Poll- Do you support "underground" midwives? - Mothering Forums

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#1 of 285 Old 08-17-2011, 07:48 PM - Thread Starter
 
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I've heard both sides, but I've been curious to know what the majority thinks about this issue.  When I say "underground", I mean any midwife who knowingly practices illegally, regardless of their credential, or lack there of. 


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#2 of 285 Old 08-17-2011, 07:49 PM - Thread Starter
 
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I added the Poll...is it not showing up...

 

Ok well if it's not working just reply, these were the answers:

 

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

 

No, I don't support miwives who practice illegally (even if it leaves a woman with no homebirth options)

 

or

 

Last resort, only if there are no other legal options

 

Feel free to add your personal story or if this is a topic your passionate about share why.  I'm asking the question because although I thought I was in the majority, I'm getting the feeling I'm not so I was curious to see some numbers.


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#3 of 285 Old 08-18-2011, 08:39 AM
 
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Don't see the poll, but here's my $0.02.

I vote - women should be able to use the midwife they want.  But I would also really like an objective and trustworthy source of data on all birth attendants, with information about how many births, deaths, interventions, etc.  That would be a huge help to parents - a maternity information source.  VA has something close for OBs, but so many providers resist releasing this info.

I live in a major metro area and wanted a birth with only the medical interventions my baby and I needed.  Especially as a first time mom, this was not possible in a hospital.  I toured 3.  One said that I would "have to qualify to be ambulatory" when I asked if I could walk around during labor.  Couldn't get out of that one fast enough.  I contacted some birth centers, and wasn't very pleased with their lack of professionalism.

Then, half way through my pregnancy, I found out I was carrying twins.  There went any chance for a CNM or birth center, even if I had found one I liked.  My choices were surgery I almost certainly didn't need in a hospital (locals ones had 80% twin c/s rates, and I could count on the 20% vaginal births being either multiparas or moms whose births came early and fast, so I was out of luck for a vaginal birth), travel a thousand miles to The Farm, or a lay midwife at home.  After lots of research, I was satisfied that a homebirth was safe for my twins and for me, and was what I wanted.

Even with positive references, I did hire a insufficiently skilled midwife, which became apparent during labor.  So I'm a pretty passionate advocate of maternity information and client reviews.  But her back-up who eventually attended my birth was amazing, and way more skilled and experienced in the kind of birth I wanted than an OB would be.  Few OBs have ever seen a natural twin birth, not because it's dangerous, just because that's not how they're trained.  If I had tried for a vaginal birth in a hospital, I would have been opting for a less knowledgeable provider.

Education comes in many different ways.  Does it come from schooling, or exams, or letters after a person's name?  Potentially.  But personally, I want a birth attendant who has seen births, lots of births, in all their permutations.  My midwife attended thousands of Amish homebirths.  She had seen more than most OBs see in a lifetime.  She was a CPM, and gave me amazing care.

As has been said elsewhere, you know what you're getting in a hospital - maybe things go right, maybe not.  If there's any doubt - surgery.  If that's not what a mother wants, if she wants a gentle, natural, well-attended homebirth, she is dependant on the skill and manner of her midwife.  Now you can surf the internet for reviews, talk to her peers and previous clients, as I did, and still get an incompetent midwife.

To improve services in this country we don't need more regulation and hurtles, we need more transparency.  More verified information.  When I was laboring, I couldn't care less whether my attendant went to Harvard med school or never graduated from high school.  All I cared about was whether my care provider was experienced, skilled and smart.  Regulations cannot guarantee that.  2400 happy mothers and babies are much more likely to come as close to a guarantee as there is in birth.


