North Carolinians to March for Legalization and Licensing of CPMs
Monday, February 28, 2011 at 9:56PM
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)
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...
Thanks,
Russ"
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.
What has your direct communication with NCFOM, et.al., been?
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...
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.
"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?
http://mana.org/statechart.html
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.
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
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.
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.
sorry for the bad grammar dear readers, I think my education is leaking out my brain.
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...
Sorry Jill, but don't the midwives in the US refer these patients on? I'm not from the US, but as I understand it in the Netherlands and the UK once you reach a certain level of risk then homebirth is no longer an option in the midwifery system. It's the same where I live, unless you can find an independent midwife that will take you on outside of the system and you can afford to pay for one. I know, for example, that once my GP finds something outside her scope of practice, she refers me on to a specialist for more expert care. I just assumed this would be a similar hierachy or is it not? Is an integrated European-style homebirth system what the homebirth advocates are wanting in the US? Or is it something different?
There's more than the breathtaking cynicism of Russ Fawcett and the North Carolina Friends of Midwives (NCFOM) behind tomorrow's planned "Birth Freedom March." That cynicism (deliberately ignoring the deaths and injuries of babies) obscures an ugly truth at the heart of the march, indeed at the heart of all homebirth advocacy. Certified professional midwives refuse to be held accountable to anyone for any reason. It doesn't matter who dies at the hands of a CPM; it doesn't matter how the baby or mother dies; it doesn't matter that the deaths could be prevented. All that matters is the ability of homebirth midwives to do whatever they want and get paid for it.
Here we have the specter of a midwife literally arrested for violating the law, trailing one dead and one dying baby in her wake, and it apparently has never occurred to homebirth advocates to investigate her conduct. It is IRRELEVANT to them whether she was incompetent, negligent or possibly practicing in violation of supposed standards of CPM practice. There has been no attempt, nor has anyone even pretended that there will be an attempt to hold the CPM accountable.
The absolute refusal to hold CPMs accountable extends from the lowest to the highest echelons of homebirth advocacy. In the state of Colorado, where the tally of babies dead at the hands of licensed CPMs is appalling and rising, the President of the Colorado Midwives Association acknowledge that the death rate was double that for the state as a whole (including premature babies and babies with serious medical problems) and then utterly dismissed it.
There has been no attempt to investigate the extraordinary death toll or to hold anyone accountable. Quite the opposite. Colorado homebirth advocates appeared before the Legislature to declare the program a success and lobby to extend it. If a death rate that is 100% higher than the state death rate is a success, one shudders to think what a failure would look like.
There is no more egregious attempt to deny accountability than that being perpetrated by the organization that represents homebirth midwives, the Midwives Alliance of North America (MANA). MANA is aware and has been aware for some time that homebirth has an unacceptably high rate of neonatal death. Their own data makes that clear and that's why they are hiding it.
And that gets to the heart of the ugly message being sent by tomorrow's planned march in support of "birth freedom":
There has not been and there will not be any attempt to hold CPMs accountable in any way. It does not matter who has been hurt; it does not matter if professional negligence is involved; in fact, it doesn't even matter how many babies have died. CPMs have no intention of being held accountable and homebirth advocates have no intention of holding them accountable.
Susan,
I want to say that I wholeheartedly agree with everything you have said. There is a fine line between the stance that midwives should be licensed and the stance that ALL midwives should be accepted as care providers. If we believe that all proffessions have imperfect members we must accept that under this new licensure there would be some that would not be qualified. I think there needs to be some sort of real standard for midwives, whether that mean testing, further education or other avenues I am all for it. I just want to make sure (as others have said) that options for birthing women will be widened rather than cut short with this change. I myself am unable to have ahomebirht attended because of my VBAC status, and by the time I am ready to have another baby I am hoping that we can change that paradigm or at least loosen some of the stringent rules for hospital birth. IF we can accomplish that then I will feel much safer and more comfortable birthing in a hospital setting (which is what I am required by law to do in order to hae an attendant of any kind)
Dr Tuteur,
I am curious as to what you think the solution is for women looking for VBAC options? Or even those who are simply looking for less interventions in their birth process? With so many OB's and hospitals refusing VBAC what exactly is the solution when we are looking to stop our bodies from being cut open again? Do you think that the fact that we have to FIGHT our way through pregnancy and birth to get what we feel is right for our own bodies and our own children is "just the way it is"? I know all of your rhetoric about the "homebirth advocates" but what exactly is YOUR view of VBAC, even in a hospital setting? Just wondering...
