Poll- Do you support "underground" midwives?

[lovebeingamomma]

I've heard both sides, but I've been curious to know what the majority thinks about this issue.  When I say "underground", I mean any midwife who knowingly practices illegally, regardless of their credential, or lack there of. 

[lovebeingamomma]

I added the Poll...is it not showing up...

Ok well if it's not working just reply, these were the answers:

Yes, women should be able to use any midwife they want

No, I don't support miwives who practice illegally (even if it leaves a woman with no homebirth options)

or

Last resort, only if there are no other legal options

Feel free to add your personal story or if this is a topic your passionate about share why.  I'm asking the question because although I thought I was in the majority, I'm getting the feeling I'm not so I was curious to see some numbers.

[Gena 22]

Don't see the poll, but here's my $0.02.

I vote - women should be able to use the midwife they want.  But I would also really like an objective and trustworthy source of data on all birth attendants, with information about how many births, deaths, interventions, etc.  That would be a huge help to parents - a maternity information source.  VA has something close for OBs, but so many providers resist releasing this info.

I live in a major metro area and wanted a birth with only the medical interventions my baby and I needed.  Especially as a first time mom, this was not possible in a hospital.  I toured 3.  One said that I would "have to qualify to be ambulatory" when I asked if I could walk around during labor.  Couldn't get out of that one fast enough.  I contacted some birth centers, and wasn't very pleased with their lack of professionalism.

Then, half way through my pregnancy, I found out I was carrying twins.  There went any chance for a CNM or birth center, even if I had found one I liked.  My choices were surgery I almost certainly didn't need in a hospital (locals ones had 80% twin c/s rates, and I could count on the 20% vaginal births being either multiparas or moms whose births came early and fast, so I was out of luck for a vaginal birth), travel a thousand miles to The Farm, or a lay midwife at home.  After lots of research, I was satisfied that a homebirth was safe for my twins and for me, and was what I wanted.

Even with positive references, I did hire a insufficiently skilled midwife, which became apparent during labor.  So I'm a pretty passionate advocate of maternity information and client reviews.  But her back-up who eventually attended my birth was amazing, and way more skilled and experienced in the kind of birth I wanted than an OB would be.  Few OBs have ever seen a natural twin birth, not because it's dangerous, just because that's not how they're trained.  If I had tried for a vaginal birth in a hospital, I would have been opting for a less knowledgeable provider.

Education comes in many different ways.  Does it come from schooling, or exams, or letters after a person's name?  Potentially.  But personally, I want a birth attendant who has seen births, lots of births, in all their permutations.  My midwife attended thousands of Amish homebirths.  She had seen more than most OBs see in a lifetime.  She was a CPM, and gave me amazing care.

As has been said elsewhere, you know what you're getting in a hospital - maybe things go right, maybe not.  If there's any doubt - surgery.  If that's not what a mother wants, if she wants a gentle, natural, well-attended homebirth, she is dependant on the skill and manner of her midwife.  Now you can surf the internet for reviews, talk to her peers and previous clients, as I did, and still get an incompetent midwife.

To improve services in this country we don't need more regulation and hurtles, we need more transparency.  More verified information.  When I was laboring, I couldn't care less whether my attendant went to Harvard med school or never graduated from high school.  All I cared about was whether my care provider was experienced, skilled and smart.  Regulations cannot guarantee that.  2400 happy mothers and babies are much more likely to come as close to a guarantee as there is in birth.

[abc123xyz]

I support all midwives, particularly if they are practicing illegally. Mostly because they are willing to risk ALL they have for the rights of women to birth where they choose with whom they choose! Of course, I would check into their previous work and speak with others who have worked with them. I did request that info from our midwife. When you live in a state where homebirth midwives are illegal, you become a HUGE advocate for all those who are practicing under the radar! No one should have the right to tell me who I choose to employ to catch my baby. I can do it home alone with no skilled birth attendant and it be totally legal, and possibly un-safe, but to have a skilled birth attendant could cost her everything she has because she's practicing illegally? I don't think so! It's my body, my baby, my birth, my choice who takes part in the experience! There are a ton of Dr's out there who should not have licenses and likewise, a lot of midwives who shouldn't either. It should be consumer choice not dictated by an arbitrary government mandate who only cares because it's putting money in their own pockets! Licensing is just another for of tax and as far as I'm concerned, I love un-licensed midwives and support them 10000%!

[lovebeingamomma]

I'm sorry the poll didn't show up, there's seems to be no way to edit it to add it...

Anyways, thanks for the input so far, I'm interested to see what everyone thinks about this topic.

[XanaduMama]

I think women should be allowed to choose their own provider, even if they're practicing "illegally"--but caveat emptor, of course: you need to scrutinize qualifications, experience, and everything else to make sure you're getting a competent midwife (which I would also advocate for *any* provider, btw). In states like NC, where I had dd, CPMs are not licensed, but that's a function of bad law, not of the effectiveness or qualifications or safety of the midwives, who are often licensed in one of the surrounding states (all of whom recognize CPMs). The fact that they have to practice "illegally" only testifies to their commitment to this important work, IMO, and they provide a vital service that may not otherwise be available. Yes, sometimes, there are cases of malpractice amongst MWs; but that's true of "legal" practitioners as well.

[Jane93]

For me, the fact that someone is willing to practice medicine illegally is, to my mind, a testament to (a) a lack of ethics (I am a professional who requires licensure by the state, and I would never consider practicing without it) and (b) being someone who is willing to accept high risks -- in other words, someone with a cowboy mentality.  Illegal practioners operate outside common checks and balances and may have their ability to best care for their patients hindered by their own need to save their butts from criminal charges. 

