Rowan Bailey: the single best argument for opposing NC S107 decriminalization of lay midwifery

Rowan Bailey

Dear North Carolina Senators,

I could offer you many excellent reasons why you should vote against Senate Bill 107 decriminalizing the practice of lay midwifery.

I could explain to you that homebirth midwives, even those who have the CPM (certified professional midwife) credential, are not real midwives and would not be eligible for licensure in the Netherlands, the UK, Australia, Canada or ANY first world country.

I could offer evidence of the many preventable neonatal deaths at the hands of North Carolina homebirth midwives, leading to a homebirth death rate that is more than 10 times higher than birth in the hospital (and that’s only the deaths that I personally know about).

I could show you that the Midwives Alliance of North America (MANA), the organization that represents American homebirth midwives, refuses to release the death rates of the 27,000 planned homebirths in their database and that they have NO standards for practice, declaring that each midwife can devise her own standards.

But I’ll take a shortcut and offer the example of Rowan Bailey, the lay midwife who is currently in jail for her involvement in one of the many NC homebirth deaths.

Read the following descriptions and ask yourself: should you really decriminalize the ability of any women to call herself a midwife and spout nonsense such as this?

Bailey describes herself as as Community Midwife, Placenta Alchemist, Co-founder Asheville Holistic Birth Collective, Birth Activist. In other words, Bailey has absolutely no formal training in midwifery.

So why does she call herself a midwife? She awarded the designation to herself after studying at The Matrona.

According to The Black Mountain News:

In a nondescript home on a quiet West Asheville street, Tina “Rowan” Bailey learned that to act as midwife, she was responsible for the birthing process — but not the outcome.

The belief that managing and monitoring a woman’s labor strips her of her power is a guiding principle at The Matrona, a nonprofit that trains about 20 women a year in unaccredited midwifery and doula programs.

In other words, the guiding principle at The Matrona is that anyone can call herself a midwife, but there’s no need to take responsibility if a baby dies as a result.

The Matrona school was founded in 2001 by Diane Bartlett, who goes by the name “Whapio” in the midwifery community…

The school teaches “quantum midwifery” and methods of “undisturbed birth,” designed for “self-directed families planning an unassisted birth,” according to the school’s website.

Bailey graduated in 2006 from the school’s “midwifery immersion program,” a four-month training that teaches “Returning Birth to the Family.”

In other words, The Matrona instructs self proclaimed “midwives” in how to think nonsense about birth, but not how identify, manage or prevent childbirth complications.

But wait! She also completed The Matrona’s Sacred Birth Mentor Program!

The Sacred Birth Mentor Program, according to the program’s Facebook page, is “a 2-year, three-level mystery school for birth professionals that focuses on consciousness, spiritual practice, physical, spiritual and financial wellness and much more.”

And that’s not all. Bailey also attended Birth Heaven Now! As Bailey herself explains:

The first time I read the words ‘Excellent Self-Care’ and ‘Birth Professionals’ in the same sentence something shifted deep in my core. When I first began working with Stephanie Dawn 1 year ago I was completely depleted spiritually and personally, rarely worked as a birth professional and cleaned houses full time to pay the bills. I no longer believed I would ever BE a midwife. Wow, how far I have come! Stephanie facilitated me in defining my ideal client and I now have a full practice of clients I love, have a soul-level connection with and who value my work. I am fulfilled now in ways I did not imagine possible before. My spiritual practice, which I used only in times of desperation in the past, is now part of my daily life. This part has been huge in creating harmony in my home, my practice and when I have challenging experiences they no longer seem so devastating. I have learned to receive as well as give. I cannot express how amazing this feels. I am looking forward to even more expansion over the next year.

What’s most disturbing about Bailey’s self-designation of “midwife” in not the fact that she has no education and training in midwifery. What I find most disturbing is that someone who clearly has no education and training in midwifery is fully embraced by the homebirth midwifery community. As far as I can determine, the homebirth midwifery community has made no effort to determine whether Bailey was responsible for the death of baby Avery. Indeed, a supporter succinctly explained:

The story behind the birth does not matter.

Rowan Bailey is a walking, talking argument for vetoing a bill that decriminalizes such behavior. These self proclaimed “midwives” are honest in declaring that they have no concern for the outcome of the births they attend. The organization that represents them is honest in declaring that they have no standards for homebirth midwifery, and, therefore, no accountability, regardless of the deaths and disabilities that ensue. At the moment, the existing North Carolina laws are the ONLY protection that babies and mothers have against untrained, self-proclaimed “midwives.” Please think very carefully before you take it away.

  • Marli

    As a physician, you of all people should understand the importance of factual, unbiased, cited research. Your overly opinionated blog has none of these qualities. You have no evidence that unlicensed midwives claim no responsibility for the death of the babies they serve nor that they are received by the home birth community. What could you, as someone who abhors this close-knit underground community possibly know about it? You are certainly not accepted or welcomed there. What is even worse is that you are grouping untrained, self-proclaimed midwives in with certified professional midwives ALL of which must pass an examination in order to be certified. They are also required to complete academic work as well as clinical experience. They are recognized in 26 states and are nationally certified. It is not an underground hippie movement with no training, credentials, or educational requirements as you falsely claim. Also, studies have shown that home birth is just as safe as hospital birth for low risk women in a supportive environment. Macdonald, Helen.
    (2009, April 4). Home Birth is as Safe as in Hospital for Low Risk
    Women, Study Shows. British
    Medical Journal. 338(7701).
    Retrieved from
    https:// illiad.uncw.edu/illiad.dll?Action=10&Form=75&Value=267427 Recognizing certified professional midwives would help protect women and increase the safety of those who are giving birth at home whether it is legal or not. Your misleading information and complete lack of evidence is appalling, especially for one who the public *should* be able to trust regarding medical information. How did you attend medical school for all those years and still not know how to accurate report and cite sources? Do better.

    • Karen in SC

      Did you mean to say that Dr. Amy does not know how these outlaw birth attendants are received by their peers? (your wording seems unclear to me, sorry). IF that is what you meant, how and why is there a funding site for Rowan’s legal and living expense?

    • Dr Kitty

      The study you cite shows HB is safe for rigorously screened low risk women, midwives with a university degree who carry drugs and resuscitation equipment, in a system where MWs are well integrated into the hospital system and where good quality antenatal care is the default, where the intra partum transfer rate was 40% and where no one lives more than an hour from a NICU.

      You CANNOT extrapolate from that study to show any of the following:
      That CPMs are safe
      That HB as currently practised in the USA is safe.
      That HB is safe in rural and remote locations.
      That HB is safe for high risk women
      That practictioners with intrapatrum transfer rates less than 40% are safe.
      That the model of antenatal care provided by CPMs is safe and adequately detects high risk conditions.

      OBSERVATIONAL data in the the USA (CDC wonder, the Oregon data) in fact, suggests HB with a non nurse midwife is very, very unsafe.

  • Judy Taylor

    After reading this article, I went and looked up historical infant mortality rates ( the info comes from census and other historical data). In 1850, infant mortality rates for whites was 216.8 and for blacks 340.0. In 2000, the infant mortality rates for whites was 5.7 and for blacks 14.1 What changed? Education and medical care. I believe midwives should be licensed and held to a very high standard; a nursing degree with an internship at a hospital and under the supervision of a doctor. (Kinda like the old county nurse). Then the midwife would understand when the women needs a doctors care. Anyone practicing without a license would be treated the same as a “doctor” without a license. If everything goes well with no complications, a home birth is beautiful, any problem and it can quickly turn tragic. Yes, giving birth is a natural thing and it’s been done for thousands of years. So is dying. So again, look at the numbers.

  • Anj Fabian

    http://www.citizen-times.com/article/20130623/NEWS/306230045/Warrants-offer-details-unborn-baby-death

    Apparently the witness list now includes the grandmother, mother, father and doula.

  • NC Midwife Supporter

    I wouldn’t jump to the conclusion that local midwives, licensed and not, are supporting Rowan. Most of us are not. She is not, nor has she ever been, particularly supported in the community because she is unsafe, and untrained. She boasts that she will take “anyone” as a patient, and she charges more than anyone else, even those who are trained. I would say that her local support by those who know what happened, and those who tried to help her understand she was wrong and guilty is very low, or even non-existiant.

  • Kazia

    That woman is not a midwife. She is a nut who thinks she knows everything there is to know about birth and babies. She is absolutely responsible for that child’s death. It’s still not a reason to prevent midwives with an actual education to practice.

    • Amy Tuteur, MD

      But the other homebirth midwives believe that she IS a midwife and are raising money to support her. That is a perfect demonstration that there are no standards for homebirth midwives and no accountability. Why would you want to license people who embrace Rowan Bailey as one of their own?

      • merryprincess

        Not every homebirth midwife does support her. I live in western NC and believe me, the general midwife community is not supporting her!

        • fiftyfifty1

          So why don’t they go on record to denounce her? Call up even the local newspaper. Then the “general midwife community” can be on published record as denouncing her and tell the reasons why within 1 week. Or heck, start a blog denouncing her and her likes.

      • Marli

        Making certified professional midwifery legal is what would create standards for homebirth midwives and form accountability. And don’t you think those who are midwives would know better than you do whether or not their own community supports her?

        • Karen in SC

          How can the CPM standards equate with safe birth? That credential would not be accepted in any European or British Commonwealth country. It was originally meant to “grandmother” those already working while new entries to the field obtained the CNM credential.

    • Eddie

      It’s still not a reason to prevent midwives with an actual education to practice.

      I’d say everyone here agrees with that. What we differ on is the definition of “actual education.”

    • LibrarianSarah

      Nobody is prohibiting CNM’s from practicing.

  • http://profiles.google.com/rainydaylove R T

    Oh, I’m so relieved Rowan isn’t her real name! It was ruining the name for me and I’ve always loved it!

    • LukesCook

      Whatever you do, don’t google “Rowen Bailey”.

      • Eddie

        D’oh! Didn’t see the “e” until after I did just that!

  • merryprincess

    A midwife is someone who delivers babies. Rowan Bailey is a midwife, but not one legally recognized in NC. And I am glad she is not. However, she and others like her would NOT be decriminalized by this Senate bill. There is a WORLD of difference in what she is and the Certified Professional Midwives that would be able to practice in NC with the passing of this bill. You cannot compare the training and certification of CPMs with La Matrona. It is a totally different story! There are quite a few doctors, including locally in NC, who appreciate and respect CPMs. This bill would not only allow them to practice, but would regulate and oversee their practice, assuring safety for the women they serve. With licensure, CPMs will have to meet and maintain standards of practice that include physician collaboration.They are highly trained and take a certification exam of the highest accreditation. Preventing CPMs from legally attending homebirths in NC is NOT preventing homebirths in NC. It is only preventing women from having a LICENSED attendant at their homebirth.

    • Sue

      “merryprincess”, you say “They are highly trained and take a certification exam of the highest accreditation. ”

      But their certification exam is not “of the highest accreditation”. Fully trained midwives are CNMs. Which elements of the training of CNMs do you think are unnecessary for the practice of midwifery, and why?

      • merryprincess

        I personally know 4 CNMs and one OB-GYN here in my NC city who are completely supportive of CPMs and are really wanting this bill to pass. (I am a labor and delivery nurse). I was quoting what all five of these medical professionals have repeatedly said to me. I also had a long conversation with a SC doctor who is the backup for a birth center in SC owned and run by a CPM. He has nothing but praise and admiration for her. CNMs are nurses who receive additional training in birth and prenatal care. Many of the CPMs actually have more clinical experience in their training, as well as more of a focus on birth itself. Having much personal experience in both hospital births and homebirths (attended by doctors, CNMs, and CPMs) and being in the medical profession myself, I want this bill to pass. I greatly see the need and feel like the passing of the bill would do much to prevent things like this situation with Rowan Bailey.

        • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

          How would it prevent someone from passing themselves off as a midwife?

          Especially in Ms. Bailey’s case, she was recommended by friends and family, not by an OB. This was apparently good enough for the family, which isn’t unusual. F&F recommendations carry a lot of weight with the average person.

          How many people do you know who pursue home births ask an OB or a CNM for recommendations for a HB attendant?

          • merryprincess

            Actually quite a few. And there is MD and CNM support for CPMs in my area. They would give recommendations. The bill would allow there to be more regulated birth attendants.There are a number of very good CPMs in NC who are practicing in Tennessee, where it is legal, who would be able to practice in NC. There would be doctor collaboration. All in all it would make more safe birth options for people. Home birth is legal and that won’t change. Having good qualified (and yes I do believe they are qualified) birth attendants will provide care for the many who will continue to pursue homebirth.

          • Amy Tuteur, MD

            How can it possibly be a safe option when licensed homebirth midwives attending planned homebirths have death rates 9X higher than term hospital birth?

          • moto_librarian

            Do you know what happens in states where CPMs are legal when there is a bad outcome, merryprincess? NOTHING. The regulatory boards for CPMs are a joke, packed full of their cronies who are to busy bitching about the persecution of midwives to actually care about what happens to women and babies. Since CPMs don’t typically carry malpractice insurance, the families have no recourse in civil court, and without criminal laws, these midwives cannot be prosecuted in criminal court either. Go read “Hurt by Homebirth” if you don’t believe me. The midwives in those cases are still practicing, and at least one of them is responsible for the deaths of 7 babies. I know that some CNMs support CPMs. Don’t even get me started on how idiotic that is. As women, we have to move beyond the idea that the “sisterhood” trumps education and clinical experience and quit embracing this notion that “any midwife is a midwife.” It is unprofessional and anti-feminist to endorse sham credentials for midwifery.

          • Guestll

            ^^^ THIS.

            Merryprincess, I don’t think homebirth is a terrible idea — I think it can be an okay idea, provided there are tight screening/risk out criteria, such as no first-timers, no breech, no VBAC, etc. I live in Canada, where Registered Midwives are required to complete a rigourous course of education and training. Entrance to the program is highly competitive and requires four years of post-secondary study. Registered Midwives in Canada are held to high standards and are integrated into the hospital setting.

            My own RMs, since we’re speaking in anecdotes, were: 1. Masters in bio, BEFORE entering the midwifery program 2. Masters in education, BEFORE entering the midwifery program 3. Masters in nursing, BEFORE entering the midwifery program 4. Masters in public health, BEFORE entering the midwifery program 5. Two undergraduate degrees (physical education, early childhood education) BEFORE entering the midwifery program.

            Why am I writing all of this? Because I’m astounded when Americans attempt to justify the CPM “credential” as being sufficient. Why, as a woman who cares for women and their babies, as a woman who went through education and training to achieve her position and is required to maintain standards and accountability WITH OVERSIGHT, why, why, why do you defend and encourage the CPM “credential”, when every other developed country holds itself to a higher standard?

            Does not compute, sorry.

          • Eddie

            How many people actually ask their medical practitioners to prove that they are properly licensed to act in that capacity? I bet it’s the tiniest fraction of a percent, and even smaller among the NCB crowd. As you say, F&F recommendations.

          • FormerPhysicist

            I’ve noticed my OB’s diploma hanging on the wall, but license? I don’t think I ever saw it, nor looked for it. Hopefully Blue Cross/Blue Shield would know.

          • theadequatemother

            In Canada you have to have a licence in order to have a billing number so that you can charge provincial insurance plans. You also have to submit a valid and current licence to the hospital once a year as part of privilege renewal. Up in the true north, unless your physician or midwife is asking for cash, cheque or credit (or barter I suppose) you can bet they are licenced.

          • Lost in Suburbia

            I read in Avery’s mom’s blog-cache, which is no longer available that a local family practice doc even recommended Bailey to them. Which I suppose is to say that when you’ve got a doctor saying hey! this is a good midwife! someone is perhaps more likely to believe it. And we all know that doctors are All, Always, Trustworthy. Dr. Biters of the world unite!

