"><b><span style="font-family: Georgia,"Times New Roman",serif;">American College of Nurse Midwives: Statement on Planned Home Birth </span></b></a></li>
</ul>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-76533153353987316182013-05-13T13:25:00.000-04:002013-05-13T13:25:19.854-04:00Considering Home Birth? Check out these recommendations...<span style="font-family: Georgia,"Times New Roman",serif;">The debate as to whether home birth is safe, and just how safe has been ongoing in the US for some time now. The only thing it's <i>safe </i>to say is that home birth is not for everyone in every circumstance, nor is it meant to be attended by just anyone who wants to call herself a "midwife". The safety of home birth is directly related to several key factors, each of which must be carefully considered. Important national organizations are expressing their positions on the matter.</span><br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b>
<b><span style="font-family: Georgia,"Times New Roman",serif;">Exactly what factors undoubtedly impact the safety of OOH birth? </span></b><br />
<ul>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Consistently reliable educational standards and training; ie AMCB certified midwives.</span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">A defined scope of practice (including consistently valued, research-based assessments, and risking out criteria to ensure only truly low-risk pregnancies are taking place OOH).</span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Midwifery practices that function within a fully integrated model of maternity care, for smooth consultation, collaboration, and transfer of care.</span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;">In addition, SMM also believes that consistent informed consent, philosophy, malpractice insurance, a balanced board for oversight, and reporting outcomes in the form of data are key elements that directly impact safety. </span><span style="font-family: Georgia,"Times New Roman",serif;"><br /><b> </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>So what do the national and international maternity organizations have to say about home birth? </b></span><br />
<br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b> </b></span><img alt="ACOG Logo" id="headerLogo" src="http://www.acog.org/%7E/media/acog_logo.gif" /><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Planned%20Home%20Birth.aspx" target="_blank">ACOG Planned Home Births</a></b></span><br />
<br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><i> "Although the Committee on Obstetric Practice believes that <u>hospitals and
birthing centers are the <b>safest</b> setting for birth</u>, it respects the
right of a woman to make a medically informed decision about delivery." </i></span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><i>"Women inquiring about planned home birth should be informed of its risks
and benefits based on recent evidence.<u> Specifically, they should be
informed that although the absolute risk may be low, planned home birth
is associated with a twofold to threefold increased risk of neonatal
death when compared with planned hospital birth."</u></i></span><u> </u> </li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><i>"Importantly, women
should be informed that the <u>appropriate selection of candidates for home
birth</u>; the availability of<b> </b><u>a certified nurse–midwife, certified
midwife, or physician practicing within an integrated and regulated
health system</u>; ready access to consultation; and <u>assurance of safe and
timely transport to nearby hospitals </u>are critical to reducing perinatal
mortality rates and achieving favorable home birth outcomes."</i></span> </li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><i>"The recognition and regulation of certified professional midwives and
lay midwives varies tremendously from state to state. <u>At this time, for
quality and safety reasons, the American College of Obstetricians and
Gynecologists does not support the provision of care by lay midwives or
other midwives who are not certified by the American Midwifery
Certification Board."</u></i></span></li>
</ul>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://www.aap.org/_layouts/AAP/img/header_logo.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="American Academy of Pediatrics Logo" border="0" class="header_logo" src="http://www.aap.org/_layouts/AAP/img/header_logo.png" /></a> </b></span><br />
<br />
<br />
<br />
<br />
<br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Issues-Guidelines-For-Care-of-Infants-in-Planned-Home-Births.aspx" target="_blank"><b>AAP's Recommendations for Planned Home Births </b></a></span><a href="http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Issues-Guidelines-For-Care-of-Infants-in-Planned-Home-Births.aspx" target="_blank"><br /></a><br />
<ul>
<li><i><span style="font-family: Georgia,"Times New Roman",serif;">"</span>The AAP concurs with the recent statement from the
American College of Obstetricians and Gynecologists (ACOG) that<u> <b>the safest
setting for a child’s birth</b> is a hospital or birthing center, </u>but recognizes
that women and their families may desire a home birth for a variety of reasons." </i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia,"Times New Roman",serif;">"Pediatricians should advise parents who are planning a home birth that AAP and
ACOG recommend<u> <b>only </b>midwives who are certified by the American Midwifery
Certification Board."</u></span><u> </u></i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia,"Times New Roman",serif;"></span>"There should be at least one person present at the delivery
whose primary responsibility is the care of the newborn infant and <u>who has the
appropriate training, skills and equipment to perform a full resuscitation of
the infant</u>. All medical equipment, and the telephone, should be tested before
the delivery, and the weather should be monitored." </i></li>
</ul>
<ul>
<li><i>"A previous arrangement needs
to be made with a medical facility to ensure a <u>safe and timely transport</u> in the
event of an emergency.</i></li>
</ul>
<br />
<img alt="" class="rg_hi uh_hi" data-height="124" data-width="200" height="124" id="rg_hi" src="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcTbRcCbUzwmJSUZhQVvdBQRHcOW_MtZ3s4UPYjMOJ52u-QXGSdr" style="height: 124px; width: 200px;" width="200" /><br />
<br />
<b><a href="http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000251/Home%20Birth%20Aug%202011.pdf" target="_blank"><span style="font-family: Georgia,"Times New Roman",serif;">ACNM Position Statement on Planned Home Birth</span></a></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"></span><span style="font-family: Georgia,"Times New Roman",serif;">"Every woman has a right to an <u>informed choice</u> regarding place of birth and access to safe home birth services.</span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Certified nurse-midwives (CNMs) and certified midwives (CMs) <u>(ie. AMCB certified midwives) </u>are maternity care professionals who are qualified to provide ongoing assessment of appropriate birth site selection over the course of the antepartum, intrapartum and postpartum periods.</span> </li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">CNMs and CMs <u>(Again...AMCB certified midwives)</u> are qualified to provide antepartum, intrapartum, postpartum and newborn care in the home.</span> </li>
</ul>
<ul>
<li><u><span style="font-family: Georgia,"Times New Roman",serif;">An integrated system of health care that includes collaboration among all health care providers is essential and fundamental to supporting a safe, seamless, transfer of care from home and/or out of the hospital setting when necessary.</span> </u></li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Reimbursement from third party payers should be available to licensed maternity care providers for home birth services.</span> </li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Professional liability insurance </u>carriers should provide coverage at actuarially appropriate premiums for all licensed maternity care providers who attend home births.</span> </li>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">The characteristics and management of normal birth, including the influence of birth setting, should be the focus of research and evaluation. This research should address <u>outcomes</u>, client satisfaction and experience, <u>markers of morbidity as they relate to birth site,</u> and development of ongoing quality assurance initiatives."</span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><br />In Summary, guidelines, recommendations, and the way in which out of hospital birth is approached matters a great deal in terms of safety. We won't preach "do your homework mama", because the vague message doesn't give any tangible guidelines for practice, nor does it help mothers know what to look for. We will however, highlight (as we've done here) the specific elements that contribute to the safety of out of hospital safety (or lack thereof) in an effort to help women better understand what to look for if they are considering home birth or a birth center birth. The absence of any one of the above named elements dramatically influences the safety of you and your baby. </span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Other opinions on the topic: </span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2013/5/2/aaps-new-home-birth-guidelines.html" target="_blank">Navelgazing Midwife: AAP's New Homebirth Guidelines</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.skepticalob.com/2013/05/mana-response-to-aap-homebirth-advocates-are-morons-and-will-believe-anything-we-say.html" target="_blank"><b>Skeptical OB: MANA's Response to AAP's Guidelines </b></a></span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.scienceandsensibility.org/?p=6627" target="_blank">Science & Sensibility: MANA's Response to AAP Guidelines</a> </span></b><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;">(by Michigan's own Geradine Simkins, CNM, MSN, and director of MANA...posted here in the "opinion" section because this piece is so <u>misleading </u>it deserves it's own blog post rebuttal...coming soon.) </span></i><b><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></b><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-346749784229772317.post-89981440541257855092013-05-06T13:01:00.001-04:002013-05-07T08:27:47.853-04:00MEAC - How to Make Accreditation Matter in Midwifery Education<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIJF3t1MsqsbGIkQGy_iVJfbC83EERgVd1Yie_EtmgNOViQHXrG0fxDlvDxcwbCZMWvkgL9sQ0B2lbE52flxxsjo4mmkX-w19RkexWsKdCwAcWzvOhd7w09daE3n7MjoXytWNpaoyA4Fjq/s1600/Midwifery-education-accreditation-Council.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIJF3t1MsqsbGIkQGy_iVJfbC83EERgVd1Yie_EtmgNOViQHXrG0fxDlvDxcwbCZMWvkgL9sQ0B2lbE52flxxsjo4mmkX-w19RkexWsKdCwAcWzvOhd7w09daE3n7MjoXytWNpaoyA4Fjq/s1600/Midwifery-education-accreditation-Council.jpg" /></a><span style="font-family: Georgia,"Times New Roman",serif;">The <a href="http://www.meacschools.org/">Midwifery Education Accreditation Council </a>- also known as MEAC - is
