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Sunday
Dec052010

ACOG v. Midwives, Part a Million

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By emjaybee

Via @pushformidwives on Twitter, we have this rather interesting news story from Illinois PBS station WTTW.

Watch the full episode. See more Chicago Tonight.

 

While The Unnecesarean is not technically a homebirth/midwifery advocacy blog, this clip is notable both for the reporters’ somewhat alarmed tone while discussing CPMs and homebirth, and for an appearance by Dr. Jacques Abramowicz, (also quoted in this related article) the Illinois chair for our old friends ACOG.

ACOG is where the push for access to midwives, right to homebirth, for lowered c-section rates, and for less intervention-heavy births intersect, in that they are the organization most opposed to all of these reforms.  This has had the, for them, unfortunate side-effect of broadening their opposition. Women who would never consider homebirth or a midwife find themselves making common cause with women who do advocate for those things, merely so they don’t have to undergo abusive treatment in the hospital or unnecessary surgery. The woman at the beginning of this video, in fact, is having a homebirth as a direct result of a previous hospital experience (though we don’t know if it was a c-section). 

Having said all that, I would LOVE a CPM to deconstruct Abramowicz’s assertions that CPMs reach certification without ever having seen a breech birth, among other things. Also that it takes an OB 15 years of training before they’re allowed to deliver a baby—can anyone offer an idea as to where he got that number?

Oh, and in the WTTW comment thread mentioned at the end of the piece you can find, among overwhelming support for CPM licensure, this snarky gem by midwife Linda Simon-Price:

I am one of the nurse midwives filmed in your piece - I am wondering why physicians are always interviewed to discuss the ‘safety’ of midwifery care. Instead, you should have contacted someone from the American College of Nurse Midwives, our governing body, to discuss CPM’s and their role in birth and especially home birth. This never makes sense to me. It’s kind of like asking a plumber to comment on electricians. Both tradesmen, but completely different jobs. You allowed him to talk about the ‘dangers’ but didn’t back that up with statistics, that shows that home birth is a very safe alternative for low risk women. No one ever talks about the bad outcomes that occur in a hospital setting. If women were not so afraid of the experiences they have come to expect in hospitals or faced with a more than 30% c/s rate in this country, or had the opportunity to use a free standing birth center in Illinois, then there would be more options available to women. Just sayin.


Related reading:

Illinois’ Home Birth Safety Act (SB 3712)

 

 

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Reader Comments (21)

First, I haven't had a chance to look into this yet, I'm on a slow connection and it will boot me off.

As a student midwife, I can see to a point that some CPM's will not see a breech birth or other variations of normal labors before becoming certified because they practice in states where a licensed midwife must transfer these. Of course you have patients who show up in labor with a breech, but I think those are fewer, especially in such small percentage of women who are attended by a midwife.

And I'm not quite sure where he got 15 years from. A medical student will start doing clinical rounds in about their 3rd year of med school, so 7 years in college after graduating high school. So technically they can start delivering babies then, and when they're in residency. Not being "allowed" to catch babies before then is like saying midwives can't catch babies until after they're licensed. And who wants to be the first patient for that?

If they go on to be an ob/gyn, they'll have their residency that averages another 4 years. That's still only 11 years by my count, and that's to be a licensed physician on your own...you'll definitely be allowed to deliver babies LONG before that point. Maybe math wasn't his strong point?

I think it's also important to note that Ob/gyns are not the same as midwives, they're trained surgeons. I'd expect the person who was going to do a major abdominal surgery on me to have more training than a midwife, because the demands (knowledge, technique, risks, etc.) are different.

December 5, 2010 | Unregistered CommenterRandee

I think the 12-15 year "quote" was a misunderstanding aka poor journalism skills. Because it was not said on camera, it is hard to know what was said. After 4 years of college and 4 years of medical school, they typical OBGYN resident starts delivering babies in the beginning of residency (4 more years). Perhaps Abramowicz said something along the lines that OBs do not deliver babies independently until they graduate after 12 years of school and training (15 years for maternal fetal medicine specialist, who do 3 years of fellowship training).

He was likely saying that CPM have 3 years of training and OBGYN have 12-15 years of training.

However, that exaggerates the education of OBs. In what way do the courses taken in college prepare an OB to deliver a baby? Same with much of medical school, which involves training and clinical rotations in many other specialties. And it ignores all the high-risk training and education an OB GYN needs (managing complex pregnancies and medical complications, performing cesareans and hysterectomies), plus education in GYN care, both simple and complex, including GYN surgery GYN Oncology, none of which is in the scope of practice of a CPM.

Abramowicz is totally ignorant of the training of CPM, claiming they are not trained in neonatal resuscitation or management of Post partum hemorrhage or cord prolapse. All CPMs are trained in recognizing and managing complications during and after birth.

December 5, 2010 | Unregistered CommenterSamantha McCormick, CNM

Just guessing 15 years = 5 years high school, 4 years university, 4 years med school, 2 years specialization??

December 5, 2010 | Unregistered CommenterAlex

And when do OB's see a breech birth?

December 5, 2010 | Unregistered CommenterRenee

I KNEW I recognized that midwife's office. I did my ALACE training at Mother Me, Inc. I learned to listen for FHT in that office :)

December 5, 2010 | Unregistered CommenterVanessa Manz

"And when do OB's see a breech birth?"

There are some out there who will.

December 5, 2010 | Registered CommenterJill

Uh, I've been a doula for only six months and _I_ have already seen a breech birth. Home is where the breeches are being born...so CPMs have many, many occasions to attend a breech. Way more than OBs would get, I surmise, and it's their own fault!

December 5, 2010 | Unregistered Commenterdd

I have worked at University of California Irvine, Medical Center for 24 years. 4th year medical students are allowed to deliver babies. First year Obstetric Residents are given all the normal vaginal deliveries, unless the patient has emphatically stated that their doctor must be there for the birth. It is ridiculous to say that an obstetrician doesn't deliver a baby until 15 years of training. That is an outright lie. We had a 8 - 5 p.m. midwife for about a year who did all the normal spontaneous vaginal deliveries until it became clear that the med students and residents were not getting their share of the deliveries. She was gone almost overnight after they determined that our number of births per year had dropped and there were no longer births to spare. You would not believe the horrible things that are done to women in a medical school environment. It is appalling. It does not surprise me that obstetricians lie in an article that deals with the issue of women re-claiming control of their health care. They do far worse in the clinical setting. I have experienced it first hand for years.

Here's the exact quote from the piece at the 03:27 mark:

"Dr. Abramowicz says that a physician may go through 12 to 15 years of training, including medical school, before delivering a baby."

That seems like a pretty straightforward quote. It's possible the reporter got it massively wrong, of course, so I suppose we'd have to ask Dr. A directly to be sure. But surely you cannot count most of undergrad (much less high school) as medical training and if you could, every college-degreed CPM would qualify. I'm wondering if he did not mean "deliver a baby" so much as "perform a c/section" perhaps?

December 5, 2010 | Unregistered Commenteremjaybee

I agree that that math seems a little off. And is it really fair to include undergrad in the calculations?
I'm thinking about going into being a CNM eventually, so if I were to include my first bachelor's plus at least a year getting pre-requisites, plus getting CNA certified, plus a year of nursing school (most programs would be 2) and then, I don't know, maybe 3 years getting a masters - that's like 9 right there. Some physicians need to get over themselves.

December 5, 2010 | Unregistered CommenterJenna
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