Thursday, September 27, 2012

When the Pot Calls the Kettle Black

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."  
- Arthur Schopenhauer

This is an unplanned post, but one that needs attention.  In response to Monday's post entitled, Finding Fault in Limited Choices, we received a comment that represents well, the sentiment of those that fight so hard to protect their own choices at the sacrifice of others.  These are the same people who have chosen to ignore multiple deaths, injuries, and near misses in the hands of midwives in the Lansing area.  The same people who have indirectly called me a slew of names in response to telling the truth about what happened to our family.  Among them, "cult leader, delusional, mentally unstable, hater of midwives, destroyer of midwifery, persecutor, and now...pathetic."

Much of these accusations have been in  Face Book groups or thorough email behind my back.  More recently, commenting anonymously on our blog seems like a way to vent anger.  The attacks are becoming more direct through my personal email, and now on the blog, yet somehow I'm the angry, hateful one in this situation...?  Yep, that's the pot calling the kettle black alright.  I thought our readers deserved to read firsthand just the kind of people we're dealing with here. 

Thank you "anonymous" commenter for making this point for me from Monday's blog post: "I've also yet to meet a grieving family who steps into the media to be scrutinized, attacked, and shunned just for the fun of it."   

Your comment is exactly the commentary I'm referring to:

     "1 person can do so much good or bad. You claim to want to improve midwifery yet you  
     are really out to destroy it. Don’t fool yourself because you are not fooling others, not for 
     a minute.  You devote so much time to hate, on so many levels including multiple hate 
     groups here on the internet, and in what you spew and write. How do you have time to 
     adequately take care of your family? I am concerned for your mental well being, 
     seriously. Remember, we all become a product of our environment thus you have
     become a bitter hateful person. You are so pathetic that I am very sad for you. I am
     glad to see you say you take responsibility for (only) some things…
    “'Anger is like flowing water; there's nothing wrong with it as long as you let it flow. Hate 
     is like stagnant water; anger that you denied yourself the freedom to feel, the freedom
     to flow; water that you gathered in one place and left to forget. Stagnant water becomes 
     dirty, stinky, disease-ridden, poisonous, deadly; that is your hate. On flowing water 
     travels little paper boats; paper boats of forgiveness. Allow yourself to feel anger, allow 
     your waters to flow, along with all the paper boats of forgiveness. Be human.”  
    ― C. JoyBell C.'"

The word denial comes to mind... 

de·ni·al  (n.)

An unconscious defense mechanism characterized by refusal to acknowledge painful realities, thoughts, or feelings.

I just do not see how anything about this blog is out to "destroy midwifery".  How is it that telling the truth of the stories I hear from families across the state, as well as my own, constitute hate?  How does asking for higher standards and safer practices represent bitterness?  This blog would be difficult to write if one word of it were fabricated.  Sadly, it flows too easily because every word, and every reference to dangerous practices is something that has happened to a family in our state.  Who in their right mind wouldn't want to  know these things were happening?  Who wouldn't want them to change?  It's not about hate in even the slightest way.  It's about pulling back a dark curtain of lies, misrepresentations, cover-ups, and untruths to reveal an ugly truth that must be addressed if midwifery is going to be a safe option for women.  I do not think the midwives I'm referring to are the majority, but the dangerous few.  If we can't delineate the safe practices from those that area costing lives, we can't work to improve the practice.      

As for spending time with my family?  Well, let's just say I'd much rather be chasing around my 1 and a half year old than telling the world about his preventable death that never should have happened, and trying to make sure it doesn't happen to others.  It's not work I asked for, but it is work I must do.  To be silent about such atrocities, would be concealing things I know are wrong, and I cannot live that lie.  I have two children to protect, one I can see and hug every day, and another whose love and life I had to learn to know differently.  Whether on this earth or not, they both deserve to be protected, defended, and loved when someone brings them harm.  There is no greater honor I can offer Magnus, or any other member of our family, than telling the truth about what happened to us. 

I'm sorry that some people are not able to walk a moment in my shoes, and see what I have seen.  Until your baby dies in your arms because of severe negligence, you can't even begin to imagine my perspective.  Until you read the lies your midwife wrote about you, and realize the lies she told you that put you in great danger, you will never understand why we must take action.  You can make up lies about me that help you cope in a sea of denial.  You can choose to ignore the problems families are facing, and in doing so, it will be the people like you that ultimately do midwifery the greatest amount of harm.   I understand that grieving for a lost illusion is easier for some that facing reality.  