the organization that accredits programs that train midwives to become
eligible to take the NARM exam and become CPMs. (<i>Note: The MEAC accredited route represents only one path to becoming a CPM.</i>) </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Believe it or not, we have had numerous discussions regarding MEAC-accredited midwifery programs and creating a requirement of graduation from a MEAC-accredited program as a provision for CPM licensure in Michigan. <a href="http://www.doh.state.fl.us/mqa/midwifery/mw_statutes.html">Florida</a> and <a href="http://www.californiamidwives.org/legal">California</a> already do this, and it beefs up the educational background for certified professional midwives licensed by these states. The American College of Nurse-Midwives has a <a href="http://www.midwife.org/siteFiles/position/MidwiferyCertification_in_the_United_States_3_31_09.pdf">position statement</a> regarding midwifery certification in the US, and supports licensure of CPMs who have completed a formal education program. Requiring formal midwifery education goes above and beyond the paltry educational requirements set forth by NARM and perhaps even fulfills the education requirements set forth by the <a href="http://www.internationalmidwives.org/who-we-are/policy-and-practice/icm-international-definition-of-the-midwife/">International Confederation of Midwives</a>. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">In our discussions we've come to the conclusion that MEAC does not do enough to ensure high-quality midwifery education, and though it is an improvement over <a href="http://safermidwiferyformichigan.blogspot.com/2012/09/cpm-education-bar-is-too-low.html">NARM's rudimentary standards</a>, it is not sufficient for licensing independent midwives. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Why doesn't Safer Midwifery for Michigan endorse the MEAC-graduate CPM as holding the minimum requirement for Michigan licensure?</b></span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC
does not assure uniformity in education</u> between accredited programs (some graduates hold master's degrees, others have a 'certificate' in midwifery)</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC does not assure more thorough
academic preparation than apprenticeship-only education</u></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC does not strive to provide an
education that is an improvement over the infamous portfolio evaluation
process (PEP)</u>, but takes care to make certain there is no advantage of
MEAC-graduates over apprenticeship-only trained midwives</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC bows to the
lowest common denominator, citing that "all pathways" to becoming a CPM are equal</u>, <u> </u></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC does not require integration into post-secondary education
institutions</u> to assure consistency with American standards for general
education requirements. This means if a CPM graduates from a MEAC-accredited program, none of the credits earned will transfer to any real university or college in the US.</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC programs do not require evaluation of the preceptor's teaching methods</u> or efficacy in training student midwives.</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC does not require any hospital-based clinical experience midwifery</u></span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>What would it take for SMM to endorse the MEAC route to becoming a CPM?</b></span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Regional accreditation</u> as well as specialty accreditation. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Requiring preceptors to have training and guidance in teaching students</u>.</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Oversight in determining how successful completion/competence is determined by preceptor</u></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Require clinical experience in a US hospital setting</u></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Require at a minimum a Bachelor's degree</u></span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Require specific coursework related to health care and midwifery</u> in biology, chemistry, anatomy and physiology, microbiology, pharmacology, statistics, risk screening, assessment, the midwifery scope of practice, ethics, embryology, primary care for women's health, and prenatal, postnatal and intrapartum theory courses. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>Commit to ensuring superior education and training of midwives</u> who are educated through MEAC accredited programs. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC should not be branded as a 'separate but equal' pathway to becoming a CPM</u>, but a more rigorous, more thorough, more comprehensive pathway that produces higher-quality midwives. </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><u>MEAC must advocate for accredited programs to be the only valid route to attaining a CPM credential.</u></span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Currently, the bottom line for CPMs is that <b>ACCREDITATION DOESN'T MATTER</b> - because graduation from an accredited educational program is <i>purely optional </i>for becoming a CPM. A student midwife could
drop out, not graduate or fail every single one of her classes, and as
long as her 'skills were signed off on' the student midwife could still take the NARM
exam and become a CPM.</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">A quote from Via Vita Midwifery Midwifery illustrates this point:</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><span style="font-family: Georgia,"Times New Roman",serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5WbpjLXr2dJLg912MMCHh5nELZD_wpLMWm_cN_0vEvRkGaEJRDXYaC30QjTWNe6wt030JTVtd_C3YiZi82tdQTkOUtrPwGhnkQDLXn04fOjZrjOATLM3Vl6xcQKkl5ATZmVkKZgsPCKF_/s1600/via+vita.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5WbpjLXr2dJLg912MMCHh5nELZD_wpLMWm_cN_0vEvRkGaEJRDXYaC30QjTWNe6wt030JTVtd_C3YiZi82tdQTkOUtrPwGhnkQDLXn04fOjZrjOATLM3Vl6xcQKkl5ATZmVkKZgsPCKF_/s1600/via+vita.jpg" height="249" width="640" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.viavitamidwiferyschool.org/">http://www.viavitamidwiferyschool.org/</a></span></td></tr>
</tbody></table>
<span style="font-family: Georgia,"Times New Roman",serif;"><a href="http://www.viavitamidwiferyschool.org/"><br /></a>
Though this is just one example of the attitude toward accreditation of midwifery programs, we have found it to be common among CPMs. Here's another sentiment expressed in a 2011 newsletter from the <a href="http://nacpm.org/">National Association of Certified Professional Midwives</a>. (Notice the glaring lack of any statement regarding assuring <u>quality</u> of education):</span><br />
<blockquote class="tr_bq">
<span style="font-family: Georgia,"Times New Roman",serif;"><i>Why does accreditation matter? It remains the first accomplishment
in the midwifery movement where we have fully achieved federal
recognition. It is that part of the movement that dips its feet into the
mainstream waters. It is the portion of our educational fabric that is
easily understood by the mainstream,and easily accessed by students who
are looking for an educational experience that they can finance in the
mainstream and defend in the mainstream. It is a portal where the
radical can slip into the mainstream and stir up a change! ~ Ellie Daniels, CPM, Past President of MEAC </i></span></blockquote>
<span style="font-family: Georgia,"Times New Roman",serif;">So the rationale for MEAC-accreditation - from the words of a past-president of MEAC - is not to assure competent and highly-skilled midwives, but merely to gain some acceptance in mainstream America?</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">We believe Michigan families deserve better than this, and this is why SMM cannot support MEAC-graduates as qualified for licensure as midwives in our state. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-22263788814016496642013-05-02T08:55:00.005-04:002013-05-02T08:55:53.963-04:00Willow Tree Family Center Board Replies to our Open Letter<b><span style="font-family: Georgia,"Times New Roman",serif;">Last week Safer Midwifery wrote an <a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/open-letter-to-willow-tree-family-center.html" target="_blank">Open Letter to the Willow Tree Family Center</a></span></b><span style="font-family: Georgia,"Times New Roman",serif;"><b> Board, stating concerns about potential staffing and/or affiliations with dangerous care providers in the Greater Lansing Area. <br /><br />We thought it was important to share their reply, and leave it open to your own interpretation:</b><br /><i> </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i>"Dear Safer Midwifery for Michigan,<br />
<br />
Thank you for your recent email to our center and for sharing your<br />
suggestions and concerns. It is very important to us that we have<br />
integrity in our endeavors, and we share many of your goals. Your primary<br />
goal of making people fully informed about their care providers and health<br />
choices is of utmost importance to us as well. We agree that providers<br />
should be transparent with their statistics, and we want to empower<br />
families to ask their care providers the right questions in order to be<br />
fully informed. We are interested in supporting and working with causes<br />
such as The Birth Survey, whose goal it is to make maternity care<br />
transparent. Statistics ranging from intervention rates to maternal and<br />
infant mortality rates should be public information for all OBs,<br />
hospitals, and midwives.<br />
<br />
It sounds as though you have heard various speculations about the services<br />
we hope to provide at our center. As far as plans for staff, we do not<br />
have plans or funds to be hiring any staff anytime in the near future. We<br />
are hoping to have a community center space available soon, however, and<br />
we are in the process of developing policies for rental and use of the<br />
center. We agree that it is important to have legal and safe regulations<br />
regarding rental of the space, and we are currently in touch with a lawyer<br />
who is helping us to develop these policies and procedures.<br />
<br />
In the meantime, we are putting feelers out into the community to receive<br />
input from people as far as their aspirations for a new center and hopes<br />
