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Did you use an unlicensed midwife? Would you? - Page 4

post #61 of 79
the CPM process itself does not endorse any particular protocols--- CPM training , anyone trying to obtain their CPM would need to have an experienced midwife at the prenatals and the birth in order to verify that they can actually do a particular skill -- but that process does not require that apprentice midwife do x number of vaginal exams during labor or that mom has a doctor's appointment at 36 weeks, maybe it has to do with the license laws in your state- some states have protocols written into rule or law-
as far as what midwives are called- in more than half the states direct entry midwives cannot legally practice , and in states where mws are licensed some midwives may still be unlicensed - regardless of legal standing mws can be CPMs
post #62 of 79
To clarify what mwherbs said--the CPM certificate was created and is maintained by a national organization that is independent of any state gov't or licensing agency. NARM (north american registry of midwives) is responsible for creating CPM (certified prof. mw) standards, testing, and so forth. It is midwives and knowledgable midwifery supporters who created it, independently of med standards/dictates as well as of state gov'ts. So yes, a mw might be a CPM and still not be licensed by her state.

Also--Garnettmama said:
"all in all, if i had a whole lot of money to spend and if i was looking for medicalized midwifery care, and i was expecting a complicated pregnancy with possible doctor oversight, then yes, i would hire a cpm."

Again to underscore mwherbs, while NARM does require a particular set of basic skills and holds to basic standards of midwifery care, I would not call this generally 'medicalized' and there is a LOT of variation among CPMs because NARM leaves the setting of particular protocols to the mw to decide (such as carrying meds or only using herbs, gbs testing, doing breech, vbac, multiples...lots of individual choices). It could be that in her state or region, the CPMs have come together and self-chosen to adhere to certain things such as Dr. visit at 36wks, or that could be a state licensing requirement.

But even where CPMs are not licensed, and so are not specifically under any regs/restrictions, they are wanting to a) seem both professional and adherent to 'norms' in maternity care--and let's face it, however much one might disagree, medical maternity care is the 'norm' in the US....so a Dr visit might seem like a nod to that norm and a way to determine 'low risk' (by med standards). CPMs might also want to b) have each others' support, which may mean that some adopt protocols they don't personally agree with, but which aren't TOO much a compromise and do earn them that peer-group support. That can be so important to a mw! And really to her clients, too--because then you know she is in communication w/other mws, willing to hold herself accountable to something besides her own will, able to learn from/share with the others.

I know a mw who completely refuses any real comm or accountability to other mws...and she is scary in so many ways--taking unreasonable risks, refusing peer review ever, not keeping up with research and so forth....and her outcomes demonstrate this. We all want to think that our mw is following her own values and especially, is perceiving and assessing us totally on an individual basis. But in some ways it can be well worth to the greatest number of moms/babies, when a mw adopts some general rules she may not totally agree with, or ask moms to do something (like a Dr visit) that are clearly not needed, in part to remain in good standing with her peers.

Hopefully, any CPM is making use of Informed Consent/Refusal--in having waivers for families to sign if someone really does not want to follow some particular protocol of the mw.
post #63 of 79
I know that last post went kinda OT! Sorry. Hard to avoid touching on the diff. between 'licensed' and 'CPM certified' in a thread like this...clarification seemed in order.
post #64 of 79
Ohio is pretty unfriendly to midwives too and has no licensing here. I had my VBAC with 2 DEM's in Michigan last year and I loved every minute of it! I have to agree that I don't think licensing means much, it's a piece of paper. Eh! I can print one of those out on my computer. lol What counts is their experience, their knowledge and whether or not you click with them.

Good luck!
post #65 of 79
I have for two births and am using the same midwives this time. There are no licensing laws in Idaho. You can find CPM's but there is no state licensing. http://www.idahomidwives.org/find_a_midwife.htm
post #66 of 79
Quote:
Originally Posted by madiesmommy View Post
I am using a CPM. She is licensed in a neighboring state, so I'm not sure she qualifies as truly unlicensed. She is not recognized in our state as legal to birth babies - and I trust her more than any doctor I ever saw. So yes, I would use an unlicensed midwife.
Same here. Mine is licensed out of VA, not here in NC.
post #67 of 79
I think maybe an issue here is your single layer suture technique used in the previous cs you mentioned. The Farm has some good data on this, and they feel that with a single layer suture, the chances of uterine rupture are greater. Ina May Gaskin had an article in Midwifery Today some time ago in regard to this. They did experience a rupture with a client with single layer, and they have rethought their protocol and I think they are not doing out-of-hospital birth for single layer. I don't know the specific issue of Midwifery Today, but it was a good recommendation to be considered.

I am a midwife and am a CPM and LM in my state. I have attended births in an "illegal" state as well as well as had my first homebirth with an unlicensed midwife, because at the time there was no mechanism for licensure. But, I think what you may ask yourself with the history of CS with single-layer suture, is in the regard of safety given the circumstances. I feel bad for the situation, because single layer suture is not fair for women and their future childbearing and chances of VBAC, etc.. I would perhaps not recommend homebirth, regardless of the legal status of the midwife.
post #68 of 79
Actually there is no conclusive evidence that a single-layer suture presents any greater risk. The Farm did have a rupture, and upon investigation did turn up some research to that effect and latched onto it. However, that evidence has not held up in subsequent studies. The current literature suggests that the method of stitching is more important to scar integrity than the layer of sutures.
post #69 of 79
I prefer unliscensed. liscensed midwives have to work by "rules" and "laws" I do not agree with in general. I do not like high manangement or guidance while pregnant or birthing. I do not think one can put a "law" on birth.