Like I said in Monday's post, I accept the blame, the anger, the "hate" that somehow makes some people feel better,  if it means things are safer in the end.   To those who call loss moms "pathetic" for speaking out and trying to advocate for safety...well, it's that darn pot and kettle idiom all over again.     

"The truth is incontrovertible. Malice may attack it, ignorance may deride it, but in the end, there it is." - Winston Churchill

Monday, September 24, 2012

Finding Fault in "Limited Choices"

Change is difficult, no doubt about it.  When one door closes, an opportunity arises for something new...dare I say something better?  It is possible.  Sometimes when we don't understand change, it's easy to find someone to blame.  Especially when that change seemingly takes something from us. 

The Greenhouse Birth Center is closing next week...for some a devastating loss, and for others a long overdue wave of relief.  An advocacy group has formed asking for higher standards and safer midwifery practices.  The safety of out-of-hospital birth is under the microscope.  Politicians are talking.  Safer options are coming to town.  Babies have died, babies have thrived, and everything in between.  Media is concerned, as is the State regulatory body.  Resources with accurate information are being developed.  There is no more hiding from the public, the lurking shadows of midwives practicing in unsafe ways.  Women want choice, but they also want those choices to be as safe as they can possibly be.  So what is a community to do? 

There are several things to consider.  First, we should think about why changes are happening in the first place.  Changes are happening because babies are dying that don't have to, plain and simple.  Changes are happening because the foundation of midwifery is cracked, and patched with unethical practices.  It's a bit like erosion, with midwifery as the cliff at seaside that stands tall and proud.  After years of the wind and waves eating away at the surface, slowly cracks penetrate.  Chunks of rock go crashing into the sea.  The mountain from which the cliff emerged, still stands, as do those midwives practicing responsibly.  There is no doubt that the structure is continuously wounded.  The erosion in this analogy refers to is ego, the inability to define risk, and further the inability to admit responsibility.  In many cases, the cracks spread far and wide because of incompetence and fear.   When midwives lie and deceive to skirt accountability, enormous boulders crash into the tumultuous waters below.  A profession cannot stand tall upon these principles and practices.  It simply cannot.  Midwifery, specifically those working in the out of hospital setting, must find a better way to serve women and babies.  It must hold itself to higher standards of education, understanding, perspective, practice, and ethics if women are to rely on it. 

Another question we must wrestle with is considering where fault lies?  Can one person, one family really cause such an uproar?  Some like to think so.  Some like to say it's our fault that changes are on the horizon.  Blame can only be attributed to one family speaking out if  you believe the notion that they are deluded cult leaders who hate midwives and want revenge.  That they are so overcome by grief that they want to take away the rights of others.   Some reason, "They must not see the other side, they must not see that they're taking away our choices."    

Folks, we have seen the darkest side.  A side we wouldn't wish upon anyone, and that is why we speak.  

I have yet to meet a loss or injury family who makes up a story for sympathy.  I've also yet to meet a grieving family who steps into the media to be scrutinized, attacked, and shunned just for the fun of it.  I have yet to meet a loss family who is at fault for taking away the choices of others because they told the truth. 

I have met many families though, who care about people, who care about right & wrong, and who don't want to see what happened to them, happen to others.  I have met many who feel used, manipulated, and duped...whose "choices" were taken advantage of.  Families who share their stories are not persecuting midwives, we are telling a truth that could just have easily have happened to any family.  In making the decision to share our stories publicly, fault is immediately bestowed upon us. It's another burden, along with grief, that we must bear. 

If someone must bear this burden of fault for instigating change, I accept it proudly.  If it is my fault for telling the community what happened to our family, for asking for higher standards, for advocating for safer practices, for suggesting things could be done better, then I accept.  If holding negligently practicing, individual midwives accountable for their actions, means that other mothers in this community have less of a chance of being served by them, and more accurate information about the reality of what is happening in their care, I accept that blame too.  If pointing out to the community, misleading associations between our own state and community, and loss of freedom makes me somehow to blame for misplaced anger, then I accept that.  Only so many babies in our state could be injured or die before someone started to talk about it.  For too long, we thought we were the only family.  Alarmingly, we learned we are not.   If someone or some group of people is to blame, consider the midwives who are practicing dangerously, those responsible for preventable deaths.  