for potential use. At this point in the process, we are being as open as<br />
possible to all ideas and suggestions, and later in the process we will<br />
work on narrowing down the concepts presented during this brainstorming<br />
stage. Right now, we are working to make the initial development process<br />
as inclusive as possible to find value in all perspectives. Because we<br />
value all family perspectives and experiences, we have made sure to create<br />
a Board of Directors diverse in backgrounds (teachers, doctors, business<br />
owners, SAHMs) and even in birth experiences (among us we have a variety<br />
of them - from c-sections to home births and everything in between).<br />
<br />
Again, we do care very much about being as objective and forthright as<br />
possible as we advocate for improved care options in Lansing. We are<br />
excited to work together with programs and activities such as yours that<br />
will empower families and make quality care available to all people.<br />
<br />
Thank you again for you valuable input!"</i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Safer Midwifery for Michigan will keep you posted as we see how the <a href="http://willowtreefamily.com/" target="_blank">Willow Tree Family Center</a> project develops. </b></span><span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="font-family: Georgia,"Times New Roman",serif;"><b>We appreciate that the board has been open to hearing our concerns, and we further</b></span> hope they are able to build a resource that is safe and reliable for the community they serve. </b><i> </i></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-24698520477287325602013-04-29T09:02:00.000-04:002013-04-29T09:07:05.560-04:00The Education of Midwives Around the World: Part 3<div style="text-align: left;">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black;"><span style="color: black;"><b><i>Welcome</i></b><b><i> to part 3 in our series on the edu</i></b><b><i>cation of midwi</i></b><b><i>ves around the</i></b><b><i> wor</i></b><b><i>ld</i></b><b><i>. The re</i></b><b><i>search and writing </i></b><b><i>presented for this part represents a<span style="font-size: small;">n import<span style="font-size: small;">ant conversation </span></span>between Safer Midwifery for Michigan and Judith Rooks, CNM<span style="font-size: small;">, about the t<span style="font-size: small;">opic of education of American Midwives. </span></span> </i></b></span></span></span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black;"><span style="color: black;"><b><i>Ms. Rooks is a certified nurse-midwife, a past-president of the American College of Nurse-Midwives, and a CDC-trained epidemiologist who has published three major studies of out-of-hospital births in this country.</i></b><b><i> She bring<span style="font-size: small;">s a wealth<span style="font-size: small;"> o<span style="font-size: small;">f knowledge and honest insight to this conversation. We ar<span style="font-size: small;">e honored to have her voice represented here. </span></span></span></span></i></b></span></span></span></span> </div>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span></span>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span data-ft="{"tn":"K"}" id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]">The
United States is home to many types of midwives ranging from those
educated at a graduate level to those who learn from apprenticeships
alone, with everything in between. </span><br id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[0].[4]" /><br id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[0].[5]" /><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[0].[6]">It is vital, yet almost impossible, for cons</span></span><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]">umers
to be able to know who they are hiring, and how their midwife's
training, education and experience will directly effect the safety and
outcome of their birth.</span><br id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[1]" /><br id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[2]" /><span id=".reactRoot[251].[1][4][1]{comment367195563399767_367482153371108}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[3]">This
is especially true in a state like Michigan, which is yet to even
legally define the term "midwife" let alone establish a minimum standard
for their education and training.</span></span></span></span></span> </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">We contact<span style="font-size: small;">ed Ms. Rooks to ask her about what the appropriate e<span style="font-size: small;">ducational standards for US midwives should be<span style="font-size: small;">, and we're happy to share what she had to say on the subject: </span> </span></span></span><br />
<br />
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">"There
needs to be a way for current direct-entry midwives, including CPMs, to
achieve the education they need. <span style="font-size: small;">A </span>growing proportion of
pregnant women in America want out-of-hospital (OOH) births with
midwives, and there are not enough midwives to serve them. Some CPMs
are excellent, but the P<span style="font-size: small;">E</span>P route to certification as a “professional”
midwife isn’t deep enough educationally. The floor is too low, some of
them are dangerou<span style="font-size: small;">s, y</span>et some of them have done extensive self-guided
education and are very competent and safe.<br />
<br />
The PEP route to becoming a CPM seemed reasonable when it was started,
but I thought it would only be used to provide an opportunity for very
experienced OOH birth attendants, and that new educational programs
along the lines of the Seattle Midwifery School—a direct-entry
professional midwifery school based on the curriculum used in The
Netherlands, would be started to provide educational opportunities for
young women who wanted to start preparing themselves as midwives from
scratch. </span></span></i><br />
<br />
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">During the 1980s, a portion of the direct-entry midwifery
community wanted to professionalize and developed a very few good
schools. SMS has since become the Midwifery Department at Bastyr
Naturopathic University, which is located near Seattle. But many
direct-entry “midwives” (I used quotes because most of them do not meet
the International Definition of a Midwife) thought that the PEP route to
the CPM was adequate. </span></span></i><br />
<br />
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>To my great disappointment, many young women who
want to become midwives seem to think it is too much bother, time or
money to complete an actual midwifery curriculum and think it is enough
to just apprentice themselves to someone for a minimal number of births,
study to pass a few tests, and become a CPM that way.</b> <br />
</span></span></i><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /><i>There are a lot of excellent CPMs. I would trust some of them with a
home birth of my grandchild. <b>But many have inadequate knowledgeable<span style="font-size: small;">,</span>
manual skills and clinical judgment.</b> <b>Some DEMs<span style="font-size: small;">/CPMs</span> say that it is
the responsibility of a pregnant pregnant woman to choose her midwife
wisely, but that is very hard to do. </b> </i></span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>I count on the state to not
license inadequately trained health care providers. I can’t assess the
skills of every professional I use. I would not hire an
electrician to change the wiring in my house without someone
knowledgeable exercising due diligence to assure me that the person I
hire has achieved some minimal level of relevant education and <span style="font-size: small;">prior</span> experience (an apprenticeship)<span style="font-size: small;">. A</span>ttend<span style="font-size: small;">ing</span> lectures or reading
some books <span style="font-size: small;">isn't enough. <b>A</b></span><b>n<span style="font-size: small;"> </span>education program that is designed to
lead to the development of the core competencies is needed to provide a
specific service, with objective ways to measure whether each of the
myriad competencies ha<span style="font-size: small;">s</span> actually been achieved. </b></i><br />
</span></span><br />
<br />
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">CNMs have a good midwifery education, but few of them have experience in
OOH births. In the mid-1990s, British Columbia and Ontario knew that
they needed more midwives, and they wanted them to be direct-entry instead of
forcing people who want to become midwives to complete an education
program in nursing first<span style="font-size: small;">. They </span>wanted the graduates to be prepared to
provide safe, satisfying and effective midwifery care in both hospital
and OOH settings. </span></span></span></span></i><br />
<i><br /></i>
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Because the governments of both provinces saw the
need for more midwives and safe and effective midwifery care in both
settings (which also allows a home birth midwife to go to the hospital
with her patient when a transfer is necessary), the governments of both
provinces had a responsibility to provide midwifery education to meet
the need. <b>As a consequence, a leading university in each of those
provinces developed a baccalaureate midwifery education program that
bypasses the nursing education requirement for nurse-midwives but
provides an equally deep education that is focused on midwifery.</b> Both
provinces now have excellent outcomes of OOH births, which are in demand
by increasing numbers of very happy and healthy mothers.</span></span></i><br />
<i><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">
<b> </b></span></span></i><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i><b>The International educational standards should be the long term goal</b>,
but you can’t just require that in a law without providing some path by
which experienced already-practicing midwives can be given reasonable
time and ways to be eased into compliance. A lot of people know that what we have now isn’t good enough and are interested in mak<span style="font-size: small;">ing</span> a real investment in change. <br />
<br />
<b>We
need a long-term solution to get where the whole country should be
eventually re midwifery, with all midwives licensed under a board of
midwifery, including CNMs and CMs. </b> I thought the CPM would be
short-term; we have lived with it now for a long time. <b><a href="https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585" target="_blank">The data from Oregon</a></b>, shows that it’s not working. Th<span style="font-size: small;">e CPM credential</span> was a
stop-gap measure from the next-to-the last decade of the 20th Century.
