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Originally Posted by WhereHopeGrows  I keep getting the feeling that liscenced and non-liscenced midwives don't really get along. Can someone clue me in to what the issues are between them? I don't get it?
I understand that the licensed ones have gone for training, and then they can also be certified. But from my experience this can also lead to a lot less flexibility in prenatal care and birth choices. Is this the main issue here? Or are there others? From your experience, how is it different working with licensed or non-licensed? Thank you very much for helping me understand this.
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I had a lovely hospital birth with CNMs and am working with a direct-entry midwife for my second birth. In my state, CPMs and direct-entry midwives aren't legally recognized medical care providers, and there is some tension about this surrounding the lack of oversight, not that the CNMs dislike the direct-entry midwives. From what I can tell, the CNMs who work in-hospital feel that the DEMs are not held accountable for meeting the same training and educational criteria, care standards, and protocols as the CNMs, and this is a problem because it can be dangerous for mothers and babies. Right now, ANYBODY can hang out a shingle and say, "I'm a midwife." Hairdressers are more closely regulated than out of hospital midwives. I think they'd like to see a licensure law put into place in the state so that there is assurance for consumers that any person hiring him- or herself out as a birth attendant has met standards for training and adheres to certain care guidelines, keeping only low-risk, healthy pregnancies as homebirths and referring higher risk patients to a medical setting that is equipped to deal with potential emergencies.
I think they feel that multiple births, breech, VBAC, GD, PIH, to name a few, are all conditions best managed in a hospital setting. BUT, not all women who have these elements in their pregnancies feel this way, and they want options for care in out-of-hospital settings. For example, if it came up, I would want the option to birth a breech baby vaginally, rather than the 'automatic section' that is what a hospital offers as one's ONLY choice. Therefore, my only choice is to find a care provider who will work with me on this, and that means an out of hospital, unlicensed provider who has training on breech as a variation of normal. Actually, if they were licensed, they might be obliged to send you to a hospital for things like breech or twin birth, so having no regulation frees them from those strictures. I think for more serious conditions like PIH or uncontrolled GD, a good HBMW would risk a client out of homebirth care and refer her to an OB.
Unlicensed doesn't mean untrained. My DEM is affiliated with MANA (I think she could be a CPM in another state, but since there is no certification recognition here, why would she bother certifying with NARM?), had a 4 year apprenticeship, carries oxygen, pitocin, suturing materials, other medications and emergency supplies. She is current on her neonatal resuscitation certification, does GBS testing and blood-glucose monitoring, has protocols for when to transfer care, and I feel very confident that her training and experience qualify her to take excellent care of pregnant and birthing women.
We could also have picked a local CNM who does out-of-hospital births, and who can bill my insurance company, but we liked this DEM a lot and feel good about her credentials, even if they aren't recognized by the state. Mostly, it's a bummer because it's all out of pocket for us. We chose to birth out of hospital for some of those flexibility reasons you mentioned (like, I can have a waterbirth at home, not so at the hospital, or if I go a day over 42 weeks, my midwife is not compelled to hand over my care to an OB like the hospital-based midwives must do...), for the less medicalized care we would receive, and because I just don't like the hospital as a birth and postpartum setting. I have been discovering that actually, the CNMs with whom I worked last pregnancy and with whom I started care with this one have been supportive and said that if I need testing or shadow care, I am welcome to come see them and that they will help in any way they can. So, I think they are not opposed to out of hospital births or DEMs per se, but they do want to make sure that only appropriately low-risk women are giving birth in out of hospital settings.
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: It is beyond me why lawmakers allow doctors to stick their grimey little hands into mw business! That makes about as much sense as allowing college professors to tell public school teachers how to do their jobs.