        • Karen in SC

          “Many of the CPMs actually have more clinical experience in their training, as well as more of a focus on birth itself.” Really? CNMs have clinicals dursing nursing school, then take additional graduate courses to become a CNM. Don’t you think two years of school and hospital rotations might give a CNM more than the handful of births needed for a CPM? Focusing on the birth itself would limit the skill, I think. Maybe that’s why these lesser trained birth attendants miss or ignore or don’t even test for complications of pregnancy.

          • merryprincess

            I didn’t express myself well. When I said focusing on the birth, I was including potential problems or pregnancy complications.As a RN, I know that nursing school clinicals give very little experience in pregnancy and childbirth. Even to work labor and delivery (which I do) requires a period of training not aquired in nursing school. I will stick with my opinion that many CPMs have more experience and even more education that CNMs. And I have nothing against CNMS. The ones I work with are great! So it says a lot to me that they are all pushing for CPMs to be able to practice in NC and feel they are very qualified. In your own state CPMs do all the same testing that is done in an obstetrician’s office. It is required. Women are fully screened and only low risk women are accepted by the CPM for homebirths.

            I want something to be done about the quack midwives with little or no training that do mislead people and cause harm. To me, and to a lot of medical people in NC, this bill would make homebirth much safer by allowing fully qualified professionals, regulated by the state, to cover these births. It would make it much less likely that a birthing mother would fall into the hands of someone like Rowan Bailey. Homebirth itself is legal and presently we have few CNMs and one doctor attending them. I know if your opinion is that all births should be in a hospital, nothing I say will change that. I just want people to have a fair and honest look at the whole debate.

          • The Bofa on the Sofa

            this bill would make homebirth much safer by allowing fully qualified professionals,

            If CPMs are “fully qualified” then OBs are a waste of time?

          • merryprincess

            What a ridiculous answer! Of course not! But they are not required at many births. I realize that I cannot convince the people on this website that homebirth with a good midwife is possible. And you won’t convince me otherwise because I know that to be true. I am not going to argue anymore. I do believe or at least hope we all want the same thing: a healthy baby.

          • The Bofa on the Sofa

            What a ridiculous answer! Of course not!

            But that is the implication of what you are said. They are FULLY qualified is what you said.

            As such, that means that OBs must be over-qualified, since they are more than fully qualified, which makes them unnecessary.

            If someone is fully qualified, then why do we need someone else?

            I realize that I cannot convince the people on this website that homebirth with a good midwife is possible.

            You are wrong again, because no one denies that. Only that it is trivial. Of course a homebirth with a good midwife is POSSIBLE, that’s a stupid strawman. Jesus, a good homebirth WITHOUT a midwife is “possible.” Just like driving home from the bar drunk without getting in a car accident is possible. That doesn’t mean it is a good thing, or desirable.

          • Eddie

            While I agree with you, let me play devil’s advocate:

            An OB is indeed overtrained for handling a normal birth with no complications. Surgical training for C-Section does an OB no good in this case, for example. An OB is most definitely *not* overtrained for handling the full suite of complications that can and do arise. I believe that merryprincess would agree with what I have said here.

            merryprincess, we all understand that ** most of the time, ** home birth is absolutely safe. Even 100 years ago, a woman only had a 1 in 100 chance of dying in each childbirth, and the baby less than 10% chance (right?). *Most* of the time, even 100 years ago, it was safe. The overwhelming majority of the time, it was safe. Yet 100 years ago, everyone knew people affected by death in childbirth, death of the mother and death of a child.

            The reason people here object is that we have a higher standard than “most of the time.” This doesn’t mean that home birth should be outlawed, nor that having medical providers present at home birth should be outlawed. It does mean that you want the same protections present at home birth that are present in a hospital: evidence-based standards of practice, malpractice insurance, the ability to remove a license nation-wide for bad providers, and so on. The law you are stumping for will not achieve these goals.

          • The Bofa on the Sofa

            Everyone is “overtrained” for easy deliveries, by definition. The point of training is to deal with difficulties. First you have to be able to recognize when a situation arises, and second you have to know how to deal with it. THAT is what training is for. And since you can’t always predict which deliveries are going to go wrong, that is why you need someone properly trained to deal with that.

            Notice that there is actually some evidence that a UCB is safer than with a CPM/DEM. As strange as it seems, there is a mechanism for it, in that the midwives could be actually preventing mothers from getting the proper assistance they need. It’s because they are improperly prepared to deal with adverse situations. That is exactly NOT “fully qualified” by any means.

          • Becky05

            CPMs are absolutely NOT fully qualified professionals when compared to the international standards for midwifery. There may be some good CPMs, but the CPM itself isn’t enough and shouldn’t be licensed. Now, I do think there’s room for a 3-4 year licensed midwifery program, as is common internationally, that could train midwives for hospital, birth and home. Florida has purposefully modeled their licensed midwifery standards after international standards.

        • MikoT

          I personally know 4 CNMs and one OB-GYN here in my NC city who are completely supportive of CPMs and are really wanting this bill to pass.

          I am a labor and delivery nurse

          …being in the medical profession myself

          Bullshit!!!

          • merryprincess

            For some reason, anyone on this discussion who has a differing opinion is a lying idiot? I thought this was a place for honest discussion and debate. Apparently not.

          • MikoT

            You can have a differing opinion, but you are not allowed to misrepresent yourself. I called you an “idiot” because you could really thought you could come onto this forum and pretend to be an L&D nurse.

            I thought this was a place for honest discussion and debate. Apparently not.

            Oh here we go again.

          • Lost in Suburbia

            Do you have evidence she is not an L&D nurse?

          • MikoT

            It’s up to her to prove that she is. Fake medical professionals need to be called out as they can influence others to make disastrous choices.

          • Amy Tuteur, MD

            I’m not sure why people decided she isn’t who she says she it. I don’t see any evidence of that. I can see where she is posting from and everything she has written is consistent with that. There are definitely MDs in NC who work with CPMs and who support them. I don’t agree with them, but they certainly exist. As far as I can tell, she hasn’t made up anything.

          • merryprincess

            Thank you for that.

          • merryprincess

            And why in the world would I pretend to be a labor and delivery nurse????? Enough, this is utterly ridiculous.

          • MikoT

            Oh don’t play dumb.
            The same reason that so many others have tried it here and IRL – because it gives them authority they haven’t actually earnt.

          • Eddie

            One person cried BS. That doesn’t mean everything thought so. I trust that you are completely earnest with what you say here. I disagree with some of your beliefs, but I cannot refute what your experience is, as that is your experience.

            Also, keep in mind that people here are used to seeing their comments on NCB blogs get deleted. In the month I’ve been active here, I have only seen posts by one person get deleted, and that was after he was repeatedly warned that he was dragging things wayyyy off topic and was being generally disruptive.

            All the evidence shows me that this is indeed a place for honest discussion and debate. But if you’re on the NCB side of the discussion, you will have to be prepared to take some heat. Just like someone arguing the medical side of things has to be prepared to take some heat when posted at an NCB site. It’s not ideal, but it’s just humanity.

        • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

          Name names.

          Personally, I think the midwives who provide excellent care and have the outcomes to prove it should be promoted to leadership positions in the midwifery community, and be publicly recognized.

          Instead we have the midwives who transgress badly enough and often enough to be criminally charged who make the headlines and even have thousands of dollars raised to support them.

    • Amy Tuteur, MD

      There’s a world of difference? No there isn’t. All Bailey had to do was take an exam and pay the fee and her “training” would have qualified her for a CPM.

      You don’t seem to understand that you don’t have to have ANY training to get a CPM; presenting the deliveries you attended when you were uncertified and unlicensed is enough.

      • merryprincess

        Are you familiar with the exam? My understanding is that it is very comprehensive and that many hours of apprenticeship are required before you can become certified. Every CPM I know has been highly trained. And every CNM I know is very supportive of CPMs and wants this bill to pass. I am simply a labor and delivery nurse who happens to work in a hospital – where I do see things all the time that really make me understand why people want home births. I happen to think it is possible to have a safe and good birth experience either place, and I think this bill will make home birth in NC safer.

        By the way, I was at a birth in a SC birth center (my sister) attended by a CPM. Having worked labor/delivery for over 10 years, I watched everything very carefully. The midwife was very skilled and nothing was done to indicate any lack of knowledge or training.

        • Amy Tuteur, MD

          Yes. I am familiar with the credentialing requirements and they are so easy as to be the equivalent of no requirements at all.

          Why should the US license women who lack the education and training of midwives in ALL other first world countries?

        • MikoT

          I am simply a labor and delivery nurse who happens to work in a hospital – where I do see things all the time that really make me understand why people want home births.
          This sounds so familiar… could it be yet another lying idiot pretending to be a disgruntled insider.
          At least this one can spell properly.

          • merryprincess

            I am neither lying nor am I an idiot. I am also not disgruntled. I am just someone expressing her opinion based upon my own life experiences.

          • MikoT

            Here’s the thing.. your life experiences do not accord with what actual CNM’s have to say about their working lives.
            And your vaguely worded overly general criticisms make it clear you have no actual field experience to draw from.

          • merryprincess

            I am leaving this discussion. I actually thought it was a discussion. I didn’t know I would be ridiculed, called a liar and made to feel I have to prove who I am. Not that it really matters, I suppose, but yes, I am a nurse, working in labor and delivery for 20 years. I do believe in natural birth when it is possible and when it is desired and I have had the privilege to have helped many women fulfill that desire. I am not against hospital births (or I wouldn’t be working in a hospital), believe medical intervention is necessary sometimes, and also support homebirth with qualified birth attendants. I enjoy discussions and debates, but this one is edifying to no one.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            Interesting teacher, life experience. We don’t all have the same experiences, and we don’t all learn the same lessons. Some professionals find the idea of homebirths horrifying, others see no problem. Some mothers who lose babies at home decide it was worth it for the experience, others are wracked with remorse. So while actual experience can lend authority, if it isn’t universal it isn’t definitive. I don’t expect all mothers of disabled children to share my view, or feel that you have to have had the same life experiences to have an opinion. Opinions are not facts though. We form our opinions through the prism of inclination and prejudices, sometimes, but not always tempered by experience.

          • Eddie

            Well put. Too many people assume that their experiences are representative. And it’s too easy to confuse one’s personal anecdotal experiences as scientific facts and then dismiss scientific facts that disagree. People on both sides of this issue are subject to do this unless they specifically guard against it, as this is just human behavior.

            Which is, of course, why it’s so common in this forum to see people demand evidence. :-)

      • merryprincess

        I know you are against homebirth and midwives anyway, and nothing I can post here will change your mind about that. But it does upset me that you see no difference between the Rowan Baileys and the many dedicated and yes, educated CPMs who are trying to be good and safe birth providers. For example, at my hospital we have a nurse who is a CPM, who legally practiced in Florida before moving to NC. There she attended many births, but does not deliver babies here because she can’t legally (although she does plan to become a CNM when her daughter is older and she can go back to school.) She works here in labor/delivery. She is so knowledgeable…even some of our doctors will ask her opinion sometimes. To compare her to Rowan Bailey really upsets me.

        • Eddie

          Let’s say there’s a nuclear plant in your city, and “lay nuclear engineers” want to be able to run the plant. So they create a certification that requires very little training. Great! Now they can take this job!

          Now let’s say that some of those people are actually very good.

          Does that mean the certification itself is a good thing? No. The certification, by itself, in this example, gives no information at all about the skill level of the operator. Just because some of the people with a given certification are very good does not mean the certification itself is meaningful.

          Do you want people running a nuclear plant who can handle everything when there is no problem, but nothing complicated? Or do you want the people working there to be specifically trained to handle rare but very serious complications that can occur?

          OK, in this example, “bad things” happen to an entire region, not just one or two people. But does that excuse allowing people who are not fully trained to take others’ lives in their hands? Again — no-one here is saying that *all* CPMs are improperly trained. But evidence says that CPM training is not sufficient, as Dr Amy has written about extensively. Sure there are those whose skill level well exceeds the minimum. Those people should go one to become a CNM.

          • merryprincess

            The point I have tried to make is that there are a LOT of people in the medical community who DO feel that CPM training is sufficient. And a lot of Dr. Amy’s comments are simply not correct. She falsifies information sometimes or twists it to make her point. I have consulted one of our OBs at my hospital about her remarks. I watrch him practice everyday so I would trust his opinions more than her, a woman I have never met who simply does not always say what is true.

          • The Bofa on the Sofa

            How many people in the medical community actually know what CPM training entails? If they are as ignorant about it as you were, then that they feel it is sufficient doesn’t mean much.

          • Eddie

            Can you give a specific example of something Dr Amy has falsified or twisted, where she is simply not correct? Also, if CPM training is sufficient, then why is the intrapartum death rate so much higher for planned home births?

            I cannot blame you for trusting an OB you know personally over an OB you do not know personally. But since I don’t know the OB you are referring to, this doesn’t help me at all!

            Also, does “a LOT of people in the medical community” mean a majority? Or just “more than one”?

          • merryprincess

            I can find no studies showing that the intrapartum death rate is “so much higher” for home births. A study by US National Library of Medicine actually showed that intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births. After case mix adjustment, the relation was reversed, showing nonsignificant increased mortality risk of home birth. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. Their conclusion: home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death.

            A lot is not a majority, but more than just a few. In the 20 years I have been at my hospital, I have seen a change of opinion. Twenty years ago, I knew one doctor who thought home birth with midwives was a good thing. Everyone else thought it was crazy. Now, I know one doctor who does homebirths, several who think it is fine, but would like to see it better regulated, and all the Certified Nurse Midwives who practice here are very supportive of it.

          • Eddie

            One such report — not a study as the data is too new — is this data from Oregon: http://www.skepticalob.com/2013/03/oregon-releases-official-homebirth-death-rates-and-they-are-hideous.html This shows in one year 4/2000 intrapartum deaths in planned home births and 0/40000 in planned hospital births. The number of neonatal deaths that same year were 5/2000 for planned home births and 25/40000 for planned hospital births. Total fetal death rate, 9/2000 = 4.5/1000 for planned home births and 25/40000 = 0.6/1000 for planned hospital births.

            Dr Amy has — over time across many blog posts — presented several other sources of data showing that planned home births have a higher mortality rate for the baby.

          • Cellist

            Like this. Am going to use this argument!

        • auntbea

          There is one way, and one way only, to try “to be good and safe birth providers.” It is the same one way that you try to be good and safe at any skill: get the most rigorous education you can get, practice under the supervision of the most skilled practitioner you can find, surround yourself with people who are better at your job than you are and seek constant feedback on your work, preferably with real consequences for bad results.

          So, in other words, if they have not done this — and if they had they would be CNM’s or OB’s — then they aren’t really trying all that hard.

          • merryprincess

            Do you realize that even CNMs (or at least the ones I know and work with in my hospital) don’t believe that? I assure you that the CPMs I know have done exactly what you are describing.

            There is a birth center in SC founded and run by a CPM. She has CNMs working for her. And she has been given an award from the SC governor for outstanding service to the SC community with her birth center. The problem on this site is that no one seems to even understand what a CPM is.

          • auntbea

            No. They cannot have participated in the most rigorous education they could get when there are master’s programs in midwifery and they did not complete them.

          • Dr Kitty

            Oh I understand it.
            I just don’t get why the USA still thinks it is acceptable.

            I work with NHS midwives- I have the utmost respect for their training and expertise.

            Which is why I think it is shocking that these dilettantes consider themselves equivalent.