We are now in the 2nd decade of the 21st Century. Michigan <span style="font-size: small;">would</span> be a
good place to start moving forward.</i><span style="font-size: small;"><i>"</i><b><span style="font-size: small;"> </span></b></span></span></span><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">What options do we have in the US for University-level education for non-nurse midwives? </span></b><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://meacschools.org/accredited_schools.php" target="_blank">MEAC accredited schools</a> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">Often we talk on this blog about concerns for the minimum standards for education. There are multiple routes to becoming a CPM, but few choose the University education route. There are MEAC accredited schools across the country, whereby prospective midwives can receive financial aid and attend college to become midwives. <b> </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Another option is the CM credential (Certified Midwife)<b>. </b> CMs have identical scope of practice to CNMs. The difference being that they have a four year degree in something other than nursing, then attend two years of graduate level education specific to midwifery. We currently have no CMs in Michigan, as they are not yet licensed to practice here. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">The lingering questions then become why are the minimum standards so low, especially in comparison to counterparts around the world? Why is it acceptable for midwives to aim for the cheapest, quickest route instead of striving to be their best? Why are the "certifying" bodies (ie NARM/MANA) keeping the bar so low...as in only requiring a high school diploma as of 2012 instead of <i>requiring </i>a college level education to deliver our babies? </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">The vast spectrum of what defines "midwives" is confounding to consumers aiming to hire reliable, competent professionals. We support midwifery, and hope to see the "profession" as a whole set clear standards for education that we can depend upon for safe options. There is not excuse for anything less. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><b><span style="font-size: small;">For<span style="font-size: small;"> more on th<span style="font-size: small;">e topic of Educationa<span style="font-size: small;">l Standards, Visit the link<span style="font-size: small;">s below: </span></span></span></span></span></b></span></span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank"><b>Education of Midwives Around the Wo</b></a><span style="font-size: small;"><a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank"><b>rld: Part I <i>Are all Midwives Created Eq</i></b></a><span style="font-size: small;"><a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank"><b><i>ual?</i></b></a> </span></span></span></span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world_22.html" target="_blank"><span style="font-size: small;"><span style="font-size: small;">Education of M<span style="font-size: small;">idwives Around the <span style="font-size: small;">World: Part II</span></span> </span><i>Is the focus for US Midwives on Com<span style="font-size: small;">petency? </span></i></span></a></b></span></span> Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-346749784229772317.post-42951804160694964902013-04-24T10:15:00.002-04:002013-04-24T14:13:54.344-04:00Open Letter to Willow Tree Family Center<!--[if gte mso 9]><xml>
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</xml><![endif]--><b><span style="font-family: Georgia,"Times New Roman",serif;">For all those living in and around the Lansing area, a new proposal is coming to town. A group of parents is rallying and fund raising to open the <a href="http://willowtreefamily.com/" target="_blank">Willow Tree Family Center</a>, whose mission is:</span></b><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> "Our mission at Willow Tree Family Center is to grow strong, empowered
families by </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> providing support groups and educational services for
pregnancy, birth and beyond. </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> By focusing on the family as a system and
providing access to evidence-based </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> resources and holistic care, we will support healthy, informed, confident families. </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> Like a willow tree, our
center will provide a calming atmosphere to grow strong, </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> flourishing
families that support each other."</i></span><br />
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<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">Sounds like a promising prospect, and sounds a bit familiar...especially when you read the board profiles and realize that nearly every member was affiliated with the <a href="http://www.lansingstatejournal.com/article/20120813/NEWS01/308130041/Greenhouse-Birth-Center-considers-closing" target="_blank">Greenhouse Birth Center </a>in some way. They value "education & informed consent" and "evidence-based" care. (I'm using quotes here because those terms are subject to definition.) </span></b><br />
<br />
<b><span style="font-family: Georgia,"Times New Roman",serif;">While the notion of such a central place to support families in pregnancy, birth and beyond is exciting, it brings with it great responsibility. It's a responsibility that was severely lacking at Greenhouse, and we sincerely hope this new project can take steps to ensure safety in the resources and care they are offering. </span></b><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">An Open Letter:<span style="mso-tab-count: 7;"> </span>April 24, 2013</span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">Dear
Willow Tree
Family Center,</span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">It has recently been brought to our attention that you’re
aiming to open a new “Family Center” in the Lansing area, aimed at fostering
community and offering families resources related to birth, pregnancy, and
parenting.<span style="mso-spacerun: yes;"> </span>While the prospect sounds
enticing, we are concerned for the message you will be sending to the larger
community about the safety of the care providers you intend to host at your
facility.<span style="mso-spacerun: yes;"> </span>Taking on this position demands
great responsibility.<span style="mso-spacerun: yes;"> </span>
<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">We are writing to ask that you consider the necessity of implementing strict
screening measures, and clear criteria for the “care providers” you intend to
host at your new center.<span style="mso-spacerun: yes;"> </span>It would not be
ethical or responsible to imply that the care providers hosting appointments at
your new facility are safe, or reliable without doing so.<span style="mso-spacerun: yes;"> <b> </b></span><b>Many, if not all, of the midwives suggested
as potential staff are also those who have been reported to our advocacy group
as being involved in extremely dangerous care practices, infant deaths, and
injuries.<span style="mso-spacerun: yes;"> </span>Some have multiple sanctions
or pending sanctions with the state.<span style="mso-spacerun: yes;"> </span>Others
have a long reputation of dangerous practices.<span style="mso-spacerun: yes;">
</span></b>Having had a good experience does not negate the possibility that others
have been harmed.
<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">We also ask that you gather references from families that demonstrate varied
perspectives about the care they received, so that prospective families aren’t
only presented with biased references, and a false sense of security.<span style="mso-spacerun: yes;"> </span>This includes references for midwives,
doulas, and childbirth educators.<span style="mso-spacerun: yes;"> </span>Unfortunately,
our advocacy group often hears only the sad stories, but <b style="mso-bidi-font-weight: normal;">they are nonetheless important</b>.<span style="mso-spacerun: yes;">
</span>Many of the families that report to us prefer to remain anonymous, but
we’d be happy to provide any contact or reference we can that would enable new
families to better know who it is they are hiring for their care.<span style="mso-spacerun: yes;"> </span></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">We absolutely appreciate the value in a community resource
hub that will enable families to be “fully informed” and seek the care they
choose.<span style="mso-spacerun: yes;"> </span>Part of being <i style="mso-bidi-font-style: normal;">fully informed</i> includes knowing ALL
sides of a care giver’s practice history.<span style="mso-spacerun: yes;">
</span>We support what you’re aiming for, and hope that there is sincerity in
your aim to provide support for genuinely <i style="mso-bidi-font-style: normal;">balanced
</i>perspectives in pregnancy, birth, and parenthood.<span style="mso-spacerun: yes;"> <b> </b></span><b>Placing yourselves as a collective group, in
association with questionable or dangerous care providers, will simultaneously
put you in a liable position for the care you represent.</b><span style="mso-spacerun: yes;"><b> </b> </span>If you aim to be a credible, long term resource
for this community, you will carefully consider who it is you allow to be
affiliated with your group.<span style="mso-spacerun: yes;"> </span></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">We hope your future endeavors demonstrate a model of safety
and integrity, and hope that you fully understand the magnitude of
responsibility that comes providing truly balanced resources for a
community.<span style="mso-spacerun: yes;"> </span></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">Sincerely,</span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia,"Times New Roman",serif;">The Team at Safer Midwifery for Michigan</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-88382175457866287562013-04-22T09:43:00.001-04:002013-04-22T13:44:16.964-04:00The Education of Midwives Around the World: Part 2<div style="text-align: left;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black; font-size: small;"><span style="color: black; font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><b><i>Welcome to part 2 in our </i></b><span style="font-size: small;"><span style="font-size: small;"><b><i>series on the edu</i></b><span style="font-size: small;"><b><i>cation of midwi</i></b><span style="font-size: small;"><b><i>ves around the</i></b><span style="font-size: small;"><b><i> wor</i></b><span style="font-size: small;"><b><i>ld</i></b><span style="font-size: small;"><b><i><span style="font-size: small;">.</span> The<span style="font-size: small;"> </span>re</i></b><span style="font-size: small;"><b><i>search and writing </i></b><span style="font-size: small;"><b><i>presented here was </i></b><span style="font-size: small;"><b><i>generously </i></b><span style="font-size: small;"><b><i><span style="font-size: small;">contri<span style="font-size: small;">buted by<span style="font-size: small;"> two special midwives in the US who want to see home birth remain an option in the care of competent care providers. </span></span></span></i></b></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Responsible conversations about improving the safety of out-of-hospital birth always come back to two central issues: a) education and training and b) appropriate risking out protocols to ensure those births taking place outside the hospital are indeed "low risk". </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">For the purposes of this series, we're focused on the educational aspects of midwifery. Specifically we are comparing how midwives around the world are educated, in direct comparison to those in the US. <b> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="font-size: large;">This post examines the question, are midwives focused on competency and quality midwifery?