‘I’m not a monster,’ says midwife charged with death of Moab newborn.
Really? What should we call we call her?
- 1983 Charged with practicing medicine without a license in California; pleaded guilty to reduced charges.
- 1993 Presided over the death of a baby at a twin VBA2C in Michigan
- 1993 Claims “They’ll have to cut off my hands to stop me [from delivering babies].”
- 2012 Presided over a neonatal death at homebirth of a VBA3C mother in Utah, administered Cytotec to induce or augment labor, delivered the baby using a vacuum extractor; massive postpartum hemorrhage.
El Halta has been charged:
Valerie ElHalta, 71, was charged in Grand County’s 7th District Court with unlawful conduct, a third-degree felony; and negligent homicide and reckless endangerment, both class A misdemeanors.
Her response:
When contacted at her home Wednesday by KSL News, ElHalta said she was unaware of the charges.
“I’m totally in shock,” she said. “I didn’t hurt the baby. I just delivered it.”…
“I’m not a monster. I’m just a grandmother,” she said Wednesday outside her Eagle Mountain home.
Cue the rally:
Tara Workman Tulley: Midwives and supporters. Regardless of the reasons for Valerie’s arrest, realize this is the second investigation of an unlicensed midwife this year, and the impact could effect every midwife and out-of-hospital birth. Two investigations is likely not an accident. We need a legislative watch group, and a united front of midwives. I will be setting up a GoTo meeting link for this meeting, and recording it. We will have an input period and figure out how to get ourselves united. We stand united and fall divided.
I only have one question. Who is more hideous? El Halta or the homebirth advocates who support her?
lol they deleted it all, but I have screencaps.
Tara Tulley was at my lawsuit against better birth of utah. She’s been a LCSW for three months and testified as an expert witness that continuing vaginal examinations when the patient is begging for it to end could not cause post traumatic stress disorder. She is SCUM. As a LCSW she is supposed to TREAT people like me. I guess lying is okay when you’re doing it for another midwife.
she tried to diagnose me with a personality disorder based off my blog. Its “attention seeking behavior”- yeah, I wanted to put attention on all the crap that goes on in her buddy’s birth center so other people wouldn’t go there.
Valerie delivered our last son in a home birth, and it went smoothly. This was after a doctor was trying to force my wife into another C-section after promising all the way until 2 weeks to go that she’d do her best to give her VBac. Still it’s not for everyone, but we were clearly educated on the risks going in and decided it was worth it. No deception whatsoever. Of course I’m very sorry for the family who lost this baby, and I’m glad the mother’s life was saved.
The risk that this could’ve been your baby was worth it to you?
You do realize that the decision to continue on with the option of a VBAC can be changed at any time until the baby actually comes out. I read so many times that ” my VBAC friendly doctor is now bait and switching me in my final hour”. Well good for her for reassessing the situation and deciding it is no longer felt to be safe.
At the first OB visit you can talk all you want about a TOLAC, but as the pregnancy progresses, certain situations will increase the risk of VBAC and make a provider recommend a RCS. You cannot expect to just have a TOLAC no matter what. The best chance for a successful VBAC is when you have an average sized baby in an averaged sized mother who goes into labor spontaneously before 40 weeks, no gestational DM. How can you guarantee a TOLAC on the first OB visit? The doctor is NOT bait and switching, she is assessing the situation and refusing to take the risks as the have developed.
VBAC
Increased success
Prior vaginal deliveries
Go into spontaneous labor
Decreased success
Recurring indication for 1st CD
Increased maternal age
Non white ethnicity
Gest age greater 40 weeks
Maternal obesity
Pre eclampsia present
Short inter pregnancy interval
Increased neonatal birth weight
Other tangible factors
Type of scar
Thickness of scar by sono at 36-38 weeks
Doctor experience
Hospital accommodations
Need for induction
Need for fetal monitoring ( usual first sign is fetal HR abnormality, not pain)
Breech/Twins/version
Previous fibroid/uterine surgery
Previous rupture
Calculator risk percentage
She is the reason my sweet son is in heaven. She gave me a pill that she said was homeopathic but was cytotec!!
That’s awful. I am so sorry for your loss.
I grew up in and around Dearborn and remember the birth center death being a huge local story, although it wasn’t until I read the link Dr. Amy provided that I knew the names of the women involved.
Rahima Baldwin ended up leaving Michigan, moving out west, and restyling herself as a Waldorf parenting expert. She wrote a book called, “You are Your Child’s First Teacher.” I bought it when I was pregnant with my son. In the “About the Author” section, she is described as the former director of a birthing center in Dearborn, Michigan.
I really still cannot understand why CNMs seem not to object, even seem to welcome, being lumped in with CPMs. Here’s an example of what I mean by “lumped in”: Google the name of Deena Chamlee CNM who comments on a regular basis here (including today). The first link that comes up is the Healthgrades website. On the Healthgrades website it lists some general info about Deena, and in the right hand collumn it suggests a few other clinicians to consider who are also a “Nurse Midwife” and “Within 25 miles”. The third and fifth alternate recommendations are for Patricia Couch CPM and Betty Ludlow CPM.
Is that cool with you Deena? Are you cool with patients trying to find you and having them re-routed to baby-killer Patricia Couch instead?
Because if my Healthgrades page listed a couple of renegade NDs (naturopathic doctors) as good alternates for me and on top of that called them “Medical Doctors” I would be outraged.
But no, CNM and CPM leaders apparently get together 4 times per year to chat about all their “common ground”. How degrading.
I think I am respecting you more with every post. I did not attend the common ground meetings after the first meeting. It just felt terribly wrong on many levels.
I have been probably one of the most outspoken midwives against licensing GED and high school graduates as professionals within the Oregon ACNM Affiliate. I have expressed oh too many times that while I may embrace my heritage (my is the granny midwives from the south) it does not mean that I embrace the educational standards from the 20 century.
In fact, I have been so verbal another tenured CNM attended the workgroup sessions with the legislators because “they did not want any confrontation.”
I think that by not confronting the very uncomfortable issues regarding ethics, educational standards and regulation with direct entry has significantly marginalized the profession of midwifery.
I really have no problem taking a stand for my ethical, educational, and practice beliefs regarding midwifery. Others seem to have a problem more than I. And then again many became extremely fired up for change. Hence all the movement in Oregon.
Amy opened my eyes and there has really never been going back. I feel the “sisterhood” that is so keenly observed in midwifery is extremely codependent. I am actually becoming even more keenly aware of the unhealthy dynamics by blogging with everyone on SOB.
I am outraged. And I am disgusted that we have allowed this to go on as long as we have. But I am only one of many. Many support each other regardless of the carnage but I could not.
I can only hope that the leaders that are addressing this at the national level do not seek middle ground because as i have experienced during my interactions with direct entry that is a very dangerous place to be. They feel they are your equal.
I am glad you are speaking out. There have GOT to be other CNMs out there that feel the way you do and are just waiting for someone else to light the spark. Trying to play nice and hope that CPMs can be eased upwards into improvement is an exercise in total futility because they don’t want to improve.
CPMs have co-opted the legacy of granny midwives. Granny midwives were true heros who strove to be as professional as they could be in a situation that denied them education, training and resources. And now CPMs say they are the true inheritors of this legacy all the while REFUSING education, training and resources!
CPMs say they are the descendants of granny midwives to play on CNMs’ sympathies so they won’t be rejected. But CPMs are the descendants of nobody but their own damn egotistical imaginations.
Throw these phonies out on their asses. Thow the woo out on its ass too. Keep the parts that should make midwifery proud: top quality care, excellent patient education, respect, communication, individualized attention, support for women and babies and families, advocacy for marginalized populations.
Someone correct me if I’m wrong, but it seems like a big difference between the Granny Midwives of bygone eras and the CPMs of today is that the Granny Midwives were serving a small community, one that they were a part of. The women who they helped were likely to be women that they knew, maybe had known since those women were children. Every time there was a death or a damanged infant, the whole community would know it, and they would continue to encounter that family regularly- at the grocery store, at church, etc. They were HIGHLY motivated to have the best outcomes possible. Very differant from some of these CPMs who are more invested in ideology than in outcomes, who never met the woman before she was pregnant, and who will be unlikely to run into the family again after the birth, regardless of its outcome.
I don’t know if Australia has a similar ‘Granny midwife’ history. Certainly the only birth I’d read about was in a biographical story called ‘Mad as Rabbits’, where the midwife passed out drunk in the corner of the room while the mother gave birth herself and tied the knot in the cord. The writer seemed to indicate that such births were not uncommon (depression era regional Australia) but perhaps there was some literary license in that.
I think we also have to consider that in the years gone by of “Granny” Midwives, especially in areas of extreme poverty, they may have been the only source of any Childbirth assistance that Women had available to them or could afford. Even in more populated areas, many births were attended by Midwives (My Father, born in Central NJ, was born at home) so naturally, midwives were connected to the community; not every community was fortunate to have a competent one, those Midwives that were competent, even given the limitations of the era, were held in high esteem. Because there just wasn’t any other choice.
Also, even with Hospital, Physician available childbirth as an option, many could not afford it.
It is a political nightmare. AAP and ACOG have given the ACNM permission to address midwifery nationally by recomending CNM/CM attend OOH births.
So what does ACNM need to do to move forward? It is a difficult answer because many feel the homebirth community are their sisters. But are they really?
Think about it for one moment.
It is because of rougue midwifery that the CM credentialed midwife has not been incorporated into all fifty states. It is because of rouge midwifery that midwifery has been stifled in the United States.
I recommend that ACOG and AAP discuss with ACNM the best way to move forward. I am not sure this would be pitting one side against the other. I think it would be helping midwives to not be codependant. It is very interesting dynamics no doubt.
Much easier to see when you are not enmeshed in the problem.
The United States is unlike Canada regarding health care. We are not ran by the goverment. Therefore, at the federal level it would not work to create mandatory delivery of OOH services by CNM and CMs. It would have to be left up to the states.
But our ACNM leaders could wake up and think twice about what truly is the best way to move forward? What way would service the consumers of America more justly. I think all one needs to do is to look at Hurt by Homebirth, the data from Oregon, the data from Colorado, the data from North carolina, the data from Michigan, the data from California, and so on and so on. This can’t be fixed unless our leaders have assistance with turning the lights on……..
Anyone performing deliveries in a hospital environment is constrained by the policies of that hospital, which usually conform to ACOG. But who is going to oversee OOH births? It isn’t just about the education and licensure of midwives, CNMs or CMs, it is also about which types of patients are strictly forbidden to have a homebirth, or the criteria for suitable candidates. [This includes the type of housing arrangements the mother is in] It is about the availability of emergency backup arrangements, and when they must be used. It is about legal requirements for the recording of births, of peer review at intervals to ensure that midwives are kept at peak educational and practice levels, just as OBs have medical review boards and department evaluations. And there would have to be teeth in any legislation to enforce compliance.
Not at all easy to accomplish. I grant that making the term “midwife” apply exclusively to CNMs and perhaps CMs [I know less about their standards, etc.] is a start, but it is only a start.
Antigonos, I totally get you on the housing requirements.
Having a baby in a 10th floor 1 bedroom apartment with a temperamental lift and 2 small children underfoot or in a caravan without running water or mains electricity on a halting site are both very different proposals to having a baby in a 4000sq ft detached home with 2 cars in the driveway, a jacuzzi tub in the master bath and all mod cons.
In order to have a Homebirth, your home first has to be somewhere safe and salubrious. For many women, the place they call home is neither.
In Cambridge, in the mid 70s, the housing criteria were minimal, but it was surprising how many East Anglian stone farmhouses, some well over 200 years old, failed to meet them:
1] Indoor running water
2] indoor bathroom
3] the ability to heat at least one room to 18 degrees Celsius. Often, this was the kitchen, which still had an open hearth. Mother would sleep on a camp bed next to the baby.
4] be on the telephone
and 5] there had to be at least one adult constantly with the mother and baby until 10 days postpartum. Fathers could get leave from work.
If these conditions could not be met, the mother and baby could not be discharged from hospital after 48 hours but had to stay for 10 days [when the midwife’s legal responsibility ended], and of course a home birth was ruled out.
After all the conversations yesterday, I have decided it is a total mess. In fact, it is such a mess it is going to take “all hands on deck” to fix it.
How does one abolish a credentialed group that does not follow any standards? The credentialing and licensing of the groups are done at the state level, hence, there is no federal oversight or body with the power to implement sanctions.
At the state level. Troops were rallied, legislative agendas were made but the legislatures refer to the direct entry for setting their own practice standards. In fact, it was made very clear by direct entry that CNMs were not going to set practice standards for direct entry .
Even after Judith reviews the mortality and morbidity rates with the legislative group, the only changes written into law was mandatory license with a loop hole concerning “traditional midwives.” And an autonomous direct entry board was demanded by direct entry in exchange for mandatory licensure and it was granted.
CNMs are not viewed as experts in homebirth by the legislatures. And majority of us are not practicing OOH.
I am telling you all this is not going to be easy. The Oregon ACNM Affiliate spent countless hours debating, considering alternatives and searching for data on OOH births, common ground gatherings 4xs a year between direct entry and cnms. And high risk obstetrics remains as inclusion criteria for OOH with CPMs and DEMs.
You can’t lead if others who are writing the laws do not see you as leaders. And that is the sad truth.
I think there is a real question here whether, in view of the danger to the INFANT, midwives should be encouraging OOH births at all in the US currently. Surely someone has to be the advocate for the voiceless baby. Why does a mother feel it is her “right” to have a choice, but the baby has none at all?
I’m not opposed to homebirth, although I personally think that even in the best of all worlds, it really isn’t all that great an experience. Looks nice in films; the reality is messier, more chaotic, with more upheaval, etc. than one thinks. And, IMO, the new mother does not get the postpartum rest she needs, having to almost immediately resume full housekeeping duties. BUT I agree with women who find hospitals cold, unfeeling, even hostile environments in which to give birth. CNMs could — and should — be major instruments of change in the entire hospital sphere — at least until some really adequate system of community midwife care can be established [which, frankly, given the size and diffuseness, as well as the history, of the US I think is a very long way off].
Because until the baby is born a woman has a completely right to autonomy of her body. I wouldn’t want to procreate in an environment where any other standard existed. A baby has no rights or choices as long as it is inside of someone else’s body! When you believe anything else you end up with Savita Halappanavar or Bei Bei shuai.
Legally, this is not true. While it’s rare, there are times when women are compelled by a court to make specific choices. Absolutes are normally a bad idea.
Actually most of those judgements have been held up as unconstitutional. However, the women have usually already had to comply with them by that point.
It really depends on what state you live in and how deeply the religious beliefs are of those particular regions and those of the people in political power where you live. Usually the Supreme Court will rule a women’s autonomy supersedes the interest of the state of the fetus to be born. Creating a class of people, in this case pregnant women, who are excluded from consitutional rights is very dangerous for all of us!
This isn’t something I’ve done research on. I’ve just heard of / read about instances, so I knew of proof of existence. Yeah, if it’s found to be unconstitutional, it’s unfortunately kind of too late to be helpful. I guess it shouldn’t surprise me that this is tied more to the fundamentalist states.
I thought that late term abortion was illegal in many / most states, with the exception of the life of the mother? I know some in the federal government have tried to make late term abortion illegal and failed. But I thought it was illegal in many states?
Thus, I thought that there were some real restrictions on what the mother could do with her body. But I could, of course, be very wrong on this.
It really does depend on the state you are in. The restrictions are unconstitutional, but its not the only situation where state and federal laws are in conflict. This is a pretty good break down. http://www.guttmacher.org/statecenter/spibs/spib_PLTA.pdf
Thanks for the link. There was a lot of information there, and this is definitely not something I am expert at in knowing the law. I mostly know what I’ve heard on the news, plus occasional web sites doing analyses with different biases, apparent and not.