            I have a postgraduate Diploma in Obstetrics and Gynaecology. It is an exam set by the RCOG and required lots of study in my own time, paying a fee and sitting an exam and everything.

            Do I think I have the same knowledge and experience as an OB GYN?
            Nope.

            If you do not have the same training, YOU DO NOT HAVE THE SAME TRAINING.

            Different but equal didn’t wash when it came to segregated education, and it sure as hell shouldn’t apply to midwifery.

          • yentavegan

            bingo

          • Bombshellrisa

            Why do you say that? I trained to be a midwife, apprentice style and through an accredited school. I understand what a CPM is.

          • The Bofa on the Sofa

            But…but…but that CPM won an AWARD for “Service to the Community.” So that is what CPMs do.

          • Bombshellrisa

            Robin Lim, with the CNN award? There seems to be lots of back patting and praising and awards given to CPMs by “the birth community”. If they aren’t getting that attention, they will go out and create a way to get it. I thought CPMs talked warmly for an hour at a prenatal visit about feelings and how lavender essential oil is calming.

        • MikoT

          She is so knowledgeable…even some of our doctors will ask her opinion sometimes

          Hmmm….

      • Lost in Suburbia

        Dr. Amy, I’m asking honestly – what is your definition of training?

        I would be very interested to see from you a side by side comparison and analysis of the skills a CPM/CNM/Family practice doc get. I mention those three specifically because you have expressed that you support home birth with qualified providers such as CNMs, so I would assume that also would extend to family practice physicians who attend births (leaving out OBs because they are especially skilled in pregnancy/birth, but clearly you don’t hold them out the be the minimum requirement to attend home births). In what ways are the specific skills the CPM student is to acquire different? Is not so much the skill itself, but your concern over how often a student might see a skill, or have the opportunity to practice it?

        My reading of the requirements to apply to sit for the NARM exam point to an effort to have multiple assessments, by multiple people in the process, even in the PEP path. It’s not like a student CPM only ever has her preceptor evaluate her skills and knowledge. At last one other CPM or evaluator has to verify the skill/knowledge of the CPM. Falsifying such documentation could result in revocation of certification. And the student still has to sit for the written exam.

        I have no comparative knowledge of CNM, family practice MD, or OB training, but I find it disturbing when I see docs and nurses talk about their experience with “see one, do one, teach one.” How different is this from a student CPM observing, and then practicing skills, and then having that skill verified?

        • Eddie

          Not counting family practice docs, what part of your question is not answered by http://www.skepticalob.com/2013/03/real-midwives-and-homebirth-midwives-apples-and-oranges.html

          • Lost in Suburbia

            That is not a comparison of the skills. It is a broad generalization, based on Dr. Amy’s assessment. While cute and concise, and parodying an information page put out by midwifery support groups, it does not address my question – of the specific skills and and analysis of how those skills are taught. Dr. Kitty’s answer above is more along the lines of what I was hoping could be addressed.

          • Eddie

            Fair enough, and a good response.

        • Dr Kitty

          Nobody does SODOTO anymore (well, not really, that is what skills labs and Directly Observed Procedural Skills and Objective Structured Clinical Exams are for.)

          It is about who is doing the teaching and the verifying and the signing off, and how.

          If Dr X, the plastic surgeon is teaching me how to suture a surgical wound, he isn’t going to sign me off until it looks perfect, no matter how long it takes.

          If Dr Y, the combat medic is signing me off on suturing a trauma patient, he might just want to make sure the edges will hold together long enough for the med-evac, and might not care as much about appearance as about speed and haemostatis.

          Dr X will not thank you if you suture his patient the way Dr Y taught you, and vice versa.

          If it is Midwife P- who learned how to suture a perineal tear from a book but has been doing them unsupervised for years, heavens only knows what she is looking for.

          If you don’t get the difference, I can’t help you.

        • fiftyfifty1

          I am a family physician and I will list my training.*** Of note, after doing my training I decided it was not enough to make me feel comfortable providing labor and delivery care without an OB in house at all times to back me up***. Since this was the case and since my geographic area doesn’t have a shortage of OBs/CNMs, I decided not to do deliver babies at all.

          6 week medical school OB rotation: delivered about 20 babies under supervision, observed others. First assisted on 10 C-sections.

          5 months of dedicated OB training in residency plus followed my own patients on a continuity basis: Delivered 80+ babies vaginally under supervision, many in unmedicated labors. First assisted on a number of C-sections. I did 3rd degree repairs, but never a fourth degree repair entirely by myself. I can numb a perineum locally and also do a pudendal block. I can interpret a strip correctly, place a scalp monitor if needed and do an amnioinfusion. I can do a vacuum but have no real life forceps skills (have only done vacuum on models). Can do manual extraction of a placenta and bimanual uterine massage while ordering the correct sequence of meds for postpartum hemorrhage. Can do a ultrasound for position but not a reliable full fetal survey. Have managed a few shoulder dystocias, but have never had the opportunity to do any of the more complicated steps (except in drills). Can resuscitate a neonate and can bag one properly but have never intubated a neonate (except on models). Have placed a neonatal umbilical line and a scalp IV. Can place an adult IV (of course). Followed 15 patients entirely through their pregnancies (all the prenatal exams, post-dates managements, delivery and postpartum. On these patients we are present for the *entire* duration of the hospital labor). Can detect and manage GBS+, gestational diabetes and pre-eclampsia. My cervical checks are accurate. Have delivered babies in a semi-reclined, all fours and squatting positions. Can induce when needed and augment labor when indicated (I have never once seen a labor augmented when not indicated or as a part of some “standard protocol” as NCBers claim).

          Also, yes I have witnessed home birth as well, as a child/teenager. My family was an NCB family and I had much younger siblings.

          So that’s my training. And keep in mind, most Family Physicians who do deliver babies have gone on to get much more training. Many have done a post-grad program to gain the C-section skills they lack. Those who don’t have C-section skills typically practice under a collaborative agreement with an OB (or in rural areas a general surgeon). One of my classmates does do OB and delivers about 30 babies per year (so has nearly 400 more deliveries in addition to what is listed above). She still only practices with an OB in house at all times.

        • Amy Tuteur, MD

          There are no requirements to receive the CPM beyond paying money for it. Wait, I take that back. In September 2012 MANA “strengthened” their requirements to a high school diploma. I have not heard of a single person who failed the NARM exam or a single person who wasn’t awarded the “credential” when she applied for it. If you can find out otherwise, I’d be happy to hear it.

          The CPM exists for only one purpose: to fool people into believing that these lay birth junkies have passed some sort of vetting process that separates out those who lack the requisite education and training. However, as far as I can determine (feel free to provide evidence otherwise) ANYONE who wants a CPM can get one. That’s not a credential; it’s public relations trick.

          • Lost in Suburbia

            I have assumed that the check lists in the application packet for skill assessment by more than one midwife would suggest requirement – if they don’t have the skills checklist documented as observed and deemed sufficient by the preceptor and at another time by an additional qualified person, then they can’t sit for the exam. Having elements that must be documented prior to an application being accepted sure reads like requirements to me.

            To be fair, I’m not commenting on whether the skills are done well, or whether the documentation process is sufficient, or whether you or other medical personnel feel they are sufficient for the job a midwife is seeking. I do think it is dishonest to say there are no requirements beyond a high school diploma, when in fact, there are.

            Regarding passing rates – NARM put out a report about the 2010 exam, which I found very quickly by a simple google search: http://narm.org/pdffiles/TechnicalReport2011.pdf Looking at the reported rates, 80% passed the first time they took the exam in 2010. They had a different exam used for people repeating the exam, and the passing rate is lower – only 60% passed of the group taking the exam for a second time.

          • Amy Tuteur, MD

            In other words, 92% passed the exam within 2 tries and 98% passed the skills assessment. That doesn’t sound particularly selective. Moreover, we have no idea whether the exam actually tests anything worth knowing.

            The CPM credential is like membership to a club. It has nothing to do with education or skills. And that’s why the death rates of CPMs are so hideous.

          • Lost in Suburbia

            But now we have reason to believe that not everyone who wants to be a CPM can be, even if the selection criteria is not what you would like it to be. People do fail, and people do fail more than once. It is not as simple as pay your fee, get your credential, and that you knew of no one who had failed, which is what you have previously asserted.

          • Eddie

            It’s fair to bring this up, and it’s GOOD to bring this up. If we want to convince people of the facts, we’ll have more success if we go way out of our way to be not merely honest, but scrupulously so. If it *appears* that anything is being deliberately take out of context or twisted or misrepresented, then we just automatically lose the argument in the court of public opinion.

            Since the goal (as I understand it at any rate) is fewer deaths and fewer injuries before, during, and just after childbirth, this stuff matters. The IPCC set itself back more than a decade in the court of public opinion because of how they argued with the critics. The IPCC was right. They were *not* deliberately misrepresenting the facts. But because of how they engaged the opposition, the public thinks the opposite. The IPCC will *never* convince the skeptics. But because of how they argued, they also lost the support of people who otherwise would have supported them.

            If we’re just trying to convince ourselves that we are right, well, then this doesn’t matter. But for most people here, I don’t think that is the case.

            Am I saying the CPM credential is meaningful. No, it is not, not compared to any other industrialized nation. But *how* we argue against it matters if we want to convince others.

          • Lost in Suburbia

            Exactly! I feel like I’m playing devil’s advocate so much here – We must be absolutely as accurate as we can be, because if we can’t trust the small statements, why should we trust the larger one, that homebirth is risky?

          • LukesCook

            Who’s your “we”?

          • Eddie

            FYI: I was confused at first, but quickly figured out that you were playing devil’s advocate and questioning assumptions, that you wanted to be sure that the facts were precisely as we understood them.

          • Eddie

            To compare and contrast, what fraction of nurses pass the RN exam on the first, or second, or later try? A friend’s mom took it multiple times before passing. (This was in the 80s in New York state) Google tells me that these days, roughly 89% of nurses pass the NCLEX exam on their first try. Some states apparently require their nursing schools to have a high rate of passing, but I don’t know what happens if the schools fail to meet that rate. Am I looking at the correct statistic here?

            Ideally, people only take an exam that they are ready for. I never met anyone who failed their PhD defense, although I know it does (very rarely) happen.

            I’m not saying that CPM credentials are good or bad. I’m just arguing that the passing rate in isolation doesn’t tell us much.

          • Lost in Suburbia

            I’ll have to look at NCLEX. I was trying to find passing rates for professions like RN, CNM, MD. Apparently my Google-fu is not good today.

          • fiftyfifty1

            No, the passing rate in isolation doesn’t tell us much, but here’s what does: the entire process. Think of all the many many tests you have to pass in order to become a CNM. Even just to get into the RN major you have to be pulling a strong college GPA. And then there are quizes and midterms and finals in every nursing class. Certain tests (like drug names and dosage calculations) require 100% correct or you can’t pass the test. Then you have to get into CNM school and pass every test and rotation and clinical. And then, THEN, if you haven’t been weeded out already you can sit for the Boards.

          • Eddie

            And that is a *perfect* reply, as it spells out what *does* matter, and why there is a difference. I’d say the passing rate is a total non-issue and isn’t worth even bringing up. EVERYTHING that you mentioned, however, is important.

          • fiftyfifty1

            I disagree that it’s a total non-issue. It *is* an issue in conjuction with the fact that hardly anything else concrete is required for the credential. A rigorous program that weeds without mercy followed by a test that most students pass…well fine. A course of self-study with an easily falsified “skills assessment” followed by a test that most students pass?…..not so fine.

            If the training leading up to a credentialing exam has little to no standardization or external verification, the credentialing exam better damn well have a high fail rate.
            You can have a rigorous training program, or a rigorous certification exam or both. But you can’t have NEITHER and turn out safe providers.

          • Eddie

            What happens when a well-meaning state mandates by state law that a certain minimum percentage of people graduating from certain kinds of schools must pass the certification exam? See for example http://www.mbon.org/main.php?v=norm&p=0&c=education/nlcex_stats.html which shows passing rates of the NCLEX PN and RN certification exams based on specific nursing college graduation rates across various years. Maryland required a 80.03% passing rate for the NCLEX RN exam for its nursing colleges in 2012. I don’t know what consequence occurs for colleges that fail to achieve this.

            I imagine this law is put into place to prevent people from being taken financially by fake or terrible nursing colleges that do not properly prepare their students for the certification exam.

            I get your point. But I think when trying to convince others that the CPM license is inadequate, talking about the passing rate is going to come across as ultimately unconvincing unless it is pretty much always included in a context the way you put it in that post. I think it’s not even worth bringing up for that reason, especially when everything else you discussed is so much stronger. This does depend on who you are trying to convince.

          • fiftyfifty1

            1. The example with the state is ok because the nursing schools do not have any power to change the test. The Board that administers the test is separate from the leadership of the nursing schools. On purpose. Nursing schools that don’t produce a student body that can pass the test will need to either provide better teaching or weed students more rigorously or both. They can’t just take the easy way out and dumb down the test until 90+% can pass!
            2. Also I am increasingly unconvinced by your proclamations of what will and what will not being a convincing argument. Why should we believe you have expertise in this area? Are we running a political campaign where everyone must stay “on message”? I can believe that passing rates would be very convincing. It’s convincing to me. I also think it could be convincing to, say, some working class guy from Middle America who has ever tried to pass a test. Something along the lines of “Hell, the HVAC certification test is harder to pass than that, and that’s just to be able to put in air conditioning not deliver a baby! Hell passing a simple state Drivers License test has a higher fail rate than that!”

          • Eddie

            Also I am increasingly unconvinced by your proclamations of what will and what will not being a convincing argument. Why should we believe you have expertise in this area?

            If the logic of my argument does not convince you, why should my appeal to authority? I don’t have more expertise in this area than anyone else who is not a social scientist or psychologist by training or experience, nor have I represented myself as someone with special authority in this area.

            Are we running a political campaign where everyone must stay “on message”?

            Absolutely not, of course. And am I *instructing* or *proclaiming* that everyone “should” stay on message? I am sharing my opinion. You are sharing yours. It’s a conversation, and a two-way conversation is what I expect and hope for. I do not expect anyone to “heed” what I say without their own critical thought. I am not right about everything. (No-one is.) I expect and listen to feedback. I’ve been wrong before, I’ll be wrong again, and when the facts or my understanding of them changes, I will change my opinion.

            Why do I think passing rates is an unconvincing argument, in isolation, without further explanation? Because the other side can easily tear it apart by showing many other tests with similarly high passing rates.

            You don’t agree with me. That’s fine. I don’t have to convince you. You don’t have to convince me. (But I will not say that neither of us will change our minds. My mind is open to change, and I hope yours is as well, if the *evidence* presented is persuasive.)

            Let’s say a state with legal CPMs and CPM schools makes the same legal requirement that more than 80% of school graduates pass the exam. It’s reasonable to expect this to occur. Does the argument about passing rates then become moot to you?

            What leads me to believe that nurses and doctors — as a group and not as each and every individual — are competent is NOT that they have passed an especially tough exam. Although they have. It’s the very lengthy training process with a HUGE amount of practical experience required, and the many weed-out opportunities across the entire training period. And that many disciplines require continuing education as well. ANYBODY can cram for an exam. I’ve seen people pass exams without deeply understanding the course content. But to make it through a years-long training program where every stop of the way the incompetent are weeded out … THAT gives me respect that those remaining are highly trained.

            Again, there is no requirement that you agree with me at all. Nor that anyone else agree with me. I’m looking for 2-way communication, not 1-way proclamations.

          • Eddie

            Thinking about this further, from the way you worded your reply, I get the impression I hit a nerve, and I genuinely don’t understand why. In the interest of communicating more successfully, I would like to understand this. The way you heard my posts in this thread is clearly different from how I intended them.

