Here’s the link for the full size printable version. Feel free to distribute it to friends and legislators.
https://dl.dropbox.com/u/27713670/Real%20midwives%20and%20homebirth%20midwives.jpg
Addendum: The original version had a typo (of course!) so I have replaced it with a corrected version.
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Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com... More
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“We’re all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don’t exist. At the same time, when there are problems in a pregnancy, that very same technology can be lifesaving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome.” http://pathwaystofamilywellness.org/Pregnancy-Birth/the-hard-science-of-supporting-low-tech-birth.html
I looked into becoming a CPM back in my more woo-ey days and I have a math disability that makes me giving medication a bad idea(think dyslexia but with numbers). I looked into schools because going straight into the field sounded terrifying. Midwifery schools are give us $5,000 to put you through clinicals on basic skills with the exception of stitching I already knew because I’d tried to do medical assisting just out of high school(see math disability above for why it was a try), anatomy classes I could have taught(they were that basic). A lot of random classes on the history of midwifery and how it was a suppressed feminist issue, classes on homeopathy,aromatherapy, reflexology, herbalism and ONE class on medications and a day of learning neonatal resuscitation because the state says they have to. Follow that with being teamed up with a random CPM as soon as your done with only three to five classes and you have midwifery school in my area.
It felt like I would be turned out as still a medical assistant with some alternative therapies, now go be responsible for life and death. Personally I found that terrifying and I don’t understand why more people don’t.
You do understand that not all homebirth midwives are only CPM s right? My daughter was delivered safely at home by a CNM in NC.
I’m sure you’re aware that some CNMs do in fact attend home births, right? I think it’s really misleading that people who don’t like the CPM license describe CPMs as “home birth midwives.” The biggest home birth midwife practice in Northern Virginia is all CNMs and in fact, most of them worked in hospitals prior to joining the practice. Do you think they suddenly became incompetent providers once they started practicing out of the hospital?
I mean, overall, I get your point. But what about women in remote areas or who only have access to hospitals with c-section rates above 50%? C-sections, like any surgery, have risks (including death) and some women feel safer at home. Even you acknowledge that in other countries, home visits are more common and presumably, the provider doesn’t forget everything she’s ever learned as soon as she walks outside the hospital sliding doors.
CNMs are not the norm in the homebirth community by a long shot. Heck there are only 2-3 practicing homebirth CNMs in my whole state compared to dozens of CPM and literally lay midwives.
I think most people can tell the difference if they have a CNM or your average midwife who only does homebirths. You can tell by the equipment if nothing else if you’ve got a real midwife by real medication rather then someone who dabbles in herbology.
Also some of those CNMs who have gone to practicing at home is because they got too far into the woo and trust birth movement making them no longer a safe provider. The hospital won’t let them practice the way they want so they stop delivering in the hospital, this would be both of the CNMs I know in my area who now do homebirths. They just got it mixed up in their heads that because one very limited community has a 2% c-section rate that we should all have it and that the hospital is wrong for having a 12% primary c-section rate.
Seen it too often because I was a part of the Utah birth forum trying to become a doula. Being a nurse unfortunately does not make you immune from some of this garbage especially when you meet the nurses who are convinced they know more then doctors.
I am an Ob/Gyn resident and I disturbed and frustrated by how much you bash home birth. I have been married 10 years and I have no children. But when I do, I want a home birth.
It isn’t homebirth in and of itself that is “bashed” here- it’s incompetent lay midwives who take blatant risks with the health and safety of mothers and babies, who brainwash mothers into denying conventional medicine when it is obviously needed, and who throw their hands up and deny all responsibility when the first two offenses result in totally preventable death or disability.
If you search this blog, you will find plenty of examples-or read the Hurt by Homebirth site. There are stories on there regarding midwives who had babies die preventable deaths under their “care”, and they are still practicing. I personally feel completely justified in “bashing” any person who is so reckless with innocent lives.
Why do you think anybody cares what you want, how long you’ve been married and how many children you do or don’t have? Do you have anything relevant or interesting to add to the discussion?
I’ve been married 5, have 2 c-sections under my belt for fetal distress and most of a BS in public health. It doesn’t make me an expert on c-sections.
The background in public health has made me see that it’s never just about having a baby at home. It encompasses a whole culture that just isn’t healthy. Feel free to give birth wherever you like, then please vaccinate on schedule, give them vitamins or supplemental foods at appropriate times, please don’t try to replace anti-biotics with applications of breastmilk or oregano oil, and please for the love of all that’s holy don’t feed them raw milk(sorry it’s my pet peeve because it’s rampant around here).
