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Poll- Do you support "underground" midwives? - Page 7

post #121 of 285

I think every woman should have the right to choose for herself. In Nebraska it is a felony for even a CNM to attend a homebirth (there are a LOT of people working to change that) so the only option for a mother to have a homebirth is to use an "underground" midwife or go the route of unassisted childbirth.

post #122 of 285
Quote:
Originally Posted by AbbieB View Post

 

Midwifery does not come with all of the pros and cons of the current medical system, that's exactly why so many women choose it. There is a very narrow middle ground in some states, licensed CNMs, with a very narrow scope of practice that can serve women that want a little of both worlds, who happen to fit the narrow definitions of low risk. But there are plenty of women that are not served by this and need another option other than the hospital.

 

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post #123 of 285

If a midwife can become licensed in a given state to practice, then they should.  But if they can't, as is the case for CPMs in some states, and they can't just move to another state or go to school to become a CNM (this isn't always feasible given the investment they've already made in their education along with their own family commitments, etc.) - then I do support them practicing without a license.  

 

I hired such a midwife for the homebirth of my first child.  She was eminently professional and upfront about all of this.  She was also highly skilled and a truly exceptional midwife.  She could not just move or go back to school to become a CNM - and it would have been a great loss to our community if she were not practicing.  I interviewed all of the area homebirth midwifery practices (licensed and not) and she was the best, hands down.  

 

I do not see her practice as unethical - I see her as serving women in a courageous way.  Women's birth choices are far too hemmed-in by our current state laws.  This is unethical, in my opinion, not the other way around. 

post #124 of 285

I would rather have an unlicensed midwife who carried pitocin, antibiotics, and IV fluids than a licensed one who didn't. My current state doesn't have any licensure for midwifery. It's not illegal, but it's not regulated either. My current midwife was licensed in another state before moving here. She's also an ND. I'm cool with the fact that she's not licensed here. Now, she's not underground at all - the fact that there are no prohibitions against her practicing make it legal - but if she were unlicensed, that wouldn't bother me. She's got training, she carries IVs and abx and all that other stuff (made legal by the fact that NDs in my state have limited prescriptive power). She's prepared. She wouldn't be any less prepared if the state outlawed midwifery by anyone but CNMs.

 

I think it's highly disingenuous when people say that all midwives should be nurse midwives, because our CPM qualifications aren't up to the standards required for midwives in other countries, then when it's pointed out that those other countries do NOT require midwives to be nurses, they essentially gloss right over that fact. It's not irrelevant. You can't try to use the training of non-nurse midwives in other countries to support the argument that all midwives should be nurse midwives. That's absurd and illogical. Listen to how that argument goes: "Look at all these other countries that allow women to become midwives without becoming nurses first. They require their midwives to attend 3 to 4 year degree programs! That proves that all American midwives should be nurses!" Uhhh...no. It proves that you are grasping at straws to support your position, and since you don't have anything better, you will use facts that don't actually support your position, claim that they do, and then hope that none of us notice. We noticed.

 

I absolutely think the CPM credential leaves a lot to be desired. That doesn't mean that all CPMs are unqualified. Additionally, there are some programs in this country which do qualify graduates to work in some of those other countries that you are referencing. For instance, the midwifery program at Bastyr, formerly the Seattle Midwifery School, does leave graduates qualified to work in Canada. You have to take a bridging course, lasting around 9 months (or maybe 7, not sure) but it's the SAME course required for ANY midwife, coming from ANY country, including those with much more stringent regulations of non-nurse midwifery. In fact, my plan for about 10 years from now is to get my master's from the program at Bastyr, move to Canada, complete the bridging program, get lots of experience working up in Canada for a few years, then move back to the U.S. to work as a home birth midwife here. And I'll have to have the CPM credential, because that's all that will be available, but I'll be every bit as qualified as those midwives you love up in Canada. So at the very least, if you want to engage in adult conversation, be honest. Admit that you like nurse midwives because it's your personal preference or because the current CPM credential doesn't require as much education and experience as you think is necessary, but do not try to act like what's going on in the rest of the world means that American midwives need education above and beyond that required in those countries you're referencing, just to be qualified to do the same job. It's so dishonest.

