Wednesday, July 25, 2012

The Marriage Between Legislation & Choice

Sometimes they say opposites attract.  Conversations about preserving our freedom as citizens don't exactly favor legislative action.  That being said, there are times when legislation and balanced regulation have worked to improve living standards and protect the people.  And so I ask, when do we consider legislation to be necessary to protect the people, or greater world?  When it comes to the food we eat, or the clean water we drink?  Traffic Laws?  Child Care?  Treatment of Animals?  Drugs?  How do we regulate, but still preserve freedom of choice?

I believe Senate Bill 1208 does exactly that, preserves choice and improves safety.  It defines "licensed midwife" to mean one of three things: 

1) A CNM (certified nurse midwife): a bachelors degree in nursing, graduate school in midwifery, and passing ACNM's exam to earn a license

2) A CM (certified midwife): a bachelors degree in something other than nursing, graduate school in midwifery, and passing ACNM's exam to earn a license

3) A new alternative to licensing is proposed: RN (2 years of nursing school), 50 births with a licensed midwife as an apprentice, and passing a state approved exam

Number three is where the controversy lies.  Our state currently has some midwives who have a CPM (certified professional midwife) credential.  They are fighting to be licensed in HB 5070.  The question is whether or not a CPM's preparation and "education" is sufficient to warrant a state issued license.  Senator Whitmer, among others do believe that more consistent education and training are needed to adequately assist women safely in their homes, birth centers, or hospitals.  In short, the CPM credential doesn't set the bar high enough when it comes to training or practice standards, and the way this credential is obtained varies widely among those who have earned it.    

Senate Bill 1208 proposes a different alternative for licensing, that being choice number 3 above.  It doesn't require graduate school, but it does establish a minimum standard of education and training that is acceptable to earn a state issued license.  

Those who are fighting for "choice" are fighting to be able to birth with anyone, qualified or not, unassisted even if that is their choice.  This bill does not take that right away.  What it does do, is stipulate that if someone is calling herself and advertising a "midwife" she must be educated according to standards, state-licensed, and insured.  It defines "midwife" as meaning something for consumers.  It does NOT say it is illegal to have your baby at home with our without a licensed midwife.  

Setting the minimum standard was an attempt to ensure that all midwives have had adequate coursework in pharmacology, physiology, clinical & emergency training.  It was aimed at helping midwives better understand the complicated ways our body systems function together.  It was meant to help them understand the way drugs interact, should be kept, and how they should be administered.  Some have even pointed out that an RN, plus 50 births without specificity toward where and what those birth setting should be, is NOT enough.  Still others feel the RN requirement is too much.  The most important aspect in all of this is the need to establish standards for education so that our midwives are prepared to be the best they can be and serve women safely.  This much needed debate has begun and  that is progress.  The goal, defining a bill that actually improves safety, preserves choice, and establishes standards for education and practices regardless of setting.  

Ultimately, women want and deserve choices when it comes to where and how to give birth.  The goal is to make all of those options as safe and consistent as they can be.  Senate Bill 1208 does not take away anyone's choice to have a home birth or a birth center birth.  It works to make sure that "midwives" attending home births are educated to a baseline standard, and are competent to be delivering babies.  We're not talking about baking cookies here, we're talking about life's most complicated event, and that must be attended by people who have met appropriate standards.  No matter how natural  your view of birth may be, we can all agree that birth is not to be taken lightly, that it is precious, and at times dangerous.  Not just anyone should be allowed to call herself a midwife, nor should just anyplace be allowed to call itself a birth center.  

This bill represents a healthy marriage between legislation and the rights of women to choose where they give the added bonus of ensuring that your midwife is well educated and trained to be taking on the inherent responsibilities of attending that birth.  Recognizing there is a shortage of qualified midwives to serve in this capacity should tell us all we have a long way to go if we are to demonstrate excellence in midwifery on a consistent basis.  Michigan mothers deserve better and the time for change has come.    

Here are some other links for exploring CPM training and practices: 

(Links below coming soon) 
Home Birth Story: Why women deserve not to be their own midwife 
Tell Me About This Credential: The CPM or the Certified Professional Midwife

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