I do understand loss, and I can see that with Greenhouse closing, some are mourning a loss in something they believed in.  What I hope this community one day understands, is that I want something better for all of you than what my family had, and I know it can be done without taking away choices.  It may seem that our choices are limited in the immediate moment, but by raising standards for education and practice, the end result will mean better care, better options, and establishment of accountability in a profession where there is none.  

Change is difficult.  It is especially difficult when it involves people you have trusted intimately, people you think are friends, people who have loved your family and delivered your babies without issue.  The fact is, no matter how great your care was, it wasn't that way for all of us.  It took the most traumatic event of my life to see past the illusion of trust and friendship I had leaned upon for so long.  Something had to change before more lives were lost, and there is more work to be done.  

Instead of misplacing blame because something so many of us thought was real, turned out to be an illusion, we should be asking ourselves: What do these changes mean, and how can we move forward in a way that will simultaneously improve the profession of midwifery for the safety of those who choose it?  Saying women are smart enough to choose isn't enough.  Ignoring the reality of unnecessary deaths and injuries is unacceptable.   Pretending these families are the villains, and midwives are somehow victims is distorted beyond my comprehension.  A shift in focus needs to occur, and it should be about working toward something better for all of us.  Time to talk about solutions. 

Wednesday, September 19, 2012

"Take Birth Back"

There's a new movie coming to town, courtesy of Christin Lott, Greenhouse Birth Center board member, local doula, and natural childbirth advocate.  The movie is entitled "One World Birth", and you can visit the link to view the trailer.  In essence the trailer sends the message that outlawing home birth takes away our freedom.  It further explains that doctors use too many interventions and don't "trust the physiological processes of birth to take place."   The obvious call to action is that women should, "take birth back". 

Christin invited the public to view the video with her on September 20th, by saying, "
I think the film hits home and is so fitting for the kinds of things going on right now in our area."  It is the implication that what is happening in our own community (and furthermore the state) relates to loss of freedom to have a home birth, that is so outrageous.  In fact, it's so outrageous that it seems more like fear mongering.  No one in Michigan is saying or has said that home birth should be outlawed.  People in Michigan are saying that if home birth is to remain an reliable option for the women of this state (which we all want to see happen), we have a right to rely a competent professional to assist us. We have a right to be protected from midwives who practice negligently, and to further hold them accountable for their actions. We have a right to demand that the professional use of the word "midwife" very clearly mean something by definition, minimum standard for education, and scope of practice if they are to hold a state issued license.  

Do women have a freedom to choose where to give birth, and should it be protected?  Absolutely.  Every legislator I have talked to in the Michigan House and Senate has agreed on that point.  Never once have I heard the suggestion that home birth be outlawed.  Does that mean there should be no expectations or guidelines for the people who practice midwifery?  Does it mean that women of this state should be subject to dangerous practices, or that they shouldn't stand up for their families when negligence has occurred?  No.  

What I cannot figure out is why those who are so protective of their home birth rights, don't expect more of the midwives that serve them.  What is there to lose by setting standards, by raising the bar to make home birth as safe as it can possibly be?  What is wrong with expecting ethical, high-quality care, and holding accountable those who do not practice as such? Would these actions not improve the quality and safety of home birth? 

I, for one, do not buy the comparison to Hungary, where Agnes Gereb is under house arrest for attending home births, (home birth is illegal there) to Michigan, or the US for that matter.  In no US state (to my knowledge) is home birth considered illegal.  Some midwives have been arrested in states like Indiana for practicing without a license, because that state has determined that a midwife must be a licensed care giver with specific education and skills before attending a home birth.  In the case of Ireena Kesslar from Indiana, who allowed her license to lapse, yet continued to deliver babies, did she not break the law?  The standard has been established and for good reason.  In other instances, midwives in the US have been arrested for involuntary manslaughter, and most recently for child abuse.  If you read the cases, every single one is full of grossly negligent circumstances.   

At what point do supporters of midwifery and home birth recognize that midwives are not infallible?  When do they stand up and demand safer practices among their peers, their "sisters", their "beloveds"?  When do they work to protect the freedom of choosing a home birth, by improving its merit, integrity, and safety?  That's when birth will be "taken back".   Hospitals are not the enemy.  I know many hospitals and doctors across this country who are embracing excellence in midwifery, who work alongside midwives, and who are supporting physiological processes very well.  Instead of spreading political fear, perhaps we should get to work at making home birth as safe as it can possibly be.  The problem is that first we have to acknowledge the dangers, the unethical practices, the dark spots, and for some that's nearly impossible.  Until we do, birth will largely remain in hospitals.  A profession cannot gain respect effectively without actually practicing professionally as a whole.  The argument implied by Ms. Lott, and this film, is self defeating.   