post #125 of 285

Wow- I didn't read the whole thread and am not sure I really have much to add- but I definitely support my 'underground' midwife.  She is a CPM and she is awesome.  Her transfer rate is 4%.  My old OBs CS rate was 40%.  Amazing huh?  I guess I don't recognize the 'right' of my state to tell me who can and can not be at my birth- nor their 'authority' to tell me where to give birth.  I can't move- that is ridiculous.  Nor can my MW.  She is providing me with a service that I not only want but need since we don't have insurance.  In the event of a transfer- I don't expect her to come to the hospital with me- given the way my state operates- I wouldn't want her there.  It isn't all about me- it is a give and take relationship.  I do believe that even if I had a transfer- she would still be my choice the next go around.  

 

Also- I never received the amount of care I get from my MW from my old OB.  I didn't know I could do better and that is pretty sad.  3 hospital births and all three times  I tore horribly and had to be stitched up for 30 min each time.  HB with a baby over a pound more than the last one and no tear- and it was not an easy labor.  I had the best care around during my HB with a MW who has caught more babies than most OBs around.  

 

Some people aren't cool with it- that is fine with me.  I don't see what that discomfort has to do with me and my choices for our family.  By saying that unlicensed MWs and the birth freedom movement is dangerous-is just another way for this nanny state to control another aspect of my life.  That is something I don't need or want.  

post #126 of 285

While I may not choose to see a "self-taught" dentist, that doesn't mean a person in America shouldn't have the right to choose that if they want it.  This is America, right?  Besides, this is entirely different.  An "underground" midwife has usually had the same training and experience as a "certified" midwife.  They just don't have the piece of paper.  If someone does all of the training required of a doula, but hasn't received the certificate in the mail yet, does that mean they don't know how to be a doula until the postman delivers the package?  Of course not.  It just means the state hasn't recognized them yet (or charged them money yet, whichever way you want to look at it).  As for nursing, the nursing program is a long and tedious process to get into and produces people who are not always as well-versed in natural childbirth.  So, for me, an "RN" behind someone's name doesn't mean anything to me.  I've seen many, many nurses who have no business having a license and I've seen people who know more than nurses do but have no "certification".  A piece of paper is only worth the ink it's printed with.  What really matters is the education that preceded the piece of paper and the experience that person has had.  Just my opinion, though.  :)

post #127 of 285

While I may not choose to see a "self-taught" dentist, that doesn't mean a person in America shouldn't have the right to choose that if they want it.  This is America, right?  Besides, this is entirely different.  An "underground" midwife has usually had the same training and experience as a "certified" midwife.  They just don't have the piece of paper.  If someone does all of the training required of a doula, but hasn't received the certificate in the mail yet, does that mean they don't know how to be a doula until the postman delivers the package?  Of course not.  It just means the state hasn't recognized them yet (or charged them money yet, whichever way you want to look at it).  As for nursing, the nursing program is a long and tedious process to get into and produces people who are not always as well-versed in natural childbirth.  So, for me, an "RN" behind someone's name doesn't mean anything to me.  I've seen many, many nurses who have no business having a license and I've seen people who know more than nurses do but have no "certification".  A piece of paper is only worth the ink it's printed with.  What really matters is the education that preceded the piece of paper and the experience that person has had.  Just my opinion, though.  :)

post #128 of 285
Thread Starter 

It's not just about the piece of paper.  Underground midwives do not have collaboration with local doctors or hospitals in case of an emergency (in most cases), which makes the transfer process entirely different, nor are they held accountable in the same way if something goes wrong.  This isn't about safety of normal birth (anybody can catch a baby), it's about the 5% (give or take), that have to deal with transferring, difficult births, and/or bad outcomes.  It's far more complicated than a debate about CPM's vs. CNM's, or unlicensed vs. licensed.  I started this thread to get a general idea of how people felt about it, because I was personally effected by this issue.  Thank you for everyone's responses.  

