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North Carolinians to March for Legalization and Licensing of CPMs

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Guest post by Arielle Stagnola

On February 20, 2011, a local Certified Professional Midwife (CPM) was arrested for providing midwifery services without a license in North Carolina, igniting passions of advocates of midwifery and home birth across the state. North Carolina Friends of Midwives (NCFOM) has been actively working to fix legislation, but has not yet accomplished this task. Supporters were outraged to hear of the arrest, something all had hoped would not happen before new legislation legalizing CPMs could be passed.

With cesarean rates in North Carolina on par with the national rising national average of 32.9%, options for vaginal birth are waning. Healthy women seeking a vaginal birth after cesarean (VBAC) who are unable to find area physicians or midwives to provide care in a hospital or freestanding birth center setting frequently seek care from CPMs, who assist them in childbirth without the risks of major abdominal surgery. There has never been a more critical need for skilled, licensed CPMs than now.

Momentum is gaining quickly in this fight and hopes are high this week. On February 23, Senator Thom Goolsby agreed to sponsor a bill that would license CPMs, which is currently being written. Angered supporters from diverse backgrounds are now channeling their energies into a protest march being held in the state capitol next week. The Birth Freedom March will take place in Raleigh, NC at 10 a.m. on Wednesday, March 2nd at the State Legislative Building. Hundreds of mothers and families will gather with home birthed babies to show support for and demand legislation to legalize and license CPMs. Attendees are scheduling appointments with their representatives to speak to them face to face about the importance of licensing CPMs.

Anyone interested in joining this most important of gatherings should visit NCFOM for more details. There is also a Facebook event set up. NC residents are encouraged to visit http://www.ncga.state.nc.us/ and contact their local state representatives to set up meetings, send letters, and make phone calls to make our voices heard.


News coverage of the story:

Professional Midwife Arrested for Practicing Illegally (myfox8.com – February 23, 2011) Dr. Henry Dorn interviewed in this article.

Midwife Supporters Outraged; Investigators Explain Arrest (wsoctv.com – February 24, 2011)



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Reader Comments (42)

You might think that the serious injury of a baby would be an opportunity for soul searching in the North Carolina homebirth community, but you'd be wrong. The North Carolina Friends of Midwives) view this as an oppportunity to promote the interests of CPMs. No one knows whether the baby will live or die, but homebirth advocates have already "moved on" to the really important issue, the fate of the midwife.

That is what is known as "reframing the conversation." North Carolina homebirth advocates aren't going to persuade anyone of anything by discussing the babies injured under the care of CPMs. They don't even bother to try to justify the conduct of the CPM, her medical judgment (or lack thereof), or the appropriateness of a homebirth in either case. That argument is a total loser, so effort is expended to divert attention from the homebirth disasters.

In fact, Russ Fawcett, the president of NCFOM sent out an urgent message to the NCFOM mailing list:

"URGENT Request

This message in being sent to all NCFOM members.

The leadership of NCFOM is moving to change the direction of the media. We will be crafting a new press release that is ENTIRELY focused on Wednesday's Birth Freedom March and legislation, with NO mention of the investigation.

At this time, please STOP ALL COMMUNICATION WITH ALL MEDIA INQUIRES that may arise that have any connection with Amy. Direct all media inquiries to myself (Spigget@aol.com) and Amber Craig (ambercraig@nc.rr.com).

Friends - I think this has been very successful, but not without concern over worsening Amy's circumstance. Nevertheless, there is a lot of positive press out there, and some negative, but had we done nothing, it could have been all negative.

Please DO NOT CONTACT OR DISCUSS with any media outlets until further notice. This includes leaving comments on newspaper, television and other media's web pages. It would be better to miss an opportunity at turning around a bad article, or celebrating a good one, than to negatively affect our need to now change the conversation. Please direct any questions about media to myself, or Amber Craig...


Only homebirth advocates could consider the life threatening damage sustained by infants at homebirth as an opportunity to rally support. According to them, the problem is not that babies are injured and die at homebirth. And the problem is not that CPMs have less education and training that midwives in ANY other first world country. The real problem, according to homebirth advocates, is that these underqualified, dangerous practitioners who have already hurt babies don't have legal sanction.

