On December 5, their son Marcus Anthony was born in Phoenix via an uncomplicated vaginal delivery, weighing seven pounds and 13 ounces.  YAY!

The story goes on to explain the reasons why c-sections are usually performed and that often the decision to have a c-section is made in the delivery room , by the doctor, for reasons that are not always emergent.

They go on to list all the typical scenarios that result in c-section and what you should ask your doctor in each of these cases.  Now, you can either print this out and bring it with you just in case……OR you can hire a practitioner that tries very hard to avoid interventions and c-sections.  This way you know that if you end up with a section, there was nothing else that could have been done.

And how do you decide what type of practitioner you might need?  Well, it seems that today the stars have aligned because the American College of Nurse Midwives just came out with a nifty little tool that I blogged about earlier today.  The “Who Should Deliver My Baby?” Quiz….

In July, the ACNM submitted a letter to members of congress opposing Federal Recognition of CPM’s for serving Medicaid and Medicare recipients.  At first glance this might seem like a cat-fight, so I thought I would highlight the issues.

First some definitions:

CNM, Certified Nurse Midwife: A person who holds a nursing degree, and a masters degree in Nurse Midwifery from an institution recognized by the Accreditation Commission for Midwifery Education (ACME) who answers to the US Dept of Education. To become a CNM, one must sit for the national certification exam put on by the American Midwifery Certification Board, Inc. (AMCB)  CNM’s practice in collaboration and consultation with other health care professionals, providing primary, gynecological and maternity care to women in the context of the larger health care system.

CM,  Certified Midwife: A person who has done post-baccalaureate training, but does not have a nursing degree.  The post-baccalaureate degree must be from an ACME accredited institution as well.  To become a CM, one must sit for the same national certification exam as a CNM. CMs practice in collaboration and consultation with other health care professionals, providing primary, gynecological and maternity care to women in the context of the larger health care system.

CPM, Certified Professional Midwife: A person educated and certified by an institution accredited by  the North American Registry of Midwives (NARM) or the Midwifery Education Accreditation Council. CPM’s are licensed to provide out-of-hospital births after passage of the NARM exam.

As many of you know, the profession of midwifery still has a long way to go toward mainstream recognition and is often misunderstood and misrepresented in the media.

The ACNM decision to take a stand again CPM’s was in step with their position statements on midwifery certification and on midwifery licensure and regulation.  They feel that federal recognition of a group of midwives in the United States that lack a standardized, formal approach to education— something that all other health professionals with similar responsibilities in the US have— could undermine progress towards mainstream recognition of the midwifery profession and full partnership in the US health care system.  It would also be a move that diverges dramatically from the successful models of midwifery care in all other developed countries.

I get this.  It makes sense.

However, the organizations who support and educate CPM’s have some good points as well.  They only deal in home births.  The fear is, if ACNM creates a standard that eventually pushes out CPM’s (which is very viable argument) it could lead to a significant decrease in home births which could seriously limit access for the thousands of women who have home births each year.  This might particularly affect rural and poor women who have little or no access to the US Health Care System.  Typically, CPM’s charge less, and their education costs less than post-baccalaureate programs which is why they are found in larger concentrations than nurse midwives or CM’s in less urban and economically challenged areas.  For CPM’s the issue is not only Medicaid reimbursement.  If ACNM secures the role of THE professional organization that deals with midwifery legislation (and licensure ) it’s the CPM’s very existence that is at stake.

Advocates for CPM’s second argument states (correctly) that there is no evidence that a post-baccalaureate degree results in better midwifery practice or better outcomes.  For an industry who still must prove their value and worth against MD’s by talking about outcomes, CPM’s feel that this is a slap in the face.

I feel that this argument, although true, is not a strong enough one to avoid standardization in the long term because standards exist in nearly all mainstream industries.   Ultimately, to gain the credibility that midwives want and deserve, there is going to have to be a standard, and probably just one- that all midwives must meet and achieve.  We want midwives to continue to do home births, we want them to serve in rural and poor markets.  ACNM and all midwives as a COLLECTIVE industry have to look long and hard at our main objective- to provide ACCESS to midwifery for birthing women.

My concern is that with standardization, people and places get priced out of the market.   Everyone who wants to be a midwife can’t always afford a post-baccalaureate degree.  Those midwives who do go for that degree might be forced to work in more urban markets to pay back loans. Future midwives won’t be able to be trained by experienced midwives in their own communities-leaving, even for a few years, could create a cultural disconnect that’s irreparable.   And the rural and underserved population will continue to be underserved.

Of course I know I’m jumping the gun here, and it’s probable that the abolition of CPM’s won’t ever happen as they are so important to the communities they serve, but there are large issues here that need to be addressed.

In an ideal world we would create a midwifery education and credentialing system that is standard, affordable and accessible to most wanna-be midwives.  Ideally, their education should primarily take place in their own communities if they so desire. (With hopes that they stay there.)

I agree that the move ACNM made was good for possibly helping to bring midwifery into the main stream through their willingness to push standardization, BUT we can’t forget our roots- which did not always involve post-baccalaureate degrees.  There are real reasons why CPM’s exist.  They meet a need.

So let’s stop whining and come to the table and figure it out.