I prefer that professional care-givers have a lower tolerance for risk. 

[motherhendoula]

Gena 22  - that was  a great story!  I too support 'illegal' midwives.  In 1996 - when my sister was pregnant with her first child, she saw two different OB's who promised her bed rest and a cerclage and a horribly complicated medical birth.  She sought out further opinions and found a HB midwife  she liked and trusted.  At about 30 weeks NY state made it illegal for direct entry midwives to attend HB's.  (as they had been doing prior to 1996)  so my sisters MW was now practicing illegally.   - rather than go back to OB's she stayed with her MW and had a lovely home water birth. 

To me the delineation of 'illegal' or 'legal' is rather arbitrary.  As in PP from NC's case - surrounding states did not agree that direct entry MW should be made illegal - its a ridiculous notion that the same action can be both perfectly fine or a felony depending on what side of the street you are on. 

[bignerpie]

Originally Posted by XanaduMama 

I think women should be allowed to choose their own provider, even if they're practicing "illegally"--but caveat emptor, of course: you need to scrutinize qualifications, experience, and everything else to make sure you're getting a competent midwife (which I would also advocate for *any* provider, btw). In states like NC, where I had dd, CPMs are not licensed, but that's a function of bad law, not of the effectiveness or qualifications or safety of the midwives, who are often licensed in one of the surrounding states (all of whom recognize CPMs). The fact that they have to practice "illegally" only testifies to their commitment to this important work, IMO, and they provide a vital service that may not otherwise be available. Yes, sometimes, there are cases of malpractice amongst MWs; but that's true of "legal" practitioners as well.

THIS. You said it so perfectly, XanaduMama. It's kind of like that joke, what do you call the guy that graduates last in medical school? Doctor. Just because someone has a license doesn't make them more responsible or ethical than a non-licensed provider. There can be awesome unlicensed midwives and crappy licensed midwives. And vice-versa, of course. I look at the individual and not the letters behind her name.

I also live in a state that does not license CPMs, but that's not stopping me from using one. My midwife is licensed in an adjacent state, though. But even if she wasn't licensed at all, I'd still use her.

[chewynotcrunchy]

I support legislation licensing CPMs so that midwives don't have to be "underground."

[Alenushka]

No, absolutely no.

There is not need to be illegal. If being CPM is not legal in a state, one can move, or go to nursing school and become a CNM.

If someone is willing to do illegal practice like this...what else their ethics will allow them to do?

[weliveintheforest]

I vote women should be able to choose whatever they want.  I don't think illegal always mean unethical.  

[lovebeingamomma]

Thank you for the the reply's so keep them coming!  So far it seems that the majority support, this is what I had suspected.

[Jane93]

I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 

[XanaduMama]

Originally Posted by Jane93 

I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 

How about if there were no "steps" they could take to become licensed? If doctors or dentists weren't recognized in your jurisdiction, and there was no alternative? This is the reality for many midwives in states that don't recognize CPMs and where CNMs don't do homebirths, and was the reality for hundreds, thousands of years, in fact: licensing is very new, historically, and still fairly limited, geographically, and isn't necessarily a guarantee of anything. Millions of people all over the world are treated by practitioners that aren't recognized by a state, and millions do just fine. And I don't see why "illegal" necessarily means "unethical"--since when is the law always the last word in ethics?

[Jane93]

Part of the ethics issue is that the very base of the relationship, the provision of the service, is illegal.  So from the first moment of meeting, the practioner has a significant goal (not being arrested) that has nothing to do with providing the best care possible to the patient. 

So there may be tension between what is necessary to protect the illegal midwife from arrest and what is necessary to protect the mother and baby from harm or assist them during period of danger (for example, calling 911 and remaining until EMS is present, making medical records available in case of transfer or accompanying the patient to the hospital during transfer). 

[ThreeLittleBirds]

I agree with a poster above. I support legislative actions to legalize CPMs. They wouldnt have to have the "cowboy mentality" if they didnt have to fear transporting and getting caught. I am the Vice President for Maryland Families for Safe Births and we are currently working on a bill to legalize CPMs in the state for this very reason. Currently only unassisted homebirths are legal. I mean really? So the state is ok with NO medical professional being there....but not ok with a certified pro midwife? Its laughable. Midwives are the experts when it comes to homebirths...CPMs and laymidwives especially. But if at least getting your CPM credential means you have NARM to back up your qualifications...I say go for it.

My CPM delivered my baby at home...VBAC..."illegally". Im so lucky for her. She put her ass on the line for me. So i plan on busting mine so that CPMs in Maryland dont have to work underground.

[Right of Passage]

Originally Posted by Jane93 

I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 

The problem is you see birth as a medical event, I see it as a normal/biological/physiological process. Mothers get to choose who they have present during the process. I would absolutely have an eye check from an apprentice, because that mean their preceptor would be there helping him/her and guiding them through the process. A self taught dentist is a lot different from a traditionally trained midwife. Apprenticships have been around a long time, it is a proven method of learning and teaching.

Ethics has come to be questioned. Is it more ethical to serve the government or serve the mother?

[Peony]

 I have respect for MWs that do practice illegally. They serve women while doing so at a cost to themselves if caught. I've used several myself, and I did have other options for MWs. 

[kathrineg]

It depends on the midwife and their individual character and motives. If someone is an illegal midwife because they can't be bothered to get appropriate training, I find it neglectful of the women who trust them with their care, and that is despicable.