As long as it’s just about having a home birth with a certified professional free from obvious complications go right on ahead.
You say that now.
When you’re 8 months pregnant and still doing your job and thinking , viscerally, that it could be you in a few weeks time in that patient’s shoes.
As your baby kicks you while you repair a 4th degree tear or manage a shoulder dystocia or manage a PPH you might feel differently about being at home.
Why, specifically, do you think the care you provide for patients is not the care you want for yourself?
I trust you would at least choose CNMs and an overseeing OB, right?
I am disturbed and frustrated that you can’t point to evidence that homebirth is safe, but still want to have one and want others not to “bash” it by pointing to the evidence that it isn’t safe.
Random question: What is the typical training for an L&D nurse? Would they at some point have sufficient training/experience to match a CNM? My nurse was making all sorts of decisions and slinging all sorts of meds, and occasionally a doctor would walk in and she would explain to him what was going down and he would just initial whatever he was supposed to initial and wander away again. The docs showed up for the actual baby-catching, but the nurse pretty much ran the delivery.
A CNM has a masters degree. An L&D RN could actually only have an Associates Degree. Nothing matching training or qualifications of a CNM. But, of course, most normal labors and deliveries are managed by the RN at the bedside, communicating with the MD as needed. FWIW, I got “out” of L&D after 5 years because I didn’t find it fulfilling and found it stressful. I saw L&D RNs being charged with caring for 2 laboring patient’s, quick handover if one patient got close to delivery, quick handover after delivery, often within 2 hours, fast, fast, fast turnover and I sought the IBCLC certification as a “way out” of L&D. But, overall, I have profound respect for the L&D nurses I have had the privilege to work with. I cannot say that for the Birth Center midwives and the lay midwife I have had personal experience with.
I like it when people answer my questions. Thanks!
my BFF from college was a labor and delivery nurse- the ONLY area of nursing that interested her, she actually went to school so she could work in L&D. A week before she started, they had a maternal death on the unit, and she found the stress nearly paralyzing once she saw firsthand how it affected everyone (it was a uterine rupture during a VBAC, btw). She only practiced for a few years before she left to do research. I was also very surprised by how much leeway the nurses were given when my kids were born- the “orders” in L&D would never, ever qualify as orders in my clinical setting (peds acute care)- I wouldn’t have accepted them as an RN and I don’t give them that way as an APN. My favorite was when my second was born and the doc told the nurse to give me “a whiff of pit”. The RN laughed and said, “seriously?” and the doc laughed back and said, “aw, I don’t care. Do what you think is right.” And this was a very, VERY old-school, conservative doc. My friend confirmed this is standard in L&D. I think it’s nuts.
It’s true that L&D nurses practice with a great deal more autonomy than most other areas of nursing. I work in a small hospital where we don’t have an inhouse OB. It is up to the nurse to interpret the EFM strip and act accordingly. Pitocin is ordered as a titrated drip and it is up to the nurse to decide when to go up and how high (within certain parameters of course). If complications arise the nurse is expected to perform most interventions before the doctor even arrives , i.e. turning off the pitocin, giving a fluid bolus, giving O2, repositioning the patient, performing a SVE (of course contacting the OB is one of the first things to be done). If an outpatient comes in then we usually perform a NST, SVE, UA, and get a history before calling the doctor to report our findings. Unless something seems wrong or the patient is in labor then she will most likely be discharged without actually seeing the doctor. If there is something minor going on then she might be observed for a few hours and then be discharged with or without seeing the OB, depending on the nature of the problem. It is one reason why communication and trust is such a key element in L&D. And why most OBs’ and hospital L&D nurses have such issue with homebirth. The lack of honest communication makes it impossible to trust the lay midwives.
I believe if you got more familiar with L and D you might think it was less nuts; or at least nuts in a different way than you think it is now. My understanding is in the ICU there are protocols for titratriting IV meds too. We have a lot of what appears to be autonomy but it’s within clearly defined parameters that you must be tested on first and then annually. I think I’d find other areas of nursing boring though most people say the thing L and D is most like is ER. ER nurses love to tell me they can do anything but pregancy and send the moms asap ( I think they enjoy having something they don’t HAVE to handle ) I on the other hand think handling every age and gender and disease from the smallest complaint to the worst trauma and never knowing what will come throught the door next has to be way harder than what we do.