Quote:
Originally Posted by muzie5 View Post

While I may not choose to see a "self-taught" dentist, that doesn't mean a person in America shouldn't have the right to choose that if they want it.  This is America, right?  Besides, this is entirely different.  An "underground" midwife has usually had the same training and experience as a "certified" midwife.  They just don't have the piece of paper.  If someone does all of the training required of a doula, but hasn't received the certificate in the mail yet, does that mean they don't know how to be a doula until the postman delivers the package?  Of course not.  It just means the state hasn't recognized them yet (or charged them money yet, whichever way you want to look at it).  As for nursing, the nursing program is a long and tedious process to get into and produces people who are not always as well-versed in natural childbirth.  So, for me, an "RN" behind someone's name doesn't mean anything to me.  I've seen many, many nurses who have no business having a license and I've seen people who know more than nurses do but have no "certification".  A piece of paper is only worth the ink it's printed with.  What really matters is the education that preceded the piece of paper and the experience that person has had.  Just my opinion, though.  :)



 

post #129 of 285
Quote:
Originally Posted by lovebeingamomma View Post

It's not just about the piece of paper.  Underground midwives do not have collaboration with local doctors or hospitals in case of an emergency (in most cases), which makes the transfer process entirely different, nor are they held accountable in the same way if something goes wrong.  This isn't about safety of normal birth (anybody can catch a baby), it's about the 5% (give or take), that have to deal with transferring, difficult births, and/or bad outcomes.  It's far more complicated than a debate about CPM's vs. CNM's, or unlicensed vs. licensed.  I started this thread to get a general idea of how people felt about it, because I was personally effected by this issue.  Thank you for everyone's responses.  



 


But this isn't always true.  It wasn't in my case.  And while I wouldn't call my midwife "underground", she can't legally be a midwife but works tirelessly with governments in our state trying to change that.  Her practice is very out in the open and she would have absolutely transfered and stayed with us the entire time.  It was something we asked about in our interview.  I know not many people have this luxury.  

 

I really think you should check out the other thread about dispelling the perfect birth theory.  It goes on for many pages but it's a very interesting conversation.  One, I feel, that is very important.  Someone is bringing up the point about transfer rates being crowed about but really, maybe we don't want the midwife with the lowest transfer rate....maybe she's too "risky".

 

I don't know your situation but I know mine and would hire my midwife again and again.  So I guess legal or underground, it doesn't cover the scenarios adequately.

 

post #130 of 285
Thread Starter 

She might want to stay with you, but to the hospital she's just some person, not your midwife (since she has no license to practice), and they have no obligation to let her stay with you...so I'm just saying, transfers have no guarantee's with illegal midwives, but with a legal midwife with offical back-up, she DOES have guaranteed support because of the legal collaboration.  Even someone practicing illegally out in the open, couldn't possibly have the support of every doctor.  Do you disagree?  And this is all to get back to my original point, that this is about more than just a piece of paper.

 

I do appreciate your viewpoint though, even though I don't see it the same way, and I will take a look at that thread you mentioned.  

Quote:
Originally Posted by Youngfrankenstein View Post


But this isn't always true.  It wasn't in my case.  And while I wouldn't call my midwife "underground", she can't legally be a midwife but works tirelessly with governments in our state trying to change that.  Her practice is very out in the open and she would have absolutely transfered and stayed with us the entire time.  It was something we asked about in our interview.  I know not many people have this luxury.  

