Arrested Midwife Says She Won’t Deliver Babies in Indiana Anymore

A supporter holds a sign at Monday's rally for midwife Ireena Keeslar. Photo courtesy of Roger Schneider, Goshen News

(April 13, 2012) Ireena Keeslar, 49, a certified professional midwife (CPM) announced today that she will no longer attend homebirths in Indiana.

In Indiana it is a felony for certified professional midwives, like Keeslar, to attend homebirths.

“We have defined the delivery of babies as the practice of medicine,” said Representative Tim Brown, M.D., 56, an emergency room doctor who is chair of the Public Health Committee in the Indiana House of Representatives, and who currently opposes the bill to license certified professional midwives.

“That’s the law,” Brown said.

Like many doctors in Indiana, Brown believes CPMs are not qualified.

“I don’t think they have the training and expertise that at this time renders them qualified that we should license them in the state of Indiana,” Brown said.

“The delivery of a child in a hospital or at home is the practice of medicine and the lay midwives do not have the educational training required in the event of an emergency,” agreed Mike Rinebold, director of government relations for the Indiana State Medical Association.

“Even in the most routine births, things can go wrong in a heartbeat,” Rinebold said, “You have to have the education and equipment necessary to be prepared for an emergency.”

Ireena Keeslar (right) talks with Mary Ann Griffin at Monday's rally protesting Keeslar's arrest. Photo courtesy of Roger Schneider, Goshen News

Are Certified Professional Midwives Really Poorly Trained?

But a spokesperson from the North American Registry of Midwives (NARM), the non-profit organization that provides national certification, disagrees. “Evaluating risk is part of the training,” said Debbie Pulley, director of public education and advocacy.

“CPMs are certified in neo-natal resuscitation,” Pulley, 58, a CPM in Lilburn, Georgia, continued. “They are trained with how to deal with hemorrhages, and they have knowledge when to transfer care to the hospital.”

CPMs must have 1,350 clinical contact hours with pregnant women, mothers, and babies, as well as the knowledge and the skills to pass a 4-hour skills exam and an 8-hour written exam.

“Our certification insures that midwives meet core competencies for knowledge and experience,” Pulley said. “NARM requires both didactic training and clinical internship and passage of the national exam for certification.”

The average length of training to become a certified professional midwife three to five years, according to Pulley.

“The required number of births, prenatals, and postpartum visits that family practice doctors, certified nurse midwives, and certified professional midwives need is virtually the same,” said Mary Ann Griffin, president of the Indiana Midwives Association.

Arrested on Saturday

Keeslar, a diabetic mother of five and grandmother of five, who lives in Howe, was arrested on a Saturday morning, March 31, 2012.

She spent the day in a jail cell with no access to her medications. There was someone else’s phlegm in the sink and she was served food inappropriate for a diabetic.

Saturday evening she was released on $10,000 bail.

Indiana Women Want Choices
Keeslar’s daughter, Anastasia Griffith, 26, was at her job at Hardy’s, a travel store on the south side of the toll road in Howe, when her older brother Nathan called to tell her their mom had been arrested.

“My brother picked me up and went over to my parents so I could sit with my father,” Griffith said. “He was sitting at the house not knowing what to do. He was just as confused as I was.”

Griffith has been married for five years and is looking forward to starting a family.

She believes women in Indiana should be able to choose where and with whom they give birth.

“I’m definitely having a homebirth,” she said. “This cause means a lot for me personally to have my mother be the one who delivers my child in my home in Indiana.”

Griffith believes criminalizing certified professional midwives is unfair.

“What hurts me the most about this is that now I don’t have that choice for myself anymore.”

Women in Indiana who want CPM-attended homebirths are crossing the border to Michigan.

In Michigan certified professional midwifery is not expressly forbidden in written law, though midwives say they are still vulnerable to harassment or prosecution.

The Safety of Home Versus Hospital Birth

The United States has one of the highest maternal mortality rates of any industrialized country.

According to Save the Children, the likelihood of a mom dying due to pregnancy-related causes in the U.S. is seven times greater than in Italy or Ireland; the likelihood of her dying as a result of childbirth is five times greater than in Germany and Spain, and 15 times greater than in Greece.

One recent study of maternal mortality in New York City found that 79 percent of women who died in childbirth had Cesarean births.

While other countries report an increase in positive outcomes and a decline in childbirth-related complications, “near misses” (pregnancy-related complications so acute a woman almost dies) are climbing in the United States, according to a 2010 report by Amnesty International.

Yet the vast majority of births take place in the hospital. Fewer than 1 percent of American women choose to have their babies at home, according to the New York Times.

Birth activists point out that it is unnecessary intervention, harmful hospital protocols, and doctor error in the hospital that accounts for the poor birth outcomes in America.

Dozens of scientific studies have found that homebirth is as safe as hospital birth, for low-risk mothers.

One study from Netherlands, where 30 percent of the births take place at home, confirmed the safety of out-of-hospital birth for low-risk women.

The Netherlands has much lower maternal and infant mortality rates than the United States.

