The pathetically minimal certification requirements for homebirth midwives

Want to know why the certification process for homebirth midwives (certified professional midwives, CPMs) is a joke? Just take a look at the certification requirements.

You can read all about it here.

What kind of background education is required for certification? Anything goes!

.. including programs accredited by the Midwifery Education Accreditation Council (MEAC) … apprenticeship education, and self-study… If the midwife is preceptor-trained … s/he must complete the NARM Portfolio Evaluation Process (PEP).

Seriously? Self-study is considered a valid means of acquiring a degree?

Who can be a preceptor and attest to the adequacy of the candidates educational background? Anything goes!

The NARM Portfolio Evaluation Process (PEP) involves documentation of midwifery training under the supervision of a preceptor. This category includes entry-level midwives, internationally educated midwives, and experienced midwives.

Anyone who calls herself “midwife” is automatically accepted as a qualified “preceptor.” Moreover, there is no effort to check a preceptor’s report of a candidates competency:

The preceptor holds final responsibility for confirming that the applicant provided the required care and demonstrated the appropriate knowledge base for providing the care.

That means that the only real requirement for becoming a CPM is taking the test. It doesn’t matter what your educational background is. It doesn’t matter how you got your clinical training. They aren’t even going to check whether you actually met the minimal clinical requirements. They’ll take your preceptors word for that and your preceptor can be anyone else who has passed the test.

Surely, the portfolio process is exercised by only a small number of women who have special circumstances? Wrong.

Consider this unbelievably scary statistic offered by the North American Registry of Midwives (NARM):

Of the more than 5000 births included in the CPM 2000 study published by the British Medical Journal, 99% were attended by midwives who received the CPM credential through the NARM Portfolio Evaluation Process.

In fact:

The majority of CPM candidates continue to become credentialed through NARM’s Portfolio Evaluation Process and all indications are that consumer demand will continue to drive aspiring midwives to seek the apprenticeship, community-based midwifery educational model that PEP validates.

So although there are midwifery schools, most certified professional midwives have never bothered to attend.

Compare that to the educational requirements for European, Canadian and Australian midwives. They must have a 3-4 year university degree, as well as home AND hospital based clinical training supervised by a variety of different instructors. Compare that to the educational requirements for American certified nurse midwives (CNMs). They have a masters’ level degree that involves even more education and clinical training.

The certification requirements for an American homebirth midwives (CPMs) are nothing more than a joke. Anyone can become certified so long as she pays the money and takes the test. There are essentially no barriers to certification, so any birth junkie can not only call herself a midwife, she can pay for a nice certificate to fool others into believing that she has completed an actual program of education and training, even if she has not.

How did this strange set of circumstances come about? As Robbie Davis-Floyd explains in Pathways to Becoming a Midwife: Getting an Education, A Midwifery Today book. Eugene, Oregon: Midwifery Today, 1998.

[Homebirth midwives] do not accept the argument that formal, standardized education is necessary to provide safe and competent practitioners.

That’s fine; they don’t have to “accept,” it, but that doesn’t mean that the rest of us should follow suit. Whether or not homebirth midwives accept it, formal, standardized education IS necessary to provide safe and competent practitioners.

  • Anna

    You seem to be confusing CPMs with LMs in a good number of instances. Shouldn’t a doctor be a bit more skilled at research and analysis? I’m a few semesters away from applying to med school, and if you are the standard to which doctors are held, it should be a cakewalk. I’ll just throw out hyperbole and do a few biased Google searches, then pretend I know what I’m talking about.

    As a mother, I chose a hospital birth because of my own medical history, and the doctor darn near killed me because he apparently misread my chart. My sister’s OB dropped her daughter on the floor during delivery, causing permanent brain damage. An OB/GYN in my hometown was convicted of rape after he was caught drugging patients and assaulting them. For every “bad midwife” story, there’s a “bad doctor” story. There are idiots it every profession.

    • Amy Tuteur, MD

      CPMs and LMs are two different names for the same thing: an undereducated, undertrained, pretend midwife, who wouldn’t meet the standards for midwives in any first world country.

    • Squillo

      Where is she confusing them? She’s referring to the credential (CPM) conferred by NARM; as far as I can see, she wrote nothing about licenses, which are conferred by the state in which the midwife practices.

      Moreover, her point–that the CPM credential is inadequate–isn’t negated by the tu quoque argument that “there are bad doctors, too.” The question is whether the basic requirement represents a reasonable standard.

    • PJ

      “You seem to be confusing CPMs with LMs in a good number of instances.”


  • Wildheartmuse

    CPMs are trained to administer pitocin, methergine and IV lines. They are trained in prenatal complications and when to refer the client to a doctor. They are trained how to suture,( and believe me when you are seeing the client for 6 weeks after the birth of her child you are going to do a much better job then if you were only there for the birth.)

    They are not trained in the high risk medical aspects of maternity care because they do not deal with high risk medical clients. They are there for those women who have researched their options and are looking for a comfortable and safe place in which to give birth.

    I would like to see CPMs and CNMs working together at birth centers and clinics that are affiliated with hospital “just in case”, and am happy to read that CNMs are hoping for that too. (what they do not agree with, and neither do I, is the PEP process, although it is how traditionally midwives have been trained since the dawn of time.)

    I have witnessed PPH and the CPMs fast response and life saving actions. I have witnessed transfer to hospital where the nurses and doctors are caring and welcoming to the CPM and her client. They would much rather she be there than the woman birth alone!

    It is my hope that a compromise be found between the total nay sayers and the educated caring community of low risk home birthers.

    They can work together. They do in many parts of the World.

    • Amy Tuteur, MD

      No, they are not trained in those things. Where did you get the idea that they are?

    • fiftyfifty1

      “I would like to see CPMs and CNMs working together”
      I would like to see CNMs denounce CPMs as the imposters and quacks that they are.
      CPMs will claim they have all sorts of skills and training, but the proof is in the pudding. If they are so skilled why are their death rates so horrific?

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