When Trusting Birth Goes Wrong
Improve Birth Rally

Monday, September 17, 2012

When Trusting Birth Goes Wrong

There is nothing inherently wrong with trusting birth, with believing your body can deliver your baby.  A certain amount of trust and confidence in yourself is a good thing for any woman preparing to give birth.  The problem I have is when die-hard natural childbirth advocates and midwives build up the trust in birth so much, that the ideal resides comfortably on a pedestal.   

When does telling a woman to "trust birth" go too far?  Is it in following up that statement with "your body was made to do this" or "mothers know how to give birth and babies know how to be born".  Or perhaps the line is crossed in telling women, "you can't grow a baby too big for your body to birth".  I'm not sure what the line exactly is, but filling women with these ideals sets them up for serious emotional trauma when things do go wrong.  

What do you tell the woman whose body fails to intuitively know how to birth her baby safely, whose baby dies as a result?  Really, what do you tell her?  Did she not trust birth enough?  Did her intuition fail?  Was her perfectly healthy child not meant to live?  Or what do you tell the woman who needed to have a cesarean, but feels so traumatized afterward, that she isn't able forgive herself for years, maybe a lifetime?  Did she not try hard enough?  Did she not intuitively not do things right?  

Instead, why can't we be honest and tell women to trust birth and their bodies, but that you can't really control how things go sometimes...that sometimes women and babies need help to be born safely.  We should further that discussion by telling cesarean, forceps, or vacuum extraction mothers mothers they did not fail, and that they are no less loving mothers regardless of the way their babies came into this world.  We should tell loss mothers who were left alone with their intuition, that their bodies did not fail, but their caregiver failed to properly assess, and recognize signs she needed help.  And to the loss mother whose caregiver did everything possible to save her baby, that she did not fail either, that she's still a loving mother that did everything right.  

The truth is that sometimes we trust birth, and our bodies, and things still go wrong.  We should tell them it's okay to ask for/accept help if that is what keeps your baby safe.  Women deserve to know this truth long before labor sets in.   Painting a mirage that trusting birth and body in a worship sort of way, sets women up for a very hard fall if, for any number of reasons, that woman isn't able to give birth the way she was taught she ought to, the way it was "meant to be".  People who approach birth in this way, are inflicting unnecessary guilt and trauma onto other women by filling their heads with unrealistic expectations of themselves and birth, and by not telling the whole truth.  Teaching women to trust birth at all costs, without helping them understand that things don't always work that way,  is irresponsible and cruel. 

Tuesday, September 11, 2012

No Liability Insurance? Just File Bankruptcy...Repeatedly

I was always taught that when you make a mistake, you tell the truth.  You admit your error(s), and face the consequences.  You let that instance of being human teach you a lesson that leads you forward to a better version of yourself.  I've never in my life known personally people who willfully and purposefully dodge responsibility, recurrently lie to avoid accountability, or even further know they have made errors that have cost lives and work very hard to cover them up.  Even worse, they continue their dangerous practices without hesitation.  I haven't known this kind of people, not until now.  

So let's talk first about the midwives who don't bother to carry liability insurance and what exactly that says about them.  It says that your midwife doesn't believe in mistakes.  It says she views herself as infallible.  It says that even if things go wrong and your baby is injured or worse, that you'll just believe she did her best and forgive her.  It means that it doesn't matter to your midwife that you potentially face a lifetime of heart ache or medical bills for which your family alone will bear the burden.   It means that your midwife doesn't like to play by anyone else's rules or safety guidelines for that matter.  Not taking the professional responsibility, as someone who delivers babies, to ensure that families are offered safe, reliable care with the safety net of insurance if something does go wrong, is just plain selfish.  A midwife who doesn't bother to protect her clients by carrying liability insurance doesn't care about safety or outcomes, nor does she appreciate the inherent dangers that come along with childbirth. Essentially, you and your baby, are not worth the investment. 