“There are places in the world where homebirth is offered as a reasonable option in a well-established system of obstetrical care: Holland, Britain,” said Dr. Mary Elizabeth Soper, M.D., 62, an Indianapolis-based obstetrician who has been practicing for 35 years.

Soper supports licensing certified professional midwives.

“There are places where homebirth is considered to be a normal, possible choice,” Soper said. “The thing that makes it possible is well-trained midwives, well-established criteria for who can have homebirth, and well-established emergency procedures.”

While many hospitals have protocols that make it difficult or impossible for a laboring woman to move freely—and most obstetricians expect women to give birth lying flat on their backs—women at home attended by midwives can labor as they wish.

Moving freely during labor, being allowed to eat and drink, not being monitored constantly, and having one-on-one attention have all been scientifically shown to increase the chance of a good outcome.

“I do not believe it’s about safety. There’s no evidence to back that up,” says Anastasia Griffith, Keeslar’s daughter. “There are too many safe outcomes for home birth for them to cry ‘unsafe.’”

Midwives and Families Rally to Support Keeslar

Monday, April 9, over 100 supporters gathered outside the LaGrange County Courthouse in LaGrange to protest Keeslar’s arrest.

One man held a sign to oncoming traffic: HONK IF U SUPPORT MIDWIVES.

Mary Ann Griffin, 59, president of the Indiana Midwives Association, was at the rally.

She said the mood was peaceful, even joyful.

Many of Keeslar’s former clients, including more than two dozen Amish women, were at the courthouse, as well as other supporters from northern Michigan and southern Indiana.

“They are very worried about what is going to happen,” Griffin, who lives in Rockville, said.

About 45 minutes after the crowd started gathering a policeman came out to announce Keeslar’s hearing had been postponed.

Like Keeslar, Griffin is a certified professional midwife.

Like Keeslar, under Indiana state law, every time Griffin attends a homebirth she is committing a crime.

But Griffin has attended about 2,000 homebirths in Indiana over the 29 years she has been a practicing midwife. She said she’ll continue to do so.

“It’s a calling. We can go to cities or other states and have a life. There are 26 states that license you,” Griffin said. “But there’s a need in Indiana and I live here. I’ve always felt like it was an issue of justice for women. Women need to have the right to choose where they give birth.”

Griffin is a mother of nine including 17–year-old twins. She has ten grandchildren. She delivered eight of them herself at home. ““I am the most vocal visible person in this state,” she said. “I’m just glad they haven’t arrested me.”

Mike Rinebold, director of government relations for the Indiana State Medical Association, is hoping that will change.

“We are thankful there is a prosecutor in LaGrange County who is willing to enforce the laws,” Rinebold said.

A Trained Nurse

Keeslar, a trained nurse, worked in obstetrics for almost ten years at two different hospitals and two freestanding birth centers.

Newspapers have wrongly reported that Keeslar let her nursing license lapse.

In 2004 she chose to put it in inactive status.

“Since that license did not allow me to practice midwifery, I chose to not keep it current in the state of Indiana,” Keeslar said.

Keeslar has a current nursing license in Michigan and is also licensed as a midwife in Virginia.

The Push to Decriminalize Professional Midwifery

Griffin said she and other Indiana midwives and doctors have been working to change the law.

In Indiana only certified nurse midwives may legally attend homebirths. These midwives are advanced practice nurses who specialize in obstetrics.

The bill to legalize certified professional midwives has been filed in the Indiana legislature for the past 17 years but has never been heard by both chambers.

“The bill has failed over technicalities or for lack of being granted a hearing,” Griffin said.

“We are being stopped by the Indiana State Medical Association, which has a powerful lobby. I’ve met with them many times. They have told us that we have been their number one priority. This little tiny group of midwives. There are about only about 15 CPMs in Indiana. It’s a tiny group. We serve 1,000 families a year who want to have a homebirth.”

Griffin says the question of who can attend homebirths is not about safety. She points to studies that have shown that birth at home with a competent attendant is as safe than hospital birth for low-risk women.

What makes homebirth dangerous, Griffin says, is when midwives are considered felons for helping pregnant moms.

“When there is no regulation and midwives are criminalized then the state drives competent safe midwives out of state,” Griffin said. “We want collaboration, that’s what makes homebirth safe.”

In the past Representative Tim Brown, M.D., has attended homebirths as a doctor.

“At that time it seemed like the appropriate thing to do,” he admitted.

“Part of all healthcare is we need to give more options,” Brown said. “… I think women should have some options.”

But Keeslar announced that she will no longer deliver babies in Indiana.

“I’m not going to do anything in Indiana. I’ve been here for 12 years and no one has said anything against me. Since they are coming after me, I’m thinking I don’t want to risk it. It’s not worth it to me to set in jail.”

“I can’t practice or even assist at a birth in Indiana anymore,” Keeslar said.

An Amish-Owned Birth Center Out of State

Instead, Keeslar is planning to practice out of state in a brand new not-for-profit birth center, funded by Amish cattleman Jonathon Lambright.

The birth center is open to any woman who wants a home birth. The cost to women to stay at the facility will be between $400-$800 for up to 36 hours, a small fraction of what a hospital-stay costs. The fee for the midwife will be extra.

