I'm sure there are great CNMs. Don't mean to put them down as a group. I only know the ones I've come across, and where I live, CNMs have their hands tied by licensing and insurance. This thread was about whether there's a place for DEMs, and given our current climate, I feel strongly that there is. DEMs are a very important part of the birthing options available to American women now.
Originally Posted by mothercat
And Gena22, could you explain how a midwife can be limited by her education? I would think ignorance would be more of a limiting factor.
Using my own profession as an example - I'm a lawyer. There's a course that prepares students to take the bar exam, +80% of students use "BarBri" as did I. BarBri, as a monopoly, decides not to teach X (I can personally attest to this happening in NY my year.) BarBri knows that by not teaching X, +80% of the test takers will get those questions wrong, and the questions will be thrown out. BarBri chooses what NY lawyers will know.
Similarly, few if any US medical schools teach vaginal breech births, so we have "qualified" licensed OBs who have little knowledge or experience with that kind of birth. Techniques lost or glossed over. If that's true of OBs (and every profession with fixed requirements) I have to assume it is or will be true of MWs too. My point is that if you standardize the educational requirements, make a monopoly, you will put knowledge in the hands of a few and it's likely to be abused.
A MW is limited by her education if its too formal. If it's all by the book. If she only knows one answer to a problem, the one her license requires, that's what she'll use over and over again. My "lay" MW learned from experience. She watched, apprenticed, talked to women around the world. She never stopped learning, reading, doing. She had attended thousands of homebirths and been active in the midwife community, educating others. At that point, late in her career, her skill and knowledge has nothing to do with what schooling she had on the front end.
Which is not to say I think there shouldn't be CNMs or OBs or any number of different options, of course. And again, I'm sure there are wonderful CNMs, Mothercat among them. I don't doubt that, and am not saying education is a bad thing.
What I am saying is that I'm suspicious of licensing and fixed, across the board formal requirements. As long as woman making reasonable choices, supported by the evidence (eg: choice of truly upright birth positions, vaginal breeches, VBACs, or me wanting a spontaneous, unmedicated vaginal twin birth) cannot be attended in hospitals and birth centers, and CNMs cannot attend a huge class of women at home, DEMs are doing a great service.