I also want to add, this is coming from a woman who went against medical advice to carry to term a fetus whose existence was directly threatening my own! However, this was my personal choice to risk my own life to give life to my son. I don’t want to end up in a country where I am forced to risk my life for an unborn fetus. It’s a very thin line here! Punish the midwives but not the women!
That is a failure of leadership, yes.
By searching for common ground, you stoop to lower standards, and raise up those who are below you.
Possibly, but more than likely it is several co-factors that lead to what I have viewed as failure. Maybe my expectations are much too high, but I don’t think so.
It has been such a difficult experience practicing midwifery in Oregon. I cannot stress the insanity that the chaos has created, not only to consumers who are grief stricken but to in hospital providers who are shocked and appalled over and over again at the tragic losses.
Providers and institutions stand up and law suits begin.
No one really knowing what to do except scurry around and try to prevent the client who’s baby is breech with an extended head and a VBAC from delivering with three direct entry that assure her that all will be well. That was one of my last experiences.
And it is so serious here because this state does the second most OOH births in the nation.
We will see how ACNM will lead at the national level. I believe we have the brightest minds in midwifery and if it can be done I think it needs to start there.
We can attempt to address things locally with direct entry such as review of cases that involve deaths of 43 week fetuses in utero. But that is not going to improve outcomes.The basic infrastructure is so badly damaged, I am frightened it can’t be repaired.
So while I see the historical meetings occurring, I can’t help but feel sadness in regards to these attempts.
I feel the national organizations, ACNM, ACOG, AAP and MANA need to meet as soon as possible and a disaster plan should be created and implemented.
One of these things is not like the other.
Again, you still want to accommodate the CPMs.
Note as I noted below, this is NOT about homebirth vs not homebirth. There is no reason that CNMs cannot do homebirths, if they are appropriate. And if they are not appropriate, then it makes no sense to put CPMs on them.
But here again, the ACNM lets the lay midwives frame the argument.
It’s as if the big players in astronomy like the NOAO and NASA and the NSF decided they needed to meet to create and implement a plan with some “thought leaders” in astrology.
And if that hypothetical day ever arrived, I can guarantee that the NSF and APS would reject it. I’m highly confident that NOAO would reject it.
NASA is tragically so highly politicized that I am not confident they would reject it. I fear they actually might try to do some token meeting in the middle, some kind of “We’ll yes them to death and make it look like we’re giving in” for political expediency. I don’t really believe that NASA would concede anything scientifically
No, the ACNM, ACOG and AAP need to *denounce* MANA.
I am beginning to agree. I think if ACOG and AAP asked to meet with the leaders of the ACNM and address all the concerns and present all the data of morbidity and mortality (I think Amy could do this extremely well) you just might be able to turn the lights on.
I am telling you they may not be able to see because of the dynamics. Going toward danger instead of away from danger. I really think it is needed.
IMHO, part of the problem is that lay providers are able to demand — and get — any concessions at all.
” common ground gatherings 4xs a year between direct entry and cnms.”
Ish. Just say no.
I have just had a revelation because of someone sharing from Canada. There are enough of us on this blog MDs, CNMs, and consumers to lobby at the federal level for tort reform.
I know I would catch much heat from some in my community but I have to agree that trying to totally overhaul the United States Midwifery structure, that would be inclusive of mandating education for the current direct entry that are not CMs, will more than likely never happen.
The ICM standards of a three year curriculum or any curriculum that is approved by MEAC, or NARM will only result in the same outcomes.
ACOG and AAP could address things with the ACNM. Because you can’t see until you can see. A tort reform law could mandate that all CNMs and CMs are licensed in all fifety states and that appropriate MD back-up for these providers would occur that would allow for birth center and home births services to be offered to consumers.
And then the CPM could be abolished.
That’s a great idea. I wonder though what comprise might really look like? Because there are a fair number of CPMs out there. I don’t think the purely apprentice and distance study midwives have a “real” education and I don’t have a problem with just abolishing that and saying “tough”. But the midwives who attended schools in Florida or Texas for example, I am thinking about the three year program in Texas I read about, I see their claim to needing some recognition of their education as having some validity. Do they get a certain amount of time to go get a CNM? Do some get “grandfathered”? Have you had discussions like this about making a change to make things safer?
Yes we did discuss things like this when our initial group of CNMs gathered in Oregon. But that was quickly squashed when the legislative work groups began their work regarding law changes in Oregon. The CPMs prevailed on almost every measure except for licensure. They conceded to this. But not banning of high risk obstetrical practice in an OOH setting.
I think you probably actually know the CNM who delivered my daughter at home. “He” has taught in Utah and Oregon. My daughter is 30 and it’s been a long time. I am still in touch with his former wife, also a CNM, they are exactly the sort of people who would be doing deliveries in my idealized home birth midwifery world. Just curious!
I think when midwifery started in BC, the midwives that were practicing prior were somehow assessed and brought into the system even tho that was before the 4 year university program was going. But standards for practice were also pretty strict and I know of several stories where hosp priv were revoked. Of course, some midwives now work outside the system, underground as trad birth attendants (gloria lemay, moreka jolar etc.) and I don’t think the legal system has really used its teeth to stop them effectively.
BTW, health care in Canada is provincial. The provinces get money in transfer payments from the feds, but the provinces decide how to organize delivery. Some have decided to licence and fund midwifery, some have not.
If they can’t jail this woman for murder because she is too old at 71, yet she can still continue to kill at 71, let’s use her own idea – cut off her hands.
Since when do we not jail people just because they are old? WTH? She can still KILL, and is a danger to the public.
Governor Ryan of Illinois went to jail, even with his ailing wife living alone.
Again, tangentially related, but you can’t make this stuff up:
http://www.dailymail.co.uk/news/article-2346554/NHS-chief-offered-bribe-hush-death-baby-Fathers-shock-scandal-hit-bosss-3-000-cash-deal.html
Not to diminish the tragedy of the man’s loss, but AFE is a pretty awful diagnosis with high mortality on its own – was it badly handled by the hospital? (I’m not especially well-read on this situation)
I think it has a 50% survival rate, which is going up, but that’s not the point. The hospital should be open to investigation. If there was no negligence then they have nothing to hide.
The background to this is that the hospital has had a string of maternal and perinatal deaths:
http://www.guardian.co.uk/society/2013/jun/19/furness-general-hospital-failings
A recent report has suggested that senior figures within the regulator hushed things up in order to avoid embarrassment.
http://www.telegraph.co.uk/health/healthnews/10128886/Cover-up-over-hospital-scandal.html
According to the father the notes and CTG are still missing:
https://twitter.com/HendricksonCarl
The mother may well have been in serious trouble, even with the best care, but the baby might have stood more of a chance if something was done sooner.
http://www.nwemail.co.uk/news/ulverston/pregnant_woman_dies_in_her_husband_s_arms_1_589497?referrerPath=home/1.250461&FORM=ZZNR4
In any case offering him £3000 pounds to shut up and leave the area was particularly callous.
“Can we have a grown-up conversation? We don’t want to be sat here in two years’ time and you’ve lost your case. So why don’t I give you £3,000, [we] will find you a job in Preston, you can move from the area, and we can all move on with our lives?”
AFE is rare and has a high mortality rate even when treated promptly in hospital.
This is one of those times that the nick “The Daily Fail” is deserved.
I woke this morning reading homebirth and direct entry horror stories all over the web. The “woo” factor, so to speak, as many call it in this forum.
I found myself feeling utterly depressed and outraged simultaneously.
I want to speak out about the gatherings that are occurring between ACNM, MANA, MEAC, NARM and AMCB. While many of my colleagues that are participating in these meeting may be east coast based and while many members from the ACNM may only know the leaders from MANA through professional associations, I want to stress I know the leaders from MANA because they sit on the board of direct entry midwifery in the state which I reside.
I have had the not so pleasurable task of being immersed in the utterly horrific carnage that has resulted from these leaders not addressing education, licensure and regulation of direct entry practice in my state. I have been saddened with the refusal of complete transparency in regards to the data that has been collected regarding homebirth morbidity and mortality, not only in the state of Oregon but nationally, that is held within the MANA STATS database.
Where I am going with this is:
The loss of Oregonians that has occurred at the hands of direct entry’s high risk obstetrical practice, in high risk out of hospital settings is unfathomable. And unless you have lived it, you may not be able to appreciate what occurs within oneself.
Therefore, I am employing my colleagues to take a very strong stand,for not only Oregonians but all Americans, when addressing education, regulation and licensure with direct entry midwifery.
Methodically address the educational structure nationally with direct entry. And take a very strong stand that uneducated, unregulated, unlicensed midwifery practice must end.
Create a board that sits at the national level that will have the power to regulate midwifery standards of practice in the United States. And ask that in order to create and foster trust release the data of homebirth outcomes by CPM’s nationally.
Then without sidestepping anyone’s toes abolish the CPM credential. And implement through mandated university based training between Bastyl and State University of New York Downstate Medical Ctr and or Midwifery Institute of Philadelphia University which leads to the CM credential an educational venue that will begin to create the new direct entry pathway.
The carnage has been much too great and the people of the United States deserve better than what we have given them.
Bastyr? As in their midwifery program? None of the credits you earn there transfer anywhere else. The instructors who do the clinical as well as the science part are CPMs with varying levels of education. One midwife who teaches a clinical as a degree in religious studies.
It is the best we have where homebirth is taught. It just is. They will have to figure out the pathway that educates in all three settings. We have an enormous amount of extremely bright minds within ACNM. And I know they have not only the knowledge but the ability and power to make it happen.
“It is the best we have where homebirth is taught”
That is telling.
yes it is telling but it is at least honest.
Bastyr University has received approval from
the state of Washington as a recognized midwifery
training facility and provides education for midwives
in a program for direct-entry midwifery students
in the articulated Bachelor/Master of Science in
Midwifery. This program is accredited through
the Midwifery Education Accreditation Council
(MEAC). Graduates of the Department of Midwifery are eligible to sit for licensure in Washington
and other states and apply to the Canadian bridging program for provincial registration. Graduates
of both programs may sit for the North American
Registry of Midwives (NARM) exam to receive the
Certified Professional Midwife (CPM) credential,
recognized in many states for legal practice of midwifery and reimbursement for services
Probably because UW is trying to close it’s CNM program. The Bastyr students went and protested that with signs (as did many CPMs). They also picketed a local hospital that was closing it’s CNM practice. It seems to be a pattern with midwives, one seems in danger, all of them jump in and defend. It goes back to the idea of the sisterhood.
I attended Seattle Midwifery School (before the Bastyr merge) and attended Bastyr for other classes. I can’t get behind a school like Bastyr that teaches midwifery classes online.
see my above post.
I find this depressing.
IT IS STILL CRAP!
We have REAL universities and real programs for CNMs, we do NOT need anything less!
I feel like, if this were for MEN it would never be an issue! No one would suggest a MAN go to a half assed health care provider!
Renee the homebirth movement started in the 70s with hippies in California as well you know. And it has grown into the mess we have today because it has always been such an overwhelming political problem that no one who lead the ACNM dare begin to tackle it. There is so much that is broken it is overwhelming to even think of ways to fix it.
So even though IMG is at the head of the movement and she is not trained in midwifery or statistics (English major) and her dialogue in the book “Spiritual Midwifery” is extremely offensive (I could not even get past page 7) she is respected and loved by others worldwide. It is just the truth.
They (the homebirth movement group) and ourselves CNMs/CMs are both responsible for the problem and we will both need to be part of the solution or there will be no solution.
I do understand. I appreciate your posts because they are educational and illuminate things I don’t get to see otherwise.
From the perspective of an outsider, I just do not see why unskilled, dangerous, pseudo professional people need to be considered in this way. In electrical work and engineering, we would never allow a group to just make up a credential, kill a bunch of people, and then say “well, they exist, so we have to include them.”
No. They would either come up to standard, or they would be stopped. I am unclear on why we let HB MWs do what we would never allow other professions get away with. Because women like them? So what? We don’t allow lay abortion providers, and they are wanted and needed too.
This conversation is interesting because our personal POVs really do inform the way we see the problem, and the way each of us would fix it.
I agree. The CPM should be abolished. There is no need to tolerate incompetent practitioners. ALL practioners should be held to high, scientific standards or not be allowed to practice. The only people who benefit from incompetent practitioners are the incompetent practitioners.
Then instead of trying to address things with the current homebirth community. Maybe we need a federal tort reform law that mandates that all CNM/CMs provide homebirth, birth center and in hospital services.
The CM credential could then be licensed in all 50 states. Maybe if we were mandated by a feral tort reform law and the CMs were brought into the mainstream healthcare system there would be enough providers.
I have never looked at it from this perspective.
I have never seen licensed electricians or plumbers rally around unlicensed people who practice without a license and do a terrible job.
I agree with you about the lay abortion providers, it’s a apt analogy.
The only reason for back alley abortions is because laws prevent them from being done by qualified providers in a safe, proper environment.
The reason we have “lay midwives” is because qualified providers do not consider HB to be a safe, proper environment.
We frequently see cases with “lay cosmetic surgeons” in the news. You have people injecting lips and buttocks with heaven knows what (sometimes concrete), as well as the occasional lay sex change operation. Cost is often a consideration.
That doesn’t explain, though, why Priscilla Presley and other celebrities fell for the dreadful Dr. Serrano.
“In fact, Serrano was injecting industrial, low-grade silicone similar to what’s used to lubricate auto parts in Argentina into the faces of these women. Several women, including Shawn King, Larry’s wife, and Diane Richie, Lionel’s wife at the time, held injection parties in their homes, with Serrano needling them with the non-FDA approved drug that he had smuggled in to the U.S. Shawn King has said the injections created a lump in her lip that made it difficult to speak and drink liquids. Serrano charged between $300 and $500 a pop.
“But wait, it gets worse. Serrano wasn’t even a licensed doc in the U.S. The injections caused lumps, paralysis and holes in the faces of some of the women (and some men) he injected.”
http://www.huffingtonpost.com/2008/03/24/priscilla-presley-treated_n_93144.html
I suspect that “non-FDA approved” was actually a selling point.
While I agree, I also believe that with significant tort reform, more OBs and CNMs would be willing to do home births.
The US seriously needs tort reform. Some states are close to no longer having enough OBs due to lawsuits and the cost of malpractice insurance. The problem is, how do you implement tort reform without just giving a pass to bad providers, without redefining a new normal that allows malpractice.
While the direct cost of malpractice insurance and the direct cost of malpractice lawsuits is not that big a fraction of the cost of medical care, the indirect cost is very high — all of the tests that doctors do not because they are indicated but to avoid a lawsuit.
But you only get lawsuits for bad outcomes. So avoiding lawsuits means avoiding bad outcomes. I have yet to hear anyone explain why that is a bad thing. Yes, the extra tests are a little more costly, but what is the cost of bad outcomes?
I’d like to hear what tort reform you think would help. Certainly not capping awards in cases where malpractice has been found.
Tort reform is an easy word to throw around, but coming up with something that makes sense is a lot harder.
Avoiding bad outcomes is a good idea, of course. But when doctors have to perform tests they know cause more harm than good to avoid a very small number of failures, simply because they open themselves to a lawsuit if they don’t, it’s not a good thing.
For example, the PSA test. With this test, ultimately, more harm is being done by biopsies and surgeries that turn out to not be necessary than good is being done by saving lives. If the surgeries had no side effects, it would be different. There’s a controversy in the US right now on how often mammogram screening should be done for similar reasons.
In some states, the chance of a doctor being sued is so high that doctors are retiring or leaving the state. This is a real problem. Illinois is approaching the point where there won’t be enough OBs in some counties, and suits are one of the primary drivers of OBs leaving the state or leaving practice.