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#4 of 285 Old 08-18-2011, 08:53 AM
 
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I support all midwives, particularly if they are practicing illegally. Mostly because they are willing to risk ALL they have for the rights of women to birth where they choose with whom they choose! Of course, I would check into their previous work and speak with others who have worked with them. I did request that info from our midwife. When you live in a state where homebirth midwives are illegal, you become a HUGE advocate for all those who are practicing under the radar! No one should have the right to tell me who I choose to employ to catch my baby. I can do it home alone with no skilled birth attendant and it be totally legal, and possibly un-safe, but to have a skilled birth attendant could cost her everything she has because she's practicing illegally? I don't think so! It's my body, my baby, my birth, my choice who takes part in the experience! There are a ton of Dr's out there who should not have licenses and likewise, a lot of midwives who shouldn't either. It should be consumer choice not dictated by an arbitrary government mandate who only cares because it's putting money in their own pockets! Licensing is just another for of tax and as far as I'm concerned, I love un-licensed midwives and support them 10000%!

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#5 of 285 Old 08-18-2011, 11:53 AM - Thread Starter
 
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I'm sorry the poll didn't show up, there's seems to be no way to edit it to add it...

 

Anyways, thanks for the input so far, I'm interested to see what everyone thinks about this topic.


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#6 of 285 Old 08-18-2011, 12:51 PM
 
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I think women should be allowed to choose their own provider, even if they're practicing "illegally"--but caveat emptor, of course: you need to scrutinize qualifications, experience, and everything else to make sure you're getting a competent midwife (which I would also advocate for *any* provider, btw). In states like NC, where I had dd, CPMs are not licensed, but that's a function of bad law, not of the effectiveness or qualifications or safety of the midwives, who are often licensed in one of the surrounding states (all of whom recognize CPMs). The fact that they have to practice "illegally" only testifies to their commitment to this important work, IMO, and they provide a vital service that may not otherwise be available. Yes, sometimes, there are cases of malpractice amongst MWs; but that's true of "legal" practitioners as well.

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#7 of 285 Old 08-18-2011, 05:43 PM
 
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For me, the fact that someone is willing to practice medicine illegally is, to my mind, a testament to (a) a lack of ethics (I am a professional who requires licensure by the state, and I would never consider practicing without it) and (b) being someone who is willing to accept high risks -- in other words, someone with a cowboy mentality.  Illegal practioners operate outside common checks and balances and may have their ability to best care for their patients hindered by their own need to save their butts from criminal charges. 

 

I prefer that professional care-givers have a lower tolerance for risk. 

 

 

 

 

 

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#8 of 285 Old 08-18-2011, 06:42 PM
 
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Gena 22  - that was  a great story!  I too support 'illegal' midwives.  In 1996 - when my sister was pregnant with her first child, she saw two different OB's who promised her bed rest and a cerclage and a horribly complicated medical birth.  She sought out further opinions and found a HB midwife  she liked and trusted.  At about 30 weeks NY state made it illegal for direct entry midwives to attend HB's.  (as they had been doing prior to 1996)  so my sisters MW was now practicing illegally.   - rather than go back to OB's she stayed with her MW and had a lovely home water birth. 

To me the delineation of 'illegal' or 'legal' is rather arbitrary.  As in PP from NC's case - surrounding states did not agree that direct entry MW should be made illegal - its a ridiculous notion that the same action can be both perfectly fine or a felony depending on what side of the street you are on. 

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#9 of 285 Old 08-18-2011, 07:50 PM
 
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Quote:
Originally Posted by XanaduMama View Post

I think women should be allowed to choose their own provider, even if they're practicing "illegally"--but caveat emptor, of course: you need to scrutinize qualifications, experience, and everything else to make sure you're getting a competent midwife (which I would also advocate for *any* provider, btw). In states like NC, where I had dd, CPMs are not licensed, but that's a function of bad law, not of the effectiveness or qualifications or safety of the midwives, who are often licensed in one of the surrounding states (all of whom recognize CPMs). The fact that they have to practice "illegally" only testifies to their commitment to this important work, IMO, and they provide a vital service that may not otherwise be available. Yes, sometimes, there are cases of malpractice amongst MWs; but that's true of "legal" practitioners as well.