How does lacking liability insurance directly effect your care?   Well, it means there are no rules to follow, no checks and balances, no source who can say a midwife has had repeated "claims" and thereby refuse to insure her.  It means if your baby spends weeks, months in the RNICU, you alone will be responsible for the enormous bill.  In the event your baby dies, (whether it's negligent, criminal, or not) it means you are highly unlikely to find a civil attorney to represent you because they will spend countless hours working on your case with little chance for any compensation for their time in the end.  In the event of injury, you will likely foot the bill for a lifetime of medical care, therapy, and treatment.  

If you are fortunate enough to find an attorney to represent you in civil litigation, that doesn't much matter either.  Your midwife can just file bankruptcy in an attempt to get your case dismissed.  It's a lovely little loophole in the circus of seeking accountability.  Without liability insurance, they can easily make it look like they have nothing to give in the event of a settlement.  Never mind the assets they've carefully moved before filing.  Low and behold, it's quite a common strategy for people trying to avoid paying a judgment for negligence. I know, I know, you must be thinking, "...but someone died or was injured!  It's not like they just missed a few credit card payments right?  How can they skirt responsibility that is so serious?"  It's a way to circumvent being held accountable because the chances of a family being able to fight back, to pay enormous legal fees to contest the bankruptcy claim are slim.  A clever strategy indeed.  In fact, so clever that some midwives are repeat filers.  No insurance means no accountability.  

What really boggles my mind is the extent to which some people will apparently go to avoid being held accountable for actions they absolutely know to be negligent.  Even beyond that, they will continue to practice, to deliver babies, to cause deaths and injuries, and there isn't a damn thing anyone can do to stop them...not the county prosecutor, not the state, not a court of law, no one.  Without laws or regulations to which to hold them accountable, what can be done?  Nothing.  You don't have to be a licensed midwife to practice in MI, and even if you are, you don't have to report your outcomes to anyone or carry liability insurance.  

At what point do these midwives become a menace to society?  At what point does someone say enough is enough?  At what point do the people of Michigan stand up and demand more ethical practices and regulations?  How many babies have to die?  How many times can one midwife be sanctioned or file for bankruptcy to avoid responsibility for the babies she has harmed?  Once?  Twice?  What is the magic number?  Apparently it is limitless and these are the midwives serving the women of Michigan in out-of-hospital birth.  Don't be fooled by the professional looking facility that reminds you of the comforts of home.  So what if they have a license?  Don't listen to how great their track record is, because the truth is you simply have no way of knowing how many deaths and injuries they are responsible for.  Nor do you know how many times they've been sued for a baby's death and filed for bankruptcy as a scapegoat. 

It saddens me to know on a human level that people like this exist, especially when it comes with a heavy price, the life of a child.  These are clearly people that are not working to improve themselves or their practices, and women deserve to know about the dark strategies of the midwives serving them in home birth in our state.  Calculated and planned deceit.  Midwives are irresponsible at best if they are not carrying malpractice insurance to protect the families they serve.  If your midwife does not carry malpractice insurance, it should be an enormous red flag.  You need to find yourself a real professional. 

Wednesday, September 5, 2012

CPM education: The Bar is Too Low

We'd like to welcome "Ex CPM Student" as our guest blogger today.  A former midwife apprentice shares her insights about educational training of CPMs.  

One reason why the authors of this blog are so adamantly opposed to licensing CPMs in Michigan is because they’ve done their research and understand the paltry requirements for one who wants to become credentialed as a CPM.

There is a lot of gloss on this credential – and proud, public proclamations that CPMs should be legally recognized as “a knowledgeable, skilled and professional independent midwifery practitioner” who “specializes in out-of-hospital birth."

First off, I want to state that I do not believe that all CPMs are poorly trained. I will not paint a black and white picture for sake of creating a tidy, diametrically-opposed argument. But I will say that CPM education requirements are not enough. The bar is set too low. This is what the authors of this blog are saying as parents who have done their research – and this is what I am saying as a former apprentice:

The bar is set too low.

So just what is required of an apprentice who wants to become a CPM?


Appropriate education is allowed “through a variety of routes” and yes, NARM includes “self-study” as an option. (I'm quoting the NARM Candidate Information Bulletin). I kind of cringe when someone says CPMs could have trained by watching YouTube videos, but I can’t imagine how this doesn’t fit into NARM’s education standard that allows education by “a variety of routes” including “self-study.”

Do I even need to say this? This is a pretty low fricking bar for educational standards.