Even as the latest injured baby struggles for its life in a local hospital, Fawcett and NCCFOM have figuratively rushed to bury the baby and support the CPM instead.

March 1, 2011 | Unregistered CommenterAmy Tuteur, MD

What has your direct communication with NCFOM, et.al., been?

March 1, 2011 | Registered CommenterJill

I just hope this doesn't hang VBAC, twins, breeches, etc. out to dry. I mean that's clearly one of the driving reasons there is a great need for CPM's and if the written bill risks them out...

March 1, 2011 | Unregistered CommenterMychel

Hiding behind the dead baby card (as though no baby ever died in a hospital under OB care) in order to deny women the right to bodily autonomy is a profoundly antichoice and antiwoman stance. Women have the right to decide where and how they will birth, and to make their own decisions, as thinking adults as to what risks they consider acceptable during birth. In a democracy, they also have the right to demand legal access to caretakers whom they believe are capable of assisting them, and to birth in the location of their choice.

Of course, fearmongering types also have the free-speech right to say that legal access to midwives and homebirth is something women are just too stupid to understand will kill them and their babies.

Such is the glory of democracy.

March 1, 2011 | Unregistered Commenteremjaybee

"Hiding behind the dead baby card (as though no baby ever died in a hospital under OB care) in order to deny women the right to bodily autonomy is a profoundly antichoice and antiwoman stance. Women have the right to decide where and how they will birth, and to make their own decisions, as thinking adults as to what risks they consider acceptable during birth. In a democracy, they also have the right to demand legal access to caretakers whom they believe are capable of assisting them, and to birth in the location of their choice."

First of all, we're not talking about the "dead baby card," we're talking about an actual dead baby and another baby who may be near death.

Second, there is no right to have a CPM attend your birth. A CPM would not be considered qualified in ANY first world country, not The Netherlands, the UK, Canada or Australia. They would not qualify for licensure because the CPM is a post high school certificate whereas midwives in EVERY other industrialized country are require to have university degrees.

Homebirth supports complain that CPMs are illegal in North Carolina, as if that is the only place. CPMs are actually illegal EVERYWHERE in the first world. If The Netherlands, the UK, Canada and Australia refuse to license midwives who have no university degree, why shouldn't North Carolina do the same?

March 1, 2011 | Unregistered CommenterAmy Tuteur, MD

They are legal in some other states and often more "qualified" than many OB's because they understand birth to be a natural process and not some bomb waiting to kill everyone around it... physically, legally, emotionally, you name it.

I find it very sad that so much faith is put in a university education, like a piece of paper makes you the best there is. That people are not capable of learning without a "proper education". Often that "proper education" leads to practices that do not benefit moms and babies in general, like making women fit a text book mold of labor instead of recognizing the individuality of each patient and their process.

I personally would rather take someone with common sense and respect for me as a person who knows a little about birth rather than have someone who is medicalized, treats me like I am carrying a disease and chops me open for no reason, who is scared of the natural birth process because they can't control ever minute of it... I despise what birth in hospitals has become and I will never subject myself to that again. If it means that I have access to CPM's legally in NC so be it, if not I will still be at home using my own common sense and knowledge I have obtained on my own to safely bring my child into the world because it is the best option for me. There is always a risk in everything in life. Babies can die at home just like they can and have in hospitals, moms are dying in hospitals too. The point of licensing CPM's is to offer moms the opportunity legally to make the best decisions for themselves and their babies and to not punish the CPM's who are providing that much needed service. These moms who choose to birth at home are not ignorant hicks that care nothing about their babies well being. I can attest that my decision to home birth was for the health and well being of both me and my child but at any point I felt like that decision was not the best option for my child, I would have changed course. What would be best is for all these providers, CPM's CNM's and OB's to work together for the good of their patients and respect their choices rather than get into pissing contests over who's piece of paper is bigger.

