Homebirth Debate

The Sisterhood is powerful

They are grossly undereducated and undertrained, but there is one thing that direct entry midwives are good at: disciplining those who question the party line.

Both Kneelingwomen and Navelgazing Midwife have deleted their posts questioning the adequacy of the CPM credential. The ostensible reason is that others have "misused" their claims. That's the funny thing about the truth. It's very difficult to control who uses it and what they use it for. The only way to exercise control over unpalatable truths is never to utter them in the first place.

Frankly, I consider the deleting of these posts as an admission that they are true. Fortunately, through the miracle of Google caching, you can still read them for a brief time here and here. The key points are these:

Kneelingwoman:

... the most pernicious and painful aspect of hearing a midwife ask the question 'why should we care about the mainstream' is over the emotional and relational damage done to, and between, women when they get the impression, as they too often do from our Midwifery community; that their more conventional choices in birth and parenting are viewed as substandard by Midwives and Homebirth parents. They feel criticized and put down when they don't birth at home or breastfeed and they feel that their choices aren't respected. There are, of course, many mainstream parents who equally disdain our ideas and choices but, the simple fact is; we're the one's trying to gain a foothold here; not them. If our way of presenting our care is being overwhelmingly rejected, and it is, then we own some part of that problem.

Kneelingwoman's personal experience of loving and caring for her medical fragile babies informs and adds value to everything she writes:

I have come to the conclusion that an essential part of Midwifery training should involve spending 12 hours in the NICU at a major, metropolitian Children's Hospital and another 12 hours just sitting in the main lobby; watching all the parents', babies and children enter and leave; families who are not 'home birth' families and women who may not even have the luxury of holding a baby to bottle feed, let alone breastfeed because their baby is too sick to move ... in homebirth midwifery there is shocking lack of perspective about how the 'rest of the world lives' that I think is more than hindering us; it's crippling our development as a true Profession because our chosen world is too narrow and we are too rejecting of the values of the majority of women and families in our country.

And:

Why don't we want to know what women want? Why do we keep going to conferences and paying out a ridiculous amount of money to stand in a circle, sing and hold hands with the 'ya ya sisterhood' and then flatly reject the idea that we should create a midwifery that actually serves women according to their needs in birth instead of what need to provide? Why are we so afraid to grow and change? Why does the very idea that the reason midwifery isn't reaching more women that there is something about it and us that doesn't resonate with the majority not addressed more seriously?

From Navelgazing Midwife:

On whether birth at home is any different than birth in the hospital:

When I was just beginning to do homebirths, midwives around me arrogantly (I believe) told me that my experiences in hospitals and birth centers needed to be set aside as I learned homebirth midwifery. Their belief that birth was different in the home always made me turn my head sideways and say, 'Huh?' ... I found that, generally, birth is birth and homebirth isn’t all that dramatically different than hospital or birth center births.

On learning midwifery by apprenticeship:

Honestly? An apprenticeship is only as good as the preceptor. And I’ve met some really crappy homebirth midwives and wonder how their students/apprentices are going to make it as primary midwives. Will they learn how empty their apprenticeship was when they encounter complications they never anticipated in the homebirth setting? At least a midwife in midwifery school is exposed to many different preceptors. If she encounters one that is less-than, she can dismiss her stupid teachings and move on to the next good mentor.

Many cities have a 'homogenous' homebirth midwifery community because one apprentice becomes a midwife who takes on another apprentice who becomes a midwife who takes on another apprentice... the single-threaded line continuing without dilution from outsiders to alter the course of education or training. Unless outside influences, either from new midwives or from a midwife or apprentice venturing out to experience birth in other places occurs, the sameness can be quite limiting to the moms in those midwives' practices...

On the differences between CNM and CPM training:

I have a (radical) belief that LMs and CPMs will be phased out over the next few years. I believe that as more women get licensed (and there are around 1300 CPMs compared to over 7000 CNMs) the legislators and attorneys will see how inadequate our education really is...

a. 10 Preconception care visits (compared to none for CPMs)

b. 15 New antepartum visits (compared to 20 for CPMs)

c. 70 Return antepartum visits (compared to 75 for CPMs)

d. 20 Labor management experiences (compared to 10 for CPMs)

e. 20 Births (CPMs [tend to] use the same 10 whereas the CNMs I have asked have said the births are separate from the Labor Management experiences. So, 10 total for CPMs compared to 40 for CNMs)

f. 20 Newborn assessments (same as CPMs)

g. 10 Breastfeeding support visits (0 for CPMs)

h. 20 Postpartum visits (0-7 days) (Compared to 40 for CPMs – add i. for CNMs)

i. 15 Postpartum visits (1-8 weeks) (Con’t. – When added to h. = 35 for CNMs)

j. Primary care visits:

1) 40 common health problems (0 for CPMs)
2) 20 family planning visits (0 for CPMs)
3) 40 gynecologic visits including perimenopausal and postmenopausal visits (0 for CPMs)

= 300 separate patient interactions

Anyone arguing that CPMs have equal education or experience at the beginning of their careers is wrong. The numbers prove this. Are some CPMs and LMs phenomenal? Of course! Could they be better? You bet...

Kneelingwoman and Navelgazing Midwife are not the only direct entry midwives to question the adequacy of the CPM credential. Of course, it is inadequate; it is below the standard of midwives anywhere else in the industrialized world.

If direct entry midwives were committed to providing safe care for women, they would constantly be questioning the adequacy of their training and adding new requirements (as all other health care providers do). However, since direct entry midwifery is about the midwives, women who cannot meet the educational requirements for adequate midwifery training, questioning the adequacy of the deliberately inadequate education and training is a major transgression. In the interests of direct entry midwives (and in opposition to the interests of women), such transgressions must be prevented, and if they are not prevented, they must be erased.

I am not the least bit surprised that Kneelingwoman and Navelgazing Midwife came under tremendous pressure to remove their posts; I am suprised that they gave in. Evidently their "truth" must be supressed to serve the needs of the sisterhood.

posted by Amy Tuteur, MD @ 7:22 AM