            I’m certainly not telling anyone what they “should” or “shouldn’t” be saying. Your use of the word “proclamation” puzzled me. Seriously puzzled me. I am trying to convince. I am not commanding. My mind is open to being convinced in the other direction. To me, this is a 2-way conversation. I am not orating.

            It is not your job or anyone else’s to help me communicate more succesfully. That said, I would appreciate feedback to help me understand why you took what I said as something offensive. Not everyone will like or agree with me, and that’s just life. I accept that as part of interacting with people. But it bothers me when I communicate so unsuccessfully.

          • fiftyfifty1

            It’s not so much that you are coming across as offensive. It’s just that it grows tiresome. There always seems to be somebody new parachuting in here telling Dr. Amy that she’s “doing it wrong”. When she links to a story about a homebirth death, she gets told that her approach is too insensitive to be effective. When she writes an opinion piece satirizing the self-centered motivations of homebirthing parents she gets told she is too condescending to be effective. When she reviews a scientific study and examines it piece by piece, others parachute in to tell her that her approach is not convincing because who is she to challenge the conclusions of the authors and re-do their math. When she writes pieces about HBAC dangers, somebody shows up to tell her that her energy would be better spent fixing hospitals so that women wouldn’t be “forced” to VBAC at home. Now you show up and opine that she should stop mentioning CPM passing rates because you don’t find that particular argument convincing. Well think up an argument you do find convincing and tackle the problem yourself!

          • Eddie

            First of all, I appreciate that you responded. Thank you.

            Now I “show up”? I’ve been commenting here regularly for over a month. I thought I was fairly well on topic close to all of the time. Am I mistaken? In that time, I’ve indeed seen people do all that you say above. I imagine that it does grow tiresome, especially for Dr Amy, but also for the regulars.

            I suppose it depends on what Dr Amy — and her regulars — see as the goal(s) of this blog. As a relatively new regular commenter, I see the parachuters as teaching moments. Clearly, you see it in a different way, which is fine.

            I guess my question is: If Dr Amy makes a mistaken or counterproductive argument, in the opinion of any reader, is it an unwelcome act to bring that to her attention? Is that form of dissent, no matter how gently and respectfully put, seen as an intrusion? I come from a scientific background, so I’m used to questioning assumption, looking into data for mistakes, and generally probing an argument to be sure it holds and is sound and strong. This is my training. I welcome that kind of response (as long as it is respectfully put) to anything I post. I forget that this kind of response is not universally welcomed.

          • Amy Tuteur, MD

            I have absolutely no problem having my arguments criticized, Eddie. In addition, it was hardly one of my best arguments. No need to feel bad about criticizing it.

          • fiftyfifty1

            Read the archives. This issue has been discussed at length in the past.

            Pointing out a mistake or logical inconsistency that Dr. Amy or anyone else makes is fine. But consider that what you think is a counterproductive argument may not be for someone else. As a clinician I spend my day presenting info to my patients. It didn’t take me long to realize that what I considered the strongest arguments were not at all persuasive to most of my patients and vice versa. Different strokes for different folks.

          • Eddie

            But consider that what you think is a counterproductive argument may not be for someone else.

            This is, of course, true. I always consider this. That’s why I see this as a 2-way conversation, not as me preaching. I am always open to being swayed by evidence or compelling arguments. If it came across to you that I was absolutely right and everyone else was wrong and deluded, then I failed to communicate, as that wasn’t what I was saying.

          • theNormalDistribution

            This is exactly the point.

          • The Bofa on the Sofa

            I agree with fiftyfifty1 on this, but with a caveat. I agree that if you have a rigorous instruction, then the certification exam is pretty trivial. And that is a good thing.

            Where I do NOT agree is that you need to have a hard exam if you lack the proper rigorous training. The reason I disagree with it is because I don’t give a shit about the exam, I care about how you are trained. If you don’t have a good rigorous training, then I don’t want you even sitting the exam!

            A good knowledge foundation is very, very important, and that’s the part the exam addresses. However, the knowledge foundation is only half of the challenge. No exam will give you a sufficient assessment of the practical aspects, and that takes lots and lots and lots of work.

            Eddie’s comparison to the driving lessons is pretty good. I don’t care if you pass your driver’s license test, that, in itself, does not make you an acceptable driver. If, after taking a good driver education class, you pass the driver’s test, then you can get a license. Not because you passed the stupid test, anyone who can read can pretty much do that, but because you have completed the training and passed the test.

            My personal example is sports officiating. It is trivial to pass the rules test to become a certified sports official. That doesn’t, however, make you good or even competent. To do that takes practice, practice, practice.

          • fiftyfifty1

            Yes, your idea is much better. Especially in a field where manual skills are so important. I can *imagine* a field that is so nearly completely cerebral that a difficult written or oral test would be a sufficient weeder. But OB ain’t that. (law maybe?)

          • Cellist

            If you follow the link at the side of the page to the ‘My midwife said what’ blog, there are a couple of examples on the site to facebook/other web pages of midwives who have offered to sign off student midwives checklists for a fee. This system seems very open to abuse.

          • Eddie

            In my state, teenagers need dozens of logged hours of driving experience before they can take their driving test. One of my son’s friends took the test with 1/25th the required experience. His parents just made up the rest of the logged hours. They were too busy living their own lives to actually teach their son how to drive. This is pretty common. Kids do not take the driving log seriously, and my teens were very angry with me that I took it seriously. The driving test in this state is quite easy compared to where I first took it, so you don’t need to be a great driver to pass.

            When records like this are so trivially falsifiable, large scale abuse is likely.

          • fiftyfifty1

            Contrast the checklist method used by CPMs to the verification process used in Family Medicine:

            CPMs: no verification if the sign-offs are real.

            Family Medicine: For each maternity patient and neonate we cared for we generated a form that contained their medical ID for auditing purposes. The procedure(s) that we had done were coded based on the level of input we had had (i.e. did it ourselves vs. assisted). These were signed off on on the form as well as signed off on the medical record by our preceptors (OBs and FPs). ALL procedures were directly supervised by our preceptors. To get hospital maternity privileges, you hand in these forms. They are easy to audit/verify. You need a certain (large) number of each procedure or you don’t get hospital privileges and you have to continue practicing supervised even if you have already graduated and passed the boards.
            Do you seriously think CPMs have enough training? Seriously?

          • theNormalDistribution

            “My reading of the requirements to apply to sit for the NARM exam point to an effort to have multiple assessments, by multiple people in the process, even in the PEP path. It’s not like a student CPM only ever has her preceptor evaluate her skills and knowledge.”

            You’re wrong. This is in the document that you yourself linked:

            “The Skills Assessment is not required for certification. There are several optional methods for verifying skills. The Skills Assessment is one of those methods. Other methods include graduating from an accredited midwifery school, obtaining a state license from a state that has been evaluated for equivalency by NARM, or having all training done with CPMs and with verification of skills by multiple CPMs in a clinical setting. The Skills Assessment is required for candidates who have not verified skills through one of the other methods.”

            So, among the other questionable routes to certification, an incompetent CPM student can have her skills “verified” by multiple incompetent CPM’s and become a CPM herself. OR, she can sit for a test that 92% of students pass on their first or second try.

            NINETY TWO PERCENT!

            How much easier does it need to be for you to agree that “ANYONE who wants a CPM can get one”? I don’t see how the requirements could be any less stringent while still pretending to perform some kind of “analysis of skill”.

          • Lost in Suburbia

            Ah, but you are wrong, and I find that exaggerated and inaccurate assertions to be unhelpful, and in fact hurtful towards making sure people have complete information from which to make decisions. Since you haven’t taken the time (I assume) to read through the candidate information packet and application available on the NARM website, I see you are taking information out of context. The document that you are quoting isn’t a comprehensive listing of what is required to apply to apply for the written exam, it is merely a report on the exams that NARM does administer: The Skills Assessment and the Written Exam. The “Skills Assessment” they are referring to (note the capital S, capital A) is a specific exam, and one of several options of verifying skills. That’s what I was tryign to point out initially – that NARM isn’t letting CPM students off with just their preceptor signing off on skills – in which ever path the applicant chooses, more than one person verifies skills. It’s not a choice of either the Skills Assessment exam or the Written Exam. I don’t know now much easier it has to be for you to read the complete information before declaring something that is not accurate.

            I find it interesting that when information is presented to refute the assertion that “anyone” can be a CPM, that you then start in on 92% passing – what do you think an acceptible pass/fail rate should be? I have yet to find information on pass/fail rates for CNMs and MDs, so I don’t have a comparison to work with. Would you be upset if 92% of CNMs passed their exam on the first or second try? When looking at the information about the CNM exam on ACMB’s site, I was interested to note that their written exam (they are accredited by the same organization that accredits the CPM exam) consists of 175 questions over 4 hours. Did you know the CPM exam is 350 questions over 8 hours?

            But back to your post – You perhaps overlooked it when I said this: “To be fair, I’m not commenting on whether the skills are done well, or
            whether the documentation process is sufficient, or whether you or other
            medical personnel feel they are sufficient for the job a midwife is
            seeking. I do think it is dishonest to say there are no requirements
            beyond a high school diploma, when in fact, there are.”

            I’m not necessarily arguing that the CPM credential is all it could be. I am fighting for truth in debate about it.

          • Eddie

            what do you think an acceptible pass/fail rate should be? I have yet to find information on pass/fail rates for CNMs and MDs, so I don’t have a comparison to work with.

            I tried to determine that. Look for my quote on this page: “Google tells me that these days, roughly 89% of nurses pass the NCLEX exam on their first try.” The pages I found were referring specifically to the NCLEX-RN exam.

          • theNormalDistribution

            Ah yes, my mistake. She’ll need to have two incompetent CPM’s “verify” her skills *AND* (not or) take the test that 92% of students pass on their first or second try. Very stringent indeed. It seems to me that any idiot could easily complete these “requirements” and become a CPM.

            “Did you know the CPM exam is 350 questions over 8 hours?”

            Yes, and we are all very impressed.

          • Eddie

            The point that Lost in Suburbia is making is an important one, that it’s important to be accurate about stuff like this if we have any hope of convincing others and achieving our goal of safer childbirth. If we don’t care about convincing others, then it doesn’t really matter how accurate we are.

            When we want to convince others, we’ll have more success if we are so strictly accurate that it isn’t reasonably possible to poke holes in our arguments. (The fact that some will always try is irrelevant. We’re not trying to convince the fringe folks. We’re trying to convince those who are actually convincable. To do so, stridently careful adherence to the facts helps.)

            That means questioning assumptions, asking hard questions, playing devil’s advocate, and stuff like that. Without this kind of self-questioning, it’s significantly easier to lose track of fact vs belief, especially in something like medicine where some facts are so difficult to nail down due to the information being difficult or impossible to collect. We have to be willing to question facts and assumptions we believe in, and ideally we can react calmly to others when they question those facts and assumptions. Why? Because we’ll be more successful at convincing others that way.

        • fiftyfifty1

          I forgot to add regarding my training to become a Family Physician:
          2 months of NICU.
          Unlike the CPM idiots who killed Wren and Mary Beth I know what neonatal respiratory distress sounds AND looks like.

    • yentavegan

      For a great big dose of what can go wrong when a CPM delivers a baby read the facebook page of Justice for Vylette.

      • merryprincess

        I wasn’t going to go there, but you know there are some pretty horrifying stories of what can go wrong when an OB-GYN delivers a baby in a hospital too. And that certainly doesn’t mean they should all be criminalized.

        • Amy Tuteur, MD

          Really? You’ve heard about unlicensed self proclaimed doctors delivering babies in the hospital who subsequently died and then those doctors were the beneficiary of a fundraising campaign created by other doctors? Do tell.

          • Eddie

            To be fair, merryprincess isn’t supporting the unlicensed midwife, and she’s talking about the bad outcome, not about the community reaction to it. I know you get that reaction to just about every blog post, and it must get incredibly tiresome. But merryprincess has explicitly said that she is not supporting this specific unlicensed midwife.

            merryprincess: A critical difference: When a bad event happens in a hospital, the parents have options for obtaining justice. When a bad event happens with a CPM’s delivery, the evidence in other states says that the parents have no effective options whatsoever.

          • merryprincess

            No, that is not what I said. And this is what I have been so frustrated about in this discussion. So many words twisted and mean-spirited sarcasm! From my first post I have stated that I am totally 100% against illegal midwifery being practiced. And the fundraising campaign for Rowan Bailey angers and sickens me. But not all midwives have participated in that. In my admittedly small number of CPM and CNM acquaintances here in my little corner of NC there is not one single person who feels she is being persecuted or that she should be assisted. But Dr. Tuteur, you have to know there are completely legal licensed doctors who make poor decision that have had tragic results.

          • http://www.facebook.com/profile.php?id=613905265 Bambi Chapman

            The thing is, there IS recourse when a DR makes poor decisions. The hospital doesn’t pat him/her on the back and speak out on their behalf while poopoo-ing the family harmed. I have NEVER EVER seen peers rushing to another’s aide because they feel they are being unfairly targeted. When these “midwives” mess up, NOTHING happens besides maybe a slap on the wrist, if parents are lucky.

            You are holding up the CPM title here. It means nothing. Nothing. You may know a few midwives who practice ethically, but you have to understand that that is not how it is elsewhere. My midwife is a CPM, and after 8 deaths+2 brain injuries, she is still practicing. Licensing her in this state will help women how?? There’s suppose to be a midwifery board, but they won’t help you.

          • Amy Tuteur, MD

            And is anyone insisting that holding them to account is persecuting them? Is anyone raising money in their defense?

            Do you think it would be ignored If an obstetrician were observed to be involved in preventable deaths?

          • merryprincess

            I agree with you on that. Although, there are sometimes peer coverups when mistakes are made with doctors (not with deaths probably, or not that I know of). I 100% support midwifery and homebirth for low risk mothers. But I also know there are a growing number of NUTS who are “into midwifery” and think it is cool. I want midwifery regulated but I do not want it demonized across the board.

          • Amy Tuteur, MD

            The midwifery nuts are the CPMs. They made up that credential and gave it to themselves so that they could fool people into thinking that they are educated and trained.

            I’m not sure why you keep ignoring what MANA, the group that represents homebirth midwives, has to say on the subject. The OPPOSE standards; they don’t require ANY specific education; there is NO independent evaluation of skills because the student gets to choose her own preceptor.

            Remember, just because you have seen some competent CPMs does not justify the conclusion that the certification requirement ensures that CPMs are competent. They aren’t considered competent by any other first world country. If the Netherlands, the UK, Australia and Canada won’t accept them as midwives, why should we do so?

          • Lost in Suburbia

            You know that doctors made up their own credential back in the day, and gave it to themselves, right? Most professions out there, who are credentialed, sought their own credentialing and licensure. Perhaps it’s not helping the cause of CPMs to equate them with 19th century doctors who were seeking a way to differentiate themselves from other people who did the same kind of work, but it’s accurate. MD’s have just had the luck of a longer history of states recognizing their exclusive scope of practice.

            And for curiosity – do we accept Netherlands, UK, Australia, or Canadian midwives in the US without requiring them to take a series of courses or exams to be sure they are caught up with American CNMs?

          • LukesCook

            Very few countries will accept midwives from other countries without requiring some kind of adaptive accreditation process involving transitional training, supervised practice or examination to test competence. The exception, I think, is between EU members. The key point here is that the midwife’s training and accreditation must first meet a prescribed minimum standard for her to be accepted as a candidate to embark on the adaptive accreditation process. A CPM would, in all but the poorest and most desperate countries, fail to meet the standard to even be permitted to attempt accreditation.

