Originally Posted by firewoman
Here is a link to the course schedule of my local MEAC accredited midwifery school. This is a school focused on preparing students to pass the NARM and to become licensed midwives in California. It is 39 months of schooling and does not include clinicals which are of course also required concurrently.
I've said before that I think that CPMs who are the product of structured academic programs may very well be more prepared than a largely self-educated CPM. My real beef, I think, was with the PEP process midwives, and how the lack of interaction with different types of midwives and different sources of information might allow for *some* midwives to "slip through the cracks" as they say. But I have to admit, I found the curriculum presented above to be somewhat alarming. One month to cover both the anatomy of the reproductive system and ethical considerations in reproductive health? What about anatomy and physiology of the rest of the body? Pregnancy can have drastic effects on the circulatory, respiratory, and digestive systems, it doesn't only involve the reproductive organs. One month to cover complications that may occur in the third trimester? One month to cover pharmocological treatments? How would one be able to help a client navigate a transfer or the need to seek medical care without being knowledgeable about the actions, side effects, compliocations, and benefits of the treatments that your patient may encounter?
What about microbiology? In order to truly understand a microorganisms effect on a person, on a pregnancy, one has to have some basic knowledge of cell structure, metabolic processes of the human and bacterial cell, and how various treatments exert their effects. How can one have an opinion on the implications of being positive for Group B strep if one doesn't have a grasp of these things? There is a difference between saying "My client has X infection, which I'm going to treat by administering X, because X source told me that it's appropriate." and saying "My client has X infection, and due to the structure and known functions of this organism, I am going to treat with X, because it interrupts a certain process needed by this bacteria, while causing minimal interruption to the cellular processes of the patient."
And especially alarming - two months devoted to business practices and legal issues, and then a certification in Advanced Life Support in Obstetrics is optional? It almost seems that the priority to protect the midwife is more important than caring for a patient in the event of complete disaster. I realize that the ALSO certification is additional to other coursework in this area, but IMO no competent or responsible midwife should ever opt out of the chance to be more prepared in a life or death situation, and this school shouldn't give one that option.
Firewoman - I hope you don't take offense to anything I am saying, if this is a program you are enrolled in or are considering. I truly believe that many, if not most, CPMs possess far more knowledge about pregnancy and birth than is presented in this program of study. Like many on this board, birth is a passion for them and that fact will drive them to learn above and beyond what is required, and they may in fact be excellent and competent care providers. But not every single MW is going to go "above and beyond". Some, hopefully a small minority, will stick to the education that is presented to them. And if the above is it, I must say, I'm less than comfortable about it.
We keep asking these moms who have had bad outcomes and are angry about it if they thought their midwives' education was satisfactory prior to the bad experience. Of course they did. Because a professional organization of other midwives bestowed a title and a certification on that midwife that said "Yes. This midwife is competent enough to safely attend your birth." If that midwife was truly negligent, it is the failure of the organization who certifies and licenses her, not the parent.
I'm starting to think that maybe there should be true "lay" midwives, who don't answer to any controlling body, be it MANA, the medical community, or the State Nursing Board, but also aren't putting themselves at legal or criminal risk. There are those women, many on these boards, who want to have a pregnancy and birth entirely free of interventions and not subject to mandated standards. They deserve that, and they are entitled to have that. They can choose a lay midwife who fits their needs without having to be concerned about said midwife having to answer to anyone but them. There won't be any confusion over licensure, education, previous outcomes, because in that situation, it truly would be just up to the parents to qualify the individual credentials of that provider.
And then for the rest of women who desire to birth at home, we can improve standards of care, improve education and preparation, improve safety for mom and baby, integrate MWs into the medical system, and all without compromising the desires of women who want a very traditional midwifery experience. We can require more of our CPMs, or as others have said, develop direct-entry midwifery programs like the CM program or those found in other countries.