</span> </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>The State of World Midwifery Report from 2011, points to, <i>"...competencies - the combination of knowledge, skills, attitude, and professional behavior that quality midwifery care requires." </i></b></span> <br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Competencies: The Foundation of Practice</b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">(State of the World Midwifery Report. 2011) <br /> <i> </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> "Being ‘skilled’ is only one element of a more complex reality. Recent and emerging </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> evidence indicate that there is often a significant difference between the number of </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> health workers designated as skilled birth attendants and those with midwifery </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> competencies meeting evidence-based standards. Counting all individuals within </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> professional health cadres to determine the supply of skilled birth attendants may </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> therefore be misleading. The correlation between the proportion of births that are </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> attended by a so-called ‘skilled attendant’ and a country’s maternal mortality ratio </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> may be weak because quality of attendance is simply not taken into account. <b>As a </b></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> result, the focus has shifted to competencies — the combination of </i></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> knowledge, skills, attitude, and professional behavior that quality </i></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> midwifery care requires."</i></b><br /><br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><u>The European Union Standards for Nursing and Midwifery: Information for Accession Countries*</u></i>, further illustrates the extensive coursework and education expected of midwives in the European Union. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><br /></i>
<i><span style="font-size: small;"><b> "All of the countries within the European Union now enforce these </b></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><b> <span style="font-size: small;"> </span>requirements for professional midwifery education. That education </b></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><b> <span style="font-size: small;"> </span>takes place at the university level.</b> <b>The curriculum includes the </b></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><b> <span style="font-size: small;"> </span>following subject areas:</b></span></i><br /><b> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><u><b>A. Theoretical and technical instruction</b> </u></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><i>a. General Subjects </i><br />– Basic anatomy and physiology <br />– Basic pathology <br />– Basic bacteriology, virology and parasitology <br />– Basic biophysics, biochemistry and radiology <br />– Pediatrics, with particular reference to new-born infants <br />– Hygiene, health education, preventive medicine <br />– Nutrition and dietetics, with particular reference to women, newborn and young babies<br />– Basic sociology and socio-medical <br />– Basic pharmacology<br />– Psychology<br />– Principles and methods of teaching <br />– Health and social legislation and health organization <br />– Professional ethics and professional legislation<br />– Sex education and family planning<br />– Legal protection of mother and infant<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> b. Subjects Specific to the Activities of Midwives</span> <br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Anatomy and physiology</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Embryology and development of the fetus</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Pregnancy, childbirth and puerperium</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Gynacological and obstetrical pathology</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Preparation for childbirth and parenthood, including psychological aspects</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Preparation for delivery (including knowledge and use of technical equipment in </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> obstetrics)</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Analgesia, anesthesia and questions resuscitation</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Physiology and pathology of the newborn infant</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Care and supervision of the newborn infant</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> – Psychological and social factors</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><b>In addition to supervised care of low risk, normal women and newborns, the following clinical education is required.:</b></span><br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>B. Practical and Clinical Training</b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b> </b><br />This training is to be dispensed under appropriate supervision:<br />– Supervision and care of 40 women at risk in pregnancy, or labour or post-natal period.<br />– Supervision and care (including examination) of at least 100 post-natal women and </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> healthy new-born infants.<br />– Observation and care of the new-born requiring special care, including those born </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> pre-term, post-term, underweight or ill.<br />– Care of women with pathological conditions in the fields of gynecology and obstetrics.<br />– Initiation into care in the field of medicine and surgery. Initiation shall include theoretical </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> instruction and clinical practice.<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">The theoretical and technical training (Part A of the training program) shall be balanced and coordinated with the clinical training."</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Check out these tables for a visual glimpse at educational standards for midwives across Europe, and beyond: </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="https://docs.google.com/document/d/1Q4eruaFHS0QikaDbhfI4so7KaqjLzTPssbIezZxuQ0Y/edit?usp=sharing" target="_blank">Table of Educational Requirements for Midwives Around the World</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><br /></b></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="https://docs.google.com/document/d/1XzEydd7yjG7yCOSRXc4Utnx4ZfDJ6hoxvg5C9ZqXggM/edit?usp=sharing" target="_blank">Table of Midwifery Education, Supervision, HB Rates, etc: European Countries</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><br /></b></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><b><a href="https://docs.google.com/document/d/1Fv0-z4dVocYHs4O13wa6V6Jd3_p68KNmfTasI1sOwYI/edit?usp=sharing" target="_blank">Table of Midwifery Education, <span style="font-size: small;">Supervision, HB Rates, etc: Other <span style="font-size: small;">Countries</span></span></a></b><span style="font-size: small;"><br /></span></span></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span></span><br />
<div dir="ltr" id="internal-source-marker_0.16551652328452293" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline;">Now consider this...</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></span></span></div>
<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">In the US we have several types of midwives with a vast range of educational training. We have CNMs and CMs </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">(Certified Nurse Midwives and Certified Midwives)</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> who have graduate level training, </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">are
often licensed as advanced practice nurses, and are the most
highly-educated midwives, not only in our country, but also in the world</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">. Most CNMs and CMs </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">work</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> in hospitals, and </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">a small percentage</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;"> work</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> out-of-hospital </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">in homes and birth centers</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">. </span></span></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span></span>
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<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">We </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline;">also</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> have CPMs </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">(certified professional midwives)</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> who are</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;"> the ones </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> pushing
hard across the country for licensing, and a place in the
"professional" world of midwifery, yet their <i>educational minimum</i> i<span style="font-size: small;">s</span></span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">having a</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> <i>high school diploma</i> and </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">completing a rudimentary apprenticeship with</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;"> <b>no formal academic requirements</b></span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">. </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">They earn their certification by submitting documentation of completing an apprenticeship and taking an exam. </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">The minimum standards for the education of CPMs are </span><b><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">not only paltry when compared to CNMs and CMs, <span style="font-size: small;"><b>and</b></span> they are also</span></b><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><b>
significantly below that of our European, Canadian, and Australian
counterparts. </b> <b>So much in fact, that they would not be credentialed to
practice in ANY other first world country. </b> These are the midwives that
largely serve the out-of-hospital population</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;"> in the US, and who are rabidly seeking recognition and credibility through state licensing</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">.</span></span></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span></span>
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<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">With little to no educational standards in the US for "</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">certified professional</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> midwives,” it is difficult for consumers to understand<span style="font-size: small;"> </span></span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">what type of professional</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">
they are hiring, and why it matters profoundly in terms of safety. As
stated in<a href="http://www.safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank"> <b>Part 1 of this series</b></a>, not all midwives are created equal.
