Saturday, August 04, 2007

15 reasons not to license direct entry midwives

This is fundamentally a public safety issue. The question: Is it safe to license a second class of midwife with less education and clinical training than any other midwives in the industrialized world? The answer:

1. This is NOT about having midwives in the US. We already have midwives (certified nurse midwives) who are among the best trained midwives in the world.
2. This is about creating a SECOND class of midwives with less education and training.
3. No other country has a second class of midwives.
4. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world.
5. Direct entry midwives are NOT trained for out of hospital birth, since no special training is required. The many taxi drivers, police officers and family members who deliver babies each year could tell you that. The only thing that requires training is dealing with unanticipated complications, and this is precisely what direct entry midwives lack.
6. Direct entry midwives are not “specialists” in out of hospital births. They are restricted to out of hospital births because they are considered unqualified for birth centers or hospitals.
7. Direct entry midwives are not “specialists” in normal birth. Claiming to be a specialist in normal birth makes as much sense as a meteorologist claiming to be a specialist in good weather.
8. Homebirth carries an increased risk of preventable neonatal death in the range of 1-2/1000 ABOVE the neonatal death rate for comparable risk women in the hospital.
9. To date there is not a single study that shows homebirth to be as safe as hospital birth. There are studies that claim to show that, but they do so by comparing low risk women at homebirth with high risk women in the hospital.
10. This is not about “choice”. Any woman can choose to have a homebirth. This is about licensing of health care professionals who do not have the necessary education and training.
11. The insurance industry will not write policies for homebirth or charge extraordinary premiums because their data indicate that homebirth carries an unacceptably high incidence of bad outcomes and big payouts.
12. There is no uniformity in direct entry midwifery credentials. There are many different credentials with differing education and training requirements. Direct entry midwives cannot agree among themselves what baseline training is required.
13. Direct entry midwifery credentials were created by direct entry midwives without input from medical or public health sources. These credentials are the “seal of approval” of some DEMs in regard to other DEMs. There is no independent objective basis for these credentials.
14. The Midwives Alliance of North America (MANA), the group that collected the statistics for the BMJ 2005 study, has collected statistics for the years 2001-2006, but refuses to release them to the public. They will only be released to individuals or groups that can prove they will use them for “the benefit of midwifery.” The public has a right to know these statistics.
15. There are no statistics at all for long term outcomes of homebirth with direct entry midwives. We have no idea (nor do they) about the incidence of brain damage, oxygen deprivation or birth injuries.

The bottom line is that we already have well educated, well trained, highly competent midwives in the US. We are being asked to license a SECOND class of midwives with less education and less training than any other midwives in the industrialized world.

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