I don’t know what the answer is, but the status quo is bad and getting worse. Hand-waving, “but preventative medicine is good, right?” misses the point. Some preventative medicine is more harmful than helpful. It’s not free of side effects.
If it comes to consensus that a screening test causes more harm than good, then it will be out of the proper standard of care, and it will not be malpractice not to do it.
Tort reform will help reduce overconsumption of medicine. We have far more diagnostic procedures in the US than many comparable countries, and our outcomes are no better. These extra diagnostic procedures are not leading to better outcomes, just to higher costs. One factor (of many, to be sure) driving these extra diagnostic procedures is fear of malpractice lawsuits.
I don’t have an exact answer. The fact that in Illinois, OBs pay a large fraction of their wages to malpractice insurance indicates that there is a problem. Malpractice insurance rates vary widely per state, and Illinois is among the worst in this area. The average OB in America is sued three times during her or his career. Do you believe that there is that much malpractice? If you win a malpractice lawsuit, you still have to pay for the defense, and barring evidence of malicious lawsuits, I wouldn’t want to change that.
In Illinois, OBs are retiring or leaving the state due to the cost of malpractice insurance. Of the ones left, some are not accepting high risk patients. This hurts patients, ultimately, more than it hurts the doctors.
Rather than punitive damages, I would rather see a bad doctor lose the ability to practice, period.
Tort reform is not a panacea. It, by itself, is not the answer. As I’ve said before, there is no silver bullet. Problems with the American medical system are many. There is no one change that will fix it. Tort reform is just one piece of a puzzle.
Again, you use that word “tort reform” but say nothing about what you are going to change (other than eliminating punitive damages, which is a debatable proposition).
Not only is “tort reform” not a panacea, it is a meaningless concept, because it never comes with an actual sensible plan.
What reforms do you propose making to the tort system that will solve the problem? Eliminate punitive damages? Cap awards? That makes no sense, because they are only applied to people who have lost.
Yes, I think there are too many lawsuits. However, you don’t want to interfere with cases where the plaintiffs win. You want to avoid lawsuits where the defendants prevail.
Now, how are you going to do that?
Keep in mind that people sometimes lose lawsuits who did nothing wrong (just as people win lawsuits who did something wrong). Also, many cases are settled, due to the costs of defense. Really, we want to reduce not only lawsuits where the defendants prevail, but also probably a great many of the ones resulting in settlement, and some fraction of the ones where the defendant does not prevail.
I don’t have good ideas for how to reduce the number of malpractice lawsuits where no malpractice occurred. That doesn’t mean I cannot recognize that a problem exists. That doesn’t mean it’s not possible to improve our current situation.
Tort laws are different between the states. If this were an area I had expertise in, I’d study those differences, see which legal differences correlate with malpractice costs, see how those legal differences affect those affected by actual malpractice, and go from there. From just a little bit of reading, it appears that simple caps on malpractice awards don’t make a big difference in malpractice insurance rates.
We both agree there are too many lawsuits. We both agree that actual malpractice needs to be punished. What would you do to fix this?
I don’t think the concept of punishment should have anything to do with malpractice lawsuits. Responsibility, restitution and prevention are what most people are after. If there ARE too many, than surely it is the lawyers who are to blame. Most lay people cannot ascertain what was malpractice without the legal process, and it all tends to hinge on what can be proved as much as what happened.
I used to think that a “No fault” system would be better, but when you look into it, it isn’t, always. Here in the UK, there are no punitive damages, the parents of a disabled child are of little account, and the costing is pretty brutal. Care still cost millions over a lifetime. In the UK it is State funded, money out of the NHS budget is balanced by the saving to the Social Security budget, nobody’s career gets ruined. The legal fees are horrendous.
Good point. I don’t know that “punish” is exactly the right word. The point is you want to flush the bad providers out of the system so they won’t cause additional damage.
The courts in America are far less inclined to charge barratry than in the UK (or at least that is my understanding). That allows and encourages — in some cases — rampant abuse of the legal system to punish, abuse, and silence. For off-topic examples, the church of scientology uses lawsuits to silence critics, and PETA has used specious lawsuits against zoos to attempt to drive up their costs to drive them out of business. The US legal system allows that and in some ways encourages it. It’s simplistic to say the lawyers are at fault when the judge and the court system allows it.
No-fault can be better in some cases, and the US has a no-fault system for handling children damaged by vaccines.
And a fair question to ask is: Should we treat an injured child where malpractice occurred any differently from a similarly injured child where no malpractice occurred? When the focus is on the courts, the answer is, “yes.” And to the extent you want to get rid of the bad providers, there is some justification to that if you have to go to the courts to do so. But this doesn’t help the families.
I’ve read from multiple sources that 2/3 of American individual bankruptcy filings involve medical costs. I’d guess that very few of these involve malpractice.
I Think you need a system that doesn’t compensate just bc something bad happened, but actually demands evidence of malpractice. Oh and doing away with “punative damages” is also a good idea. And yes, insurance that is spread amongst most or all providers also keeps cost down. Some kind of universal coverage for medical insurance also works. Damages awarded in Canada aren’t as high for several reasons that I can think of – universal medical so the family isn’t on the hook for hosp an outpt bills, rare or no awarded punative damages, and the CMPA, which insures over 95% of the doctors fights cases aggressively when they can find support from experts and settles quickly when they cant.
That’s what we have. You have to convince a jury that it is more likely than not that it was malpractice. It’s about following the standard of care.
Not in the least. It’s an awful idea. Without punitive damages, there is no motivation to avoid bad outcomes, because they merely become part of the cost equation.
What’s the cost of a dead baby?
Without something like punitive damages, folks can make safety a simple cost/benefit, and will build a model that allows the maximum return. We don’t want that. We want folks to minimize risks, not maximize benefit/risks, especially where the benefit is profits.
Bad behavior needs punishment, in addition to restitution. Consider, for example, a person who vandalizes your house by breaking your window. Is it sufficient that their punishment is that they have to pay to replace your window? Not at all, because that’s not really punishment for bad behavior. For example, that’s the exact same consequences you would face if you broke your own window.
Imagine that: break a window in your house, you have to pay to get it fixed. Now if a vandal breaks a window at your house, you are going to be satisfied just to have that person pay to replace your window? I hope not. You will want them arrested for vandalism, in addition to fixing your window. If restitution (“damages”) is all you require, then you aren’t actually doing anything to prevent bad behavior, you are only seeing how willing people are to pay damages.
I don’t care if they are willing to fix my window or not, I don’t want people vandalizing my house. Similarly, I don’t want people deciding medical decisions based on their willingness to pay for any damage that might be incurred. Malpractice needs to be penalized in addition to paying for the damage.
There are at least two systems to punish practitioners that don’t meet the and of care…actually three. First mds have been charged and convicted with criminal negligence causing bodily harm or death and served jail time. Secondly hospital priv can be revoked for hosp base physicians or limits placed on their practice. Thirdly the licensing body can revoke a physicians ability to practice…and the medical licensing bodies certainly have “teeth”. You don’t need punative damages to serve as a deterrent. All they do imho is drive up awards and insurance costs and I would like to see evidence of your assertion that punative dangers will decrease risk for patients. Awards in malpractice cases should be to cover the costs of ongoing and special care, lost earning potential and perhaps psychological harm.
I am against tort reform. It doesn’t help lower costs, and it hurts patients that NEED huge settlements to make up for the damage done to them.
A better solution is co-ops or non profit consortium for malpractice insurance. This can cut the cost, without harming those that need the funds from a suit. Remember- people win big when bad things happen!
As others have noted, it is only a problem because folks like you allow it to be.
You’ve mentioned the recent joint meeting of CNMs and CPMs to set standards. But why should the CPMs be involved at all? The ACNM does NOT need the support of CPMs to set standards. They should be the ones setting standards and saying, if you aren’t doing this, then you aren’t doing it correctly.
This makes no sense at all, and needs to change. Without the friggin approval of the CPMs. They can either step up and meet the requirements, or be recognized as the ones who don’t.
BTW, Deena…
“western medicine”? Your words betray you…
There was a fantastic speech by the Australian Army chief recently. It was about a different issue, but one of the lines was ‘the standard you walk past is the standard you accept’. Turning a blind eye to the poor care and outcomes of other “midwives” has lowered standards for all in the profession. The public has difficulty in telling the difference between a CPM and a CNM. I think that is one big red flag there.
Exactly. And what I am suggesting that needs to be done is, instead of turning the blind eye toward other midwives, what the ACNM needs to do is to put the spotlight on them, and, in particular, their lack of quality. The way to do that is for the ACNM to stand tall and lead in the area of midwifery, setting the standards and then challenging those who don’t live up to them.
This is not an issue of homebirth vs non-homebirth. If there is a place for homebirth in the US, then CNMs can do them. If CNMs aren’t willing to do a homebirth, then, as I’ve pointed out before, it makes no sense to outsource it to less qualified practitioners.
I am sure more would step up to the plate if we were trained OOH. I went to a couple of homebirths because as a midwifery student, prior 16 years labor and delivery nurse, I was biased against homebirth because of tragic transfers I had either witnessed or cared for when nursing.
They both were very nice and serene. Different because it was her environment but not difficult.
Many of us do not get exposure as students and that creates fear. If we had exposure I am sure many more CNMs would be willing.
I have a bit of a problem with the idea that fear is automatically a BAD thing. Being fearless doesn’t really do much to lower risk, does it? Wouldn’t argue that increasing confidence in their ability to cope with (some) things is OK, as well qualified, trained providers are an improvement to the alternative if people are dead set on homebirth – but I am sure the Lisa Barretts are quite fearless.
Gotta agree with you there, how many direct entry schools are there for urologists that specialize in men’s healthcare? And if there were, how many men would use them?
None, and there won’t be.
Trust prostate!
Have you seen the classes and credits needed? Their “Bachelor of Science” and “Masters in Midwifery” is a joke. Looks good on paper, and yes, WA state wants those joke CPMs in the mix and recognized because their assistance to pregnant women program uses them as care providers with home birth as an option. So the state is legitimizing home birth and making tax payers fund it. It’s not about quality of care, it’s about cost containment.
A bad argument, as ONE baby with preventable HIE will wipe out any savings, and push the balance sheet into the red.
That is the part that is so WRONG. I know, it’s the best example of structured education for CPMs. And it still lacks any kind of consistency. Setting Bastyr as an example legitimizes the woo. It still lets birth junkies who just want to catch babies and don’t want to do actual women’s healthcare an outlet. One of the biggest obstetrical malpractice cases in WA state involved two of the CPMs who teach at Bastyr. The birth injuries the little girl sustained left her unable to do ANYTHING. Those midwives still precept and teach.
I understand your concerns. This is the problem from my perspective.
When trained as a CNM/CM midwifery students are immersed in western medicine and the art of midwifery within a hospital setting. Majority of graduate prepared AMCB programs do not train midwives for OOH births.
The second issue. Because this is our history and is the current standard of the educational structure, programs that are MEAC and not MEAC credentialed exist that train direct entry midwives that lead to a DEM, LDM or CPM.
Obviously those of us who are trained in a completely different belief system look at the carnage and the curriculum of these educational pathways with judgement and criticism.
Third issue. Because the CNM pathway is one that is derived via a nursing curriculum, undergraduate and graduate, we are clueless about homebirth. We are for the most part hospital based providers.
Conclusion: While we may sit in judgement when looking at the current direct entry educational pathways, that do not result in a CM title, the mess is ours to clean up. You cannot just say abolish the CPM credential, abolish homebirth. The reason why one must be inclusive of the current direct entry credentialing bodies and organizations is because THEY CURRENTLY EXIST!
If you did not your work to change midwifery in the United States would be without merit and without success.
You do not have to be inclusive, that is the mistake CNms make (MDs do to with CAM). You can create a new structure, just like they did when they made up the CPM. It would be easier to create something new, even start up a whole new educational program, than it would be to fix the current mess. Just my opinion.
There does come a point where something is such a mess, with so little value, that it needs scrapped. I do feel the CPM and all the things that support is too far gone. **I could be wrong and am open to learning that where I am wrong. I am merely a bystander, appalled at the deaths of, and injuries to, dear friends babies. I admit my belief is based on what I see here in OR, as well as other professional experiences I have had where starting new was the best thing to move forward.
I want to see safe HB providers, ones that do not take high risk cases or lie to parents, ones that do not say GBS is no biggie. Ones that use evidence based care. I have no interest in restricting HB, and don’t know anyone else that does.
Bombsellrisa YES… they have to STOP legitimizing WOO as their unique knowledge base. That fuzzy thinking can’t be at the heart of midwifery education for CNMs or CMs to be taken seriously.
If Bastyr is the best, there are even bigger issues. That school would need a total overhaul to be able to turn out decent MWs.
But why do we need homebirth to be taught?
I can see needing to have techniques available for home, as it IS a totally different setting, and is low resource. But I can see it as an add on to a regular MWery or OB program, not a stand alone program.
IIRC, Deena said she thinks the best, most seasoned MWs should be the ones doing OOH birth, and I agree. Right now it is the opposite in too many cases, because experienced people are afraid to do OOH.
Perhaps there are separate skills for homebirth because of the different setting. But I can’t off the top of my head think of what they are, other than a particular bedside manner. I suspect most well-trained CNM’s or OB’s could handle a homebirth if they had to.
I suspect I could if I wanted to but I don’t want to. And many of my colleagues feel the same.
So who has the most prevalent presence at homebirths? The CPMs, LDM, DEM who are educated and trained via the PEP pathway (that only recently required a high school education) and the schools that exist that are accredited by MEAC and many not accredited by MEAC.
We are trained and educated in two totally separate beliefs systems. Hence, creating a barrier to understanding each other.
But ACNM will eventually be The America College of Midwives or The American College of Midwifery. The movement that is occurring with all of the meetings and gatherings is part of the process to get us there.
Deena, I have no doubt you would be skilled and competent in an out of hospital setting. The fact that you don’t want to (because you understand the risks and the numerous things that can go wrong) speaks volumes. The fact that poorly or untrained, uneducated birth junkies without any medical background think that they are qualified to provide care and attend women at home speaks volumes as well.
I am curious, do you believe that there really is a place for a second type of midwife, even one trained to a Bastyr level? In nursing, there is the RN and the LVN or LPN, however the difference in education and training as well as scope of practice is clearly spelled out. How do you believe the scope of practice can be spelled out and enforced between the two classes of midwives?
You know after everyone’s shares today I don’t think that an overhaul of the current midwifery structure/system in the United States that is beginning to occur with the ACNM and MANA is the answer to our woes.
I think it should be tort reform at the federal level that mandates CNMs/CMs be licensed in all fifty states and that home birth and birth center services along with in hospital services be offered to consumers.
This would ensure appropriate care and stop the rogue midwifery from occurring and harming families.
Isn’t that at the heart of the problem really though? I know well educated practioners who support homebirth. Most just support the right to homebirth. A much smaller subset choose homebirth for themselves, think it’s reasonable, but don’t choose to take on the burden of actually providing home birth care. I think education and intelligence in and of itself will make the majority of university educated midwives say, ok fine but I don’t want to have the homebirth disaster on my conscience. It’s once thing to choose home birth for your own baby’s birth, the odds are actually very low, especially with good care, that anything will go wrong. But if you make it your career? Absolutely, sooner or later, you will have a disaster at home that would have been better handled at the hospital, and you will have to live with that. I really DON’T believe that it’s “as safe of safer” at home. I think it’s mythology. I think the CNMs who believe it’s “as safe or safer” are usually woo infected. I do, personally, know of exceptions. But I believe these people are so rare that in the end, these changes would end up making it very hard to find someone to care for you at home. That’s fine with me but I think that home birth advocates will believe it’s the goal. I know it’s not the goal, but I think that would be the outcome of implementing these kinds of standards.