</span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Here's what NACPM <span style="font-size: small;">(<span style="font-size: small;">National Association of Certified Professional Midwives<span style="font-size: small;">) </span></span>has to say in their <a href="http://www.blogger.com/blogger.g?blogID=346749784229772317" target="_blank">recent new</a><span style="font-size: small;">sletter<span style="font-size: small;"> </span></span>about the purpose behind "accreditation"<span style="font-size: small;"> for CPMs: </span></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br />
<i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"> <i> </i></span></span></span></span><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]">"Why
does accreditation matter? It remains the first accomplishment in the
midwifery </span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]"> </span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]"><span style="font-size: small;"> </span>movement where we have fully achieved federal recognition. It
is that part of the </span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]"> </span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[0].[3]"><span style="font-size: small;"> </span>movement that dips its feet into the mainstrea</span></span><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]">m
waters. It is the portion of our </span></span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"> </span></span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><span style="font-size: small;"> </span>educational fabric that is easily
understood by the mainstream, and easily accessed by </span></span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"> </span></span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><span style="font-size: small;"> </span>students who are
looking for an educational experience that they can finance in the </span></span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"> </span></span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><span style="font-size: small;"> </span>mainstream and defend in the mainstream.<b> It is a portal where the
radical can </b></span></span></span></span></span></span></span></span></span></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><b> </b></span></span></span></span></span><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><b><span style="font-size: small;"> </span>slip into<span style="font-size: small;"> </span></b></span></span></span></span></span></span></span></span></span></i></span><b><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><b><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]">the mainstream and stir up a change!"</span></span></span></span></span></b></span></span></span></span><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><b><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"> </span></span></span></span></span></b></span></span></span></span></i></b><i><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="font-size: small;"><span data-ft="{"tn":"K"}" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[234].[1][4][1]{comment366199953499328_366593286793328}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]"><b><a href="http://www.nacpm.org/documents/NACPMnews2011-web.pdf" target="_blank">(Pg 10, NACPM Newsletter)</a></b></span></span></span></span></span></span></span></span></span></i></div>
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<span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;">Let's reflect again on</span> The State of World Midwifery Report from 2011</span><span style="background-color: transparent; color: black; font-style: italic; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">:
"...competencies - the combination of knowledge, skills, attitude, and
professional behavior that quality midwifery care requires." </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></span><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></span></span></span></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><b>Are <span style="font-size: small;">midwiv<span style="font-size: small;">es</span></span></b><span style="font-size: small;"><b> in the US truly focused on competency?</b> </span></span></span></span></span></span><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Not according to <span style="font-size: small;">NACPM<span style="font-size: small;">: </span> </span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><br /></span></span></span>
<span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"> <i>"In our fervent defense<span style="font-size: small;"> </span>of apprenticeship, have we lost sight of the whole vision our </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>professional roots dreamed of? We had the vision that gave birth<span style="font-size: small;"> </span>to our movement, </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>that organized around a federal credential, that<span style="font-size: small;"> </span>created a credentialing process </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>that honored multiple ways to<span style="font-size: small;"> </span>be trained, that brainstormed what we needed to do </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>to become<span style="font-size: small;"> </span>educational accreditors for our diverse schools, and that has led to more </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>than <u>1700 credentialed autonomous midwives in less than<span style="font-size: small;"> </span>15 years. Some of those </u></i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i><u> <span style="font-size: small;"> </span>midwives came through apprenticeships,<span style="font-size: small;"> </span>some through schools.</u> We created a </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>profession that offers optimal<span style="font-size: small;"> </span>access to women with diverse learning styles, family </i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i> <span style="font-size: small;"> </span>and economic<span style="font-size: small;"> </span>limitations, and geographic realities. <u>There is no one way that is<span style="font-size: small;"> </span>better </u></i></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"><i><u> <span style="font-size: small;"> </span>than another; it all leads to a common denominator, which<span style="font-size: small;"> </span>is the CPM.</u>"</i> </span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"><span style="font-size: small;"> (pg<span style="font-size: small;"> 10 NACPM Newslett<span style="font-size: small;">er)</span></span></span> </span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">It would appear th<span style="font-size: small;">at the purpose behind accreditation according to NACPM has m<span style="font-size: small;">o<span style="font-size: small;">re to do with creating a name for themselves <span style="font-size: small;">using multiple routes to a made up <span style="font-size: small;">"certification". Nothing about the way their <span style="font-size: small;">non-existent standards are set up has anything to do with co<span style="font-size: small;">mpetency<span style="font-size: small;">, knowledge, or adequate skills on<span style="font-size: small;"> a consistent<span style="font-size: small;">, reliable ba<span style="font-size: small;">sis</span></span></span>. The professional behavi<span style="font-size: small;">or and att<span style="font-size: small;">itude <span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;">demonstrate<span style="font-size: small;">d</span> time and time again, illustrates preci<span style="font-size: small;">sely<span style="font-size: small;"> the opposit<span style="font-size: small;">e of <span style="font-size: small;">"quality midwifery<span style="font-size: small;">"</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>. <br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Is midwifery care, particularly in the out-of-hospital sector, truly as "</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">high-</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">quality"
as it could be? </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">Is it on par with our fore<span style="font-size: small;">ign counterparts? </span>Should
states be issuing licenses to individuals with such skimpy education
and training of those who attend births outside hospital walls? Why
should we settle for any less than the best, most skilled, and highly
trained midwives to be attending childbirth in out-of-hospital settings? </span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; vertical-align: baseline;">It's time for the US to establish higher standards for "professionals<span style="font-size: small;">" so we can have reliable options on par with our foreign cou<span style="font-size: small;">nterparts. We are a nation full of resources, educational opportunity, schools, libraries, etc. Ther<span style="font-size: small;">e is no excuse for not expecting more<span style="font-size: small;"> in terms of educational standards of our midwives. </span></span></span></span></span></span></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span><span style="font-size: small;">
</span><b><br /></b></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><b>More on this topic: </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">The Education of Midwives Around the World: Part 3 (Coming Next Week)</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">(*Second edition Revised and updated by: Thomas Keighley, 2nd edition, 2009)</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-346749784229772317.post-58526638329894389362013-04-18T21:03:00.003-04:002013-04-18T21:06:34.837-04:00Disaster in the Making: Senate Bill 292<span style="font-family: Georgia,"Times New Roman",serif;">Last week Senator Green introduced a new bill in the Senate, <b><a href="http://www.legislature.mi.gov/documents/2013-2014/billintroduced/Senate/htm/2013-SIB-0292.htm" target="_blank">SB 292</a></b>. It looks much like last year's <b><a href="http://safermidwiferyformichigan.blogspot.com/2012/06/why-licensing-cpms-will-not-make-out-of.html" target="_blank">HB 5070, and its sister bill SB 1310</a></b>, all of which propose to license CPMs in the State of MI. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>In summary, this bill is a disaster in the making. </b><br /><br />According to Kate Mazzara, CPM and President for the Michigan Midwives Association:<br /> </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> “The purpose of licensure is to protect the public's safety by
providing a mechanism </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> for consumers to verify that their midwives have
appropriate training, proficiency </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> and accountability, as determined by
the state,” said Kate Mazzara, president of the </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> Michigan Midwives
Association. "Licensed health care providers are
subject to </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> oversight by state boards that are responsible for
determining standards of practice </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> as well as hearing consumer grievances
and carrying out disciplinary measures </i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i> when necessary.” </i>~ <b><a href="http://www.lansingstatejournal.com/article/20130412/NEWS01/304120037/A-year-later-home-birth-questions-remain-unanswered" target="_blank">Quoted from recent LSJ Article</a></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">All sounds good right? "Appropriate Training ~ Proficiency ~ Accountability ~ Oversight ~ and Standards of Practice"... so what's the problem? Isn't this precisely what Safer Midwifery for Michigan is all about? <br /><br />The problem is that Ms. Mazzara's statement is a carefully crafted PR move, with absolutely no meaning or intention behind it. Anyone who takes the time to read this bill will see glaring discrepancies between what she claims to support, and what is actually being proposed in this bill. It's almost as if the small number of midwives supporting this bill are counting on the fact that the public won't read it for themselves. <br /><br />Well, we did read it, and in a nutshell here is what this bill proposes for MI families: </span><br />
<ul>
<li><b><span style="font-family: Georgia,"Times New Roman",serif;">A body of licensed midwives whose minimum standard for education is a high school diploma or a GED, hold a CPM certification, and pass the NARM exam. </span></b></li>