THIS. You said it so perfectly, XanaduMama. It's kind of like that joke, what do you call the guy that graduates last in medical school? Doctor. Just because someone has a license doesn't make them more responsible or ethical than a non-licensed provider. There can be awesome unlicensed midwives and crappy licensed midwives. And vice-versa, of course. I look at the individual and not the letters behind her name.

 

I also live in a state that does not license CPMs, but that's not stopping me from using one. My midwife is licensed in an adjacent state, though. But even if she wasn't licensed at all, I'd still use her.

 


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#10 of 285 Old 08-18-2011, 08:33 PM
 
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I support legislation licensing CPMs so that midwives don't have to be "underground."

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#11 of 285 Old 08-18-2011, 08:43 PM
 
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No, absolutely no.

There is not need to be illegal. If being CPM is not legal in a state, one can move, or go to nursing school and become a CNM.

 

If someone is willing to do illegal practice like this...what else their ethics will allow them to do?

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#12 of 285 Old 08-18-2011, 08:45 PM
 
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I vote women should be able to choose whatever they want.  I don't think illegal always mean unethical.  


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#13 of 285 Old 08-19-2011, 05:32 AM - Thread Starter
 
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Thank you for the the reply's so keep them coming!  So far it seems that the majority support, this is what I had suspected.


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#14 of 285 Old 08-19-2011, 07:59 AM
 
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I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

 

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 

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#15 of 285 Old 08-19-2011, 09:41 AM
 
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Quote:
Originally Posted by Jane93 View Post

I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

 

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 



How about if there were no "steps" they could take to become licensed? If doctors or dentists weren't recognized in your jurisdiction, and there was no alternative? This is the reality for many midwives in states that don't recognize CPMs and where CNMs don't do homebirths, and was the reality for hundreds, thousands of years, in fact: licensing is very new, historically, and still fairly limited, geographically, and isn't necessarily a guarantee of anything. Millions of people all over the world are treated by practitioners that aren't recognized by a state, and millions do just fine. And I don't see why "illegal" necessarily means "unethical"--since when is the law always the last word in ethics? headscratch.gif


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#16 of 285 Old 08-19-2011, 10:01 AM
 
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Part of the ethics issue is that the very base of the relationship, the provision of the service, is illegal.  So from the first moment of meeting, the practioner has a significant goal (not being arrested) that has nothing to do with providing the best care possible to the patient. 

 

So there may be tension between what is necessary to protect the illegal midwife from arrest and what is necessary to protect the mother and baby from harm or assist them during period of danger (for example, calling 911 and remaining until EMS is present, making medical records available in case of transfer or accompanying the patient to the hospital during transfer). 

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#17 of 285 Old 08-19-2011, 10:37 AM
 
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I agree with a poster above. I support legislative actions to legalize CPMs. They wouldnt have to have the "cowboy mentality" if they didnt have to fear transporting and getting caught. I am the Vice President for Maryland Families for Safe Births and we are currently working on a bill to legalize CPMs in the state for this very reason. Currently only unassisted homebirths are legal. I mean really? So the state is ok with NO medical professional being there....but not ok with a certified pro midwife? Its laughable. Midwives are the experts when it comes to homebirths...CPMs and laymidwives especially. But if at least getting your CPM credential means you have NARM to back up your qualifications...I say go for it.

 

My CPM delivered my baby at home...VBAC..."illegally". Im so lucky for her. She put her ass on the line for me. So i plan on busting mine so that CPMs in Maryland dont have to work underground.


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#18 of 285 Old 08-19-2011, 10:39 AM
 
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Quote:
Originally Posted by Jane93 View Post

I am curious as to how many who are willing to support illegal midwives would be willing to see an illegal doctor?  

 

How about it -- a little surgery from a doctor trained in Hungary, or Peru or Australia who hasn't taken the necessary steps to obtain their license in your jurisdiction?  Or a little dentistry from a self-taught dentist?  An eye check by an apprentice opthamalogist? 


