Judith Rooks speaks out on homebirth midwives (CPMs)

Rooks quote

Sara Snyder, of Safer Midwifery for Michigan, has produced an excellent series on the education of homebirth midwives around the world. Part 3 was published on Monday and is especially timely.

Sara invited Judith Rooks, CNM, MPH, who recently reported on the hideous death rates of licensed Oregon homebirth midwives, to share her thoughts about the CPM credential. Those thoughts are eye opening.

On the education of homebirth midwives (CPMs):

… the PEP [portfolio process] route to certification as a “professional” midwife isn’t deep enough educationally. The floor is too low, some of them are dangerous …

The PEP route to becoming a CPM seemed reasonable when it was started, but I thought it would only be used to provide an opportunity for very experienced OOH birth attendants, and that new educational programs along the lines of the Seattle Midwifery School—a direct-entry professional midwifery school based on the curriculum used in The Netherlands, would be started to provide educational opportunities for young women who wanted to start preparing themselves as midwives from scratch…

To my great disappointment, many young women who want to become midwives seem to think it is too much bother, time or money to complete an actual midwifery curriculum and think it is enough to just apprentice themselves to someone for a minimal number of births, study to pass a few tests, and become a CPM that way. (emphasis in the original)

On the licensing of CPMs:

… [M]any have inadequate knowledgeable, manual skills and clinical judgment. Some DEMs/CPMs say that it is the responsibility of a pregnant pregnant woman to choose her midwife wisely, but that is very hard to do.

I count on the state to not license inadequately trained health care providers. I can’t assess the skills of every professional I use. I would not hire an electrician to change the wiring in my house without someone knowledgeable exercising due diligence to assure me that the person I hire has achieved some minimal level of relevant education and prior experience (an apprenticeship). Attending lectures or reading some books isn’t enough…

On the credential itself:

The International educational standards should be the long term goal…

I thought the CPM would be short-term; we have lived with it now for a long time. The data from Oregon, shows that it’s not working. The CPM credential was a stop-gap measure from the next-to-the last decade of the 20th Century. We are now in the 2nd decade of the 21st Century.

Rooks gets to the heart of the matter:

The lingering questions then become why are the minimum standards so low, especially in comparison to counterparts around the world? Why is it acceptable for midwives to aim for the cheapest, quickest route instead of striving to be their best? Why are the “certifying” bodies (ie NARM/MANA) keeping the bar so low…as in only requiring a high school diploma as of 2012 instead of requiring a college level education to deliver our babies?

Why are the minimum standards so low? Because the CPM isn’t an academic credential; it’s a public relations ploy designed to falsely reassure women that CPMs meet the same international standards as midwives in the Netherlands, the UK, Canada, Australia and all other first world countries. It’s been an incredible success as a public relations ploy, but it is been a horrific failure by the measure that really counts: safety. CPMs have presided over so many preventable perinatal deaths that their own organization (MANA, the Midwives Alliance of North America) refuses to release their own death rates.

This has been known for a long time in both obstetrics and nurse-midwifery. Obstetricians have been speaking out about preventable deaths at homebirth for years; Ms. Rooks is to be commended for bravely doing the same.