</ul>
<b><span style="font-family: Georgia,"Times New Roman",serif;"></span></b><ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Just a reminder here that the minimum standard for education in every other first world country is 3-5 years of UNIVERSITY education. <b>The educational standards for CPMs in the US would not qualify them to be employable in any other first world country. </b> Is this "<i>appropriate training and proficiency?</i>" Not by anyone's standards but their own. This level of educational training is <i>no where near </i>a university level education, in fact there is literally NO university level training required whatsoever to earn a "CPM" credential. </span></li>
</ul>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<ul>
<li><b><span style="font-family: Georgia,"Times New Roman",serif;">Midwives who carry prescription medications and administer IV fluids with <u>NO MEDICAL TRAINING or even so much as a course in Pharmacology. </u> </span></b></li>
</ul>
<ul><ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">No, they don't want to bother with jumping through the hoops of earning prescriptive authority, instead they propose to work under the prescriptive authority of other "<i>health care providers</i>". Other "health care providers" is purposefully defined as Physicians, Nurse Midwives,<b> or<i> any other </i>licensed, registered, or authorized health care professional</b>.</span> </li>
</ul>
</ul>
<ul><ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">The bill further states<i><b>:</b></i></span></li>
</ul>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><i><b> "The department shall not promulgate any rules that limit the </b></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><b> authority of a midwife to administer prescription drugs or </b></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><b> medication or prohibit the administration of medication." </b></i></span><br />
<br />
<ul>
<li><b><span style="font-family: Georgia,"Times New Roman",serif;">A strategically biased board of "midwifery" that consists of 5 midwives and 2 members of the public. </span></b><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
</ul>
<ul><ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Note that this bill also defines "midwifery" as being completely separate from Nurse Midwifery. Therefore, there are no Nurse Midwives that will participate on this board, no physicians, no balance. It's a sneaky little way to <i>avoid accountability </i>by protecting the sisterhood, just as is done now with "peer review". </span><span style="font-family: Georgia,"Times New Roman",serif;"> </span></li>
</ul>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"> </span><ul><ul>
</ul>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b> A "board" that promises to promulgate rules about regulating, limiting, prohibiting, the tasks, acts, or functions of midwives, yet in the same bill states: <i><br /></i></b></span></li>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> "The department shall NOT promulgate any rules under this </i></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> section that limit or restrict the scope of practice of midwifery </i></b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i> as established under this article." </i></b></span><br />
<ul><ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">In other words, there will be no risking out criteria, <i>no defined scope of practice</i> that ensures families will be properly assessed and appropriately limited to low-risk births. The bill specifically states that no one can limit a midwife's scope of practice except for themselves. </span></li>
</ul>
</ul>
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;"><b>Collaborative care will be determined by the "board" with the "appropriate health care providers".</b> </span></li>
</ul>
<ul><ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">So an unbalanced board will determine when, if ever, a client would need to consult with a "health care provider." For example, a woman with a breech presenting baby might be referred to a local chiropractor in lieu of consulting with an actual OBGYN. (Yep, that happened.) We all know that high risk birth is considered, "just a variation of normal" anyway. </span></li>
</ul>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"> </span><ul><ul>
</ul>
</ul>
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://safermidwiferyformichigan.blogspot.com/2012/11/why-licensing-alone-wont-make-midwifery.html" target="_blank">Licensing alone will not improve the safety of out-of-hospital birth</a>! </b> Time and time again, experts have said that the factors that contribute to the safety of home birth (or OOH birth) are: <br /> a) Highly educated care providers (In the US that means a CNM or a CM)</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> b) Clear screening guidelines and risking out criteria that ensure homebirth is an </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> option for only low-risk women</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> c) Truly collaborative care between midwives and medical personnel<br /><b> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth" target="_blank">ACOG has issued a statement on Planned Homebirth</a></b> explaining the critical factors in achieving favorable outcomes: </span><br />
<br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> "Importantly, women should be informed that the <u>appropriate selection of
candidates</u> </span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> for home birth; the <u>availability of a certified
nurse–midwife, certified midwife,</u> or </span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> <u> physician practicing within an
integrated and regulated health system</u>; ready access </span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> to <u>consultation</u>;
and <u>assurance of safe and timely transport</u> to nearby hospitals are </span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> critical to reducing perinatal mortality rates and achieving favorable
home birth </span></i><br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"> outcomes.</span></i><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">Licensing CPMs wouldn't come close to meeting educational standards for "highly educated care providers", and dangerous bills like SB 292 work intentionally against appropriately defining a scope of practice as being for low-risk pregnancies in the OOH sector. The notion that this bill is about accountability, proficiency, oversight, or safety is an absolute lie. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">There
is no doubt that our options in MI are limited, and that licensing is
part of a bigger picture that can potentially offer safer options, but
it MUST be done responsibly, including all of the factors that impact
safety. Handing out a license to those who haven't earned them
according to educational & safety standards, will undoubtedly cause more harm than
good. Women in MI deserve to have safe, reliable options, and this bill
will not provide them with that. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>Please read the bill for yourself and contact your <a href="http://www.michiganvotes.org/Find.aspx" target="_blank">Senator and State Representative</a> immediately to share your concerns for the safety and well being of mothers and babies in MI. </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>* Tell them that p</b></span><span style="font-family: Georgia,"Times New Roman",serif;"><b>eople with a high school diploma, & no medical or university level training, have NO business administering drugs or IVs, let alone delivering babies. </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b>* Let them know you value options surrounding birth, but that MI women deserve for those options to be safe and reliable...this bill won't get them there.</b></span><br />
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;">What would improve the safety of OOH birth? </span><br />
<ul>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Licensing only the most educated to serve as midwives, those with a university level education </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">A clearly defined scope of practice and risking out protocols that ensure only low-risk births are taken on outside the hospital</span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">Appropriate transfer of care and Collaborative Care guidelines </span></li>
<li><span style="font-family: Georgia,"Times New Roman",serif;">A balanced board of midwifery, including a majority of highly educated midwives, doctors, and citizens</span></li>
</ul>
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<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Check out this link for more reading about <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html" target="_blank">Educational Standards for Midwives Around the World</a></b>. </span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><b><i>(Part II in the 3 part series on Education of Midwives Around the world, coming on Monday.) </i></b></span><br />
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<br />Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-346749784229772317.post-85442367075260222422013-04-15T08:53:00.000-04:002013-04-17T12:41:57.080-04:00The Education of Midwives Around the World: Part 1<span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black; font-size: small;"><span style="color: black; font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><b><i>We'd like </i></b><span style="font-size: small;"><b><i>to invite you to follo</i></b><span style="font-size: small;"><b><i>w our <span style="font-size: small;"><span style="font-size: small;">3</span> part </span>series on the edu</i></b><span style="font-size: small;"><b><i>cation of midwi</i></b><span style="font-size: small;"><b><i>ves around the</i></b><span style="font-size: small;"><b><i> wor</i></b><span style="font-size: small;"><b><i>ld</i></b><span style="font-size: small;"><b><i><span style="font-size: small;">.</span> The<span style="font-size: small;"> </span>re</i></b><span style="font-size: small;"><b><i>search and writing </i></b><span style="font-size: small;"><b><i>presented here was </i></b><span style="font-size: small;"><b><i>generously </i></b><span style="font-size: small;"><b><i><span style="font-size: small;">contri<span style="font-size: small;">buted by<span style="font-size: small;"> two special midwives in the US who want to see home birth remain an option in the care of<u> competent </u>care providers. </span></span></span></i></b> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: small;"></span><br />
<br />
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><b><span style="color: black;"><span style="color: black;">"Out of hospital birth is only safe if your midwife practices safely!" </span></span></b></span></span></div>
<br />
<br />
<i><span style="font-family: Georgia,"Times New Roman",serif;"><b><span style="color: #a64d79;"><span style="font-size: large;">Part 1: A midwife is a midwife is a midwife...or maybe not. Are all midwives created equal?</span></span></b> </span></i><br />