Thank you for this wonderful flyer to distribute. I posted a bit about myself on the other thread. I am hoping that in time, some of the statistical realities on homebirth outcomes with US lay midwives will get thru to the homebirth community. Currently in Texas, House Bill 1507 is being considered to provide more regulation on birth centers. My belief is that birth centers are no safer than homebirth, and in fact, can promote a false sense of security and thus could potentially be a worse choice of birth location than home. I worked in a local birth center last year for about 2 months. It was all I could tolerate. I was appalled and saddened by the lack of professionalism and standards that I saw. I sincerely hope that this legislation passes.
http://www.legis.state.tx.us/tlodocs/83R/billtext/pdf/HB01507I.pdf
Why Apples and Oranges? Why not Apples and Horseshit?
I am glad that you’re not using the term “direct entry midwife” here to equate with the CPM. In Australia the term “direct entry” refers to a proper midwife with a 3 year university degree (they just don’t have general nursing)
I still get a bit worried about the direct entry midwives here. I’ve been involved with supervising two and Neither had degrees in any health related field. They both were a bit woo-ey but at least were coming through a rigorous training program.
This dropbox link is no longer working. Alternative source?
It still works for me. What happens when you click on it?
It would be great if someone can make a meme like this but for CPMs:
http://knowyourmeme.com/photos/267953
I suggest that the “what I really do” panel be a thief absconding with a bag of cash or something.
I was going to suggest that this commercial be redone (make it a woman talking instead of a man and use the word “baby” or “baby’s life” in place of the word money) and it would really fit a great deal of the CPMs and the mess they leave behind http://www.youtube.com/watch?v=Catva7gb8s8
One of the biggest differences in the education between CNMs and CPMs is the number of people who have to evaluate them as competent individuals before they get to call themselves a professional. By the time I am able to sit for the AMCB exam, I will have had dozens of highly educated people evaluating me. I will have had several letters of reference written by chemistry, physiology, and microbiology undergraduate professors and nurses who supervised me as a volunteer. I will have been interviewed by and have defended my previous education to a number of different nurses and CNMs who are looking to see if I have the ability to complete a rigorous masters program. I will have my undergraduate grades evaluated by admissions committees with increased weight given to difficult science coursework. No grade lower than a B will be acceptable in any circumstances, and the programs are all so competative that I will essentially need a 4.0 to be considered unless I have other exceptional characteristics. And this is before the nursing portion of my program begins. Then I will have additional coursework in pathophysiology and pharmacology and hours upon hours of nursing clinicals. Each with a different professional evaluating whether or not my skills and knowledge are acceptable. Again, if I at any time receive a grade lower than a B, I will not be allowed to continue. I will be giving dosage calculation exams, where I will be required to score 100% or take remedial math courses until I do. Then I will sit for a difficult licensing exam where my knowledge and judgement are evaluated once again. And then I will be a NURSE. The whole thing starts over again for the masters portion of my program. More evaluation from MANY different clinical instructors. More patho. More pharm. Another difficult exam. Then I will be working in a hospital surrounded by more knowledgable and experienced nurses and physicians, all of whom are making sure I am practicing appropriately.
A CPM? She doesn’t need ANY coursework, and might be evaluated by only ONE preceptor before she sits for the reportedly ridiculously easy NARM exam. And that preceptor may have had only one preceptor as well. There is no comparison.
Last year I wrote to all the MEAC accredited schools asking about their admissions standards. The only one that was more than “fog a mirror and send a check” was Bastyr.
Bastyr does talk a good game and that makes people feel safer when being cared for by their graduates (doulas, midwives, ND, ect).
Guest post this!!!!
Yup. Good luck, Laura. I remember thinking what a schmuck degree nursing was… and then I decided to become one. I could not beleive how competitive the program was, and how many of my peers who got in did not succeed in making it to the finish line. Not to mention how much I feel like I have no clue about or only just the most basic understanding of even after all my classes and clinicals and getting my license! (my BSN, not CNM) Attend a birth? Solo? At your house? NUTS!
Don’t forget that once you become a nurse, and later a CNM you will be required to work a minimum number of hours and complete continuing education in order to maintain your licensure and certification. Also the hospital you will work with will most likely require you to maintain certifications in BLS, ACLS, NRP, and if it is a facility without a NICU then STABLE as well. After all of this you will be considered to have reached the MINIMUM level of competency. You will still need years of experience, practice, and dedication to keeping up with the latest information above and beyond this be considered good at what you do.
Might I add that the evaluation process is even more stringent for those who graduate from medical school and become board-certified physicians. This is how they weed out the incompetent nutters! I’m sure a few get through, but THERE IS NO WEEDING PROCESS FOR CPMs, in addition to their lack of education.
