Midwives Angling for Money Again (MAMA)

What do you do when no one will pay you the money that you want? You get your favorite Congresswomen to pass a law.

That’s what the homebirth midwives of America are trying to do; in collaboration with the MAMA Campaign (Mothers and Midwives in Action) Congresswoman Chellie Pingree plans to introduce a law forcing payment to substandard practitioners who insurance companies consider unqualified to provide medical care in childbirth.

So what if no one thinks their “skills” are valuable? Who cares if people don’t think they are a safe practitioners? They want money and dammit, others should be forced to pay. So much for the free market.

That’s the problem facing certified professional midwives (CPMs), member of a second, inferior class of midwife that exists nowhere else but in the US. They have less education and training than midwives in ANY first world county and would not be eligible for licensure in the UK, the Netherlands, Canada or Australia. Since they hare banned from hospitals as unqualified, they are restricted to attending homebirths. All the existing studies to date, as well as state and national statistics show that homebirth with an American homebirth midwife (as opposed to a certified nurse midwife) is the most dangerous form of planned birth in the US.

Actually, some people do want to pay them. A tiny percentage of women who think that homebirth with a high school graduate supervising is just dandy would be very happy to pay the thousands they think they deserve. One problem, though. Those patients don’t have the money. That’s why the large corporations who insure them must be pressured to pay for services that they don’t want, don’t trust, and don’t consider safe.

Birth junkies unite! Why should you be forced to get a college degree? That’s too hard. Why bother to learn about pregnancy complications? That’s too much of a downer. Just get together, give yourself a pretend degree and start collecting cash. Oh, wait. You already did that. You called the degree the CPM (to deliberately create confusion with the real degree, the CNM). But alas, no one wants to pay you to be a birth voyeur.

Enter Congresswoman Chellie Pingree and the MAMA Campaign. MAMA is supposed to stand for Mothers and Midwives in Action. The name is misleading on its face since it is sponsored by homebirth midwives with nary a mother in sight. According to their website:

Midwives & Mothers in Action, or MAMA, is a collaborative effort by the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council

MANA, NACPM, NARM and MEAC and ICTC are organizations by and for homebirth midwives; indeed, MANA, NARM and MEAC are just branches of the same organization, Ina May Gaskin’s self created empire. Citizens for Midwifery is arguably the only organization among the 6 that is composed of mothers, but its only purpose is to promote homebirth midwifery. A more accurate name for the MAMA Campaign would reflect who runs it and why. That’s why I propose Midwives Angling for Money Again (MAMA), since that is its real purpose.

What is a CPM anyway? The CPM is a second, inferior class of midwife that exists in addition to the more highly trained nurse midwife CNM. In all other first world countries, a midwife has a four year university degree that includes in-hospital training. Certified nurse midwives in the US have a nursing degree and a master’s degree in midwifery. CPMs in contrast have a post high school certificate with no in-hospital training in preventing, diagnosing and managing childbirth complications. Real midwifery training was simply too hard, so a group got together and created a pretend credential to fool unsuspecting pregnant women. And who created that credential? MANA, NARM, MEAC and CfM, of course.

The MAMA Campaign claims to be:

Advocating for CPMs as a high-value option for quality cost effective maternity care.

Curiously, the slogan does not mention the safety of CPM care. That’s probably because every study done to date (even those that claim to show that homebirth with a CPM is safe) and state and national statistics show that homebirth with a CPM triples the neonatal mortality rate. Indeed, homebirth with an American homebirth midwife is the most dangerous form of planned birth in the US (See Homebirth kills babies, Homebirth with a direct entry midwife is th most dangerous form of planned birth, and Inexcusable homebirth death toll in Colorado keeps rising).

And it’s not clear that certified professional midwives provide care that is either high value or cost effective. Indeed, Canada, which used to have a similar class of midwives, has banned them from practice. Now all midwives in Canada must have a four year university degree.

Ironically if CPM care were safe, high value or cost effective, the insurance companies would probably be first on the bandwagon to pay CPMs and promote their use over the more highly trained (and more highly compensated) certified nurse midwives. Yet most insurance companies do not accept the CPM credential. The cost for a CPM attended delivery may be cheaper, but when you add the cost for hospital transfers, NICU stays, and handicapped infants suffering brain damage from lack of oxygen in childbirth, it no longer seems like a cost effective alternative.

The bottom line is simple. If you want to practice midwifery, you should be required to have a real midwifery education and real midwifery training, comparable to that anywhere else in the first world. If that’s too hard, you can award yourself a pretend credential (the CPM), but don’t expect the rest of us to pay you to live out your fantasy. The law promoted by the MAMA Campaign is nothing more than a special interest lobbying effort. It exists for one reason, and one reason only, to force insurers to pay practitioners who are undereducated, undertrained and unsafe: Midwives Angling for Money Again (MAMA).

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