The problem is you see birth as a medical event, I see it as a normal/biological/physiological process. Mothers get to choose who they have present during the process. I would absolutely have an eye check from an apprentice, because that mean their preceptor would be there helping him/her and guiding them through the process. A self taught dentist is a lot different from a traditionally trained midwife. Apprenticships have been around a long time, it is a proven method of learning and teaching.

Ethics has come to be questioned. Is it more ethical to serve the government or serve the mother?


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#19 of 285 Old 08-19-2011, 02:41 PM
 
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 I have respect for MWs that do practice illegally. They serve women while doing so at a cost to themselves if caught. I've used several myself, and I did have other options for MWs. 


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#20 of 285 Old 08-19-2011, 03:32 PM
 
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It depends on the midwife and their individual character and motives. If someone is an illegal midwife because they can't be bothered to get appropriate training, I find it neglectful of the women who trust them with their care, and that is despicable. 

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#21 of 285 Old 08-19-2011, 04:49 PM
 
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Thanks for great post! Absolutely agree. The law got to be "the law" only because a certain number of people agreed and made it a priority - not necessarily because it's more correct than something that is not law.

 

Quote:
Originally Posted by XanaduMama View Post

How about if there were no "steps" they could take to become licensed? If doctors or dentists weren't recognized in your jurisdiction, and there was no alternative? This is the reality for many midwives in states that don't recognize CPMs and where CNMs don't do homebirths, and was the reality for hundreds, thousands of years, in fact: licensing is very new, historically, and still fairly limited, geographically, and isn't necessarily a guarantee of anything. Millions of people all over the world are treated by practitioners that aren't recognized by a state, and millions do just fine. And I don't see why "illegal" necessarily means "unethical"--since when is the law always the last word in ethics? headscratch.gif



 

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#22 of 285 Old 08-20-2011, 05:08 PM
 
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This is the sort of thing I'm talking about when I say the interests of the illegal midwife and patient are not aligned...see the following text from the book "From Calling to Courtroom"...

 

"For those midwives who do carry Pitocin, I would advise them to never admit it to anyone who has the ability to testify (that is, anyone except your husband). If a midwife ever feels the need to inject Pitocin or administer any kind of drug, such as Methergine, she should refer to such substances as "minerals.""

 

So basically, the advice is to deny the mother information about what is being injected into her body and make it so she cannot accurately report to the hospital (in case of transfer) what medicines she has had during labor (an extremely important point for her new medical team to know). 
 

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#23 of 285 Old 08-21-2011, 10:28 AM
 
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No, I don't support "underground midwives".

 

Moms would face incredible difficulties to even do a basic check on that midwifes' credentials and if things go south it'll be next to impossible to hold that midwife even a little bit accountable.

 

 

Come to think of it.....if you want to get a really good picture of whether working with an "underground midwife" is a good idea, find a couple moms that gave birth with an "underground midwife" in attendance and then experienced some kind of complications / emergency.

 

THAT will give you a good picture like no poll can.

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#24 of 285 Old 08-21-2011, 11:29 AM
 
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No, I do not support underground midwives. I want midwives to be of the certified nurse midwife CNM type where you have a four year nursing degree and a master's in midwifery.
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#25 of 285 Old 08-21-2011, 12:42 PM
 
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Absolutely I support them, nor do I think it should be illegal in the first place!!!  JKSeaWell basically took the words from my mouth so... in agreement with her post:)  I feel that having a license from the state or certifaction is great but there are pearls of knowledge out there that have been handed down, knowledge from past generations with way more knowledge and experience than someone with a piece of paper and less experience.  I would rather have someone who has the hands on experience and knowledge from generations past legal or not...   My babies will always be more to me than someone elses opinion, a law, or a statistic! 