          • Amazed

            You know what happened to phrenologists, right? Theu made uo their own credential and gave it to themselves. They were pretty popular, too, back in the day. Alas, it turned out that phrenology was a bogus science and it died away, leaving phrenologists stranded. There is no such profession today.

            Somehow, doctors are still around. CPMs are in the process of proving their worth and they are not doing great this far.

          • Eddie

            Unless I misunderstand (which is entirely possible), MANA does not have the ability to certify someone as a CPM, right? Do they have any input at all into what is required to become a CPM? Aren’t they just an advocacy/lobbying group?

          • Amy Tuteur, MD

            MANA, NARM and MEAC are sister organizations that handle CPM representation, licensing and credentialing of homebirth midwifery programs.

          • Eddie

            OK. Is this relevant to the North Carolina law, that specifies the credentialing organization must be accredited by ICE? When I search their list of organizations, I find NARM but not MEAC or MANA.

          • Amy Tuteur, MD

            The credentialing issue is a red herring. It is my understanding that organizations like ICE accredit the PROCESS by which a credential is award (making sure it is fair, no-descriminatory, etc.) but make no judgment about the validity of the credential itself.

          • Eddie

            It is my understanding that organizations like ICE accredit the PROCESS by which a credential is award (making sure it is fair, no-descriminatory, etc.) but make no judgment about the validity of the credential itself.

            That is what I would expect them to do, as they won’t be subject matter experts in all those different fields. According to the North Carolina law, doesn’t that mean that only those CPMs who got their credentials from NARM would be allowed to practice midwifery in North Carolina? I’m not saying the credential is solid or valid or good. (Because I honestly do not know and have to trust others’ judgement in that area.) All I’m saying is that MANA’s stance on requirements to become a CPM may be irrelevant to North Carolina, specifically. Not irrelevant in general, but just specifically to North Carolina with this proposed law.

            Tangent: According to Wikipedia, NARM was created by MANA, which is interesting.

        • Eddie

          The critical difference is the *rate* at which these events happen.

          • merryprincess

            My whole reason for beginning to post here was because I do believe CPM regulation in NC is a very good thing. The midwife being charged for murder is not a CPM. I maintain that there is a hugely significant difference. I know that you, Dr. Amy, and the majority of posters here do not agree and I know we are not going to change one another’s opinions. I am more than willing to accept being wrong about something, especially something of this importance. I have researched for years, reading studies, nurse-midwifery journals. I just don’t see the same statistics you keep referring to. Yes, I agree that Oregon has a high (compared to other places) rate of homebirth problems, That state is full of the same type of midwife as Rowan Bailey. (I know, my brother lives there) This midwifery is unregulated and I firmly believe that is the problem. There are bad doctors out there; we all know it. There are bad midwives and there are midwives so into the cause they can’t see that there are bad midwives. And that is a real problem. But that doesn’t make all midwives incompetent and it is not really fair to evaluate them all based on what some really bad ones do, just as we shouldn’t come to the conclusion that no MD can be trusted when we hear some horror story relating to MD care.

          • Amy Tuteur, MD

            “Yes, I agree that Oregon has a high (compared to other places) rate of
            homebirth problems, That state is full of the same type of midwife as
            Rowan Bailey. (I know, my brother lives there) This midwifery is
            unregulated and I firmly believe that is the problem.”

            The 8X greater rate of homebirth death is for LICENSED, REGULATED midwives in Oregon. People like Rowan Bailey are not included in those figures.

          • Lost in Suburbia

            Oregon does not require midwives to be licensed to practice legally, nor does it require that a midwife be a CPM to hold a license. So yes, people like Rowan Bailey are included in those figures – Unlicensed, Unregulated, self-described midwives are included in those Oregon death rates.

          • Amy Tuteur, MD

            No, those figures are LICENSED, REGULATED CPMs. There is another figure for the unlicensed + unassisted + CNMs and it’s a lower death rate than for CPMs.

            The MOST dangerous form of birth in Oregon is PLANNED homebirth with a LICENSED, REGULATED CPM.

          • Eddie

            For 2012, there were approx 2000 planned OOH births in Oregon. Of these, 1235 were attended by a DEM and 760 were not. When they say DEM in those statistics, does that include or exclude CPMs? The 760 planned home births not attended by a DEM — does that mean CNMs, OBs, and planned home births without any medical attendant? Or does that mean CPMs, CNMs, etc?

          • Lost in Suburbia

            Ok, I found this in reference to the oregon numbers : https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/10024

            Is this what you were reading from? I see that the DEM numbers that Judith Rook quoted did appear to include unlicensed DEMs, and that there is no apparent distinction between DEMs who would qualify as a CPM and those who would not. I do see that most of the reported births and deaths with DEMs were indeed with licensed DEMs.

          • fiftyfifty1

            ” I have researched for years, reading studies, nurse-midwifery journals”
            My parents raised me to believe in evolution. I didn’t break out of that thinking by just continuing to read the “evidence” that was published in the fundamentalist Christian press.
            Continuing to read the midwifery literature is nothing more than an exercise in confirmation bias.

          • Siri

            If a CPM is safe, ethical and competent, it is probably because she is the kind of person who would be ethical and competent in any profession; it isn’t her CPM title that makes her so. Why can’t those CPMs who have the brains and skill to make good midwives train as CNMs? That is what people who want to become midwives in other countries have to do. Why does the US need both types of midwife? What value does the CPM add? Why do you support a two-tier system?

          • Lost in Suburbia

            Has Dr. A demonstrated that the difference in homebirth vs hospital birth death rate is statistically significant?

          • Eddie

            You can do the math yourself if you doubt it. For the Oregon data, go to https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 (which Dr Amy links to). Comparing deaths associated with a planned out-of-hospital birth to a planned in-hospital birth, you have 9/1995 deaths (OOH) vs 25/39984 (in-hospital).

          • Lost in Suburbia

            Unfortunately, I can’t do the math myself. I’m not a statistician. I can run some raw numbers, you just did, but I really don’t know how to do the calculations to determine if the difference in homebirth vs. hospitals deaths is statistically significant. Emotionally, and in terms of babies who should be living, but are now dead, Iit’s definitely significant.

          • The Bofa on the Sofa

            So at two standard deviations below the results for the OOH birth, the mortality rate is 1.5/1000. Two standard deviations above the rate for in hospital births is about 0.9/1000. The probability that one outcome is more than 2 standard deviations low and the other is two standard deviations high is 5%*5% = 0.25%.

            This means that there is a 0.25% chance that the death rate of home births is only twice as much as in hospital births. Given that statisticians are quick to accept p=0.05 (5%), a smaller than 0.0025 value is more than sufficient to consider it “statistically significant.”

            Now that stupid semantic games are aside, can you address the issue?

          • theadequatemother

            I loaded those crude death rates into SPSS and ran a crosstabs analysis asking for the chi sqare statistic…which is a correct way to look at categorical data (which this is…home vs hospital dead vs alive).

            Chi square statistic was 34.00, degree freedom = 1, p = 0.000

            It’s both statistically significant and clinically significant.

          • Lost in Suburbia

            Thank you

          • fiftyfifty1

            LIS, can’t you tell from those numbers right off the bat without calculating them that they are going to be strongly statistically significant? I’m asking this in all seriousness. Imagine a hat with over 40,000 slips of paper. Only 34 of these slips of paper say “dead” on them. One person is instructed to draw out 39,984 slips. The other person draws out only 1,995. The first person gets 25 dead slips but the second person gets 9 even though she drew out less than 5% of the slips overall! Would you guess that such a result would happen by chance or would you guess that the dead cards didn’t get mixed in well enough? If you can’t eyeball this one there is no hope for you!

          • Lost in Suburbia

            In all seriousness, I didn’t, and I find your illustration to be helpful. But to the general point of whether it should be expected that someone who doesn’t write or read research and statistics as a regular, continually practiced part of my life, I think it’s reasonable not to expect that I would be able to eyeball statistical significance. I figure if researchers put so much effort and assign so much meaning to statistical significance that I’m not going to just make a guess about whether the numbers are significant, or not.

          • theNormalDistribution

            You don’t need to be a statistician. If you understand the concept and aren’t just using ‘statistically significant’ as a buzzword, then you could learn how to run the numbers, if you cared to verify them.

            Anyway, using a normal approximation to the binomial for large sample cases (n,m>40), I calculate a p value of 0.0049 (Z = 2.58) based on the hypothesis that the homebirth death rate is not higher than the hospital death rate. I don’t know what significance level you would set for rejection of the null hypothesis, but 0.0049 is pretty definitive, I think.

          • fiftyfifty1

            yes

          • Lost in Suburbia

            Please point me to the post.

        • LukesCook

          That statement, even if true, would only be relevant if the things going wrong were caused by the inadequate training and experience of OB-GYNs, or the failure of effective monitoring and enforcement of standards applying to OB-GYNs. Is that your contention?

          • merryprincess

            My statement is true and, as repeatedly stated, in my previous posts I want effective monitoring and enforcement of standards for midwives.

          • Amy Tuteur, MD

            We already have standards: the CNM credential.

            Why should we have lower standards for women who want to be midwives but aren’t willing or able to meet those standards?

          • The Bofa on the Sofa

            But remember, CPMs are “FULLY QUALIFIED” to deliver babies. Except for those deliveries that have complications.

            By the same logic, I am “fully qualified” to play in the NBA. I could have sat on the bench and never gotten in the game just as well as the guy from Cleveland did in last night’s Cavs/Pacers game.

          • Lost in Suburbia

            But Dr. Amy, CNMs oversee deaths, like Vylette’s, and clearly having the CNM credential didn’t help Vylette. Maybe we should be equal opportunity baby-killers, and let CPMs bury their own cause with piles of dead babies.

          • Amy Tuteur, MD

            But LIS, some people who die from lung cancer never smoked, so clearly not smoking doesn’t prevent lung cancer. Does that make any sense? No, so why did you just state the equivalent?

          • Lost in Suburbia

            I said it mostly because I’m having fun. I just get frustrated when I see people attributing a death to CPMs and homebirth, when in fact it had nothing to do with homebirth. It just hurts the cause of truth in homebirth, and gives NCB people one more thing to blather about you and/or your readers not telling the truth. because at least there, they are right.

            But I do wonder why not let CPMs be licensed – people who choose homebirth will keep on doing so, and eventually, the truth will come out. Yes, it’s a little cold-hearted, but if homebirthers are so intent on personal responsibility, well fine. Be responsible, and suck it up when the truth is out, and then it shouldn’t be so hard to shut the whole thing down.

          • yentavegan

            from what I understood, the birth center in Brooklyn is in essence a homebirth in someone elses house.

          • fiftyfifty1

            A *little* cold hearted??! You are advocating that Dr. Amy back off and let babies die, and relax on the beach, and wait until the problem is so awful that even MANA can’t continue to hide it and then pop back into the picture when the story breaks and say “ha,ha, I told you so, suck it up heartbroken parents”. Does this sound ethical to you?

          • Lost in Suburbia

            Are the current numbers working to prevent licensure of CPMs? We’re about to see the 28th state recognize CPMs this year, maybe more states, too. I’m saying what Dr. Amy is doing is not working, so something else should be done.

          • http://www.facebook.com/profile.php?id=613905265 Bambi Chapman

            Then maybe you and your ILK could start getting it together and calling for more standards, education, insurance, accountability, etc.

          • Lost in Suburbia

            I’m seeing that people are calling for all of what you stated, and I support that.

          • Lost in Suburbia

            What do you think me and my ILK is? I know what I am is a person full of conflicting ideas and information, and I’m trying to sort it out.

          • The Bofa on the Sofa

            What do you think me and my ILK is?

            By your fruits, they shall know ye

          • Lost in Suburbia

            If we’re going to talk about biblical references to fruit, here are some fruit I’m not seeing in the voices of the commenters here on Dr. Amy’s blog: patience, kindness, gentleness or self-control. Although it should be evident by my posts that I lean towards licensing CPMs in states, I come here sincerely trying to learn from and understand Dr. Amy’s point of view. I enjoy reading her posts. I find them informative, and definitely it gives me something to think about. I also feel I benefit from some of the comments left on posts by others. However, I totally get a sick feeling in my stomach when it comes to reading most of the comments, especially comments directed towards people who disagree with the majority point of view. The comments on this blog make me feel that way, Not what Dr. A posts. So, are my poor widdle feewings hurt? Yes. I feel some of the attitude here is pretty toxic, and does not help to “convert” people who might be seriously considering the matter, but have not arrived at the same conclusion as many of the commenters. Perhaps I have misunderstood the whole point of this blog: is it to help people consider a different side of the issue, or is it to pat each other on the back? I will probably continue to read and comment here, but please, even if one does not care for me or my point of view, try to be willing to consider that snark and hurtful words can distract from the message.

          • Bombshellrisa

            Bofa wasn’t referring to the fruitages of the spirit (were you? Cause I read that comment as meaning people can say they are one way, but their actions and who they stand with tell the real story)

          • LukesCook

            License CPMs so that unsuspecting women will hire them and enough babies will die to prove their incompetence to your satisfaction? That’s not “a little cold-hearted”, that’s depraved.

          • Lost in Suburbia

            I guess I’m thinking that more than half the nation recognizes CPMs. Why not focus on getting states to more accurately and consistently record perinatal deaths so the numbers will speak for themselves? Yes, I know many readers here think the numbers do speak for themselves, but to the NCBers, they don’t. And those are the people who are out there getting their legislators to pass bills allowing CPMs. It’s not my satisfaction that really needs to be met.

          • LukesCook

            You may find the idea of piles of dead babies funny. I find you repulsive.

          • Lost in Suburbia

            I don’t find dead babies funny. I didn’t even coin the phrase – Dr. A did, at least in connection with CPMs. My statement about having fun was in reference to enjoying the debate, but ultimately, no death is ever, ever, ever funny.

          • Siri

            To be fair, LIS’s remark about having fun was in response to Amy not spotting that her prior remark was tongue in cheek. I don’t think LIS is either depraved or repulsive, or someone who delights in dead babies…

          • http://www.facebook.com/profile.php?id=613905265 Bambi Chapman

            I am NOT ok with just sitting back and watching babies die. What the ever-loving fuck could someone be thinking to say that’s ok and promote it as an idea?

          • Lost in Suburbia

            I am not okay with watching babies die, but I guess I don’t feel there’s a whole lot we can do about it other than try to talk about it to help people see the numbers and the stories. I see that making DEMs illegal doesn’t seem to be saving babies, nor does licensing, at least in Colorado or Oregon.

          • LukesCook

            What’s true, that there are horrifying stories of what can go wrong when an OB-GYN delivers a baby in a hospital too? You don’t have to tell me that, my baby died after being delivered by an OB-GYN in a hospital. My question was whether you believe that the cause of the things going wrong is the inadequate training and/or monitoring of OB-GYNs. Which you evaded.

        • fiftyfifty1

          So some OBs make horrifying mistakes. So we should license providers with almost no education and no oversight to fix the problem? Wow!
          Some commercial pilots have been the cause of horrifying crashes. So instead the airlines should hire “pilots” who have helped out a few times in the cockpit of a personal aircraft? I’ll say “no thanks” to that idea!

      • Lost in Suburbia

        For a great big dose of accuracy, note that the midwives who were responsible for overseeing Vylette’s birth were CNMs, in a birth center. But Dr. Amy apparently fully supports CNMs presiding over birth center deaths like Vylettes, or at least, she’s okay with CNMs doing homebirths, so presumably birthcenters are acceptable places for maternity care providers she approves of to be negligent.

        • Amy Tuteur, MD

          I fail to see how incompetent CNMs justify incompetent DEMs. Perhaps you can explain it to me. And while you’re at it, please explain to me why we should license women who wouldn’t be licensed in the Netherlands, the UK, Australia or Canada.

