I live in Oregon, which means that there are no "illegal" midwives where I am. One of the reasons I choose to live in Oregon is because the wide range of legal birthing options means that someone in my situation is NOT held hostage to the medical profession's so-called standards.
My first midwife, who acted as labor support for my first birth, a hospital birth, did far more to keep me and my daughter safe and healthy during the last months of pregnancy and first months of her life than ANY of the medical professionals involved in our care, despite the fact that at the time, she was a lay midwife who had not even graduated high school. She has since gone on to become a CPM. What did she do? She helped me not go in when labor "stalled" at 35, 36 and 37 weeks (I dilated, contractions <5 min apart, it was prodromal labor, not just "braxton hicks") despite the fact that the doc would have been happy to put me on pitocin at 36 weeks. I made it to 40+ weeks, with her reassurance. She helped me have an unmedicated birth in a hospital with a 90% epidural rate. Had the doctor not gotten in the way (quite literally), I might not have even torn. She saved our breastfeeding relationship. She researched and went to the mat for me.
By contrast, the perinatologists insisted that hospital birth was the only way I could birth safely, but they shoved an unnecessary tube down my screaming, healthy baby's throat, cut her cord so fast she was anemic by 4 months, literally forced me (I was lifted bodily onto the bed) into a position that put maximum stress on my perineum, which tore terribly, sewed it up so badly that it looks like it was never repaired, 18 years later, and sent me home before I even hit my period of "maximum risk". I had to fight not to have my veins violated (I have a clotting condition, and the last IV that had been started left me with clots running up and down my arm and a painful infection), not to have monitors strapped on me for the whole labor... and when they cut and clamped the cord and whisked my baby to the respiratory team because I had *faint* meconium tint in the waters, the doctor stood between me and my baby and I had to stand up and shove her out of the way in order to see my child. The "help" I was given in the hospital with breastfeeding nearly wrecked my breastfeeding relationship with my daughter, and they sent me home with blistered nipples and the message that I was "doing things right" despite agonizing pain.
My "uneducated" "uncertified" midwife fixed our latch problems in half an hour.
My midwife did not one thing to make the process more dangerous.
My doctor did not one thing to make the process safer.
My second child, I was going to go unassisted, but after a miscarriage, wanted a midwife for backup so that I would have some way "in" if something went wrong, because it was clear after my miscarriage that I needed someone on my side, and that things could go wrong.
The first midwives I interviewed told me dead baby stories to persuade me that it was absolutely necessary for them to be there. They clearly did not trust me to call if I needed help. The next midwife was okay with unassisted birth, but told me a dead baby story anyway and then balked when I started having bleeding and wanted an ultrasound to see if the baby was still alive because I'd miscarried not long before. She thought it should be "all or nothing" and that if I was going to get an ultrasound I should just have a hospital birth and be done with it. I don't remember who fired who.
The next midwife? Said, "I trust your knowledge of your body, and it is clear that you're willing to ask for help when things are out of your comfort zone, and I'd be honored to help you." She was a CPM and licensed, but I was not technically low risk.
She was my liaison between the low tech birth I wanted and the few medical interventions that were, in fact, appropriate. Like getting an ultrasound when I'd been bleeding for a week and had started having flashbacks to the miscarriage and just needed to know if my baby was alive.
When things got out of my comfort zone, I called her, she came, and helped reassure me that while they weren't typical, they weren't pathological either. I birthed at home, despite a situation no one knew about that would have resulted in a c-section at the hospital. Birthing at home kept us from a host of other interventions that would have made my daughter much worse off.
The rules are such now that even a technically high risk mom like me can birth legally with a licensed midwife. None of my risk factors make the birth itself "safer" in the hospital.
And my current midwife is a licensed CPM. I see her and a perinatologist, am on blood thinners but will go off of them and onto a safer (but more caloric) method of anticoagulation at 35 weeks. I was able to do genetic screening, have an ultrasound when I was bleeding, all without arguing with anyone.
Does this mean that I think all unlicensed or licensed midwives are safe practitioners? Nope. But you know what? I've seen a hell of a lot of less-than-competent doctors, too. Most OBs won't touch me with a 10 foot pole. I've seen so-called specialists brutalize my daughter unnecessarily while ultimately shrugging their shoulders and passing the buck. I'm not a doctor, but I've done more for my daughter's long-term health than any licensed practitioner, because I *read* and *research* and do the friggin' homework they don't have time to do. Sometimes we need more help than I can give (I wouldn't dream of trying to put ear tubes in her, or take out her adenoids), and we get help from medical practitioners. But when it comes to the huge unknown that is my daughter's rare, rare syndrome, we're all starting from the same place.
And while doctors may catch a hell of a lot more babies than midwives when training, and see a lot more complications, they don't have anything near the experience with normal birth, or even the concept of "trying to keep birth normal" that your average lay midwife has.
That said, midwives have a moral obligation to be honest with their potential clients about their training, background, practice philosophy, etc. And I have ZERO patience for midwives who leave the laboring mother alone when she's in active labor or who fail to listen to their clients when their clients are sure something is wrong. Just like I have zero patience for doctors who make up stupid excuses to induce women just so they can go on vacation with a clear conscience, or who tell women that because their first birth was hard, or they tore or whatnot, that their bodies are flawed and can't birth a bigger baby.
In most states my choice would be unassisted or hospital. And I've done the hospital thing. It was worse than useless. Nothing like having a nurse come in 6 hours after you've had an unmedicated vaginal birth and say, "Let's check your incision, dear?"
"From your c-section."
Tell me that someone who can't even be bothered to read a chart is a safer caregiver than a midwife who, with great skill and intuition, managed to take a freaked out first time mom from 35 to 40 weeks with many bouts of prodromal labor without getting pitocin to "help" things along unnecessarily.
I care less about certification and more about the ability to listen, pay attention, and be honest.