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#26 of 285 Old 08-21-2011, 01:51 PM
 
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Umm, heck yeah I support them. I had my first baby in a state that did not license midwives, so my choices were: underground midwife, 5 hour drive to The Farm, a hospital with a CNM who I didn't click with very well, the hospital being the most natural birth friendly BUT had a mandatory nursery stay for the newborn for at least an hour (if pediatrician signs off on it) but usually more like 4 hours. (And, being incredibly active in the birth community had never even HEARD of anyone who successfully fought the policy) or hospitals that were less natural birth friendly but didn't have the unbendable nursery stay policy. I chose the underground midwife. Obviously its not ideal, but I felt it was my best choice. A choice I agonized over for the first 24 weeks or so of my pregnancy (that was when I made my final decision) Underground midwives (at least the ones I knew in that city) weren't underground because they are "unethical and have a high tolerance for risk". Its because they are passionate about offering choices to women in an area that had few choices. They were honest and upfront about what kinds of situations they were and were not comfortable with, safety wise. And when things weren't looking good, they transferred to the hospital, staying with the mother. The biggest risk they face is prosecution, but they stick their necks out to offer women that choice, and yeah, I damn well appreciate them for it! I personally DID transfer, and unfortunately had a c-section (chose the not-very-natural-birth supportive hospital option because at that point I knew I was not getting a natural birth, but wanted to keep my baby with me at all times!) my midwife and her apprentice stayed with me and cooperated with hospital staff, identified themselves as lay midwives, handed over prenatal/labor records. They are actively trying to change the laws to license midwives there, but in the meantime, women deserve a choice somewhere between hospital and UC. I can see how in a location that is openly hostile towards midwives and they're being prosecuted, there's the possibility of it being "less safe" because a midwife's risk tolerance could be stretched thin, delaying transfer with signs of distress to avoid being "caught" at the hospital. I'm sure it happens. Luckily where I used underground midwives, I have not heard of any attempts to prosecute, so that is not hanging over their heads. When there's distress/abnormality, they transfer.


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#27 of 285 Old 08-21-2011, 03:27 PM
 
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No, I do not support underground midwives. I want midwives to be of the certified nurse midwife CNM type where you have a four year nursing degree and a master's in midwifery.



I huge *yeahthat* to philomom.  I am in 100% agreement with this post.

 


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#28 of 285 Old 08-21-2011, 06:35 PM
 
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IMHO I believe women should be able to use any midwife they want. How is it fair that another person judge how a woman should give birth and who she chooses to attend her birth. One added point is that in many states a VBAC at home also known as a HBAC is not legal with any attendant. Soooo a woman not wishing to give birth in a hospital  has the choice of giving birth at home without anyone there or go with an underground support person.


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#29 of 285 Old 08-21-2011, 09:08 PM
 
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Originally Posted by mindfulmomma View Post

IMHO I believe women should be able to use any midwife they want. How is it fair that another person judge how a woman should give birth and who she chooses to attend her birth. One added point is that in many states a VBAC at home also known as a HBAC is not legal with any attendant. Soooo a woman not wishing to give birth in a hospital  has the choice of giving birth at home without anyone there or go with an underground support person.


How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.

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#30 of 285 Old 08-21-2011, 09:22 PM
 
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Originally Posted by philomom View Post



How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.
 

 

Wait--how does "not licensed" necessarily = "not qualified"?? If a MW is licensed in one state, and not in the next, does that make her "not qualified"? Who gets to decide what being "qualified" really means? You evidently believe in certification, state-issued licensing...but who's to say that this is the best way to evaluate qualification? This may be your comfort level, and that's great--everyone has different risk-tolerance and ideas about what qualification entails, but it's a huge leap from there to condemning all mothers who choose "underground" MWs as dangerous mothers bent on endangering their babies.

 

 


 

 

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read.gifSarah ~ wild.gifds X 12/05 ~ flower.gifdd E 3/08 h20homebirth.gif  ~  stork-suprise.gif 7/12 dizzy.gif

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