          • Lost in Suburbia

            Incompetent CNMs do not justify incompetent DEMs. But I am saying, don’t pretend that an incompetent CNM is a DEM in an effort to make CPMs look worse than they already do. Let’s at least be truthful about who is responsible for these dead babies.

            I’m also saying that if we’re gong to be fair about pillorying CPMs because there are some incompetent DEMs out there, we should be just as stringent with the CNMs who attend births and have death on their hands because of incompetence.

            Why should we worry about who the rest of the world does and does not license when we’re not interested in looking to the very same countries for other maternity care information, such as homebirth stats and GBS protocols?

            Regarding midwives trained in other countries – do you have information on what would be required for any of those midwives to be able to be licensed here in the states? I assume it might be a few courses and an exam, but I would appreciate more information if you have it. I’m also curious to know what a CPM (without RN or CNM or CM credentials) would have to do to “catch up” and be licensed in another country. Would she have to complete the entire program? Just take a few courses and exam? I don’t know much about reciprocity between countries, and how much of that has to do with what the various gov’t are willing to work out.

          • Eddie

            Why should we worry about who the rest of the world does and does not license when we’re not interested in looking to the very same countries for other maternity care information, such as homebirth stats and GBS protocols?

            Why do you think the “collective we” is not interested in doing that? I’ve heard people claim that home birth stats from other countries don’t apply to the US given the very different levels of training required for midwives. I haven’t heard anyone claim that we don’t care what occurs in other countries.

          • fiftyfifty1

            ” in an effort to make CPMs look worse than they already do”
            “Don’t make CPMs look worse than they already do” is not a ringing endorsement. And yet you SUPPORT them?

          • Bombshellrisa

            I thought that direct entry midwives in other countries still had a bachelor’s degree before they were able to start training to be a midwife. I know that nursing school in Canada is four years of nursing school with clinicals starting the first year, as opposed to the US which is two years of prerequisites and then two years of nursing school with clinicals OR with an associates degree a few prerequisite classes and then nursing school taken along with whatever other credit classes needed to complete the degree.
            Depending on where a CPM trained, the idea of a degree can be very misleading. Bastyr University is a MEAC school outside of Seattle and it sounds so official, offering a bachelors and masters degree in midwifery, but the credits earned there don’t transfer and you still end up learning by apprenticeship and distance learning. How useful is to learn that in certain cultures, a gardenia blossom is floated in the water when a woman starts to labor and then when it opens, that is the sign for the midwives that the woman is ready to push? Apparently it’s more important for the students at Bastyr to learn that then to learn why cervical exams are important. Also, it’s more important for them to learn to use the cohoshes instead of learning facts about pitocin.

          • Squillo

            Anecdotally (for what it’s worth), I’ve heard that it’s very difficult for a UK-licensed midwife to get credentialed in the U.S. I don’t know if the reverse is true, as I haven’t personally run across any U.S.-licensed CNMs trying to practice abroad.

          • Bombshellrisa

            Only CPMs flock to other countries so they can practice their “skills”.

          • Siri

            Our beloved Lisa Barrett trained in the UK, and has held senior positions as a hospital midwife. Just goes to show that dangerous mavericks exist at every level..

          • Siri

            To become a direct-entry midwife in the UK, a CPM would need to complete a 3-year BSc(Hons) degree in Midwifery, or else a 3-year nursing degree followed by 18 months’ post-registration university training. I imagine that far from counting in her favour, her CPM experience would be seen as rather a liability.

        • Eddie

          Isn’t there legal recourse with an incompetent CNM, which is not present with a CPM? The reality is that some licensed providers of any type you choose will always be incompetent or unwilling to follow best practices. We cannot do anything about that. What we *can* do is make sure there are processes for getting rid of those people so they cannot practice *ANY*where, ever again, and make sure that proper malpractice insurance exists to compensate those who ran into the bad providers.

          Don’t you agree that there will always be bad providers? So the goals are:

          1) Make sure the minimum level of education is sufficient
          2) Make sure the certification is meaningful
          3) Make sure you can prevent bad providers from practicing
          4) Make sure malpractice insurance is always present.

          Am I missing something?

        • yentavegan

          really? I thought the midwives were CPM’s. With no hospital privileges and no ob/gyn over sight.

        • yentavegan

          Now I am even more disgusted by the lack of care given to Vylette Moon and her mother.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        those women were CNMs.

    • Captain Obvious

      Says the CPM of the La Matrona midwife, that the CM says of the CPM, that the CNM says of the CM, that the MD says of the CNM. So how is the CPM certification of the highest accreditation? Try sitting for the written and oral OB/GYN board exam.

  • GiddyUpGo123

    Was anyone else as bothered by this bit as me? “This part has been huge in creating harmony in my home, my practice and
    when I have challenging experiences they no longer seem so devastating.”

    By “challenging experiences” does she mean bad outcomes? If so, she’s basically saying that she’s now OK with dead babies. Personally I think any person who provides medical services ought to be devastated by bad outcomes, because if you’re not then you’re a) a sociopath and b) not going to bother taking a hard look at what happened and taking steps to make sure it never happens again.

    • Becky05

      Yes, that’s very concerning. Midwives of this ilk seem to be making it clear that they are hardly even trying to avoid bad outcomes.

    • Eddie

      /sarcasm: Isn’t death just a variation of normal?

  • KarenJJ

    I’m focussing on a completely inconsequential part of a serious post,

    but, “Whapio”? Really?

    It just sounds as though she’s taking the piss…

    • Lost in Suburbia

      Yeah, the whole fake name thing in the midwifery community bothers me. I know of an illegal (at the time) midwife who used a fake last name. It was only by a client of hers digging around, after her home birth, that she discovered it was a fake name. Definitely suggests the midwife is trying to protect herself, at the expense of honesty with the client.
      That or people like “Rowan” Bailey and “Whapio” are trying on character names like people who play at historical reenactments/gaming/creating personas. Not to knock gamers, because I have those in my family, but most of them know it’s play, unlike some of these midwives, with whom their “playing a part” has a real life consequence.

      • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

        LARPers go, play a game, come home and carry on their normal lives under their given names. They understand the difference between reality and fantasy.

        Some of these birthy women remind of of Karl Rove’s infamous quote about “..making our own reality.”.

        (For the non-Americans, Karl Rove and company made multiple confident predictions about the last election that were trounced by reality, and by number crunchers like Nate Silver.)

  • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

    Well, Postmodernism may have paved the way for idiots to spout this kind of half-baked gobledygook, but I don’t think it is entirely responsible for these dimwitted ramblings. Stupidity and/or pretension accounts quite well for that.

    I may be in the minority in believing it is a good idea for NCB to go down this path. Expand at length on philosophies of birth and the mystical approach, and individual women can then decide for themselves whether their priority is a birth experience or a healthy child, and stop the pretence that one is guaranteed to lead to the other. The real problem with NCB is the false claim that stunt births/homebirths/rejecting medical advice is a safety issue. We could have licencing for Birth Advocates, Birth Attendants, potential birth soul mates – much like licensing for hairdressers and tattoo artists, and proper training and regulation and oversight for midwives. At least that way women would know what they are getting. Separate the physics and the biology from the metaphysics and mysticism and then women can own their choices.

    • Becky05

      The problem is, though, when you have midwives trained in this sort of nonsense, but women who have been told “home birth is as safer or safER than the hospital,” without being given enough information on the different kinds of midwife around.

      • Something From Nothing

        Call me an intellectual snob, but any woman who accepts on face value that home birth “is as safe or safer than the hospital” already has their mind made up. A thinking person couldn’t believe this claim at face value.

        • Eddie

          I don’t think that’s completely fair.

          Death in childbirth is so rare today (compared to how it used to be) that I can understand people believing that. You don’t have to be into the woo to believe that it’s possible. You just have to be ignorant of history (which is frightfully common) or misattribute the causes of the higher historical death rate. And you have to be ignorant of the evidence, which is trivial to achieve, especially with so many people out there lying.

          • The Bofa on the Sofa

            I’ll take SFM’s snobbery a bit further: anyone who believes that homebirth is “as safe or safer than a hospital birth” hasn’t thought about enough to even realize what that means.

            In order for that to be true, that means that for every baby that dies in HB that would not have died in a hospital, there must be at least one that has dies in a hospital that would NOT have died at homebirth.

            So either they must believe that almost no babies that died in HB would have been saved in a hospital, or that there are a lot of babies that die in the hospital that would not have died in HB.

            If they get this far, the answer is typically the first one, with the “some babies weren’t meant to live” excuse.

            So whether they say it or not, that is the implication. Do they really believe that?

          • Eddie

            I’ll take SFM’s snobbery a bit further: anyone who believes that homebirth is “as safe or safer than a hospital birth” hasn’t thought about enough to even realize what that means.

            I absolutely, unequivocally agree with this.

          • Becky05

            Actually, I’ve absolutely seen it claimed that babies die in hospital due to the interventions. There’s some truth to this — inductions increase the risk for uterine rupture, even in unscarred moms, and this can’t result in the death of the baby. But though these interventions have risks, they’re done when the benefits far outweigh the risks. That’s what the women don’t get.

          • Something From Nothing

            It is completely fair. I understand your point and I agree. However, I didn’t say people who buy it are not intelligent. I said they don’t think. By that I mean people who have a tendency to take things at face value, not question and not think for themselves ( people who blindly follow religious teachings without questioning what they are told is a good example). And furthermore, you don’t need a grasp of history or the research to know, you just have to know a tiny bit about the plight of women globally. And I’m sorry, if you don’t know that women in other places in the world are dying for lack of access to obstetrical intervention, then, IMO, you are incredibly sheltered /lack curiosity about the world / don’t think enough. Ignorance is no longer a very good excuse.

          • Something From Nothing

            And, Eddie, death form childbirth is NOT so rare today. A woman dies from complications of childbirth EVERY FOUR MINUTES.

          • Eddie

            I’m certainly not going to argue that ignorance is a good excuse. However, a great many Americans are ignorant of what goes on — outside their social status, not just outside the country. I’ve been outside the United States. I’ve seen poverty inside the US and outside it. How many Americans — how many folks outside the US, even — really have much of a clue how women outside their own country or region or even socio-economic status fare?

            While this does not justify ignorance, people are busy living their lives. The news in the US doesn’t present a lot of this kind of background information, primarily I think because news shows have to turn a profit via advertising and because Americans don’t care that much about people outside their realm. Americans are a funny bunch. Very generous when a disaster happens in another country, but with a very short attention span and with very little long-term focus on chronic problems around the world.

            And, Eddie, death form childbirth is NOT so rare today. A woman dies from complications of childbirth EVERY FOUR MINUTES.

            In a country of 315 million people, that argument is weak. That means that in a given year, 0.08 PERCENT of women die from complications of childbirth. Since we know that these deaths are not spread equally across the population, but are comparatively concentrated in groups with less access to health care, that means that a great many middle and upper class people will never know someone who died from complications in childbirth, especially one due to a preventable cause. I’ve known of many more people who died due to drunk drivers than I’ve known of women who died during or as a result of childbirth. Of course, there is much more effort to publicize the former than the latter, but my point stands.

            Relative to other causes of death in the United States, and relative to history, yes, death of the mother from childbirth in the US is very rare.

  • Tara

    It’s really too bad that these mystic midwives are forced to take care of actual corporeal bodies. If only women could just give birth to spiritual babies it would make the midwife’s job so much easier. It’s so selfish of these mothers to expect their midwife to worry about all the blood and guts of having a baby.

  • thankfulmom

    “Stephanie facilitated me in defining my ideal client and I now have a
    full practice of clients I love, have a soul-level connection with and
    who value my work.”

    I valued my mfm’s expertise, but I didn’t need to have a soul-level connection with him.

    • Elizabeth Abraham

      Both my kids were delivered by strangers who happened to be on shift at the time.

      Know what rocks about modern civilization? We have entire *buildings* full of people who will lend a hand, infinite clean sheets, and anesthesia or surgery as needed to anyone who shows up in labor. No soul-level connection required.

      • Eddie

        Apparently for some, a “soul level connection” can substitute for competence. Bedside manner is a factor in choosing any doctor, any kind of medical provider, but give me a competent provider over a nice one, any day. Ideally you can find a doctor with both, but in a pinch, competence always wins over nice.

        And quite frankly, the idea of having a soul level connection with any medical provider is creepy.

        • Sue

          Not only creepy, but unethical.

        • GiddyUpGo123

          My OB had terrible bedside manner. It wasn’t until my fourth pregnancy that I actually started to be kind of friendly with him. He was very short when he spoke and instead of explaining why I shouldn’t be concerned about something he would pretty much just say, “you don’t have to worry about that.” All things that bugged me a little, but they bugged me in such a small way that I never considered switching providers. He had a great reputation, a competent staff, he was incredibly dedicated (he would rarely allow another OB to deliver his patient and would come do it himself regardless of the hour/shift). I sure as hell didn’t need a “soul level connection” with him to feel like I was in good hands. And even if I did have a “soul level connection” with him but didn’t feel like he was competent, dedicated or had a good reputation, *that’s* what would have made me look for another provider. You can have soul-level connections with friends who help you through a divorce or deal with the death of a loved one or whatever, but you don’t need that with the person who delivers your baby. It’s not important and it’s stupid to imagine that it is.

          • GiddyUpGo123

            Oh I know, it’s because midwives don’t do any monitoring, so they need that “soul level connection” so they’ll just know by magic that something is wrong.

          • http://www.facebook.com/profile.php?id=613905265 Bambi Chapman

            My DR with my oldest was that way. You know, I went into preterm labor and he chewed his nurses out for being so lax with scheduling me because he was worried something was missed. He cared a lot, just wasn’t all kumbaya with me.

    • Cellist

      Yes exactly. I’m a little disturbed at the thought that my husbands oncologist could stop seeing him based on not having a soul level connection with him!

    • Dr Kitty

      I don’t get to have only “ideal” clients.
      Illiterate Travellers, middle class professionals, drug addicts, paramilitaries, murderers, people with learning disabilities, soldiers, asylum seekers, housewives, children, nuns, people I like, people I don’t like. It doesn’t matter (and yes, that is a representative sample of my patients).

      They’re my patients and I’m going to do my best for them, because I have both personal and professional integrity.

      No, I don’t have a soul connection with patients.
      That would be icky and weird.

  • Lost in Suburbia

    I’m not finding what you state to be convincing or accurate – to my reading, “Rowan” Bailey was not a CPM, and couldn’t have passed the NARM exam. So she was not, and could not, have been a CPM.

    You said: “Read the following descriptions and ask yourself: should you really
    decriminalize the ability of any women to call herself a midwife and
    spout nonsense such as this?”

    The bill to which you are referring does not decriminalize anyone who want to be a midwife. It specifically refers to CPMs, and does not decriminalize people such as Tina Bailey. If that law were passed as is, she would still be a criminal, and not a license midwife. So, saying that Tina Bailey is a reason why you should vote no on the bill doesn’t fly. If anything, it points to why any ol’ person calling herself a “midwife” should not be licensed, which is specifically what the NC supporters of the “home birth freedom act”, or whatever it is they are calling it, are saying.

    I appreciate all the things you refer to prior to talking about Tina “Rowan” Bailey, but after that, your argument doesn’t hold up.

    • JenniferG

      Read “Can I become a CPM if I complete your programme” here: http://www.thematrona.com/#!__potentials-of-a-matrona-education

      And just run a search and you find lots of midwives with that background: http://www.maitrimidwifery.com/about_me.html

      That is one of the fundamental problems with the CPM designation. You apprentice with a quantum midwife who has a CPM credential (bearing in mind the rules changed) for your what 40? births, and you write one exam and you’re in!