I think they would need to learn, to make home birth as safe as possible, risk criteria, considerations and indications for who “risks out” antepartum, intrapartum and postpartum. Additionally how to “set up” for homebirth, interfacing with 911 and hospital resources. There would be things to learn. What medications and instruments are standards to have… things like that. I guess if I were trying to guess what would be the ideal education there would be a clinical rotation through homebirth in midwifery programs. If home birth with the standards that just came out from AAP was part of all midwifery curriculums it might make sense. The part I have an issue with is that there is so much evidence that there is a three times higher perinatal loss rate. Maybe if homebirth were done only with AAP guidelines it would be less? If I were the midwifery rule maker I would also remove all “woo” from the curriculum, no cohosh, raspberry leaf tea, moxibustion. none of that crap. Only standard evil Western medical and midwifery care thank you!
The “midwifery rule maker”-love it! That is something I think needs to happen-make sure that the midwives have clear transfer plans. Not just call around to whatever hospital has an available bed and enough staff. No birth affirmations. No herbs or aromatherapy or other woo. Standardized charting-even if the hospitals that the midwife has privileges at uses computers only for charting. And yes, maybe if clinicals included home births it might be helpful
Time to go deliver some babies. For now each of us will just keep doing what we can to try and make a difference. For me it just can’t happen soon enough.
I love the new AAP guideline. All too often when a homebirth goes wrong for mom postpartum we get a call from EMS that not only is the mom coming in but the baby is cold and blue because it lies forgotten during mom’s emergency. I actually had a father forbid me from warming the baby, calling in RT and MD , and trying to draw labs because ” we don’t want routine procedures”. I ended up telling him that I’m sorry nobody told him his baby was sick, and I would be committing malpractice if I left his child alone. He grudgingly allowed me to do my job.
What in the world was he thinking he was protecting his child from at that point?
The midwife had told him it was fine to deliver a premature infant at home, and the baby started out looking ok. I also think it was a bit of a psychological defense to let himself believe we were being silly and the baby is really fine. His wife was critically ill and he was at his limit of stress.
It was “fine” to deliver a preemie at home? Oh lord. Poor woman, poor baby.
Dad let it slip that the baby was 35 weeks. Ended up that the baby had RDS and stayed for a few weeks.
According to my mother, my twin sister died because she lay forgotten during an emergency. Maybe my anger at wasteful deaths comes from that.
During my midwifery training in the UK, I did homebirths. There really is nothing special about them, by way of different knowledge or techniques. There is a certain amount of improvisation — beds at home, for example, are too low, and usually too soft, and so you learn how to raise them and tell the family they will need a bed board — that sort of thing, not specialist OB knowledge. Babies are not born any differently than in hospital although, for the birth attendant, hospitals are far more convenient, with supplies and personnel to hand in a way they are not at home.
It seems to me that there are several issues here, not just deciding which sort of midwives there should be. What impressed me in the UK was the complete integration of the midwifery services within the NHS: the profession was REGULATED on a national level from the moment a student midwife began studying, through her licensure, and her actual career as a midwife. She is entirely accountable for her actions. The system supports her with backup but also by its oversight of her performance. She has limitations on her scope of practice but also very considerable autonomy and both aspects are made very clear. This means a pregnant woman has the security of knowing that she is in the hands of a responsible person. In the US, it is just a case of “anything goes” and “whoops” if it goes wrong.
In Canada many of the provinces that state licensing midwives mandated that they offer both home and hospital birth. Thy cant do just one. This integrates them into the hospital system and ensures that trained providers are available for home births. Smart. No one should work strictly in a home setting – too much isolation and practice drift. And since after a few scary experiences or Near misses or fears of liability you don’t want a gap to be left where all the trained midwives drop the home service and leave it wide open for traditional or untrained yahoo mock wives. I don’t think the US is going to solve this problem with some kind of tort reform and a massive overhaul of the midwifery system. Not to say we have it solved in Canada either. The midwives here and sliding into the woo and I would never eer (like fifty fifty) recommend midwifery care to anyone. You just don’t know what you are ping to get
I think the Canadian system is pretty good-I had two Canadian friends who wanted to have home births. Both were risked out, so that tells me the midwives are not providing home births just to make a woman happy.
I now understand what you all have been trying to get across about homebirth being taught. I absolutely need to re-phrase this line.
Bastyr, other MEAC and non MEAC approved schools and via apprenticeship is how the majority of homebirth attendants in the United States receive their training.
Theadequatemother thank you for sharing. Maybe we do need tort reform at the national level that requires not just CNMs/CMs to provide homebirth services but all providers to provide homebirth services.
Now if this became the case then MEAC, NARM, CPM, DEM, LDM, PEP could all be scrapped. Because we would have appropriately trained providers providing services at home.
And yes short of a federal tort reform law, total overhaul will need to occur.
Which would be easier? Probably tort reform but I can tell you now MDs and members from ACOG would lobby against that bill.
And I do not think there is enough CNM/CM providers to take it on alone.
Look at the data, something obviously needs to be taught to somebody.
No, I don’t mean why do we need to TEACH homebirth. I mean why do we need to teach HOMEBIRTH. It’s sort of like running a program to teach pediatricians how to correctly use naturopathy.
It’s not a skill to hold the space while knitting?
You’re right. Bastyr should teach that. Or at least require proof of attendance at Michael’s evening classes.
Deena, I just want to say, as someone else has, that I appreciate your contribution to the discussion. You are someone who is directly attempting to change the system and that’s a lot more than most of us can say as outsiders. I appreciate that you speak up here and that you say what you think and discuss options for change that you know may not be popular on “Skeptical OB”. I personally had a homebirth with two CNMs in 1982. I went very well and was a great experience. Despite that, after becoming a labor and delivery nurse, it took about one year for me to decide the notion that home could be “as safe or safer” was likely nonsense. In fact I did have a third baby and would never have considered home birth again. But, when I read the stories here and from my discussions with CNMs and direct entry midwives, it’s just SO obvious that CNMs have the “real” education. My midwives were scrupulous about the risk screening to a degree I now see as very impressive. I didn’t hear one “woo” belief throughout my care. They believed home birth was a reasonable and safe choice but clearly told me if something like a prolapsed cord happened that the hospital would be safer. I think that’s what homebirth could look like to keep it as safe as possible. If it’s a given that women are going to demand then I believe that’s the correct standard– the best educated and most careful midwives. Right now that’s CNMs. Could there be good midwives that aren’t CNMs? I believe so. But does it really make sense in the US? I am not sure. Knowing as many CNMs as I have not everyone ends up doing intrapartum care their whole career. It’s so demanding and stressful. I think the idea that a CNM can do other things, whether its functioning as NP, even being a labor and delivery nurse, managing a OB unit, lots of things I have seen CNMs do who didn’t want to take call anymore, to me it makes sense for the person entering the profession to choose a CNM over the limitations of a four year midwifery degree as you said Judith Rooks envisions it. As a labor nurse, it’s never hurt me that I am a nurse and had exposure to med/surg, psych, peds etc in nursing school. We graduate ready to learn, not ready to practice a specialty anyway. Why I think it makes a lot of sense for a midwife to have nursing education. Perhaps not absolutely necessary, but overall is it better? I think so.
What you say is true and important, but here you are preaching to the converted. It’s the major news organizations, who seem to have no trouble publishing puff pieces about the glories of homebirth who need to be convinced to get the opposite message out there, IMO.
This is a very powerful blogsite, therefore, you never know who is reading. Putting it out there could spark ideas for other MDs and CNMs to ponder. And it also allows parents who have lost their babies to have a better understanding of midwifery’s struggles and current thoughts regarding implementing change.
FYI- Keep talking and you are likely to become a target for hate from the LDEM followers! They hate Dr Amy and anyone that associates with her, even by just being a reader.
Welcome to the club 🙂
Renee if others hate me it is none of my business.
They can be particularly vicious, so I think its always worth the warning.
I never thought anything of the haters either, until one went and made a blog with nasty lies and started linking it to peoples professional pages (unrelated to birth at all)! It is insane.
Thankfully, they are passive aggressive, and usually only nasty online. IRL they don’t have much to say.
I think its great you are speaking out, and hope more of your colleague follow.
Yeah. It’s a recipe- anonymity, borderline personality and a cult like belief in a cause- never underestimate what a nut like that will do because they have found an excuse to inflict pain on another individual.
You can’t live your life intimated by others who use abuse to control you. And too late now, my name is out there and it has been out there.
I agree with you and respect you for speaking out!
How many 71 yr old midwives are working in hospitals, in team-based safe practice environments? (rhetorical question)
same question only without the age restriction.
The important part is the environment which has both the resources and the protocols in place.
Or again same question, but with:
“Midwives who administer Cytotec to a patient with three previous c-sections…”
or
“Midwives who fail to monitor the FHR correctly..”
or
“Midwives who use a ventouse without supervision..”
Age is an important factor all by itself. I would not want a 71-year-old obstetrician. I like older people fine in a variety of different professions, but reduced cognitive ability, reaction time, and physical strength make midwifery or obstetrics a particularly bad match for the older worker.
This makes me think think you don’t know too many older people that are still working. My Dad is 72 and in better shape than I am. If he was an OB, I would trust him. The hospital is a TEAM. If the OB had to be totally alone, an age restriction might be relevant, but they work in teams.
I think I might be OK with an older endocrinologist or similar, but I do notice that high-quality medical people do retire promptly in their early or mid-sixties (that’s presumably one of the reasons why Dr. Amy does not intend to go back).
http://well.blogs.nytimes.com/2011/01/24/when-older-doctors-put-patients-at-risk/?_r=0
I think it’s very different with white collar jobs outside medicine and I agree that many people are able to work well into their 70s and even beyond. Even in the blue collar world, my grandfather is 91 and he’s just now selling off his cattle herd.
My feelings about CNMs have made a big change in the last 10 years. I no longer recommend them to my friends or patients. I encourage even the low risk moms to use OBs and actively discourage them from choosing CNM care. This is a big change for me; 10 years ago I chose a hospital CNM delivery for my first. Partly this was for more privacy for myself (I had trained under the OBs at my local hospital), but mainly it was because I thought “Why shouldn’t a low-risk mom use a CNM if she is healthy. It’s the best of both worlds, longer appointments, more “homey” etc.”
My opinion started to change in the aftermath of my difficult birth. I don’t blame the CNMs for the fluke outcome. Bad pelvic floor damage happens. But I was a bit taken back by their total lack of knowledge and intellectual curiosity in the aftermath. It was like “Hmmm, I’m not sure what that mass in your vagina is. I don’t THINK it’s a hematoma. Go home”. It was like if it didn’t involve Birth itself, they just weren’t interested anymore. The OBs I consulted were way more engaged. OBs are in it for the long-haul of a woman’s reproductive problems. CNMs look like (and I hate to say it, but this is how I feel) birth junkies in comparison. Not as bad as CPMs, but still…
The other thing that changed my mind was seeing how NCB infects the CNM community. I had previously not realized it. I thought CNMs were like other midlevels, having less training and more time for talking and patient education than MDs, but otherwise the same. And I still think some of them (many of them? most of them?) are. But I realize there is a big streak of NCB and willingness to play fast and loose that infects them. And why are they still in bed with CPMs? Why??!
And then my local hospital CNM group hired a total NCB loon! That was the last straw. I met her at an IT training class and it was NCB bingo. She encourages homebirths, previously owned her own free-standing birth center, supports CPMs without reservation. Told me that OB-led hospital births “do more harm than they do good” and that she believes it is her job to “protect” her patients from standard hospital care. Everything even down to the fake Native-American name she has adopted. And she is part of the CNM group at my hospital! And the other CNMs chose her and hired her. Even if she isn’t who you see for your pre-natal care, she may be the one on call the night you deliver. There is no way I can recommend CNM care to my friends or patients now. It’s really sad.
Yes, I was surprised, and a little dismayed, at the amount of NCB and CAM woo At Your Cervix was exposed to during her CNM courses at the Frontier Nursing School [including a field trip to The Farm for new graduates of the program]. But this seems to have infected nursing too [I was once advised by a supervisor to leave hospital nursing, when feeling burnt out, and “do reflexology”] and I remember Orac writing in his blog about how medical schools seem to be taking it up too. Very sad. It took so long to really develop medical science and we seem to be regressing.
It’s true that some of this stuff is infecting nursing. I think for some reason it’s especially true in academics in nursing. I hold my former nursing instructors in very high esteem, even the instructors who believe in home birth, so it’s difficult. When I went to the Lamaze instructor program the presenter I found most offensive was a nursing instructor. Her answer when challenged “it’s all evidence based”. I couldn’t like the local OB nursing instructor more but she is a former lay midwife and shows the Business of Being Born to every class. It was long ago that I graduated but as I recall therapeutic touch ( where hands are moved without actually touching over a patient to somehow change energy fields ) was a legitimate modality to write on a NANDA care plan. I can’t speak to MD education but this is something that’s always embarrassed me about nursing, that the very people you would most count on to be science based don’t recognize woo for what it is.
Wait, Reiki part of a valid treatment plan? Oh dear…
At Univ of MD we would all use “altered energy field” as a NANDA diagnosis if we needed that one last diagnosis to finish our care plans. The paper would come back with a diagnosis of “altered grade ” and a few points off 🙂
Yesterday in the NICU I overheard a nurse authoritatively telling a preemie mom not to keep her cell phone in her breast pocket or she’d get breast cancer. Another was telling someone diet pop causes brain cancer. The nurses in my family are full of this weird crap as well. I don’t get it.
actually, splenda has been linked with cancer, and it’s in diet soda pop. Maybe they’re on to something there… oh, wait… that was just for rats… http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners
Do you even read your own links?
“There is no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans”
Splenda is sucralose, which is addressed in the 5th section down.
I am always worried when I see Frontier Nursing School on a CNM or NP’s CV. They pride themselves too much on their cowboy history.
And yet, Frontier was one of the first, and the best, of the schools teaching midwifery in the US, when midwives were still regarded as people who occasionally washed their hands, and were fit only to take care of poor Southern black women [or hillbillies in Appalachia].
I am increasingly glad that [1] I got out of nursing in the US, and [2] have retired. I did my RN before academic degrees existed, and the training was rigorous and thorough, and exceedingly practical. The matron of a London hospital once said to me that she “had a problem” with nurses from the US: “they know everything there is to know about the theories of pillow placement, but they can’t arrange the pillows so the patient is comfortable. And they want to lecture me about it”. I doubt I’d last a week in a woo-contaminated CNM program these days. [Nursing in the UK ain’t what it used to be, either, alas]
From what I had seen, she’d already bought in before she started that program. guh. I read her blog waiting for a trainwreck, honestly.
These are things that concern me, too, as I will be applying at my local university to become a CNM in the next 4-5 years. What will the landscape be then? I have an intense interest in all aspects of women’s health care and I will absolutely keep the long term health of women in mind at every season of their life. I am not tolerant of silly, woo-based ideas, but I do ascribe to evidence-based, solid medical care. I don’t know where I’ll fit in or practice, but I do believe there is a place for me as an advocate for women, the best birth outcomes possible, and sensible, informed medical care. I suspect it will be a very interesting journey….
It’s my sense that some CNM programs might be so “woo” that you’ll have to keep your woo intolerance under cover to get good grades.
nahhh
I agree! And I am good at being polite and keeping a rein on my tongue. I had a total woo-ish nutrition professor this last semester and it was hard for me to keep from rolling my eyes. But, she even complimented me in front of the whole class regarding some healthy nutritional practices I have. Whatever. I got an “A” in the class and I am moving on-with my mouth closed. 🙂
AreawomanPDX is in a CNM program and its mostly good. There are days where they have to do woo though it seems minimal.