 

I really think you should check out the other thread about dispelling the perfect birth theory.  It goes on for many pages but it's a very interesting conversation.  One, I feel, that is very important.  Someone is bringing up the point about transfer rates being crowed about but really, maybe we don't want the midwife with the lowest transfer rate....maybe she's too "risky".

 

I don't know your situation but I know mine and would hire my midwife again and again.  So I guess legal or underground, it doesn't cover the scenarios adequately.

 


 

 


Edited by lovebeingamomma - 3/11/12 at 8:24pm
post #131 of 285

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

 

I would prefer if they were licensed so I had some idea of what I'm getting, so to speak. But here in IL, CPM aren't licensed. There are only a few "legal" midwives. SO I'm left with very few options other than hospital (not gonna happen), unassisted (possibility for me) or underground midwife (my choice for my last 2 homebirths). Yes, I'd prefer they didn't have to be underground but I'd still use one over having all option taken away and being forced into a hospital birth.

post #132 of 285

Quote:

Originally Posted by lovebeingamomma View Post

She might want to stay with you, but to the hospital she's just some person, not your midwife (since she has no license to practice), and they have no obligation to let her stay with you...so I'm just saying, transfers have no guarantee's with illegal midwives, but with a legal midwife with offical back-up, she DOES have guaranteed support because of the legal collaboration.  Even someone practicing illegally out in the open, couldn't possibly have the support of every doctor.  Do you disagree?  And this is all to get back to my original point, that this is about more than just a piece of paper.

 

I do appreciate your viewpoint though, even though I don't see it the same way, and I will take a look at that thread you mentioned.  

 

 

I'm sure it's different state by state, but here in TX the hospital doesn't care that it's your midwife when you transfer.  Whether or not she stays is up to the hospital- they absolutely can (and do) kick them out.

post #133 of 285
Quote:
Originally Posted by lovebeingamomma View Post

She might want to stay with you, but to the hospital she's just some person, not your midwife (since she has no license to practice), and they have no obligation to let her stay with you...so I'm just saying, transfers have no guarantee's with illegal midwives, but with a legal midwife with offical back-up, she DOES have guaranteed support because of the legal collaboration.  Even someone practicing illegally out in the open, couldn't possibly have the support of every doctor.  Do you disagree?  And this is all to get back to my original point, that this is about more than just a piece of paper.

 

I do appreciate your viewpoint though, even though I don't see it the same way, and I will take a look at that thread you mentioned.  


 

 


I just feel like you're making a lot of assumptions.  I agree that everything should be "above ground".  But it isn't...I know that my midwife wouldn't have legal rights to act as my midwife if I transfered.  There is no legal way for them to bar her from coming in.  A transfer would be us, coming together, her acting as a monitrice.  If I transfered, I would need help.  I am there to get it with the CNMs I did my shadow care with. 

 

post #134 of 285
Thread Starter 

I'm assuming it's a real emergency, where things happen fast, there's no time to call your midwives to come, there's an OB assigned to you because you require a c-section.  In which case yes, he would have the authority to not allow your "montrice" to stay with you.  I don't think I'm being unrealistic.  I admit I'm talking about a very small chance of this happening.  If that small chance doesn't matter to women, fine, but I don't like the assumption that transfers who be just as smooth as with a legal midwife, I just don't buy that.  

Quote:
Originally Posted by Youngfrankenstein View Post


I just feel like you're making a lot of assumptions.  I agree that everything should be "above ground".  But it isn't...I know that my midwife wouldn't have legal rights to act as my midwife if I transfered.  There is no legal way for them to bar her from coming in.  A transfer would be us, coming together, her acting as a monitrice.  If I transfered, I would need help.  I am there to get it with the CNMs I did my shadow care with. 

 



 

post #135 of 285


 

Quote:
Originally Posted by lovebeingamomma View Post

 but I don't like the assumption that transfers who be just as smooth as with a legal midwife, I just don't buy that.  