      • Lost in Suburbia

        Fair enough – she could have been eligible to sit for the exam. But she didn’t, as far as we know. And she wasn’t a CPM. So she still wouldn’t have been licensed under the law to which Dr. Amy was referring. So the whole argument that the law should not be passed because Tina Bailey was not qualified to be a midwife still missed the mark.

        And another thing Dr. A mentioned – The whole homebirth community is not rallying behind her – if there are, what, 29,000 mothers that homebirth each year in the US, I would say that maybe 1% of the 1% of home birthing families out there are willing to put money towards her legal support? Poking around the internet is showing me that there is not unanimous support for her, although it’s incredibly unfortunate that more people in the homebirth community aren’t standing up against Tina and midwives like her.

        • http://www.facebook.com/profile.php?id=613905265 Bambi Chapman

          You are right, not everyone supports her, which is fantastic. I just wish more people would stand up and voice their disapproval.

    • Lost in Suburbia

      To correct/clarify myself, aside from poor grammar –

      What I’ve read suggested she wouldn’t have been eligible to sit for the exam, and probably couldn’t have passed it.

      And, the way the law is written only refers to CPMs and CNMs, but since CNMs are not criminals currently, and are licensed under other law, this law wouldn’t apply to them.

    • auntbea

      Is there a law regulating the use of the CPM title and restricting it only to those who pass NARM certification? If not, the law decriminalizes all lay midwives.

      • Lost in Suburbia

        Did you read the proposed legislation linked? It specifies “any person who holds a current ministerial or tocological
        certification from an organization accredited by the Institute for
        Credentialing Excellence (ICE)”
        The law does not use the term Cerified Professional Midwives, or even say midwife. It’s not something you can just “self-certify” according to the law. It says that people who have certification from the organization are legal. So yes, the law restricts it to people who have passed certification.

        • Lost in Suburbia

          again with the correcting myself – I said the law several times above – it should be “the legislation.”

        • auntbea

          You’re right. I looked at it but somehow thought the green part was something else. Anyhoo…I guess it comes down to the question of whether or not certification would keep out the Rowan Baileys.

          • Lost in Suburbia

            As to that, I don’t know that it would, honestly, as much as I would hope so. I do think though, that the rogue midwives will always be there, even in places where they are licensed, simply because they don’t care about meeting a widely recognized minimum standard. Licensing CPMs won’t change those people or their disregard of standards. But, I do believe that creating a legal structure would provide for some degree of exposure and recourse for families, as weak as it might be, and I believe sincerely the majority of homebirth families are interested in being able to identify quality homebirth CPMs, and I believe that ultimately those consumers will demand improvements in the system and education, even when the CPMs might not like the fact that consumers want something different from what the midwives are aiming for.

          • Amy Tuteur, MD

            CPMs are licensed in a variety of other states. It has not provided exposure or recourse for families.

          • Lost in Suburbia

            Like I said, however weak it is – at least there can be a listing of midwives who have had actions taken against them, like in Texas, even if it (unfortunately) doesn’t result in anything significant for the family involved in the reason for the disciplinary listing. Now, in NC, there is no public record of actions against midwives, except for catastrophic things like with Avery, which is a criminal record.

            Isn’t something better than nothing wth a group of people who won’t go to the hospital to birth and are already willing to choose illegal, unlicensed midwives?

          • auntbea

            No. Because licensure prevents one powerful tool in the state’s arsenal for holding unqualified midwives accountable: charges for practicing medicine without a license. If the licensing process does not contain a commensurate process for ensuring that licensed midwives truly are qualified, then granting them license unleashes them on the public will little legal recourse.

            NARM is a private organization credentialed by a private organization. There is no state body overseeing this. There is nothing in this legislation that would compel NARM to list actions against midwives or to take away the licenses of midwives who deviate from standard of care.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            Not suggesting they should be licensed as MIDWIVES – licence them as necromancers, placenta alchemists, soul mates.Specialists in natural birth, indifferent to outcome. They don’t practice medicine, so any woman who has the sense to realise that medicine might be required won’t be taken in.

        • Eddie

          any person who holds a current ministerial or tocological certification from an organization accredited by the Institute for Credentialing Excellence (ICE)

          What does that mean in practice? I went to their web site and couldn’t find any serious information about what organizations were accredited for giving those certifications.

          • Lost in Suburbia

            Thi is the list of accredited organizations http://www.credentialingexcellence.org/p/cm/ld/fid=121 just hit the search button, and it has a complete list
            In practice: ice/ncca doesn’t do any credentialling for ministers. Tocological refers to obstetric related work – you’d have to read the specific federal code which is referred to in the bill. Ice/ncca only accredit two tocological organizations – amcb and narm. Being accredited by ice/ncca is no small thing, and although there is certainly the possibility down the road that some competing midwifery organization could spring up and seek accreditation, i think it unlikely that the rogue midwives would gather themselves together enough to create a comprehensive program of woo-ducation. They don’t want to work together. They want to be unencumbered by labels and definitions ‘the system’ wants to apply. You know, like trained. Or certified.

          • Eddie

            That’s exactly the search I did. When I click “all” to get a list of all organizations, the list that comes up does not contain the strings “Tocological” or “amcb” or “narm” or “midwife” anywhere. That’s why I asked what that means in practice. I couldn’t find a list of tocological organizations from that search page.

            Did you find AMCB or NARM from that web page, or from already knowing the answer?

          • Lost in Suburbia

            I found already knew what I was looking for, but I was able to find it on the webpage. I tried entering criteria and got nowhere, so instead of selecting an industry, I just went straight to the search button, per the instructions on the search page. “If you do not select any search
            criteria, all organizations will be returned in the results. Also, some
            organizations who may not have completed their entire profiles may not
            show up in acronym or industry searches, so you may search again using a
            partial or full organization name.”

            It would appear that ACMB and NARM (along with what looks like a bunch of other organizations in the list) have not completed their profile to be fully searchable.

            I admit that I have not looked into detail in to what each of the organizations accredited by NCCA certify, but looking at the name of the organizations and the list of accredited programs seems to back up the sense that no other organizations on the list do anything that is “tocological” certification, which is not a term used by ICE or NCCA, but just in the legislation to reference federal law.

            As an aside, the legislation appears to be almost an exact copy of the sneaky language used in Missouri to decriminalize CPMs, except that they are not trying to be sneaky in NC, and they are upfront that it is to decriminalize CPMs.

    • Becky05

      Unfortunately, people are being taught these same sorts of things even in programs aimed at preparing midwives for the CPM. Carla Hartley and the Ancient Arts Midwifery Institute are the ones I’ve seen the worst from. “Birth is safe, interference is risky.” “Authentic midwifery is about serving mothers, not saving mothers or babies, from birth.” “Midwives who believe that their presence, or drugs or gadgets make birth safe don’t believe the same things that I do about birth.”

      She’s also the anti-hatting lady.

      • Lost in Suburbia

        Anit-hatting. That whole thing cracks me up. I mean, I kinda get that hatting may be neither here nor there – we never really had hats on our babies much past the first few hours, but the whole approach that not only is it unnecessary, but it somehow super-duper harms things and does way-bad damage to bonding!11!! Nope. I love sniffing newborn baby heads – there’s honestly nothing quite like it, but to treat it like it’s practically criminal to put a hat on a baby? That’s a bit much.

  • guest
    • Eddie

      The use of the word “mama” in the NCB community just grates on my nerves. It seems to take on a religious, worshipful meaning.

      • Certified Hamster Midwife

        For similar reasons, I loathe the word “kiddo.”

        • Guestll

          Mine is “littles.” *grinds teeth*

      • The Computer Ate My Nym

        I’m starting to seriously dislike the word “amazing”.

        • Eddie

          The comedian Louis CK has a bit about the overuse of the word “amazing.” Too off-color (and off-topic) to post there though.

          • LibrarianSarah

            I thought it was the word “awesome”

          • Eddie

            See about 1:55 in http://www.youtube.com/watch?v=vzwXqkGApBk for the quote I was referring to. There may be other examples about other words. NSFW so use your headphones.

    • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

      Please put your helmet on before reading this link. You may do yourself an injury otherwise.
      At home:
      ” I stayed calm when I finally went to pee and almost passed out on the way to the bathroom…and when I had to crawl back to bed”

      Imagining what would have happened if she had been in the hospital:
      “I imagine I would have been terrified and thought I was in real danger
      (whether or not I was in fact in danger is still something I’m unclear
      on, and to be honest I’d rather not know…”

      Ignorance really was bliss. She was anemic and had GD during the pregnancy, retained placenta, PPH, serious tear…

      The whole “In the hospital, things would have been like _____.” speculation is something I’ve seen repeatedly in HB stories. They feel the need to tell themselves how miserable the hospital birth experience would be. Why? Shouldn’t their home birth story stand on its own?

      • Eddie

        Yeah, she admits to willful ignorance, and from that place of willful ignorance, judges that a hospital would have been worse. Apparently, when you’re hemorrhaging, it’s most important to feel like you’re in no danger. Emphasis on the word “feel.” I’ll stop there.

      • AmyM

        Yeah and they HATE it when people who have hospital births do it. I forget where it was (some ncb blog) but there was a whole post about how they can’t stand the “If I hadn’t been in the hospital, I would have died!” and they insist that you couldn’t know what would have happened. And also that whatever complication it was, was caused BY the hospital, so therefore it wouldn’t have happened at home.

    • Awesomemom

      I do not like that she totally bagged on CPMC, those guys saved my son’s life and I adore the doctors and nurses there.

      • Eddie

        Let me pretend to be NCB for just one moment: “If you hadn’t gone there, you wouldn’t have needed to have your life saved.”

        OK, back to reality.

        I mean, that post was written by a women who hemorrhaged and still thinks she made the right choice by not going to the hospital. She bragged about how much blood she lost, as if it proves how tough she is.

        • Awesomemom

          Well my son has a heart defect so even if I had never stepped foot inside a hospital something bad would have happened. CPMC is a great hospital that takes high risk patients (which I am sure is why the csection rate was so high) and they have awesome people there so it made me cranky that she was dissing them and acting like they were just out to cut her for shits and giggles.

  • The Bofa on the Sofa

    Bailey describes herself as as Community Midwife, Placenta Alchemist, Co-founder Asheville Holistic Birth Collective, Birth Activist. In other words, Bailey has absolutely no formal training in midwifery.

    Jesus, compared to this, the Certified Hamster Midwife and Pablo Certified Midwife don’t sound the least bit silly.

    • Certified Hamster Midwife

      I am also a Hamster Pup Alchemist, but I don’t brag about it or anything.

      • Siri

        You turn tiny hamster pups into gold? Wow.

    • The Computer Ate My Nym

      “Placenta alchemist”? I don’t want to ask, but I must…what does she transform the placenta into?

      • Certified Hamster Midwife

        Dehydrated placenta.

        • araikwao

          Why is that “placenta alchemist” rather than “placenta dehydrator”, I wonder? Or “placenta desiccator”? Doesn’t alchemy involve transformation of one substance into another? Ergh, now that I’ve asked that, I fear I’m going to be educated on the weird things people actually do with their placentas…

          • Eddie

            Apparently, not only is their science bogus, but so is their non-science (aka alchemy). At least they achieve consistency in their absurdity.

          • KumquatWriter

            Nice one, Eddie.

          • Petanque

            I think they operate using the extreme counterintuitive notion that if it’s this hard to believe in, it must be real!

        • fiftyfifty1

          A placenta alchemist doesn’t just dehydrate the placenta, you idiot. She “Brings it Earthside”.

          • Petanque

            If she’s not going to turn it into gold like a proper alchemist I don’t want it back!

    • Amazed

      Jesus, compared to this, the Certified Hamster Midwife and Pablo Certified Midwife don’t sound the least bit silly.

      And they are harder to obtain! When I tried to become a Pablo Certified Midwife, the Big Boss, a.k.a you in your previous incarnation, would not even consider me. I am deeply impressed – if your program finds a genius like me lacking, you surely accept only demigods.

      • Aunti Po Dean

        Pablo would give me one either I had to make up my own

        • The Bofa on the Sofa

          Oh please. You two were all concerned about trivial stuff, like watching births. I didn’t ask much, just that you provide the proper pop culture references. You two were so unqualified that you would have failed a preliminary Gilligan’s Island test. You think you were going to succeed in the MASH or Cheers sections?

          The PCM has standards.

          • Karen in SC

            this is a hilarious mini-thread. Thank you all!

          • The Bofa on the Sofa

            They also failed to agree to additional terms of being a PCM. In particular, they did not agree that they were not allowed to knit, only to crochet, but only if they pronounced it “crotch-it”

          • Karen in SC

            I guess I’ll have to go the Hamster route if I decide to go ahead with my nicely decorated RV Baby-mobile that parks outside of hospitals. Or maybe I should call it the Hamster-mobile to keep it discreet. A knitted placenta backpack is extra.

          • auntbea

            Is that backpack that holds the placenta? Or knitted from the placenta?

          • Sue

            BOTH would be ideal for maximum sparkleness

          • The Bofa on the Sofa

            PCMs are allowed to have an RV, but you have to paint, “If the RV is rockin’, then don’t come a-knockin’” on the side of it

          • Amazed

            Oh my, I knew it was the knitting that failed me. I don’t knit, I don;t crotch-it, I only weave golden threads with a mother’s hair. And that was not good enough to you? I thought education varied from PCM to PCM. Oh wait, that was CPM? It’s hard to keep track…

  • Auberry2

    All of this makes me so very angry. I came very close to getting sucked into the woo myself as I started planning for my next child. I had a lovely, easy, hospital delivery with my son, but the NCBers got ahold if me after and did their best to convince me that everything had really gone wrong. (I had the dreaded epidural {it was fabulous}, I let them give me an IV, it was my fault there was meconium and my baby was blue because I allowed interventions, etc)

    I had the utter gaul to not care how my son delivered as long as he was healthy. And I was stupid enough to listen to them for a time and start planning a militant intervention free birth for my next darling. I found SkepticalOB while trying to research NCB and it has restored my senses, reminded me how great my son’s birth really was in the scheme of things, and above and beyond all that, my baby came home and is now a happy healthy nine year old, worth more than any experience.

    I may never get darling #2, I have secondary.infertility issues and miscarried a few months ago. That there are people billing themselves as caring for women, openly admitting that they don’t care or accept responsibility for the birth outcome is an outrage. I just pray more people stumble to this site or one like it and find sense, because they need it, desperately.

    • The Computer Ate My Nym

      I have secondary.infertility issues and miscarried a few months ago.

      I’m so sorry that you’re having problems getting baby #2! Do you know what’s going wrong? If not, has anyone done a coagulation workup on you? (I’m a hematologist so that’s a “when all you’ve got is a hammer…” question, but it’s something that occasionally gets missed in OB so asked on the off chance that it might be useful. Coag problems are at least partly treatable so if the answers to the above are both “no”, it might be worth checking out.)

    • Dr Kitty

      I’m sorry for your loss, and I hope you get what you hope for in future.

      We’re also having issues with getting our #2, but in my case because I have to schedule some surgery first (nothing major, but not, unfortunately, as postponable as we had hoped).

  • COdoula

    “What’s most disturbing about Bailey’s self-designation of “midwife” in not the fact that she has no education and training in midwifery. What I find most disturbing is that someone who clearly has no education and training in midwifery is fully embraced by the homebirth midwifery community.” <—–this right here is spot on. Another fantastic piece Dr. A.