I am dying to know her fake Native American name, but it’s probably too identifying for you. So sad.
I thought I knew the person too. But then I realized the only difference was she never owned a birth center, otherwise, it sounds exactly like a nurse I used to work with. There are lots of OB nurses that do buy into this stuff actually.
Yeah, I don’t want to say the name outright but imagine a conversation that goes something like “I was a L&D nurse and when I felt the calling to become a midwife I discarded my old name and took my current name Blahblahblah which means Wise Woman in Cherokee”. Tweek that a little and there you have it. Ish.
Isn’t it a bit arrogant? To call yourself Wise Woman?
Not to mention totally racist!
I feel the same way too after a CNM blew off my high blood pressure at 26 weeks and it turned out I was getting preeclampsia. An OB would have realized that high BP in pregnancy is never to be ignored or explained away. Then, I had a friend deliver with CNMs in a hospital the birth story she blogged was full of awful, dangerous decisions and ignoring ominous warning signs. Her baby’s heartbeat was stuck in the 80s for a long time but they told her to just keep going because they thought a c-section was more dangerous than allowing the labor to continue with fetal distress. Unbelievable. She’s lucky her baby isn’t dead or brain damaged.
Sadly, fiftyfifty1, I agree with you. Coming to this conclusion over the past few years has left me sort of drifting… I acquired my BSN with the intention of going on to do my CNM… now I wouldn’t use a CNM so why on earth would I become one?
I unfortunately had a similar experience- as horrifying as my prolapsed body was to me the look on the CNM’s face and how she acted at my post-partum visit was, well, it didn’t help. I was promptly referred to caring OB’s who were able to assess the situation and helped me cope as well as helping with my own perception of everything. I was treated so much gentleness and compassion. I don’t know what they thought but they managed to hide the repulsion/shock in caring for me. Thank goodness.
The ‘woo’ aspect was so pronounced at the practice of hospital based CNM’s I last used. They had an adversarial relationship with some of the L&D nurses, and did not follow CDC guidelines for the treatment of my GBS. Not at all what I expected, and it made the experience so much more stressful; it eroded any confidence I have in the credential. That truly breaks my heart. I am home with my kids these days, but I know in my bones that I very much desire to have a professional career when they are a bit older. While my family is really my life’s work I always felt so lucky to have a ‘calling’ something I knew I wanted and was willing to work for and sacrifice for… now what?
What were the aspects of being a CNM that attracted you to the career (before the idea got ruined for you by the nuts)? The reason I ask is I still feel that advance practice nurses are very important. I love the fact that they can spend more time with patients–this is a huge plus when working with certain populations like teenagers, the elderly and low income/low education patients. The OB dept at my City’s county hospital employs a number of CNMs and sends them out to small clinics embedded in poor neighborhoods. None of these CNMs seem to be in it for the woo (the typical NCB mom would refuse to deliver at the county hospital anyway!). The county CNMs are in it because they have a passion for improving outcomes for at-risk women and babies and to do that you need a lot of time to build relationships and educate. And I know and respect a lot of NPs who do work like geriatrics, psychiatry, family planning clinics, HIV and Hep C care.
I agree with you there, I don’t know ARNPs that are into the woo so much. It’s just when that CNM is added that it changes things. I saw an ARNP for years who was as science minded as my doc and while she did have more time for appointments, that time was never devoted to personal chitchat or using it to become my best friend.
CNMs are ARNPs and NPs also. It is according to the state in which one resides whether the initials are NP or ARNP.
My greater point is that CNMs are the only type of midlevel provider, whatever initials they use, that are infected with woo on a profession-wide basis.
You are not going to be able to control other’s wooness. While you may dislike it, they may like it. So for Pete Sake give it a rest.
I am not woohooo and trust me there are many others also that are not.
I do not know how many CNMs you have been exposed to but from what I am reading it appears very little.
Give it a rest? What – just accept that a large set of health-care providers are into mystical mumbo-jumbo instead of proper care?
I have to disagree with you on that one. I don’t care how much *they* like being into woo, it’s not acceptable.
I guess what I am trying to convey is midwifery in the United States has it’s flaws. But so does every other professions.
And I think it takes humility and courage to not only admit it but try to do something about it. And that is what I am seeing the ACNM do at the national level. You will never be able to control other’s wooness.
But you can implement standards, educational pathways that lead to HEALTH CARE PROVIDERS not uneducated “clowns” as many say in this forum. And you can begin to regulate the profession at the national level.
If you can get to that, excellent.
Fighting the WOO is CRITICAL. As it is the WOO that makes all HCPs dangerous- including OBs. No one is immune to it, and it can cause serious problems and even death.
Accepting it is not OK.
I am not saying we accept it but as we begin to implement new standards, new direct entry pathways, a new national board that oversees midwifery standards and regulations nationally, and whatever else they plan to create I think eventually it will dissipate.
I hope so.
I have no problem with spiritual care, or alternatives, but not in place of evidence based care.
If a mom wants a faith healer- and a DEM that sits and knits, is a faith healer IMO- that is fine. But that faith healer should not be called a MW, nor bill Medicaid.
I totally disagree. I feel a responsibility to steer my patients toward safe care. I know a number of CNMs both personally and professionally, and while many perhaps even most of them are not into woo, a fair number of them are. And most CNM groups use an on-call system in the hospital. So even if 7/8 of the CNMs in a group are non-woo, my patient may draw the crazy one by luck of the draw. Often woo is basically harmless, but sometimes it is downright dangerous, and patients are not in a position to be able to tell the difference. So no, I won’t give it a rest.
Here’s what it comes down to for me. There are some professions that are infected with woo and there are some that are not. As Bofa has said before, if you find yourself saying “But we’re not all like that”, you know your profession has a problem.
Do I know some sensible chiropractors? Yes I do. But I don’t recommend chiropractic care because the profession has a problem with woo. If a patient has chronic back pain I send them to Physical Therapy because PT is not infected.
Some other woo-infected professions include Lactation Consultants and Nutritionists. And yes, I know “They are not all like that”….but the fact that I have to say that in the first place is a warning sign.
Fiftyfifty1 it is your right to refer your clients to whom ever you feel will administer the appropriate and safe care.So the fact that you denounce CNMs is your right also.
I am merely and have been merely trying to drive change within the midwifery profession because as it currently stands, the profession is immersed with nursing and medicine. It’s lacks a true identity. We practice by ACOG standards and many get paid less than nurses.
The profession has a very small group that are “woo” and unregulated, uneducated and unlicensed. Running rouge and causing havoc in everyone’s live who is even remotely touched; Providers and consumers.
All of which holds midwifery back from truly becoming a well respected and trusted profession.
That is it in a nutshell.
Yes,fiftyfifty1, I have a lot of respect for the nurses and advanced practice nurses as well. Honestly I was inspired to pursue midwifery by the birth of my firstborn- and I believed the ‘woo’- but I believed that the idea that natural birth was best was based on evidence- I believed that midwives practiced safe, evidenced based care… that was 14 years ago. I was amazed at how HUGE the transition to motherhood was, and how vital support and care was for mothers to aid in that transition. I also discovered how much I totally adore babies, which surprised me. Anyway, over the years many of the things I thought have been proven wrong; and I know there are some midwives who practice sound, evidence based, professional care, but, it is just not a profession I can easily ‘fit into’ anymore. I think I will eventually just get back into nursing when my little ones are older and see if I get inspired in any direction once I’m in the field actively again. I can give great care as a plain old nurse- it gives me a lot of satisfaction.
And I agree with you that it IS about fighting the ‘woo’; if not then it is hardly a profession worth any respect at all.
I delivered both of my boys with the same CNM practice, and I still recommend them to my friends. I say this because I had severe complications during my first delivery that were managed very well because my CNM was working in close consultation with the attending OB. I was also having pelvic floor problems after my second delivery, and when I talked to another CNM in the practice about it, she immediately referred me to rehab with a qualified physiotherapist.
BUT…I would never advise anyone to use a different CNM practice without scoping it out carefully. We have seen that there are far too many CNMs who have internalized the whole “trust birth” mantra. There is no excuse for any woman to receive substandard repairs or treatment for pelvic floor problems or other complications. A competent provider doesn’t brush these problems aside, but consults with colleagues who have more experience in such problems. The ACNM needs to vigorously weed out the NCB nonsense that impairs clinical judgment.
This terrifies me. I had an 8 week intake appt with my OB office’s
LPN where she informed me that really the inky thung that causes breastfeeding failuire is breast implants. A few weeks ago I found out my OB office hired a CNM. At my last appointment my
OB said, ” I want you to have a good experience.” And when I called his (regular) nurse a few days later about something that was worrying me she told me “trust your body” <_ I'm infertile with repeat loss, WTF?
Ive considered finding a new office, but it's difficult to believe it will be any better.
You can do better! Get yourself out of that office.
A friend of mine eventually fired an OB who said stuff like that he went into obstetrics because, “Nothing bad happens in obstetrics!” Holy cow.
Being de-registered as a CPM? Can that even happen? One would HAVE to be bad.
Yes, you can lose your CPM credential, but you’re right, it’s very difficult, you have to be truly awful and it’s rare. Check the NARM website. http://narm.org/accountability/revocation-of-certification/ Oh, and yes, Valerie El Halta is on that list. And her one-time apprentice, Bridgett Ciupka who still practices in Michigan, a state with no regulation for CPM’s. http://www.wxyz.com/dpp/news/local_news/investigations/mom-to-be-says-her-hopes-were-destroyed-by-a-midwife here is a news clip of her actual revocation, although it says nothing about WHY. http://www.narm.org/pdffiles/2004-09cpmnews.pdf
From the news article “In fact, Bridgett Ciupka used to be a CPM, until NARM took the rare step of revoking her credential back in 2004. While NARM officials say they can’t give us details, they did receive several complaints about Ciupka, and NARM determined that she violated their policy.” Why can’t NARM give the reason? Unless there is a court order involved I suppose. If a licensed health care professional did this the information would be public.
I agree with your hint that while CPMs may be licensed, and they provide health care, they are not licensed health care professionals.
Sorry to double post, but did anyone read the NgM threads on this case? There’s a comment from a mother who experienced the same treatment from El Halta. “OMG, Val, AGAIN!?!?! CYTOTEC!??!?!
Excuse
me while I break down all over again. This is the midwife who
birth-raped me 17 years ago and LOST her NARM CPM status due to a
different vacuum birth gone wrong.” from another…”
She
used to be here in Michigan, more than one infant death here related to
illegal use of vaccum at a home birth–her CPM credential was revoked
(and later, one of her students, having learned similar practices at her
“knee” also lost her credential) so I’m not surprised, but still
shocked–I had understood that she was “retired” from Midwifery after
she moved to Utah; I’m very saddened by this.” She’s spread death and sorrow spanning decades. If that’s not a monster, I don’t know what it.
What is NgM?
tks
Navelgazing midwife
Thanks for clearing that up!
I think they are equally matched in hideousness.
http://www.aimeee.com/pregger/midw.html
Valerie El Halta, CPM
“I am one of the senior midwives in the country, having participated in over 2,500 births in over 21 years. I began my midwifery career in Southern California after having six children of my own, the last two home born. I had a home birth practice in California from 1976-83, and in Oregon from 1983-86. I was the Intern Director at a free-standing birth center in El Paso, Texas for three years, (1986-89) where I was responsible for over 1,000 deliveries and for the training of midwives. In October 1989, Rahima Baldwin Dancy and I opened The Garden of Life Birth Center, in Dearborn, Michigan. This was later renamed The Birth Center. This birth center was unique in that it was completely unattached to a hospital, or a medical board of directors, and was one of only a handful in the nation to be solely owned and run by non-nurse midwives. I became a Certified Professional Midwife through NARM (The North American Registry of Midwives) in 1996. After a very fulfilling eight years of serving our community, we decided to close our doors and return to a home birth practice which we both missed so much.
I am currently working on a book for midwives, as well as two books of anecdotal accounts of my experiences. I have taught, and am continuing to teach midwives from all over the country, through seminars, speaking at conferences, and through my writing. I am dedicated to the “Midwifery Model of Care” and in providing the highest quality of this care to mother’s and babies. I feel that my years of practice, the variety of practice which I have had, along with my considerable experience at birth, combine in a way that I can offer you an optimal birthing experience. My personal transport rate is very low and my cesarean rate remains at 1.5 %.
Kathy and I have had an on going friendship and midwifery relationship for over six years. We believe that our educational route to midwifery compliment rather than conflict with one another and that in working together, we can bring to you, our client, the best of both of our worlds. As we worked with one another during the summer of 1997, in a hospital maternity ward in Malawi, Africa, we realized that we could serve birthing women in a truly holistic way, and made the decision to establish this practice.”
“This birth center was unique in that it was completely unattached to a hospital, or a medical board of directors, and was one of only a handful in the nation to be solely owned and run by non-nurse midwives.”
That someone would brag about this leaves me sputtering.
”The court was unique in that it was completely outside the legal system, had no presiding judges, and was one of only a handful in the nation to be solely owned and run by non-legal pracitioners.” Can you IMAGINE?
In a world where Airborne is a strongly selling cold remedy, yes I believe it. Supposedly created by a teacher who got tired of catching colds, and decided that she could solve what actual medical researchers were unable to solve. And people fall for that crazy advertising gimmick.
It’s not just that legislators “don’t have a clue” about direct entry midwifery — they don’t have a clue about midwifery, period. Or much else regarding women and reproduction in general. Just think of these “rape doesn’t usually result in pregnancy” comments a couple of idiots have been making recently.
The US badly needs a professional organization of exclusively CNMs who will be willing to be vocal against non-CNMs, as well as lobbying for better regulation of the profession. Right now, most of the “professional” organizations are pussyfooting around, trying not to step on their “sisters'” toes for fear that some people will be put off ALL midwives as a result. The fact is that there are NO direct entry methods of educating midwives to the standard of CNM; and in nearly all states, no competent oversight of midwifery practice. There isn’t ANY body out there with the legal force to prohibit midwives from accepting high risk patients for home delivery, or even in hospital without OB backup [or which defines “high risk”]. As long ago as 1975 I heard calls from midwives to be allowed to use forceps [!!] and until now I’ve never heard of a midwife using vacuum. If a patient needs either, in the UK, the patient automatically becomes the OB’s responsibility and the midwife’s responsibility is superseded. A midwife who did not transfer in these situations would lose her license pronto.
I think one of the reasons the current situation seems to be inert is that there is a feeling that somehow it’s “unethical” to restrict the practice of midwifery to one form, just as it’s “unethical” to insist that women can have only one option of where to give birth. Ideas of the “right” to personal freedom of choice get all mixed up in this, and Americans in general are absolutely paranoid about not being able to kill or injure themselves as they see fit. The whole “socialized medicine” wrangle is part of this: the concept that a person will be coerced by “Government”.
One OB that had been asked about the home birth question here in California recently commented that, “California won’t touch the lay midwife issue. It’s all rolled up in ‘a woman’s right to choose.'” So, there is the perception, at least with this highly respected, older OB that there are very powerful political forces intertwined in this issue of regulation regarding women’s health across the spectrum.
It seems to me that the best way to characterize it is that support for homebirth is an inch wide and a mile deep. Very few people support it, but those that do are extremely vocal.
Until very recently, no one else cared about the issue so that it made sense for legislators to appease the few, but that is changing. The recent efforts by Ricki Lake and others to popularize homebirth are going to kill it. Those recently attracted to it were told that it is just as safe as hospital birth. When they found it wasn’t, they were extremely angry and determined to do something about the lies and incompetence.