If we separate out the clinical training from the educational requirement, we can see that the clinical aspect of apprenticeship is more clearly defined - and dare I say, more stringent - than the education requirement. The clinical requirement specifies at least 1350 contact hours (and how these clinical hours are tracked and verified is defined by NARM) and states that these hours must take place over a period of time at least one year in length. Disregard the fact that 1350 contact hours could be acquired by working 40 hours per week for a duration of less than 9 months. This is a trifling technicality.

These clinical requirements are verified by the supervising midwife, or preceptor, by signing paperwork and having correlating documentation of the apprentice’s participation in client charts.

Well, let’s look at what the specific clinical requirements are:

Initial prenatal appointments:                20
Prenatal appointments:                            55
Postpartum appointments:                      40
Newborn exam:                                          20
Active Assistant:                                         20
Primary midwife under supervision:     20

Now many apprentices will have had more clinical experiences than what is required here when they sit for the NARM exam. But the point is not what “many” or “most” or “some” CPM candidates have done prior to becoming certified, the point is to show what is actually required. So let’s look at just what that is.

Prior to apprenticing in the role of “primary under supervision,” the student midwife usually will attend births as an “active participant.” (At this point, I really want to add my own personal opinion regarding the clinical responsibilities that should exist for one who is acting as “active participant” at a birth in an out-of-hospital setting like being trained in CPR, NRP, qualified to monitor contraction patterns, perform vital signs and assess FHTs to name a few. But NARM does not specify this, so neither shall I.)

OK – 20 births as “active participant” (Whatever that means, maybe placing cool washcloths on the laboring woman’s forehead.)

Then the next 20 births, could feasibly be the apprentice’s “primary” births. The primary under supervision requirement means the apprentice is managing the labor, making clinical decisions and performing all skills relevant to midwifery under the supervision of a preceptor.

OK – add 20 births required for “primary under supervision.”

We’re up to 40 births.

Now, for the appointments: 55 prenatals, 20 initial prenatals, 20 newborn exams, 40 postpartum exams

All of these requirements could be fulfilled with the 40 women whose births were attended as active assistant and primary under supervision. The routine course of prenatal care, if started in the first trimester, can easily include to 8 to 10 prenatal visits, (8 x 40 = 320 prenatal visits) and midwives typically include 3-5 postpartum visits in the weeks following birth (4 x 40 = 160 postpartum visits). If the apprentice performed the newborn exam for half of the births she attended (20 births = 20 newborn exams), this requirement would be fulfilled as well.

I’m not saying this always happens – only that it could: 

The NARM clinical requirements could be fulfilled 
by participating in care for 40 midwifery clients.

That’s the bar. 40 clients.

If you participate in the care of 40 women having babies in an out-of-hospital setting, and your preceptor signs off on your experience, and this takes longer than one year, you will have completed the clinical requirement for NARM.

Include the (non-existent) educational requirement and a bunch of paperwork, you, too, can sit for the NARM exam and call yourself a CPM offering “expert care" and claim to have gone through “rigorous training” to become a certified professional midwife.

At this point, (THIS IS THE BAR – I’m repeating for emphasis: 40 clients, nary a course in anything, and passing the 350 question exam) NARM considers CPMs "knowledgeable, skilled and independent" care providers for pregnant women having an out-of-hospital birth.

Is this bar high enough for you? For your friend? For your sister? For your daughter? For your cousin? For your neighbor? For the pregnant teenager working at the fast-food joint?

It is an appallingly low standard apparent to those who’ve done their research. Safer Midwifery does not support permitting licenses to individuals who have cleared a bar set so dismally low. It does not assure adequate training or competence and it does not assure safety for women and babies.

Monday, September 3, 2012

Is HB5070 for Safer Midwifery?

With much debate in recent months about proposed legislation that would regulate Michigan midwives, the question of safety remains paramount.  We've written numerous times on this blog about HB 5070 and all of the reasons why it would do more harm than good.  I'd like to address the difference between legislation that will directly protect midwives versus legislation that would directly protect consumers, people, mothers, & families.  (And can I just briefly note, it's not the midwives who are losing their lives in these situations.) 