The “p” stands for pretend?
I was attended by CNMs during my daughter’s pregnancy. When I started showing symptoms of ICP and expressed my concerns, they took me very seriously and started treatment right away. The CNM who delivered my daughter was still fairly new to the profession (she had gotten her master’s degree only a year or so before), but she was very skilled and seemed to know exactly what to do during the delivery. I felt like I was in good hands, and I was.
I will most definitely be using the same midwives for my next pregnancy. I’ll probably see the OBs in their practice too 🙂
Dr. Amy, what are your thoughts on this Indiana bill? http://openstates.org/in/bills/2013/HB1135/ I know the pretend midwives are super happy about it and supporting it.
This just made me think about how much I absolutely adore my CNM.
When my daughter was born last month, she was delivered by a CNM I was told was “new”- which I assumed meant she was new to the office but actually meant she was new to the profession. Because of this, my daughter’s birth was also attended by another CNM with many years of experience AND an OB. Neither of the more experienced ladies were “necessary” during the delivery- the CNM-in-training delivered my daughter and managed my third stage without any assistance or any problems. (She did get “talked through” stitching my tear by the OB).
The CNM who brought my daughter into the world has more education, more training, and probably more experience than the majority of HB midwives- and STILL she had supervision and backup if necessary while handling a low-risk birth in a medical setting. WHY do HB advocates continue to spread the lie that doctors don’t care about mothers and babies? They cared enough about myself and my baby to have two extra professionals there, just in case. To me, that’s a good deal more “caring” than a midwife who assumes everything will work out just dandy in spite of glaring evidence to the contrary, or, for example, a midwife who can’t even be bothered to show up for the birth!
Sorry, this is long-winded; I just am astounded by the vast differences between CNMs and lay midwives, and that anyone, no matter how woo-immeresed, could possibly look at the differences and STILL insist that the hospital is more dangerous!
Thank you, BeatlesFan for letting that midwife train on you and our baby. It sounds like you got top-notch care. One day, that will be ME asking if I can train on some lady and her baby!
oops – I mean “your” baby 🙂 (And congratulations! Enjoy your little bundle of joy!)
Thank you, we are enjoying her tremendously, especially her big brother 🙂 I won’t be having any more babies or I’d let you train on me too 😉
I can’t wait for the Safer Midwifery for Michigan website to get up and running, because it’s definitely going to address this and other issues. I really hope it becomes a top result for google searches on homebirth and midwifery so any mom seeking one learns the difference between the two before they decide to go with a fake midwife who has very little experience and no formal training or education. By the way, I think today’s the last day to donate to their cause.
OT, but since it’s almost Easter, I figured I’d give one last Feminist Breeder update for the benefit if the folks who gave up watching the train wreck for Lent. After weeks of constant fanfare about giving away a free subscription every Friday, she very suddenly stopped without explanation and is lashing out at people who ask her what happened. She also stopped selling 99 cent day passes. Who else thinks it’s because everyone who was going to buy a subscription already has, and her revenue stream has dried up? She’s probably hoping a lack of free or cheap options will force people to buy the $35 or $200 options, but I doubts he’s going t be able to squeeze any more money out of her dead blog.
I have a feeling I’m going to be very busy on Sunday…
Clearly, I am out of the loop. TFB is charging people to read her blog? I guess I won’t be tempted to check it out anymore…
You know that the Midwife who attended Safer Midwifery for Michigan, WAS a CNM? And thus her magical campaign against CPMs doesnt make any sense.
Have you even read any of the excellent info presented on that website? If magical = factual and informative, then it is magical. But I don’t think that is what you mean. If it was a CNM, it was a very poor excuse for one, trying to deliver a large breech baby. I find that even more sickening. If CNMs let themselves be “dumbed down” to a CPM level, what does that say about homebirth safety and the absence of regulations?
That’s great. I know the idea that the lay midwives are birth junkies has come up often. I wonder if there is an element of sadism, since they only like to watch unmedicated births, the more complicated the better.
Totally unrelated to the above paragraph, I spent a month on hospital bedrest when I was pregnant with my twins, and one of my favorites among the people that provided care was a CNM. She sometimes ran the NSTs and we would chat…she was very supportive and never mentioned any NCB idea to me, let alone try to make me believe it was what I should have been doing. She always seemed competent and came across like she truly cared about women and babies. I would certainly have considered having a CNM like her as a primary care provider during a pregnancy, if my pregnancy hadn’t been so complicated.