“support for homebirth is an inch wide and a mile deep. Very few people support it, but those that do are extremely vocal.”
EXACTLY THIS.
Now that there is organized opposition, things are starting to change. The opposition doesn’t have to be as big, or as loud, just big enough, and loud enough, that giving LDEMs what they want is no longer an easy victory for lawmakers. They will stop giving in to the HB MWs if it will hurt them, even a tiny bit.
The public doesn’t care, and that is a problem. They either sympathize and see it as “choice”, or, more often, think HB Moms get what they deserve for being foolish. Like most things, people will ignore it unless it hurts them directly.
The have been foolish. However, this doesn’t mean it should be allowed to happen. Drunk driving is foolish, but that doesn’t mean it is allowed.
How awful. I recently gave birth to a healthy baby boy in a Utah hospital, and I required the assistance of forceps due to exhaustion and failure to progress (poor baby had a bruise on his head from whamming against my pubic bone for hours); that meant that the CNM who’d been caring for me stepped aside for one of the OBs at her practice, because as I understand it by law she, with 12 years of experience and actual medical training, can’t use instruments. He did great and my son was born in two contractions.
And this clown used a vacuum at a homebirth? Christ.
“I didn’t hurt the baby. I just delivered it.”
That, right there, is a jaw dropper. If you define what you do as ‘gentle birth’ then I guess any harm that comes to a baby has to be by some other agency than yours. But holy cow: cytotec and a vacuum? Could there have been any more intervention and trauma here?
If she’s killed multiple people without remorse and with every intention to continue doing it, yes, I would think she’d qualify for the term “monster.”
Serial killer monster!
That is terrifying.
Ms. Tulley has it wrong. Incredibly, to me at least, El Halta has not been arrested.
According to a Fox News report 6/19/13:
“Officials said that because of El Halta’s age, she will not be arrested. She will be served with a summons to appear in court.”
This makes me so angry. She doesn’t deserve special treatment. This woman should be in jail. Not only has she acted with total incompetence on numerous occasions, she is unrepentant. And she’s still delivering babies (as of last Monday)! She really should be in jail; that’s the only way to stop her.
I hope that a jury in Utah will bring this monster to justice.
And for the love of heaven, midwives everywhere should be denouncing her.
The babies she has sacrificed won’t get to be too old to be arrested…
I have come to believe that change is going to rest with the states. I have been telling Judith and anyone else who would listen not to license uneducated providers. Think of it this way: If the state licenses them then the state is responsible for their credentialing process.
The states are licensing high school prepared CPMs thinking that ” now the public will be safe because they will be regulated.” BONGGGG wrong, they have now placed the state at a much higher liability for legal recourse.
Do you think the state would license a high school or GED prepared midwife to practice in hospital? Well of course not. In fact you must have a masters to practice in hospital midwifery in my current state.
This is logic plain and simple. If you must be mastered prepared for one venue why not the other two?
And the new bill HB 2997 in Oregon gives the direct entry board complete autonomous control for regulation, licensing, investigations and discipline. Oh one more thing, rule making. That’s right it has been written into the new law.
They just do not have a clue how to say NO! We have the data that shows homebirth mortality rates with CPMs is 5.4/1000 which is actually 7-9 xs greater than in hospital births with similar co-factors. That should have been everyone’s wake up call.
The only thing is that a midwife who is no longer licensed to practice midwifery can still do it if she is also an ND. Or still call themselves a CPM and know damn well that they aren’t licensed anymore and still advertise their services. This is true of Brenda Holcombe, who practices under an ND license in the La Grande area. The other midwife in the La Grande area delivered a footling breech at home (this is Sherry Dress).
I know. We have ND “midwives”, PEP prepared midwives, Birthing-way prepared midwives, OHSU prepared midwives. How does a ND get the title midwife? Very loosey goosey verbiage. I thought the title midwife was going to be protected via the law. But that did not happen either. It is extremely frustrating.
She held the ND in addition to the CPM and when the midwife license was surrendered she simply kept on catching babies, just using her ND credential.
I glad you are trying to make a difference. We have a place in La Grande and I actually heard some moron praising her “calm” midwife who helped her birth a footling breech at home. That midwife was Sherry Dress, who also practiced in Washington (I am a Washington resident). There aren’t a lot of choices for midwives in Eastern Oregon, but the two that are practicing are scary. The problem is that people hear midwife and how long they have been practicing and they don’t realize it’s NOT the same as a real midwife, that 30+ years catching babies but only seeing 500 births is not really experienced.
ANYONE can be a MW here in Oregon. You call yourself a MW, and off you go. You only need a license if you want to bill insurance or Medicaid.
No, this has to be tackled at the Federal level. There is already too much variation at the state level, from defining “midwife” as ANYONE who attends a birth, to banning even CNMs from licensure and practice. As long as even one state has a loophole, midwives will continue to practice uneducated, unlicensed, unsupervised.
I believe both! The federal will take time it is a very LARGE WHEEL to turn. Until the federal level has addressed standardization the states will suffer and should begin to take action.
If Obamacare could get through Congress, then I believe the DHSS could initiate the necessary legislation for education, standards of practice, etc. for midwives. The only reason it hasn’t been done for MDs is that MDs were intelligent enough to see that the status of the whole profession stood or fell on how well it policed its own members and set up the necessary infrastructure to do it, from the state level right down to individual hospital departments. Any OB who behaved as this midwife did would not last a month without disciplinary action. For all that we see rogues like Dr. Biter around, we can also see that the system is activated against him.
It IS Obamacare that is making the biggest, most important changes here in OR/
It would be unconstitutional.
On what grounds? Obamacare was challenged constitutionally and the Supreme Court did not knock it down.
The individual insurance mandate part was upheld because the SCOTUS said it was a tax (a fact many would argue). That’s a lot different than licensing individuals for particular professions at a federal level. That would violate the 10th amendment.
Professional licensing is the poster child for powers left to states. It would be on any lawyer’s list of classic state (rather than federal) powers. Obamacare’s constitutionality was a lot less obvious.
Let’s see what happens in Winsor this week…
I don’t believe the federal government can tackle professional licensing. Theoretically the federal government has limited powers, and while the Supremes have let a lot in, professional licensing is solidly in the states-only bucket.
“And the new bill HB 2997 in Oregon gives the direct entry board complete autonomous control for regulation, licensing, investigations and discipline” I have to ask, does this board include Melissa Cheyney or people like her? If so, this may be a way to have a law to protect the way they operate, not make them change into beings of accountability and transparency.
They don’t say NO because the MWs and their supporters are so loud and pushy, and up until last year, there was absolutely no push back. All the legislators see is a organized, large, loud, group of fringe women making demands that no one really cares about, so its been an easy political victory for them.
I realized this when I went to a town hall meeting to remind the reps of this issue. Out of everyone there, about 85% were there for “health care for all”. Only 2 of us were there about HB MWery licensure, plus one that was there for health care that also was interested. Other town halls have had large numbers of HB supporters.
I realized that lawmakers have MUCH bigger problems, so that when a small, loud, group makes demands about things they don’t know about, and no one else cares about, the group will WIN.
For the first time, in the last 2 years there has been organized opposition. This group has done more to make change than anyone else in the last 30 years. But its hard to get new laws done, especially when there are much bigger issues, that effect more people, like the economy, homelessness, and health care reform.
Sure, babies are dying, but the overall number is low (8 last year IIRC) enough, and the moms “made the choice to HB”, so the public just doesn’t care (I say ONE baby loss is too many!). You have to wade through a LOT of misinformation to realize that there ARE dangerous HCPs out there killing with impunity. People simply just do not believe it is true! And then they brush it off as something that doesn’t effect them.
The one good point here is that if the opposition to CPMs/DEMs can get organized and loud, there is a very good chance of creating serious regulation changes. In less than 2 years, MANY positive things have already happened, and are happening now. Once it is no longer an easy political win to give into the DEMs, tides will turn. It CAN be done, more people are needed to put pressure on the reps.
The other claim, I think, that has appeal to politicians is that they claim to speak for feminism and ‘what women want’ and being ‘with women’. It’s an easy policy implementation that gets the crazies off your back and will hopefully mean you are seen as ‘understanding’ and ‘pro-women’ without actually having to listen to what the majority of women might actually be saying about the issue.
Spot on, Karen. This ideological approach is a real cop-out, all too common amongst the political left at the moment. It’s easy to brand the medical profession as arrrogant/powerful/male and midwifery as holistic/caring/female – until you reveal the deaths.
The WORST part of this is that NCB is ANTI feminist, IMO. It is biological essentialism, and based in racist misogyny.
Besides, some of the most egregious instances of bad care I have ever heard have come from HB MWs, who regularly don’t show up, scream at the moms, and totally ignore their cries for transfer, as well as give them meds/procedures they know nothing about.
Given this woman’s track record in MI alone, I’d assert that serial killer or serial birth rapist would be more appropriate terms than monster.
She had her NARM credential revoked after an incident in MI involving gruesome results from using vacuum extraction. She has mothers here referring to her care as being “birth raped”. She sold her birth center in MI to an apprentice, none other than Bridgett Cuipka, another notorious MI midwife for baby deaths and dangerous practices. Bridgett is the midwife who attending Alia Mushin’s birth and death in 2008, and had a record long before then that went undisclosed. The cycle of reckless practices continues.
Valerie also had two felony charges in 1983 in Monteca, CA for practicing medicine without a license. She took a plea, saying she was moving to none other than…Oregon.
I’m so tired of midwives who believe they are somehow above the law and any kind of professional standards. As for those that support them? They should be charged as accomplices. I am a teacher and this is no different that the MEA supporting a teacher who molests children. It’s absurd in every way. It makes the profession of midwifery look grim.
The scariest part is that Valerie represents many of the practices that permeate OOH midwifery across the country. Every OOH midwife is well aware of the use of illegal drugs in which they are not appropriately trained to use. Every OOH midwife is aware of the ego boost involved in taking on high risk birth. They have to support Valerie b/c they practice the exact. same. way…gladly taking on VBACs after multiple cesareans, twins, breeches, etc. It’s happening all over MI, and across the country as if it’s some kind of trophy to be won or lost. In fact they look to Valerie as some kind of mentor, or hero, publishing her writing in Midwifery Today, using her made up breech scoring system as she lectures about “normalizing” breech birth, and so on. This woman is beyond hazardous, as are her followers.
Mothers beware. Not all midwives are safe or practice safely.
Horrible. Just horrible.
I’m confused. Are midwives supportive of her or did NARM strip her CPM? If her CPM was stripped, isn’t this a sign that these practices are not supported by most home birth midwives?
I am referring to the midwives and people who are rallying to fund her legal costs and support her “fight” in the name of supporting midwifery. The mentality that they must somehow support every midwife or be divided and fail is not boding well for the “profession” as a whole. It makes those midwives who do practice safely look like quacks. NARM did revoke her CPM after many, many incidents. She still continued to practice in several states. In MI, you don’t need any kind of certification, license or education at all to call yourself and practice as a “midwife”. I could open a birth center in a garage tomorrow if I wanted to and deem myself a midwife, regardless of my history.
Oh, please. Not only are her supporters rallying around her now, but she has published articles in Midwifery Today and sells her breech birth video on their website. She is a hero in midwifery circles. Not only at, even though the CPM requires almost no effort, there are plenty of midwives who don’t even bother to meet those minimal requirements. The fact that NARM chose to revoke her certification and not, say, Faith Beltz’s or Jennifer Gallardo’s or Brenda Scarpinos means next to nothing. They revoked her apprentice’s for paperwork snafus, not for the baby she killed.
I almost wonder whether they actually stripped her CPM for using too many interventions.
no, they stripped it because she deemed herself to be even above THEIR laws and refused to participate in a process wherein the complaint against her is discussed. She claimed that only IMG was her “peer” and thus able to sit in judgement on her actions. IMG declined to participate because she thought the complaint should be handled on a local basis. Because El Halta would not participate in the peer review/complaint process, she was stripped of her CPM. Which did NOTHING to stop her from continuing to harm mothers and babies for years afterwards.
Apparently she was in Oregon for a while. Anybody know where she worked there?
I am surprised she didn’t stay.
Regardless of the reasons for Valerie’s arrest, realize this is the second investigation of an unlicensed midwife this year,
Wow. That says it all about the NCB movement doesn’t it. Um, no, the reasons for arrest are the crux of the matter. Midwives wouldn’t be investigated if moms/babies weren’t dying or getting injured under their care.
Replace “Valerie” with “Father Doyle” and “unlicensed midwife” with “Catholic priest”.
Doesn’t the phrase “there’s no smoke without fire” occur to these people? that the investigations might be prompted by actual wrongdoing?
I never realized before Amy’s blog that there are midwives in the US who offer their “services” with absolutely no standards of care – a VBAC3 at home? Seriously?
I live a rural area with very few birth options – 3 obstetricians, 0 CNMs, a few poorly trained lay midwives. One of my good friends is pregnant and was about to take the contact info of one of the midwives from a message board in a cafe when a woman came from across the cafe and whispered to her that she had heard bad things about that midwife. It’s scary. Such things should not be whispered. If midwives are legally allowed to practice, there should be an ironclad standard of care. We need much better regulation in Michigan.
So glad to see this woman’s being taken to court. It seems like many homebirth neonatal deaths are from deliveries where the presiding midwife was actively negligent. How can incompetent “midwives” be prevented from taking on high-risk pregnancies? How can high-risk women be encouraged to seek hospital care rather than terminating care with an OB and “going underground”? One large part of it is dismantling the propaganda of the NBC, but I wonder what else can be done. ..
It’s extremely tricky.
Prosecution is difficult unless a) a death or grievous injury occurs and b) the attendant was clearly negligent.
The other viable option is self regulation, but that’s unreliable in midwifery.
(Civil lawsuits are a plausible option, but due to the high costs, seldom filed.)
Ducky — I’m in Michigan. Wondering who the midwife was, if you know.
Hi A. — I’m on the UP, Houghton County . I’ve seen a few postings around but I’m not sure who this particular midwife was.
I often think they offer those services because they don’t want to tell any Mom “no”, lest she have no care at all.
I have a dear friend that was a great example of this- she had cervical cancer, something wrong with her uterus (“lots of little tumors”) that was untreated, histoy of bleeding issues and hemorrhage, RH positive and sensitized, multiple MCs, is on Adderall, and has a severe case of schizophrenia that is treated with anti psychotics (severe enough to be on disability).
But she wanted to avoid the hospital, and liked the idea of a water birth, and was determined to do it even if that meant a UC alone on her sail boat (which is her and DHs home). She had planned a UC, but then found a water birth center that would take her. She told the MW if she did not take her she would go it alone. They actually did lots of tests, and she also saw an OB, and specialist psych. But the water birth center kicked her out at 32 weeks when their staff OB said “HELL NO”. (I think she even got this amount of care because FL is more regulated than most places. In OR it would have been much worse IMO.)
So she went to the local hospital, expecting to just go there if no one would take her. But, by saying she would UP/UC, she found a CNM to attend her HB on the boat, and a doula to help, and found an OB to sign off. She was a nurse for 15 years, so she got all her records sent, talked to the charge nurses and staff, and was prepared for a HB transfer. Again, ALL these people took her on because she told them it was this, or UC.
(Thankfully, her water broke at 33W, and she had a hospital birth after all. Her DD is healthy and about 5# now, and should be out of the NICU on Sunday. The FIRST thing she said to me was “You got what you wanted, I had the baby in a hospital!)
there’s so much going on there, I have no words. All that risk – carefully planned for yet never no risk – for what sounds like a miracle baby. And she’s here and she’s healthy.
I was relieved baby was early, so she wouldn’t try a HB. Baby is adorable and healthy, and both parents, and the families, are thrilled.
