"Direct Entry Midwife" in the US can mean a person who calls herself a midwife who has had no formal training or education at all. It may also mean a CPM. Or a CM. I've even heard graduate midwifery schools call their programs call their BSN-MSN/CNM programs "direct-entry" programs as well. This makes it exceptionally confusing.
European countries have "direct entry" midwifery programs. There really is no equivalent in the US. The key distinction between European "direct-entry" programs and DEMs in the US is the European midwifery programs require formal education. Being a "DEM" in the US requires no training, no education, no certification exam. Most midwives who refer to themselves as DEMs in the US are of this variety.
All other US "direct-entry" midwives would refer to themselves by their professional credential. (CPM, CM)
I doubt there is a European midwifery program equivalent to American DEM training or even the CPM training process. And I think the point mothercat is trying to make is that American midwives often use studies from Europe to support OOH practices in the US - when, in fact, there really are considerable differences in terms of training and formal education of midwives.
Which gets back to the original question - are there increased risks in OOH birth? And can we expect the same outcomes from midwives who were trained differently? Do CPMs have equivalent outcomes as CNMs? Do DEMs or lay midwives have equivalent outcomes as CPMs or CNMs? Does licensing of midwives improve safety and outcomes? Does training and integration into the health care system make a difference in outcomes?
I would venture to say yes. That the training and skill and legality of the midwife matters in providing safe care and assuring the best outcomes for mothers and babies.