<span style="font-family: Georgia,"Times New Roman",serif;"></span><span style="font-family: Georgia,"Times New Roman",serif;"><br />There is a long list of studies (<i><b><a href="http://www.bcmidwives.com/files/Home%20Birth%20Annotated%20guide%20to%20the%20literature%20May%202011.pdf" target="_blank">Homebirth: An Annotated Guide to the Literature, May 2011</a></b>. Saraswathi Vedam, Laura Schummers & Colleen Fulton.</i>) which show that birth out of hospital is safe. These studies are frequently quoted by advocates, parents, and midwives when discussing the safety of out of hospital birth, and specifically home birth. Birth out of hospital is safe in the studies cited, but <b>the common thread that makes them safe is the educated, knowledgeable, licensed and regulated midwife responsible for the care of the mother and baby. The studies discuss the outcomes, but they don’t discuss the training, education and experience of the midwives providing the care. Nor do they examine the supervisory role of a more experienced midwife, or collaboration with a physician in the larger medical system.<br /> </b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">The three studies listed in the Meta Analysis and Systemic Review are the best available evidence (Section 1:A) of the safety of out of hospital birth. However, included within those analyses were large studies that included home births in British Columbia, Canada, the US and the Netherlands. One of the US studies cited was the National Birth Center study from 1992. As has been shown in the <b><a href="http://safermidwiferyformichigan.blogspot.com/2013/02/five-surprising-things-you-should-know.html" target="_blank">National Birth Center Study of 2013</a></b> the great majority of women receiving care at birth centers receive care provided by Certified Nurse-Midwives (CNMs). CNMs are licensed in all 50 states and their educational requirements are much different than CPMs and non-certified non-nurse midwives (those that provide the majority care in the home birth setting). <br /><br /><b>CNMs usually are graduates of university based midwifery programs and at a minimum posses a bachelor’s degree with the standard for newer graduates of these programs being a Master’s degree. </b> The midwifery education programs are similar to the one offered through Wayne State University in Detroit, MI. Students must complete 48 college credits which includes over 600 clinical hours and completed in 2 years. Most states require a Master’s degree in nursing for CNMs to be licensed in that state. </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Of the 4 studies that Vedam (2011) cites in the North American Cohort Studies section of her paper, three of them examined a Canadian population. Midwives in Canada are Registered Midwives (RM). <b>Midwifery education in Canada leads to a baccalaureate level degree in midwifery. It is currently offered only through universities. </b>Admission and Graduation Requirements for Canadian midwifery education programs are direct entry and do not require a prior nursing degree or diploma. Admission is based on secondary school eligibility and completion of prerequisite sciences and other courses with minimum grades or an overall average. Most midwifery programs recommend at least one year of university studies and/or related work or volunteer experience before applying. The admissions process usually includes a personal interview as well as assessment of academic eligibility.<br /><br />In addition, the four-year Canadian curriculum includes required courses in health, social and biological sciences (anatomy and physiology, biochemistry, reproductive physiology, pharmacotherapy) and a series of midwifery care courses that integrate academic studies with clinical experience. Clinical courses taught by program faculty are combined with placements in midwifery practice settings, during which students develop clinical skills in prenatal, intrapartum, postnatal and newborn care under the supervision of midwife preceptors. The equivalent of at least 2400 clinical hours and 850 academic hours over a minimum of 18 months of midwifery education. Placements extend over five to six semesters with electives in interdisciplinary and international settings and a clerkship (internship) in the final year. Graduation requirements include successful completion of academic courses and examinations, demonstration of competencies in all levels of the program, and attendance at a minimum of 60 births (40 as the primary care provider) <i>in hospital and out-of-hospital settings</i>. Most provincial/territorial regulatory authorities also require new graduates of midwifery education programs to write the national Canadian Midwifery Registration Examination (CMRE) before registration.<br /><br /><b>The profession of midwifery in Canada includes significant emphasis on medico-legal issues and risk management. Canada has a single, regulated model of care which includes informed choice and continuous on–call care of clients by fully autonomous midwives. As of 2011, nearly all the Canadian provinces required that midwives be registered in order to practice.</b><br /><br />There are 6 studies listed in the International Cohort Section of Vedam’s paper. The studies detailed were two each from the Netherlands and the United Kingdom, and one each from Australia and Switzerland. <b>Midwives in the Netherlands are educated at institutions of higher learning (colleges) in a program that lasts four years. </b>A high school diploma with courses in biology and chemistry is a prerequisite. The educational program includes 3560 hours of practical classes and 3160 hours of theoretical classes. In the Netherlands women are only allowed the option of home birth if they live within 15 minutes of the hospital.<br /><br /><b>In the United Kingdom (UK), midwifery education takes place at a university and is 3 years in length. </b> Prerequisites include science and English. Each of the midwifery programs include 2500 hours of practical classes and 2500 hours of theoretical classes. Although there are midwives in the UK that choose to practice independently (less than 1% of all midwives), most are employed by the National Health Service. <b>All midwives are required to be licensed and to carry liability insurance.</b> All midwives whether independent, or NHS, have a supervisor who ensures their practice is of a satisfactory standard. The home birth rate is less than 2.5%. <br /><br />The same educational standards are true of midwives certified by the American Midwifery Certification Board, which certifies nurse midwives (CNMs) and certified midwives (CMs) in the US. (<i>Note: Not all CNMs and CMs carry insurance if they are practicing outside a hospital in the US.</i>) </span><span style="font-family: Georgia,"Times New Roman",serif;"><b>These two
types of midwives have educational standards and competencies consistent
with the International Confederation of Midwives (ICM) and the World
Health Organization (WHO).</b> CNMs are licensed and regulated in all 50 US states.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: large;"><b>However, the standard of being licensed, educated, and insured is <i>not </i>true for the majority of midwives serving the home birth sector. </b></span> </span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">In the US, there exist other types of midwives which include certified professional midwives (CPMs), Direct Entry (apprentice style) Midwives (DEMs), Lay/Licensed Midwives (LMs), community midwives, and practical midwives. CPMs are "<i>certified</i>" by the North American Registry of Midwives (NARM), but only recently (2012) has NARM required<b> <u>a minimum educational prerequisite of a high school education. A</u></b></span><span style="font-family: Georgia,"Times New Roman",serif;"><b><u><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-family: Georgia,"Times New Roman",serif;"><b> university midwifery education program is not required to become a CPM.</b></span></span> </u></b><span style="font-family: Georgia,"Times New Roman",serif;"> Currently 26 states license CPMs
but the licensing regulations vary greatly by state. <b> </b><br /><br />Please see the attached pdf for details <a href="http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000001385/CNM%20CM%20CPM%20ComparisonChart%20082511.pdf" target="_blank"><b>comparing CNMs, CMs, and CPMs</b>.</a><br /><br />Non-certified,
non-nurse midwives are not licensed in any of the 50 states, although
they may be licensed as licensed midwives (LMs) in a few states. They
may be known as lay midwives, or direct entry midwives (DEMs), community
midwives, practical midwives, or traditional birth attendants (TBAs). <b>
They have no minimum educational requirements. Their experience,
knowledge and skills may vary greatly.</b> Because they are not certified, a midwifery education program is not required to become a non-nurse, non-certified midwife.</span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black; font-size: small;"><span style="color: black; font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><br />T</span>he educational requirements among the non-CPM, unlicensed midwives is si<span style="font-size: small;">milar, if not the same, to the t<span style="font-size: small;">raditional birth attendants in developing countries<span style="font-size: small;">.
Even the governments in those countries recognize that TBAs do not have
the knowledge or skills to care for even some of the more common
complications. They may be knowledge<span style="font-size: small;">able w<span style="font-size: small;">hen all is going well, but cannot save mothers or babies lives when things aren't going well. <span style="font-size: small;">The </span>countries with high maternal and infant mortality rates also have a high prop<span style="font-size: small;">ortion of <span style="font-size: small;">TBAs.
These countries are training midwives at the university level to go out
into the rural areas and train the TBAs to be better midwives. It is
the same thing that happened in the US early in the 20th century.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br />Although
CNMs may provide care to women planning births in hospitals, birth
centers, or at home, <b>CPMs and uncertified and unlicensed midwives only
provide care to childbearing women desiring to give birth at home and
sometimes at birth centers.</b></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br />The United Nations Family Planning Association has this to say about regulation and education:</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /><i> <b> "The purpose of regulation and the process of regulating combine first <br /> and foremost to serve and protect the public. Regulation is a way to <br /> oversee whether health professionals are competent to practice. It is <br /> an essential accountability function for a government to fulfill its <br /> responsibility t0 protect its citizens, and ensure their right to <br /> health, including the obligation to grant special care and attention to <br /> women during a reasonable period before and after childbirth. <br /> Conversely a health care system that relies on midwives or other </b></i></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><i><b> cadres who are less than competent to provide care through their <br /> professional careers is dangerous to women, newborns, families, and <br /> communities.”</b></i><br /><br />The United Nations Family Planning Association (UNFPA) in 2011 published a comprehensive study, <i>The State of World's Midwifery 2011: Delivering Health, Saving Lives </i>that detailed the state of midwifery worldwide. They looked at how midwifery is saving the lives of mothers and babies around the world. In order to continue and improve the services that midwives provide, the UNFPA recommends additional education and continuing competencies.<br /><br /><b>The best OOH birth outcomes result from attendance by a trained and skilled midwife who collaborates with physicians and medical facilities and has clear risk-out criteria for eligibility for home birth.</b> Unfortunately we do not have an ideal system for assuring this type of safety and high-quality care in the US. Even licensed midwives can have difficulty assuring smooth referral or transfer of care to the hospital or collaboration with physicians when needed. I've found that unlicensed midwives have an even harder time assuring these safety measures.<br /><br />I believe that low-risk mothers experiencing healthy pregnancies with no discernible risk factors attended by a licensed certified midwife who practices in accordance with safe standards of care can provide care that is pretty darn good - and probably comparable to hospital birth. <b>But removing any of these factors (risk-out criteria, practice standards, qualified midwife), the outcomes will be poorer, as we've seen demonstrated time and time again across the US. </b><br /><br /><b>Thus, to say that home birth in the US with an undereducated, possibly unlicensed, and definitely unregulated midwife is as safe as with educated, knowledgeable, licensed, and regulated midwives in the US (CNMs and CMs), Canada (RM), Europe, or Australia is a disingenuous, false and dangerous comparison. </b></span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif; font-size: large;"><b>Midwives are not all created equal. Knowing the difference may save you or your baby’s life.</b></span><br />
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<span style="font-family: Georgia,"Times New Roman",serif;"><span style="color: black; font-size: small;"><span style="color: black; font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><br /><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-size: small;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>Unknownnoreply@blogger.com3