That is so sad. If a breastfeeding mother said to me “either you help me exclusively breastfeed my underweight baby with inadequate milk supply, or I just won’t feed him at all,” at least I would have the option to call the baby’s pediatrician and/or child protective services. A midwife with a noncompliant mother does not have that luxury, since the fetus is not legally a person. She has to either leave that fetus in a UC situation, or risk making herself liable legally and morally by assisting with an unsafe delivery. Yet giving the fetus legal human rights infringes on the mother’s right to her own bodily autonomy. I dont see any solution for those poor babies.
Many of these moms would go to the hospital if no one would take them. They threaten UC to get what they want, but few are really willing to do it.
At the risk of starting a flamewar… I think that the first wrong decision this woman has done is to become pregnant in the first place.
One of the reason I have chosen not to have children is a history of mental problem in my family. While I would never force other people to agree with me, I do think this woman, in particular, should have thought more before deciding to have a child.
I hope it will go as well as her homebirth had.
She thought she was infertile. After 5 MC, RH sensitization, and reproductive system cancer, you would have thought she would be. She went in to the GYN because she thought she had another tumor, and was shocked there was a baby. We are all stunned (and thrilled!) the baby survived.
For brevity, I left out all her wonderful points. Her mental illness *is* being treated, and her husband is awesome. She is a brilliant, caring, tough, person, and will be a better mom than most others out there. Lets not say she shouldn’t have had a baby because of her mental illness.
Her ideas about hospitals may be unusual, but at least are based on 15 years working in them, not on ignorance. She is no more extreme than any HBer in this town, and is more responsible because at least she bothered to see OBs and go to the hospital when needed.
Of course I am talking in general terms. I do not know your friend and her particular case. You know her and as such you are most probably right, she will be a good mother 🙂 I hope her daughter will not suffer from skyzopherenia, depression, bipolar, or other mental disease. Lets hope.
I do think, very firmly, that people who have mental illness (whenever themselves or in the family) or other kind of genetic diseases should think long and hard before having biological children. Something beyond the “I want a child then I MUST have one, even if I have Huntington’s disease”.
There is a general thread in society that having biological children is some kind of inherent right. I think it is a choice to be make responsibly, taking into account things like your age and level energy (there are indeed 40 years old who have more energy than someone in their 20s), your family history of genetic diseases, your financial state, etc etc.
I admit this is not the normal view though.
And of course it is a general thought, not about your friend or any particular case.
It’s not the normal view by any means. Usually, even if you do say “I have chosen not to have children because I don’t want to pass on genetic health problems” you are still told “but you would be such a good mom!” and “you and your partner would make such beautiful baybees!” at every turn.
Yes CHM 🙁 It bugs me to no end. I can make choices for myself, after all.
I have complicated feelings regarding your point of view… Depression and anxiety run both in my family and in my husband’s and we’ve thought about this a lot. I agree that people should be supported in the decision that’s best for them – and if they feel their genetic history or personal situation preclude parenthood, no one should try to talk them out of it. Even so, life involves suffering – part of living fully is embracing its imperfections. If other people are willing to accept the risks of their parenting decision, I don’t see why it’s anyone else’s business. Life is imperfect. It always will be. Outside of mental illness, people make decisions that burden society every day… and also there’s no guarantee that society will burdened if those with mental illness choose to reproduce. For example, many times, great genius and creativity are also intertwined with mental illness.
I’m bothered most by this paragraph: “There is a general thread in society that having biological children is some kind of inherent right. I think it’s a choice to make responsibly.” I agree with this statement. I disagree with your interpretation of “right” and “choice”. In my mind, “right” and “choice” are synonymous. I think of the Bill of Rights — people do not have a “right” to happiness, or to children, because neither are guaranteed. But they do have a right to pursue those things. While I agree that an attitude shift regarding childbearing could be positive for society, you can’t hope to impose criteria on how people make the decision to bear children. Otherwise you’re on a very slippery slope in terms of human rights and eugenics. Even from a utilitarian point of view, limiting human rights in such a way is probably not going to bring a net benefit to society.
I really like how you pointed at it 🙂 Good points!
I think that, aside some glaring case, what is the right choice may depend a lot on the individual case. What I believe is that people should think before making important, life-altering decision, whenever this decision is to accept a job oversea or to have a baby, you must think on it and decide if and how is better for you (and your family). If one is a carrier for a genetic disease (not only mental, generic) then one should reflect on it before deciding to have biological children. At the end of the reflection, they may have chosen anything from: “no children” to “adoption/fostering” to “biological children but with pre-implant diagnosys” to “biological children but I’ll be careful about possible signs of troubles”. It is like having GD and being aware that you could develop shoulder distocia. If it doesn’t happen everybody is happier, if it does happen, you are ready for it. And yet when you mention those things people accuse you of being “negative”. I am not being negative if I say that it is possible that a woman 42+ weeks may have a stillbirth, and I am not negative if I say that I, personally, having severe cases of autism and epylepsy in my family, could have a child with the same problems. I am stating facts. My personal choice had been not to have children, but another person may choose differently, but at least getting at it with your eyes opened.
What I hope for is the opposite of eugenetic: it is people making choices in a responsible manner instead that just doing it because “it seemed the best idea at the time” (which is very often a recipe for unhappiness). Not only about children and childbirth, but even about your jobs, your partners… everything. Choose, but after having thought on it.
I think we agree on pretty much anything, btw 🙂
Innocent, honest professionals would welcome an investigation as a way to prove they acted correctly and to showcase the safety of homebirth.
I only have one question. Who is more hideous? El Halta or the homebirth advocates who support her?
That really is an interesting question, and it really underscores the fact that for these folks, it really, really, really isn’t about the rights of the mother or the safety of the mother and baby; it’s all about the right of birth junkies to do whatever they want with absolutely no consequences whatsoever.
+1
How do I vote this one to the top! My first thought was, will she be on the next panel speaking about “Human Rights in Childbirth”?
Holy shit, NARM revoked her CPM certification. Hers is a level of incompetence that even that organization could not overlook.
I don’t know how much you all know about Utah geography, but driving from Eagle Mountain to Moab takes at least three and a half hours and usually four. For her to take a high-risk client that far away is insane.
http://www.narm.org/pdffiles/july01.pdf Interesting info too, according to this she could have reapplied two years later to have her CPM reinstated. Either she did and it was denied or she just chose not to. This newsletter on one pages talks about how her certification was revoked and on another page talks about the process to reinstate after being revoked. All you have to do is wait two years. You don’t even have do anything special like classes or something. That is what a medical board would do.
Oh GOOD.
2 years de-skilling from not having hands on experience.
Then full certification without proving you have kept your knowledge up to date. No tests, no probation or supervision period, just back to business as usual.
That sounds SUPER SAFE.
A doctor or nurse or proper midwife would have re training, exams, supervision and a probation period prior to gaining back the ability to practice independently.
NARM is the antithesis of what an independent self regulating professional standards body should be.
Looking back at it I now notice they have to have CEUs and are only eligible for reinstatement in certain circumstances. But their CEUs are a joke too. That same article states that they get 25CEUs for submitting their statistics for the data they were collecting for 2000. Hmm CEUs for doing something you should do anyway that doesn’t even enhance you continuing education.
This is what occurs when poorly educated individuals are allowed to practice as a professional. When are the states going to say enough is enough and protect the vulnerable public?
Seriously, this should never be allowed to happen not here or anywhere. It happens over and over. Stop licensing individuals who are not graduate prepared and accredited by the AMCB.
It really is that simple. I don’t know if everybody is so codependent that they lack the ability to say no or if they truly cannot see the truth that is staring them in the face.
You have to be graduate prepared to practice in hospital and it should be no less when one is practicing out of hospital. In fact, they should be tenured graduate prepared midwives because the setting out of hospital is extremely high risk by the mere fact that it is “out of hospital.”
Legislators must wake up for Pete sake.
There is a midwife accredited by the AMCB who is administering pitocin orally in a home setting for induction of labor. Her community knows this and is doing nothing while lambasting the obstetric community for not providing evidence based care, even though we have vaginal twin, vaginal breech (even in primips!) and an obstetrician who will support pregnancy to 43 weeks and will support TOL even with estimated fetal weight over 11 lbs.
Deena, I love your heart and how outraged you are. I’m outraged too, and it’s part of how I wound up leaving the natural birth community. It’s that kind of heart in midwifery that makes it impossible for me to chuck midwifery as a whole, which has been very tempting in the face of malpractice and manipulation. I just hope that you keep your eyes and heart open as you discover just how deep this rabbit hole goes. Best wishes.
I have been immersed for three years now and I am never more disappointed than when I hear an educated colleague is not following the standards for homebirth.
Why not admit her to in hospital and induce her if the client desires this and it is warranted? Why take such risk with the client and fetus?
I mean really you can have everything you want in hospital with a CNM except for your dog!
My community has 3 CNMs practicing. One has a reputation for falsifying GBS results and not making it to births (she’s taking on far too many patients), one offers a repeated stretch and sweep method of “labor induction” over the course of hours to try to help mom avoid a hospital induction after which at least one mother had a baby in the NICU with presumed sepsis, and the third is the one I mentioned. All three practices accept moms with twins and support pregnancy past 42 weeks.
“not making it to births”
Oh, how I hate this blatant betrayal of a woman and family at their most vulnerable.
And you bet she still bills for it, having not actually made it to the birth.
Does she send an apprentice or a colleague, or just leave the family hanging?
That is horrifying. And by falsifying GBS results, do you mean that she reports that the mother tested negative when she actually tested positive?
She tells mom to do their own swab, and that she has no real way of knowing what you’re swabbing. Result is a documented negative.
That is awful.
That is what the midwives at Puget Sound Birth Center do. The pregnant woman does her own GBS swab, weighs herself and also does the urine dipstick for protein and glucose.
LOL what an example of the difference in standards in a hospital. The lab had to certify that RNs can actually read these tests annually where I worked. It was kind of annoying actually. Perhaps, they are trying to get around some pesky quality assurance regulation for health care providers ? And nobody would EVER lie about their weight…..
Lol Never!
Some hospitals in my area have stopped letting nursing students use the point of care devices like glucose meters and ISTAT machines. The lab certifications require all users of the machines have documented proof of their education and students don’t have that before graduation.
The parents are so shocked when we end up with sick babies in the NICU after all this self testing. Then we end up explaining YES your baby has GBS sepsis, or hypoglycemia, or mom has preeclampsia and desperately needs c section! Then we get to convince the parents we aren’t trying to do a csection for the sheer fun of it!
That’s because OBs are “surgeons” who “only know how to cut”. And those parents treat the nurses like they aren’t worth anything, all the education, training and experience we have can’t possibly be more valuable than their “supportive, warm” midwife’s.
the idea of letting a patient self test really speaks for the level of accountability a midwife wants to be held to. If something turns out to be wrong, she can blame the patient for it.
WHAT do they pay the MWs for????
They pay them for the long prenatal visits in which the midwife and her client discuss how superior they are to other mothers.
Also, there is tea.
To be their best friend and birth keeper, silly! That space isn’t going to “hold” itself-needs cash to stay that way (holding one of those fish net scoop things to clean out the birthing pool).
Shaking my head. It will change, I believe it will change
But we cannot deny what is so blatantly obvious with perinatal death after perinatal death because it is uncomfortable. No ma’am we must face this head on without fear. Refusal of transparency regarding MANA Stats. I scoured the internet for days and put together a 160 page document that sited neonatal funeral after neonatal funeral. It was the only way to try and make sense of what the truth actually was and not believe direct entry when they informed me that others don’t like midwives and that the complaints were about politics.
That was not the truth. After I sent it forward to individuals and data is assessed the death rates are found to be 5.4/1000. 7-9- x’s greater than that of in hospital births by CNMs with similar cohorts.
The truth will set you free. And little by little that rabbit hole is going to get some light of day shined in so we can purposefully move forward. Trust is earned and that will have to be fostered also.
Good luck and Godspeed, Deena. I wish you nothing but success and I hope that if there is any way this community can ever help that you let us know.
” Delivering in hospital is like a safety net and you can have everything you want except for your dog.” That is so true! The newest local hospital here has in room massage for new mothers and their partners, complete with candles and aromatherapy. The labor tubs are in the actual room, not the bathroom so you can be with your support people and not have to worry about where they will sit. There are dimmers for the lights, views that are amazing, and a huge menu that you can order from 24 hours a day. Oh yeah, and there are teams of people there ready to jump in and help if things start going south.
Ok, where the heck is this hospital? I need to move there.
http://www.swedish.org/Services/Pregnancy—Childbirth/Services/Issaquah-Postnatal-Massage#axzz2WpAemTXj
This is a direct answer to those people who choose a birth center for the idea that its more beautiful and more comfortable than a hospital.
OHSU, Riverbend, and McKenzie Willamette are like this too. There is NO excuse to have a HB or BC birth in Oregon. NONE.
do I know you?
A few months ago we got a birth plan request for a dog to be present in the labor room. We welcome documented service animals but no PETS! Well maybe a goldfish in a bowl. Not your 100 lb German Shepherd.
What was the reasoning about including the dog?
The dog is her child and she wanted all the members of her family there for her natural childbirth.
What about a hamster in an aquarium?
I’m asking for, um, a friend.
Hospitals today are like hotels, all rooms with a jacuzzi, and room service. Don’t get why on earth someone would want to stay home. They can even call a doctor in if you’re not doing too well.
My hospital wasn’t anything like that and I *still* don’t get why anyone would want to stay home. I got four days of being waited on, having food brought to me, and not having to listen to my other kids fight and ask for things. I have no idea why anyone would want to trade that for home.
Someone here mentioned that they stayed home so they could labor while walking through their beautiful garden. It’s the idea that if you are in a comfortable setting ,you feel more in control and confident and your body will relax, allowing an easier labor and delivery. What makes me more comfortable is the idea that everything a midwife or doctor would need to treat me is either right in the room or can be had in seconds, with lots of trained staff ready to step in and help. (Although the thought of a post delivery room service meal and a massage in my room is a very comfy idea too).
Where do you live?! I want to give birth there.. 🙂
The link is further down (www.swedish.org and then the link takes you straight to the part about in room massages)
“Why not admit her to in hospital and induce her if the client desires this and it is warranted? Why take such risk with the client and fetus?”
But what fun would that be?
Oral oxytocin would be completely ineffective, though, no?
It is a peptide hormone which would be destroyed by stomach acid.
Physiology and pharmacology epic fail.
We don’t give oxytocin by mouth for the same reason we don’t give insulin by mouth. It won’t work.
Oh that makes it even more hilarious/sad.
Hope she’s not administering it orally in case of a hemorrhage and thinking that it’s effective, then.
Maybe she knows this but does it to please the mom? I can see this.
Give her a sugar cube and say it’s Pitocin?
Didn’t they used to give buccal pit though? That’s what I thought it probably referred to.
Here’s a reference for it. 1986.
http://www.ncbi.nlm.nih.gov/pubmed/3469841
That’s horrible, and the Dr. Biter homebirth death story is horrible too. There will be examples of people with licenses going off the deep end but at least there are mechanisms in place to deal with those providers. The home induction is bizarre. Pitocin is given IV so the dose is the smallest possible dose and it’s never given without careful monitoring (EFM) and with protocols to turn it off ( which you can’t do if it’s oral ) and to be able to respond if it causes too much in the way of contractions. It’s flagrant malpractice to administer Pitocin, or Cytotec ( I have heard that it has been used at for induction at home as well) for induction at home. Postpartum I think it’s reasonable that licensed providers have these meds at home but working within a protocol. I can’t imagine any context where the risk of using them at home would be worth it and the patient shouldn’t be transferred to the hospital if induction or augmentation is necessary. Just crazy.