    • Lost in Suburbia

      I posted this elsewhere, but I don’t know that I would say she and midwives like her are fully embraced by they homebirth community. Compared to the number of homebirth families out there, only a handful put any money towards her fundraiser. It is very unfortunate that those who don’t support tina and midwives like her are generally staying so quiet and hush-hush about their disapproval.

      • Eddie

        It is very unfortunate that those who don’t support tina and midwives
        like her are generally staying so quiet and hush-hush about their
        disapproval.

        Thus giving the exact appearance that the entire community supports her. Staying silent is implicit support in this context.

        • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

          People are speaking out against the support “Rowan” Bailey, but they are the usual suspects and there aren’t that many of them.

          Whoever is the most vocal contingent wins the PR battle. Whoever most consistently wins the PR battle becomes the public face of the group, even if they are a tiny minority.

  • ersmom

    WTF is placenta alchemy?

    • Dr Kitty

      Well, you know how alchemy is about turning base metal into gold?
      Placenta alchemy is about turning your rotting (but free) placenta into useless (but really expensive) capsules, teas and tinctures. Similar principle, obviously.

      • Amazed

        Oh my. Dr Kitty, did you really, really have to be this helpful? I was just headed for a much needed dinner… And the worst part is, I have to have this dinner anyway since it’s 10 p.m here and all I’ve had this far is 2 apples and 2 cups of coffee. A headache is on the way (no idea why it’s a headache. Most people say they’ve got a stomachache when hungry. Not me, thought).

        Hey, do you know who tries to utilize the Rowan Bailey fiasco to pass the CPM-friendly bill? No less anauthority than Audrey Trepiccione. I’m holding my breath and waiting for Kim Mosny to make an appearance.

      • PrecipMom

        How could *anyone* be a placenta alchemist?! Placenta is more valuable than gold, so what could you possibly turn it into that would be worth more than what it already starts out as?

        • KumquatWriter

          Metaphorical gold =/= Cash

  • AlexisRT
    • Cellist

      Grinding. Teeth. Hard to believe it, but some of the comments were actually worse than the article. Expecting midwives to have some sort of insurance is A REPEAT OF THE WITCH TRIALS PEOPLE.
      Barmy doesn’t begin to cover it!

      • Eddie

        I didn’t even follow that link until your post. Ugh, a great number of the comments are of the sort, “bad things happen all the time in the hospital.” And of course as you say the complaints about the cost of insurance, as if the insurance companies make 80% profit rather than 3%. As if the root cause of that problem is the cost of insurance, instead of the risk of loss.

  • LukesCook

    So the role of the “midwife” in the Matrona/Rowan model of midwifery is explicitly and exclusively to indoctrinate their “clients” in their “philosophy” of birth, and not to provide any actual care?

    • DirtyOldTown

      I was going to be even more cynical and suggest it was explicitly and exclusively to collect fees from gullible women for doing nothing, but that works too.

    • Sue

      and also to take their money….don’t forget the “financial wellness” – for the provider, not the client!

  • Something From Nothing

    I was just looking through the comments on the indigogo site where they are raining money for Rowan’s bail. Not a single commenter mentions the baby that was lost, or even seems to care. They make it blatantly obvious that it is about process and they couldn’t care less about their clients. Why don’t women see this? They have already raised over $15,000. What a crazy world we live in. Gloria lemay is right there, posting her support. It’s funny, but in order to have your post not be anonymous , you have to contribute, so Gloria contributed $2 and posted about how proud she is of the birthing community running to Rowan’s rescue. It’s sad.

    • Sara

      Nah, there were plenty of comments mentioning the baby. They were all deleted.

      • Eddie

        That is so pathetic, and that makes it clear that they do not care about the dead baby at all. Just the right of the live midwife to kill more babies.

  • Ardent

    “Responsible for process but not outcome” is the best description of woo midwifery every!

    • Sue

      And every other king of woo… (all care and no responsibility)

  • AT

    The Sacred Birth Mentor Program, according to the program’s Facebook page, is “a 2-year, three-level mystery school for birth professionals that focuses on consciousness, spiritual practice, physical, spiritual and financial wellness and much more.”

    I’m pretty sure “mystery school” and “professionals” makes this sentence an oxymoron. I’m also baffled how someone writes a sentence like that without thinking it’s a joke…

    • Siri

      ‘Scooby-dooby-doo, where are you? We’re going to mystery school now..’

      • Siri

        The Shaggy Rogers Mystery School of Birth. Looks like we’ve got a variation of normal on our hands. Zoicks! (Sorry)

      • JustADoc

        I’m so glad that I’m not the only person whose mind went immediately to Scooby Doo when I heard “mystery school.”

        • KarenJJ

          Me too.

        • Squillo

          Scooby-Doo was far more reality-based than the Sacred Birth Mentor Program.

          On the other hand, I think I’ve found the solution to my ethical problem (i.e., I’d love to make $$$ from the credulous and infirm of mind by starting an alt-med practice or New Age religion, but it would be too much like taking candy from a particularly dim baby): I’ll just start a school to take money from morons who want to do alt-med mixed with New Age religiony goodness.

          • KarenJJ

            A bit like Robin Hood. Take money from alt-med and donate it back into real medical research.

        • Siri

          They would’ve gotten away with it too, if it hadn’t been for that meddling OB-GYN…

  • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

    I have to wonder which “clients” she might be referring to:

    “Stephanie facilitated me in defining my ideal client and I now have a
    full practice of clients I love, have a soul-level connection with and
    who value my work.”.

    I’d suggest falling back on her house cleaning skills. It’s safe, legal and if she reports her income, she won’t get into trouble with the IRS.

    • auntbea

      Selecting the people whom you will help based on how much they value you is the hallmark of a true professional.

      • Kerlyssa

        Hey, that too is ethical.

        As long as you stick to cleaning houses.

  • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

    “when I have challenging experiences they no longer seem so devastating.”

    This could be interpreted as “When births have bad outcomes, I no longer feel personally responsible.”

    • MaineJen

      I think that is the statement that seemed the most chilling to me, also

  • CNM

    I don’t even think that Rowan would pass the NARM CPM qualifications… As a nurse midwife, I agree with you Amy that the CPM qualifications are S@*T, but I think Ms. Baily even fails to meet those substandard guidelines and would ONLY be supported by other midwives in a state that does not allow CPMS (otherwise the CPMS would all be biting at her throat and turning her in so that they could get all the clients ;) ). I know in NY state the CNM homebirth midwives have a history of turning in CPMs (who are illegal in NY) to the state.

  • UNCDave

    I do have a nit to pick with the title of this post; vetoing a bill is something the governor could do after it was passed by both houses of the state legislature. We’d rather not see it get that far.

    • Amy Tuteur, MD

      I knew someone would mention that. I chose that wording because “the single best argument for voting against …” sounded awkward.

      • UNCDave

        Hey, go with whatever stylistic choice you prefer. Of course, you just know there will be someone who says “See! We knew that ‘Dr’ Amy isn’t even a doctor anymore, but now we also know that she doesn’t even understand how the legislative process works!!1!1″ Or something.

        • Amy Tuteur, MD

          Fixed it.

  • Captain Obvious

    So doctors and CNM bust their butt with years of (expensive) education and supervision to be able to care for women and babies, but this woman who could barely make ends meet cleaning houses was embraced by Homebirth midwifery and is now having the same job description and responsibility? All states need to hear this debate and abolish non-CNM midwives.

    • Durango

      Well, no, not the same responsibility since the outcome isn’t her problem. I wonder if she tells her “ideal clients” that?

      • Sue

        “three-level mystery school for birth professionals that focuses on consciousness, spiritual practice, physical, spiritual and financial wellness and much more”

        Financial wellness?!
        Is there a session on paying your own bail?

  • Kalacirya

    Was reading through some of the sections on the Matrona’s website. It is literally some of the stupidest, made-up garbage I have ever laid my eyes on.

    • CNM

      Agreed. WTF is ‘quantum midwifery’???

      • auntbea

        It’s when you can know either where your midwife is or the speed at which she is driving away from your complicated homebirth, but not both.

        • theadequatemother

          Snort!

          I suppose if there are an infinite number of universes, each containing adifferent outcome, one would not have to feel bad if the baby died in this universe…because it would be alive in the one next door…amirite?

          • auntbea

            Alive, a genius AND already potty-trained.

          • LibrarianSarah

            Unfortunately in that universe you had a c-section and didn’t get the experience you wanted. Poor other you.

        • Dr Kitty

          Thanks for that!
          I needed the laugh today…looks like I’m looking at another surgery. Boo.

          • DirtyOldTown

            Sympathy boo!

          • Cellist

            :(

        • Renee Martin

          +100 internets for auntbea!
          You won the internet today, with your excellent, accurate comment.

          Plus, you defined the previously indescribable for us unenlightened, disempowered, sheep- quantum midwifery!

          • http://breastfeedingwithoutbs.blogspot.com/ Breastfeeding Without BS

            “Plus, you defined the previously indescribable for us unenlightened, disempowered, sheep- quantum midwifery!” Of course, reading that sentence too quickly makes me want to know what sheep-quantum midwifery is….;)

      • Amy Tuteur, MD

        It’s this:

        http://www.skepticalob.com/2009/12/more-goofy-midwifery-theory.html

        Midwives have a large and growing problem with scientific evidence since it turns out that there is no scientific evidence to support much of what is exclusive to midwifery.

        “Since the [midwives'] assumptions must be right, it follows that the definition of scientific evidence must be wrong. Prof. Downe could make that simple assertion, but she knows that everyone would laugh. So instead she opts for what seems to her a more sophisticated assault on scientific evidence.

        Mohr [another author], writing about pseudoscience in nursing, anticipates this approach:

        Most recently, several quacks have defended themselves using concepts from postmodernism… Postmodernists have applied such
        ideas and concepts as Gödel’s theorems, relativity, quantum mechanics (particularly the uncertainty principle), chaos theory, and catastrophe theory to literature and psychoanalysis.

        The postmodern movement has infiltrated health care and nursing. Thisapproach encourages people to believe that healthcare advice based on scientific research is of no more value than any other healthcare advice… Some authors borrow terms from theoretical physics without regard for what those terms actually mean… Many readers have little understanding of the scientific theory being invoked or the philosophical implications of what is being said. They may assume that if an author has a PhD, he or she should be believed without question.”

        Soo Downe, PhD faithfully follows this pseudoscientific approach:

        “Maxwell’s laws of thermodynamics represented an important shift in concepts of nature from those that pertained previously. While his first law described the principle of conservation of energy, the second described its dissipation (such as by movement producing heat). This implied a shift from order to disorder and led to the concept of entropy (that matter breaks down over time). Einstein’s
        relativity and quantum theories built on this work…”

        Never mind that Einstein was not the originator of quantum
        mechanics, Heisenberg and Schrodinger were. Never mind that Einstein wasa vociferous critic of quantum mechanics. Never mind that Einstein famously retorted “God does not play dice” in response to the implications of quantum mechanics. (And those who are familiar with physics know that Maxwell’s equations are about electromagnetism, not thermodynamics.) Einstein was smart and he had something to do with quantum theory so that must make it true and relevant to midwifery.

        “The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”

        Wait one moment while I picked myself up off the floor fromlaughing
        so hard. Prof. Downe seems to have missed the most basic, most
        important fact about quantum mechanics, which is not surprising since she doesn’t have a clue as to what it means. Quantum mechanics is an explanation of events at the atomic level, not on at the level of objects in the world. So unless Downe would like to discuss the individual atoms that make up the molecules that make up the cells of the fetus, quantum mechanics has no applicability.
        Never mind. It sounds so cool and so scientific.”

        • The Bofa on the Sofa

          And those who are familiar with physics know that Maxwell’s equations are about electromagnetism, not thermodynamics.

          There are Maxwell RELATIONS in thermodynamics, which are distinct from Maxwell equations on electricity and magnetism. I am not aware that Maxwell actually created the 1st and 2nd laws of thermodynamics, however (or the 0th or the 3rd).

        • The Bofa on the Sofa

          As I said in another thread, one way to kill pseudoscientific application of the laws of thermodynamics is to ask about the Clausius inequality.

          Similarly, for QM, in order to determine if it applies, ask them to write the Hamiltonian. Because PROPER applications of QM start with the Hamiltonian. From that, you can get a lot of really cool consequences (especially when you start applying the Pauli principle)

          • Eddie

            Asking people to write out the Hamiltonian would even fail a number of physics majors. Have the people spouting nonsense actually shut up after you asked them these questions? Became aware of their ignorance? That would be most impressive. (And it’s “quantum argumentation” as you pointed out their uncertainty! I crack me up.)

          • The Bofa on the Sofa

            As I said about the 2nd law, it’s not their ability to apply the clausius equation that matters, it’s to even understand why i would ask that question.

            You ask a physics major to write the hamiltonian, they can admit that it is probably beyond their capabilities (hell, it’s beyond mine most of the time, but it’s fun to read papers where it starts with, “The Hamiltonian for the system is shown in eq X”

            You ask a woo to write the hamiltonian, they stare at you blankly because they don’t have the first clue what that means. They absolutely become aware of their ignorance (not that it will necessarily stop them completely, but stick to it). And I say, if you don’t know what a hamiltonian is, then you don’t understand QM enough to be claiming to apply it in any situation. Then again, that’s because I know enough about QM to know that I am not qualified to use it improperly.

          • Renee Martin

            You ignorant, arrogent, man! The “physics” you “learned” in the oppressive, patriarchial system called university, is nothing like the *real* quantum reality. All your so-called “book learning” means nothing in the face of a connected MW.
            /snark

          • Eddie

            I wish I could find a link, because you just cannot make this stuff up, but over a decade ago (I think) there was a feminist paper that came out deconstructing male, patriarchal science as something that needed to penetrate nature. (It went into much more detail than I give here. I just can no longer remember the details.) When I read the abstract, I blinked several times at the astonishing sexist stupidity of the paper.

          • Cellist

            I’m hoping that it wasn’t this one. I’m feeling a little bit ashamed of being an Australian!

            http://www.uow.edu.au/~sharonb/STS300/science/shaping/articles/artenvironment5.html

          • Eddie

            That’s not it, but it’s close in some ways. That article is much more reasonable — WAY more reasonable — than the one I was looking for, but I was not able to find it. (I haven’t had a lot of free time for the search. Given the search terms I’d have to use, I don’t want to do that search while at work!)

            I’m not going to defend the sexist history of science, as there’s nothing to defend there and I applaud those who call out the sexism — past and present — in science. As in any area of life. But this one paper just went so far beyond the pale, well into the rediculous. I wish I could find it.

          • Cellist

            Not certain if my first message held. If it didn’t, then google:
            “Careful of Science: A Feminist Critique of Science, Patsy Hallen”.

          • auntbea

            If I give you an answer about the Federalist Papers that is not what you are looking for, right?

        • LukesCook

          “it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”

          I can’t even fathom how what went before even remotely implies this. It’s like “A=B and B=C therefore X=Y”.

        • Cellist

          “Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.”
          Albert Einstein.

        • Jo

          I’m going to draw the obvious conclusion that they are viewing the birth process like the famous Schrodinger’s cat in a box: If the baby is in the womb it is neither alive nor dead. And midwives shouldn’t check, because that’s baaaad.

          • Petanque

            Yep, opening the box is unnatural.

      • Amy Tuteur, MD

        Jen, lay nuclear physicist explains it all:

        http://www.skepticalob.com/2011/09/jen-lay-nuclear-physicist.html

      • Squillo

        It’s where they substitute the word “quantum” for actual competence. It’s a fun game, kind of like adding “in bed” to the fortunes you get out of fortune cookies.

      • AL

        Yes, that in itself made me laugh. How is that not a farce.

    • Lizz

      So many multi colored vaginas. Why?