You're assuming that a transfer WITH a legal midwife is guaranteed to be smooth.  Here in TX where we have CNMs and licensened midwives, how a transfer goes can vary GREATLY.  In no way do all OBs respect the midwife- quite the contrary actually.  Is it POSSIBLE to have a smooth transfer?  Absolutely.  Is it a sure thing since the midwives are legal and above board?  No way.

post #136 of 285

I agree with what YoungFrankenstein point out - that this thread could relate well with this one:http://www.mothering.com/community/t/1345213/dispelling-the-perfect-birth-theory

 

I have no problem with anyone choosing whatever type of attendant they want at their birth, or none at all. But I think women need to be aware of what they are really getting and what the possibilities are... and that is pretty much their responsibility to educate themselves to that end. Unfortunately, there is bad information or people who will intentionally mislead others out there.... but that is true for pretty much everything...

 

For example - as long as a mom knows that illegal mw can't go to hospital with her in case of transfer (as you guys are debating above, not sure what is really true and where/which states), and she is ok with that possibility and wants to risk it, who cares?

 

post #137 of 285
Quote:
Originally Posted by lovebeingamomma View Post

I'm assuming it's a real emergency, where things happen fast, there's no time to call your midwives to come, there's an OB assigned to you because you require a c-section.  In which case yes, he would have the authority to not allow your "montrice" to stay with you.  I don't think I'm being unrealistic.  I admit I'm talking about a very small chance of this happening.  If that small chance doesn't matter to women, fine, but I don't like the assumption that transfers who be just as smooth as with a legal midwife, I just don't buy that.  



 

I do think this can vary.  If I have to go to the hospital, by ambulance, for a transfer emergency, I will go to a facility and be treated.  I would expect the same thing in a life-threatening car accident.  I won't have control over it at that point.  I'm not suggesting that my midwife would be involved in being a monitrice in this type of situation.  If I transfered for exhaustion, or I got a fever, etc.  she would stay with me as we all drove to the hospital together.
 

 

post #138 of 285
Thread Starter 

I'm just going to agree to disagree with you guys.  I'd rather discuss with women who have actually had transfers, not just a promise of a good transfer.  And yes I know not all transfers are smooth, I just absolutely believe they are safer and have more certainty with legal midwives, in most cases.  Everyone has the right to choose whomever they want whether it's legal or not, who's going stop them?  Nobody, however the midwife could get arrested, that does happen.  

 

I did read thru a lot of that other thread.

post #139 of 285

So you disagree with your own poll results?  I would like to think most midwives are upfront about their credentials- but it is obviously up to the mama to double check and be sure that they are ok with it.  Also- are there many who are completely naive about a transfer and think it will be sunshine and puppies?  I hope not- because if I had to transfer I know it would go bad- most likely really bad.  Cause what are they going to do with my paper records that get left in my cupboard after each appointment as a security issue- probably laugh and throw them away!?  Yet I am still cool with that.  And who doesn't google their midwife to see it they have been arrested?  I would think everyone would google them...  But it is again up to the mama on if that matters to her and her family.  In a perfect world there wouldn't have to be underground midwives.  Reality being what it is- it is necessary or a lot of us would be run again through the OB baby system with not much hope of anything better.  

post #140 of 285
Quote:
Originally Posted by lovebeingamomma View Post

I'm just going to agree to disagree with you guys.  I'd rather discuss with women who have actually had transfers, not just a promise of a good transfer.  And yes I know not all transfers are smooth, I just absolutely believe they are safer and have more certainty with legal midwives, in most cases.  Everyone has the right to choose whomever they want whether it's legal or not, who's going stop them?  Nobody, however the midwife could get arrested, that does happen.  

 

I did read thru a lot of that other thread.


 

I did not have a transfer so I don't know, for a fact, how one would go.  We interviewed and felt good about hiring this midwife.  She doesn't work "legally" in Ohio as a midwife.  

 

You're telling us that we who live in states with no legal midwives we shouldn't home birth.  I disagree with that.

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