OT: http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies
Someone just posted this on babycenter as “proof” that homebirth is safer. Because there’s a big ole list of studies at the bottom, that must make it true! The list of “reasons” why it is safer is an especial treat.
*headdesk*
That article is horrible – the lack of data doesn’t mean it is safe. It means no one has collected the data. And this website has examples of each of the “rare” things happening on low risk births.
That really made my head hurt. A car crash on the way to hospital? EFM CAUSES fetal distress? (And what is this with lying on your back? I sat up for mine.) Paralysed for life by epi? Written by a CNM?
It says at the top that education leads to empowerment, Can’t say I felt very empowered at the end of reading it.
Nuts. And I bet Antigonos knows of the midwife….
“Judy Slome Cohain is a masters degree certified nurse
midwife in the US who has been living and working in Israel since 1983 as an
unlicensed midwife. This twist of fate enables her to practice evidence-based
midwifery, instead of less-than-optimal protocols to protect a license”
the name sounds vaguely familiar; but it is a common name. I would like to know more. It is absolutely ILLEGAL to practice medicine, nursing, or midwifery in Israel without the appropriate licensure, which is in the hands of the Ministry of Health, and she should be reported if she is not licensed IN ISRAEL.
Wow, that’s just horrible. And of course, we can translate “either lower or similar rates” into “well, we have some studies, and the most favorable among them find the same rates die to having numbers too low to see the differences … but we can logically say ‘same or lower’ because it’s logically equivalent.”
“Car accidents to or from hospital “? Are you kidding me? o.0
And there it is: it’s not about the safety of mothers and babies, it’s about the safety of homebirth midwives. Mothers and babies be damned. Do you see this, NCB advocates? You true believers are so blind.
TWINS at home with an unlicensed mockwife after two cesaereans??? For the love of GOD what is wrong with these women??? You may as well pull a Michael Jackson and dangle your baby over a balcony – you’re showing just as much reckless disregard for your child’s well-being.
And for your own life, as well.
Should have JAILED her after the first, second, or third offenses. ….
She is a criminal.
All I can say is ETHICS…..How in the world can anyone state their belief in guilt and then turn around and call in the troops?
This is what I blog about over and over. You would NEVER and I mean NEVER witness this within the CNM community. We are not trained nor educated in such a manner.
Prosecuting a 71 year old woman who attends extremely high risk births, is responsible for several perinatal deaths is not persecuting midwives for God’s sake. She has attended and caused at least two deaths and has not learned or gained one once of humility.1993 Claims “They’ll have to cut off my hands to stop me [from delivering babies].”
This is not persecuting a grandmother, it is seeking justice for the poor lost neonates and their parents!
Deena, how do you explain Evelyn Mulholland (sp?) in Maryland? She is a CNM. In my greater community, we have CNMs falsifying results, in some cases keeping two sets of charts for high risk scenarios. I wish that this was relegated only to the CPM community but it’s not.
Unfortunately it is not “relegated only to the CPM community”, but I often wonder after reading about these stories where CNMs are involved. It seems like many times they are working as colleagues to CPMs in birth center settings, or in some cases I have seen CPMs turned CNMs. A third and common scenario I see is that they spend little or no time in hospital settings before practicing OOH, and get swept up into the NCM community. These are not excuses for their horrifically unethical behavior and these points are not true for all of them, just an observation.
In regards to “what have they done to prevent this”, I agree. I think the ACNM needs to be called upon to take a stand. It is unethical to support a credential that does not release it’s stats for peer review, and the state released ones are terrible. Their credentials (CNM/CM) will continue to be associated with the CPM, until they do. Ironically, they already have a DEM credential accredited by AMCB (the CM) that they have barely acknowledge and only helped to legalize in 5 states. Why? Why “support” the CPM, when they could take a stand and promote the CM?!
There is a fourth class. Midwives who have significant hospital experience but leave the hospital setting because they do not like following rules.
LISA BARRETT!
Yes, was just about to say we have this problem in Australia. You can do direct entry midwifery course at the university, do minimal hospital training (although Lisa Barrets’s sounds like it was quite extensive) and set up as a private midwife delivering at homebirths outside the hospital system.
That, I am sure, is true. We could also throw Fischbein (sp?) and Bitter under those guidelines as well from within the OB community. It sounds like in your community you have seen quite a few CNMs who may fall into that category, which is beyond unfortunate. I think anecdotes aside, the CNM outcomes in hosp have been really great. I don’t know what the “solution” is, but I think one unified credential is a good place to start, again with a strong stance on these issues from the ACNM.
I love hospital based CNMs. My solution is the one credential but also mandated hospital privileges. And when you hit the door with a trainwreck that adhering to sensible standards would prevent, you bear the consequences with so much more built in oversight.
I don’t think the problem is CNM vs CPM, though obviously the CPMs will have much less knowledge. The issue is NCB rot that takes over peoples thinking. I would take a LDEM that follows basic standards and protocols over a CNM fully into the woo.
NCB is why professionals that have Masters degrees will falsify, use pitocin OOH, lie, and take super high risk cases for HB. Its not because they do not know better, its because the NCB is just stronger.
Bingo
I think you are right but still, when it comes to a story like some of these, it’s a combination of NCB ideology and some sort of narcissist personality. I think the worst of these people aren’t just into the woo but have a fundamental personality disorder. I am thinking of Dr. Biter here, the example of a CNM keeping two sets of charts, the McGlade case in Florida, and this horrible midwife ElHalta. There is something about the worst of the worst of these cases that goes beyond a license. I think of Genine Jones and the doctors and nurses who have been found to be killing patients…. it’s a big world with some very very sick people. Maybe it’s back to the question at the end of Dr. Amy’s post, which is worse, the lunatic birth provider or the fact that someone reflexively defends them?
But WHY are so many of them HB mWs? Is it because it takes no effort to become one?
Noted. I do not see this in my community. So of course I am speaking from my experience. I know there are wonderful direct entry. But the PEP pathway is woefully inept. and the lost has been much too great.
The ACNM is beginning to address this at the national level. It will not be quick or easy but they are moving forward and I am grateful.
She’s an EXCEPTION, and a rare one at that. How many “midwives” Amy’s talked about have lost perfectly healthy children? Seems to be a little too high.
So Deena, why are the midwives complaining?
And great, a CNM would never do this, you claim. But what have they done to prevent it? Why did it take the law to go after this beast? Why didn’t midwives throw her ass out of the profession years ago?
NARM revoked this woman’s license, right? So midwives did throw her ass out at some point…
Also I don’t know much of anything about the CNM community, but in the current institutional layout, how would the CNM profession have any jurisdiction over a CPM?
I’m sure there’s malpractice in the CNM community, too. The free-for-all needs to end, which I think is something all of us can agree on, Deena included.
NARM revoked her license, but did nothing to stop her from practicing. Nor did the ACNM. They let rogue MWs run all over. You don’t need to have any credentials to call yourself a midwife.
Where is the ACNM standing up to protect their profession? They don’t do it. I have never understood why.
Bofa, I tried to reply to this thread and posted below PrecipMom. I was pointing out how the ACNM even has a DEM credentials (the CM) accredited by AMCB. They train with CNMs, except they don’t have a BSN (usually they have a BS in bio, chem, etc). Why are they supporting the CPM instead of taking a stand and promoting the CM?
They have NO way to stop a rogue MW. No one does, short of legal means in places those remedies are available. This is the problem.
I cannot blame other MWs for not stopping her- I didn’t step in and stop every single bad electrician either. I sent the info to the right people, and expected them to do it, just like they got NARM to remove her CPM. You can police your own by revoking licensure, speaking out, but what more can one do, really? This is why state laws are needed to stop dangerous HCPs, like they have for practicing medicine w o a license.
I do not get the CNMs that support CPMs, but I am willing to bet that those ones know some good CPMs and don’t want to put them out of business. Or talk against the sisterhood, or whatever. Otherwise, I have no idea.
FWIW, Judith Rooks said that the CPM was taken to be a temporary thing, just to shore up MWery while the DEMs got educated. But it didn’t turn out like that because I say- who wants to go to college when you can make the same doing nothing now?
No, they can’t directly prevent a rogue MW from doing what she will, BUT they can
a) shun her; as noted above, this “rogue” MW was completely embraced by the MW community despite having lost her CPM. They need to make it clear that they will NOT support MWs who work outside high sets of standards.
b) set HIGH standards, and promote that in the community. Send the message to mothers that they should NOT accept incompetent providers, and that rogue providers are NOT safe.
She can advertise her services all she wants, but if the culture is such that her crap is not acceptable, then she is not going to do much.
The dumb thing is that taking this type of aggressive approach not only will help rid the community of this drek, but will serve to promote the activities of CNMs. You would think that the ACNM would be all over that, but they aren’t…
Well, NARM may have revoked her license, but this woman was BIG in the midwifery community — speaking at conferences, writing (frequently) for Midwifery Today (which still sells her breech video), etc.
That is really bad. She should have been SHUNNED.
The ACNM needs to start making a big deal about the incompetence of barely educated midwives instead of glossing over it in the name of sisterhood.
None of the investigations are accidents! Those are deliberate attempts to ascertain facts and determine how best to proceed.
I’m appalled that ANYONE would administer cytotec to a VBAC mom or use a vacuum extractor outside of a hospital setting. Instrumental delivery should, IMO, only be done with surgical backup on hand.
Sure doesn’t sound like the “natural” delivery the HB crowd promotes. How are they defending a killer MW or the the use of cytotec and a vacuum? If an OB did this they would want them dead.
Really, in what other context do baby killers get defended? I didn’t hear anyone sticking up for Casey Anthony after what she *allegedly* didn’t do. If I killed or injured a baby in any other context than homebirth, I doubt anyone would organize a legal defense for me.
Where’s Nancy Grace when you need her? Seriously, she jumps all over missing/dead children’s cases, even when there’s very little evidence that the parents/caregivers did anything. Why doesn’t she go after these serial killer midwives with as much zeal?
Because outside of the cult, few even know about it. MAybe we ought to contact Nancy.
Wow, a great idea!
Here’s the contact info:
http://www.cnn.com/feedback/forms/form5c.html?24
Perhaps Magnus’ or Abel’s parents could send in a show subject idea. Or Dr. Amy could do a “round up” kind of post summarizing the most recent arrests and lawsuits, including one or two of the more infamous US serial killer midwives. Then several of us could send Ms. Grace the link to that post!
I think the round up of US serial killer MW is a good follow up to this post, and perfect segway to Nancy Grace.
I think a balanced post would be to find OB lawsuits in similar circumstances – second breech twin, GBS etc – where the OB didn’t adhere to standard of care and suffered the consequences. Alternately, examples where the standard was met and outcome beneficial.
That would answer anyone who parachutes in, asking what about hospitals?
Great idea! Though serial killer MWs are what want Nancy to see, so maybe 2 posts.
“Two investigations is likely not an accident.” Yeah. I don’t think it is. I think it’s the expected result when unqualified, uneducated people call themselves “midwives” and mess with matters of life and death.
Oh no, they’re holding us to standards! Nooo, we should just be allowed to do whatever we want with no oversight! And while we’re at it, why do we have traffic laws or building codes? The Man is just trying to hold us down, that’s why!
My God, they’re investigating people breaking the law? How horrible. Yeah, I agree we need a watch group.
What is truly terrifying is the thought of what was happening between 1993 and 2012. How many near misses? How many unreported tragedies?
If midwives want the privledge of caring for pregnant women and babies they must quit standing for gross malpractice and incompetence.
But look at yesterday’s post. Deena assures us that midwives are trying to do better. Of course, what has the midwife “profession” done about this beast? Nothing.
The CNMs can’t take disciplinary action against the CPMs. They can come out and say we refuse to be associated with this gross incompetence, and make a statement against the credential, but I wonder besides who is actively involved in this community of women how many people (or even care providers) realize what is going on. I know many CNMs who have no clue about what is happening.
According to Deena, they are having conferences together.
The national level is addressing standardization of midwifery nationally based on global standards. Their first meeting was this past April.
It will take time to fix this mess but it will be addressed and standardization will eventually occur. In the mean time the states need to do what the states need to do to protect their consumers….
Historic meeting of US MERA—A new era in U.S. midwifery
An historic joint meeting of seven organizations directly responsible for education, regulation and professional associations for the three U.S. midwifery credentials—CPM, CNM and CM—was held April 19-21 at the Airlie Conference Center in Warrington, Virginia.The Meeting objectives were to: 1) strengthen the foundation for organization responsible for midwifery education, regulation and professional associations to work collaboratively to advance the midwifery profession in the U.S., and 2) grow together as leaders creating the future of midwifery in the U.S.
Member organizations included, American College of Nurse-Midwives (ACNM), Accreditation Council for Midwifery Education (ACME), American Midwifery Certification Board (AMCB), Midwives Alliance of North America (MANA), Midwifery Education Accreditation Council (MEAC), North American Registry of Midwives (NARM), and National Association of Certified Professional Midwives (NACPM.)
By consensus of those in attendance at US MERA (US Midwifery Education, Regulation and Association,) participants recommended the establishment of the US MERA Work Group as an ongoing entity with the following purpose:
“The purpose of US MERA is to create a shared vision for U.S. midwifery within a global context, generate an action plan for collaboration to strengthen and promote the profession of midwifery in the United States, thereby engendering a positive impact on U.S. maternity care that will improve the health of women and infants.”
Each of the identified meeting goals were met:
Describe a history that reflects the ongoing efforts to move professional midwifery forward in the U.S., including identification of challenges and accomplishments
Engage in a dialogue that creates a deeper understanding of current strengths and challenges for U.S. midwifery
Develop knowledge and trust to support successful ongoing communication Identify opportunities for future collaboration
Conduct a collaborative analysis of the International Confederation of Midwives (ICM) three pillars—Education, Regulation, and Association (ERA)—as they apply to U.S. midwifery.
Within the next several weeks, the US MERA Work Group will issue a joint statement on its work together.
While this sounds promising that people are addressing this and it is possible that the topics may be vague sounding because so many different aspects are covered, but I feel like it should say something like “establish a minimum standard of care or protocols that will improve maternal and prenatal mortality and morbidity (and not having the improved morbidity be at the expense of poor mortality.)” It should also talk about having accountability and how to address malpractice issues. It is important to improve education for example, but it means nothing if lay midwives taken on cases in the OOH environment that they should not, like a VBA2C twin birth. A lot of midwives think it is okay to have a regulatory board of a bunch of midwives that all think the same. When talking about regulating midwives they are like “doctors should not be on the board because they don’t know anything about midwifery.” Who care. I am not saying they are without their flaws but they do know about safe care and a board like that should be diversified. I have been torn about this CPM/CNM/lay midwife thing because I have midwives in my community that seem nice and I hate to feel like I am taking away their livelihood but I hate the thought of women losing their babies because they didn’t have all of the risks truly explained to them. I think there are probably lay midwives that transfer appropriately and truly screen for low risk patient and maybe that is not so bad an option to offer women but there are the ones that don’t and so what do we do about those ones because they were probably at that conference pretending to be a part of the solution? aye aye rambling here…..
it will be a process. It will be difficult, challenging but oh so worthy of our drive and attention.
I was email about this not long ago. I have to be honest: it sounds like a lot of circular dialogue and a lot like the same discussions promised about MANA. Engaging in dialogue is all well and good, but as a future CNM I’m certain I don’t want to “create opportunities for collaboration” with the CPM. If we are going to move forward and discuss what really needs to happen, why not talk about a singular credential with a university basis of education?
YES!
Deena do you have a way to email you privately? I would LOVE to talk to you and pick your brain. I have been following your comments, and I have a few things you might be interested in hearing.
yes hikinore@msn.com