and how do we define best outcomes? It seems that is the same thinking that makes the high c-section rate "okay" so long as most babies and moms survive and possible bad outcomes sometimes are prevented. After all, if baby is healthy, the question of how violated your bodies were along the way, necessary or not, doesn't even matter, right?
seems like you are for the medical model
protecting homebirth is critical, making it operate like hospital birth destroys it and forces justifiably frightened women to UC instead of have attended homebirths, please choose hospital or hospitalesque birth center births if you want the medical package
Increasing information on provider outcomes in a database is not "regulation" and it seems to me that the difference is huge. Who is against better information? I don't disagree with that, but I strongly disagree with requiring CNM/malpractice insurance, doctor "approval" or oversight of a midwife as a condition for providing backup support, etc.
I'd propose to exclude the practice of attending births from the definition of "practicing medicine" across the board. If something like a medical emergency occurs, then the midwife would provide "medical" care and be exempt legally the same way as someone providing first aid. She could transport, remain with transfers as a doula, provide information without fear. If attending births as midwives was simply fully legal everywhere with the existing CPM licensing, but officially not considered medical practice, then midwives could all practice openly and databases could be openly available as well. They could be self-regulating but no longer underground. This would allow midwives to operate legally and openly alongside rather than inside the sick and twisted medical system. The CPM community would just need to create the right protocol to fit this model, so that everyone had guidelines for when and how to transition to medical care.
So birth is not an illness, attending is not medicine, and responding "medically" to unexpected events or helping a mother get needed medical care at a hospital would never get a midwife in trouble. Training and licensing could include many things, all documented and open, and the body of practicing midwives would maintain their own regulations and licensing. If that body was not constantly in a defensive posture, it would no longer need to "protect homebirth" nor would midwives feel the need to gather around and keep quiet about incidents that may or may not be misinterpreted to be used against homebirthers and midwives in general. CPMs need to feel safe practicing all around, so they can feel safe also acting and speaking against a peer who has acted unethically or unprofessionally. (Though I notice that doctors and nurses do the same thing--hide things to protect the reputation of peers.) I am ALL FOR legalizing CPMs and seeing a world in which there is no such thing as an illegal birth attendant. I am not at all for the mainstream medical establishment and/or insurance companies having a hand in it, though. I am not for negating existing training and licensing models and structures of CPMs because not all practitioners have acted professionally. And I certainly do not think CNMs should be the only recognized legal homebirth attendants. No need to throw the baby out with the bathwater. Illegality causes a lot of problems within the midwifery community, but that doesn't mean that CPMs are poorly trained or qualified, or that their certification should not be acknowledged, or that their own regulation cannot be adjusted and adapted to correct problems. Identifying problems and fixing them is one thing but launching broad attacks on midwives who find ways to practice despite the frightening obstacles they face is really missing the point.
I strongly respect law and order. But if the laws violate me they lose my respect. My values system is such that when a law is in the wrong and causes harm, we should feel it is right to practice civil disobedience. And when we know a law is wrong, it's not only acceptable, but perhaps our duty as well to support those who are engaged in such civil disobedience even when we do not choose to take the same action alongside them.
Legalizing midwives would be wonderful, accessible background information about each practitioner would be wonderful, internal regulation can be maintained and improved, external regulation would be disastrous, and those who are currently practicing illegally deserve a lot more respect than they are getting from some folks here.