March 1, 2011 | Unregistered CommenterMychel

The bottom line for me is that there should be someone with some training for women who want to have their babies at home. And as long as hospitals make it well nigh impossible to have a normal birth, and do not allow women to VBAC, or say they will but then nervously hurry them off to another C section, women who want to escape from being obstetrical cripples will have to give birth at home, and there should be somebody who knows something to help them. In my opinion, these are the people that perhaps CNM's and birth centers should be helping..but they are just the people that birth centers have to refuse. I believe that if one could have a truly normal birth in the hospital....with only intermittent monitoring by doppler, with only a saline lock, not an IV, with the ability to move at will, shower, get in water and out of it, get in any position for labor and birth, eat and drink what one wants, most women would have at least the first VBAC in the hospital. (Of course if hospitals were like that, pretty soon there wouldn't be so many VBACS because there wouldn't be so many C sections!)

Make hospital birth less of a nightmare to endure, so that high risk women can still have good births. Make it possible for CNM's to do home births, with good hospital support. Then you have a right to complain about CPMs not having enough preparation. Since none of these things are true, and there is no one else for most women who want to birth at home, allow the law to certify them so women know their birth attendant has at least a minimum level of preparation. And don't make the law limit them so they can't take care of the very women who need them!

There will always be cases of some birth attendants making errors of judgment, and this applies to OB's and CNM's as well as to CPMs.
Many of us know hospital dead baby stories too. I do. I grieve for their mothers where ever this happens. I don't think women should be encouraged in any case to turn their raw grief into anger at any one set of providers. It happens anyway without encouragement because anger is a much more comfortable feeling than grief. It never solves grief though. And it is wrong to USE a woman's grief to push your own agenda. It is wrong to USE a person's grief for anything.

I don't much like, however, this person who is trying to "control the message." I don't like control of "the message" and in this case it is a guy telling women to shut up and let him run things, and that rubs me the wrong way. Now, advice on how to address issues is OK, but telling people not to answer articles, only he can do it right.....no, not for me.

Susan Peterson

March 1, 2011 | Unregistered CommenterSusan Peterson

In all honesty, I think Amy has a very legitimate point. Reading that letter from NCFOM deeply pisses me off (assuming it's legit) specifically AS one of the people who believes in supporting birth choices.

I disagree with Amy on many things. I am AM a supporter of midwifery, including CPMs. But to me, this absolutely does NOT mean blindly supporting ANY midwife under ANY circumstance no matter what. I think most of the readers here would agree that there are some incompetent doctors out there, and that they should be investigated and penalized and possibly prevented from practicing if they're too dangerous. No question. Well, there most certainly are incompetent midwives out there as well, and they, too, should be investigated and dealt with accordingly.

Was the midwife in question incompetent and dangerous? I don't know enough about these cases to say for certain. It sure seems possible, but again, we don't have the full story. Hiding it is NOT the way to turn the tide on the legal status of licensed midwives in North Carolina. Sweeping the details of this situation under the rug so brazenly to try to spin this as a rah-rah rally? I find it galling on an ethical level, not to mention incredibly counterproductive in terms of PR if a letter like the above were to get out, which, well, here we are.

I think one can be pro-midwives AND pro-improving the standards of said midwives. This goes for education, for licensure and certification, and for whatever governing bodies oversee CPMs. Situations involving incompetent midwives shouldn't be whitewashed. They need to be taken very, very seriously. I know in some circles this might not be such a popular opinion, but I've been feeling this way for a while.

March 1, 2011 | Unregistered CommenterDou-la-la

The CPM does not in any way come from a bachelor's degree (for instance) or a master's degree (for instance) as a pre-requisite, it is a certificate based credential, based in the experiential learning and study of midwifery. This may or may not be in the context of a structured program.

However, many CPMs hold degrees in various fields and are nurses, cnms, and at least one MD prior to the NARM process so to say that they are less trained than any midwife in the following countries: Canada, Australia, England and the Netherlands is not entirely accurate, too much of a generalization there. I understand your point entirely Dr. Amy and do not disagree with you that stringent education requirements are needed for the CPM to be considered alongside these other countries. This being said, the other education one acquires through their prior study does not leak out of their brain because it is not a bachelor's of midwifery, or a BSNursing, MSNursing that precedes your entry into the NARM process.

March 1, 2011 | Unregistered CommenterSaanenMother

sorry for the bad grammar dear readers, I think my education is leaking out my brain.

March 1, 2011 | Unregistered CommenterSaanenMother
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