"I am curious as to what you think the solution is for women looking for VBAC options?"
I don't understand the relevance of this for three reasons.
1. I haven't heard that any of the babies who died or were injured by Amy Medwin were born at home because their mothers were refused a VBAC.
2.If the goal is to have providers who will attend VBACs, it seems to me that you would want providers with the highest standards of education and training, not the lowest. Competence in this situation would be even more important, not less. So how can the desire to have an attended VBAC be used as a justification for turning a blind eye to CPMs who practice incompetently or negligently?
3. Has it occurred to homebirth advocates that the reasons why CPMs will attend VBACs at home is the same reasons why they have appalling mortality statistics? In other words, they are willing to do it because they lack the basic education and training that would have taught them that VBACs are a high risk situation.
I think this march is a blot on the reputations of CPMs. It is basically a finger in the eye to the parents that have suffered. It says in the loudest and clearest possible way that CPMs have no intention of being held accountable for their actions and homebirth advocates couldn't care less.
How many babies have to die at the hands of CPMs before homebirth advocates care?
Admittedly my question was off-topic, I was not asking it in regards to this particular post, only in a general sense. I am not referring to the choice of having a CPM involved. I am simply asking if you have any thoughts on the predicament of VBAC mom's who would like the options to be more open? In any case, just wanted to see if I could get a straight answer out of you, since I have not seen you say much about VBAC or the lack of options when trying for TOLBAC, serves me right for trying.
Some facts that folks seem to be glossing over in their discussion here (quotes from wsoctv.com article):
"Medwin is now being investigated in two counties because her certifications do not meet state guidelines."
"Medwin was not there for the birth, but deputies learned she had provided prenatal care and was with the family hours before the birth."
It is gross assumption and misrepresentation of the known facts to say that Ms. Medwin was responsible for *any* deaths (much less a trail of dead of dying babies). All we know is that Ms Medwin was not legally allowed to practice midwifery in this particular state.
"Medwin was not there for the birth, but deputies learned she had provided prenatal care and was with the family hours before the birth."
Is that likely? Or is it more likely that in the wake of the intrapartum death, Ms. Medwin ran off and instructed the parents to say that she hadn't been there for hours? She would hardly be the first CPM to dump her patient when disaster struck.
No one from the CPM or homebirth community is planning to investigate, are they? They'd prefer to imply that Medwin did nothing wrong rather make any effort to find out what she did, whether it conformed to the standards of practice for a CPM or whether she was negligent. That's the ugly problem at the heart of the homebirth movement. There is absolutely, positively no accountability.
As I asked above, how many babies have to die at homebirth before homebirth advocates recognize that they have a very serious problem?
Well, that scenario (midwife ditching the family) doesn't sound like it was the case here, at least according to the mother, according to this article: http://www.charlotteobserver.com/2011/03/01/2101901.html#ixzz1FSivJl6x The mother states that the labor was precipitous, the midwife was indeed not there, but had provded prenatal care. And further, that she came forward about it in response to a possible CPS investigation when it was suggested that the family had been negligient in not obtaining care.
I'm not saying that this means the prenatal care was therefore good or adequate; we don't know the details. It could have been a mismanaged condition, or it could really have been a normal pregnancy. We just don't know. In no way does this excuse the directive for silence or the chutzpah of the rally's timing - that's exactly why I'm so aggravated.
Seems to me that the speculation that has already gone on here regarding what happened, who was where when, and guessing about the details of the case based on newspaper articles kind of explains the reason for the first email- (another reason would be to protect the privacy of the family experiencing a devastating outcome).
to the bigger question, I think that asking for licensure IS asking for accountability-- not through criminal justice, but through the system which regulates and disciplines and investigates whether all other health care providers have acted reasonably and in accordance with their skills & the standard of care for the profession.