Licensing the incompetent will not make them competent

Head over to the Oregon Register Guardian to read Dr. Paul Burcher’s guest editorial about the latest needless, senseless, utterly predictable and totally preventable homebirth death.

Dr. Burcher, who reportedly was involved in the care of the patient, appears to think the problem is that, in Oregon, anyone can call herself a midwife:

Less than two weeks ago in Eugene, a woman gave birth at home after a long labor.

Unfortunately, unbeknownst to her and the two midwives attending the birth, the baby had died during labor… The preliminary autopsy shows a previously healthy, full-term baby. What went wrong?

It would be incorrect to place responsibility at the feet of home birth itself, or of licensed direct-entry midwives who attend home births. The two midwives who attended this birth … are not licensed by the Oregon Health Licensing Agency.

The Oregon Board of Direct Entry Midwifery … licenses direct-entry midwives to practice in Oregon. The minimum training and skill requirements to become an LDM include a certified professional midwife credential …

Actually, it would be completely correct to place the responsibility on homebirth and specifically on direct entry midwives (licensed or not) who attend homebirth. Licensing the incompetent will not make them competent.

As I wrote in a comment:

1. Homebirth midwives (certified professional midwives or CPMs or LDMs) are a second, less educated, less trained class of midwives. No other country in the industrialized world has a second class of less educated, less trained midwives.

2. American homebirth midwives have less education and training that ANY midwives in the first world. They are not eligible for licensure in the UK, the Netherlands, Canada or Australia or ANY industrialized country because they don’t meet the basic requirements.

3. Statistics on homebirth collected by the CDC since 2003 show that homebirth with a homebirth midwife has TRIPLE the risk of neonatal death of comparable risk hospital birth.

4. The state of Colorado, one of the few requiring licensed homebirth midwives to submit records directly to the state, has an appalling and RISING rate of homebirth death…

5. The Netherlands, the country with the highest homebirth rate in the industrialized world also has one of the highest perinatal mortality rates in Western Europe…

6. The Midwives Alliance of North America, the organization that represents homebirth midwives, REFUSES to release their own death rates. They have amassed a database of 23,000 homebirths. They have publicly offered the data to those who can prove they will use it for the “advancement of midwifery.” Even those who meet the standard of proof must sign a legal non-disclosure agreement promising not to release the death rates to anyone else. The fact that MANA refuses to disclose the death rates of homebirth midwives is a big red flag.

Dr. Burcher reports:

The details of the labor were reviewed with Melissa Cheyney Ph.D., a medical anthropologist specializing in home birth practices and a member of the Oregon Board of Direct-Entry Midwifery.

That would be the same Melissa Cheyney who, in her role as Director of Research for MANA, refuses to release the death rates for the 23,000 homebirths in their database. While they were busy reviewing the details of this homebirth death, did Dr. Burcher should have asked her how many of those 23,000 babies died at the hands of LICENSED midwives.

Before we license anyone, we should insist on data that shows them to be competent. There is no reason to believe that licensing the incompetent will make them competent.

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