I understand many people greatly disagree with me on this one. that's okay by me. to each their own.
post #70 of 79
NashvilleMidwife WHY would we need conclusive evidence for the obvious??? If I single layer suture my jacket, it is more prone to rip . . . Why would a uterus be any different? IDK I am not in the crowd that believes let's do some dangerous thing until we have 'conclusive evidence' that it is wrong!
post #71 of 79
I just don't see why uterui should be sutured to a lower standard than the cheapest item of clothing on the rack!
post #72 of 79
Quote:
Originally Posted by dinahx View Post
NashvilleMidwife WHY would we need conclusive evidence for the obvious??? If I single layer suture my jacket, it is more prone to rip . . . Why would a uterus be any different? IDK I am not in the crowd that believes let's do some dangerous thing until we have 'conclusive evidence' that it is wrong!
clothes don't grow back together. the body does. that's a BIG difference.

it's not that it's likely that one suture is less stable but nobody has proven it yet... it's that there is no evidence either way b/c it really isn't more likely - it's just a theory. it depends a lot of how your body tends to heal. how long it is been (the longer you've given it to heal)... etc. the sutures aren't what is going to hold your "seam" together when you're in labour.
post #73 of 79
Quote:
Originally Posted by dinahx View Post
NashvilleMidwife WHY would we need conclusive evidence for the obvious??? If I single layer suture my jacket, it is more prone to rip . . . Why would a uterus be any different?
Because your jacket and a uterus are completely different! How can you even think of comparing the two? When you put stitches in your jacket, those stitches are the only thing keeping your jacket together for the rest of time. When you suture the uterus (or any body part) back together, those stitches are only meant to hold the tissue together for a short time while the body heals itself and the tissues grow back together and strengthen on their own. Yes, in the first few weeks after the surgery a double-layer is going to better prevent the uterus from rupturing until the scar forms, but once healing has taken place the number of layers of sutures are irrelevant.
post #74 of 79
I see that . . . But I feel like it should have to be proven that single layer was just as stable in order to do it that way, not proven that it isn't in order to stop, kwim? Like erring on the side of caution. :sigh: I know, I know, no other place in Western medicine does that!
post #75 of 79
Thanks for your explanatory reply.
post #76 of 79
I will probably have no option but to use an unlicensed m/w because my state does not license them. If I was in a friendly state I would probably want them to be licensed.
post #77 of 79
My midwife is unlicensed in my state, but is licensed in a neighboring state. My state too is unfriendly towards CPMs or lay midwives, but that might change in November. It was kind of hard to find a midwife to do a homebirth out here, but after asking a friend I found her. And I wouldnt use anyone else!:
post #78 of 79
Thread Starter 
Thanks for all the informative replies.

My option turned out to be unlicensed midwife or RCS, so we went with the unlicensed MW. I have an OB on co-care to do any testing I want, but don't intend to see him unless I actually NEED a c-section. The licensed MWs here wouldn't touch my unproven pelvis and single layer closure with a 10 foot pole.
post #79 of 79
Quote:
Originally Posted by liberal_chick View Post
My only other option was an unlicensed midwife. I found 2 in my area; one wouldn't take me b/c my c-section was closed with a single layer suture.
For what it is worth...although Ina May Gaskin is very much against single layer suturing, I've heard that the research actually shows single layer to be BETTER. The reasoning for that is that the uterus contracts so much within hours of birth, that the stitches are hanging loose very quickly. So all a double layer does is introduce more trauma to the uterus--more needle punctures.

Quote:
Have you used an unlicensed midwife? What was your experience? Would you use an unlicensed midwife?
I have used an unlicensed midwife for 2 births, and am expecting to birth within the next month with an unlicensed midwife. Bottom line is that in my state, I don't have much of an option if I want to homebirth. The nearest licensed midwife practice that attends homebirths (CNM practice) is one hour from me, and they only attend births in a 30 minute radius of their office. Certified Professional Midwives are not licensed/legal in my state. I really have a lot of respect for what these women do--putting their personal lives on the line to follow a calling and provide high quality care.

You may want to consider doing "co-care" with one of the VBAC "friendly" (stated loosely based on your comment) OB's just so that you have a comfort level of having that fall back. I'd just encourage you to minimize visits with the OB so that it doesn't get too onerous to be seeing 2 care providers. Research actually shows that more than 8 prenatal visits doesn't improve outcomes in a low risk pregnancy, and yet the average low risk woman in America sees her OB 14 times! But anyway...just stretch out the appointment intervals as best you can, mention about how the travel time makes it difficult to go in more frequently if anyone challenges you on it. I found that I didn't get any challenge when I'd be scheduling appointments and would say to the scheduling person "oh that week isn't good for me, what do you have open the following week?" This pregnancy I out and out told my midwife that I didn't see a need to follow the regular appointment schedule since I had 4 healthy pregnancies under my belt, and she's been more than accommodating...I'm coming up on 36 weeks, and I've only had 5 prenatal visits so far. Next one is scheduled for 37.5 weeks. Not sure if I'll schedule one for 38.5 weeks or 39.5...if history holds up, I will birth at 39 weeks...

Jenn
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