I have to start then with why non-nurse midwives (CPMs in this case) would want to be licensed through the state in the first place, and further why Representative Ed McBroom would support the notion. For midwives, the key components of having a state issued license is that they can then be reimbursed for medicaid.  For some bizarre reason, they also think this will prevent them from being charged in the criminal court system.  I don't see that connection, because license or not, gross negligence is gross negligence...manslaughter is manslaughter...and practicing medicine without a license is practicing medicine without a license.  A state issued license doesn't protect anyone from criminal charges, whether you believe they are warranted or not.  The third reason non-nurse midwives would like a license is that it would earn them status in some circles, on par with that of holding the same license and practice rights as nurse midwives.  

Let me just point out that nurse midwives have a bachelors degree in nursing and have gone to at least two years of graduate school in midwifery.  They are advanced practice nurses, with extensive clinical training, scope of practice guidelines, and on and on.  Non-nurse midwives however are "educated" in a variety of ways, most not earning a degree of any kind and learning midwifery "apprentice" style.  The exception are Certified Midwives, those who have a bachelors degree in something other than nursing, then attend graduate school for midwifery.  HB 5070 does not address licensing for these midwives to my knowledge.  

What then about Representative McBroom's motivation?  I'm not sure if it's really motivation as much as a lifestyle choice for him.  He comes from a farming family in the rural Upper Peninsula, where there is an extreme shortage of OBs on hand.  His mother had her babies at home, and he and his wife have successfully had their four babies at home, one being breech, and the most recent arrived just this summer.  I think he sees a need for licensed midwives and competent caregivers to serve the women of rural Michigan.  While I agree with the idea, our definition of "competent" differs slightly.  I'll remind readers that two of the four midwives present at our out of hospital birth were nurse midwives, and it still ended in disaster.  This issue is about more than education and licensing.  For that reason, there are several guidelines that need to be added to this bill if the primary goal is to improve safety for those that choose out of hospital birth.  I also think there are many details that need to be addressed and deleted from this bill in the way it is presently written. 

The point of this bill should be to offer licensed, competent, accountable midwifery services for families in MI, with safety at the forefront.  The good news is that Representative McBroom plans to revise his bill for resubmission this fall.  Here are Safer Midwifery for Michigan's suggestions for what would actually preserve choice as to where to have your baby, but would provide appropriate guidelines to help those who do choose out of hospital birth to do so as safely as possible:  (Note, these guidelines are on par with Canada and Europe, but a far cry from the low expectations for midwifery education and practices in the US, particularly MI.) 

1) Licensing:  A license should determine who can use the term "midwife".  Earning a license should define "midwife" as a licensed professional with a specific body of skills and knowledge according to minimum standards for education, and a defined scope of practice. 

2) Minimum Standards for Education: Establishing minimum standards for education is critical to improving consistency in quality of care, and ensuring that those who are advertising themselves as professionals have met a minimum standard for training.  International standards (CNM or a CM as the non-nursing alternative) should be the absolute minimum acceptable education and training for any licensed midwife. 

3) Defined Scope of Practice: Define scope of practice for out of hospital birth, as attending only low-risk births, and further specify the proper steps to screen, evaluate, and risk out any woman whose pregnancy becomes high risk.  The board providing oversight should promulgate risking out criteria and transfer of care protocols, thereby defining "high risk".   

4) Report Outcomes: Mandate that all out of hospital midwives report their outcomes to the state, even in the event of hospital transfer. 

5) Malpractice Insurance:  Require out of hospital midwives to carry medical malpractice insurance, like their in-hospital counterparts.  If they are licensed, it's affordable.  (Or, at the very least, the board providing oversight should draft a state-wide informed consent document that discloses whether or not a midwife carries malpractice insurance, as many other states do.) 

6) Define "Birthing Center": Every "birth center" in MI should be required to be a licensed facility, and responsible for hiring only licensed midwives as defined above.  

7) Establish a "Balanced" Board:  Establish a balanced board within Licensing and Regulatory Affairs that includes majority midwives, OBs, family practice doctors, and citizens to establish practice guidelines, collect data on outcomes, and review cases of questionable care for out of hospital birth is critical in establishing fair and balanced oversight. 

I do think it's possible to write legislation that both, protects midwives and the families they serve.  SB 1208 is the closest we've come to that, despite differences of opinion.  I hope that Representative McBroom can thoughtfully hear the stories of families that have been put in harm's way, and revise his bill thoroughly.  Michigan's families deserve competent, accountable care, no matter what part of MI is their home.  This isn't just about choice, it's about having safe choices.  Legislation must do more than protect midwives, it must protect and serve the people of this great state.