Pregnant women who want more information about the birth center, which doesn’t have a name or a website yet, can call 260-367-0174.

Keeslar has not yet been contacted with a new court date.

I asked her if she was concerned she might go to jail.

“I don’t feel worried,” Keeslar admitted, “but I don’t know if that is peace from God or if I’m just ignorant about how this works.”

Readers who want to help Keeslar cover legal fees can send checks to:

Ireena Keeslar Legal Fund

7570 East 750
North
Howe, Indiana 46746

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Categories: pregnancy and childbirth.

Comments

  1. Jasper

    The remaining midwives in Indiana are providing the only way for women to choose where and how they give birth: if they don’t want to be forced into a C-section 1/3 of the time, if they want to give birth in their own choice of position, if they want to have a trial of labor after previous C-section. Freedom of choice for women is not doing well in Indiana.

    • Midwife CNM

      It’s not just Indiana. CPMs are illegal in many states, including Michigan, which is also introducing legislation to license them. The fact is that delivering a baby requires a license in every state, as either a physician, nurse-midwife and/or CPM. In states that don’t license CPMs, they can be prosecuted for practicing medicine or nursing without a license. There is no such thing as midwifery not being “expressly forbidden” in the law–many other laws apply, including those requiring a license in order to carry certain medications.

  2. Mommagina

    I know if my CPM stops practicing here in Indiana I will be having unassisted births from here on out. I will not be forced by the state government to go to a hospital and be treated like a sick person when pregnancy and birth are not illnesses.

  3. Shanti Bradley

    Not licencing CPMs in Indiana greatly limits access to care for many women. When OB/GYNs have a 3 week wait for an emergency appointment and are over booked to the point of diminishing the quality of care for their patients they have no tight to limit alternative options for care. Furthermore, pregnancy and birth are natural events that occurred successfully long before the arrival of modern medicine. As a woman and mother I find it both offensive and demeaning that anyone would suggest that these are medical events instead of something natural. The doctor making such a claim should be ashamed of himself.

  4. b2manatees

    My heart hurts for the women who will no longer benefit from the care of this midwife – the pregnant mothers who are now without a trusted birth provider and the women who can now no longer birth further babies with a midwife they already know, love, and trust. No one is forcing women to give birth at home. So why does the medical community keep trying to force those of us who want a home birth to birth in hospitals where, quite frankly, you have to fight like hell for an unmedicated birth and truly can’t have an intervention/interference free birth? They hide behind “safety” but anyone with a brain knows the cause is driven by money.

  5. Jennifer

    I wish the article had mentioned the fact that CNMs are perfectly legal to operate in Indiana. There are homebirth CNMs who have legal access to meds and everything they need to make the low-risk homebirth a possibility without fear of prosecution.
    The article makes it sound like it’s CPMs or nothing for homebirth options.

    • Ashley

      I’m not sure about Indiana, but for Illinois that’s pretty much true. Yes, CNMs legally can attend homebirths in Illinois, but they need a doctor overseeing them and there are no legal homebirth CNMs outside of the Chicago area. I just had a wonderful, totally textbook homebirth last week with an unlicensed midwife that undoubtedly would have been a c-section had I been in the hospital (big baby, VBAC, past 40 weeks). So, for me, it was literally homebirth with a CPM or c-section.

    • Wendy

      The article does mention Indiana only allows CNM’s – thats the problem. CPM’s are just as capable and expand choices for women in the home birth arena.

    • cNMs are not able to legally practice in Indiana. They need the collaboration of a doctor and doctors do not collaborate with home birth midwives. It may interest people to know that in indianapolis, Methodist is the only hospital that will even hire midwives. Clearly there is an anti midwife bias in the State. And honestly, I expect more from Indiana. My daughter is 9 days old. I had both a midwife and a doctor. My midwife caught the emergency with my daughter and my doctor did the c section. Unfortunately, we could not collaborate because of Indiana law. I had to be the go between. Midwives are surprisingly medically qualified and making them legal will increase their ability to use the medical training they already have, especially in emergencies. Right now, they operate in fear.

    • Lisa

      Not to mention many midwives have views that would conflict with the training required to become a nurse in the traditional system of so-called “health-care” and this is what makes them excellent, true providers of CARE to women and have a sensitivity and desire to do what is in the best interest of the patient, mother and child. This is NOT true of the medicalized model of birth and the OB/GYN providers that herd women like cattle through their process, which benefits them and not women. Some of the BEST midwives are CPMs – CNMs seem to carry more baggage from the system with them, as is my experience.

    • Fiora

      CNM’s in most states, while they may be “legally allowed” to attend homebirths, in practice are kept from doing so by the requirement to have a doctor back them up. It’s a very convenient way for the state and the medical system to keep those babies a’borning in the hospital, since there are usually no doctors who will back them up. Ob’s who backup CNM’s are often ostracized by their fellow doctors, threatened with increased malpractice insurance rates, and lost hospital privileges. So no, CNM’s, while technically “legal” are not a homebirth option in nearly all cases.
      The only truly legally safe homebirth option in many states is an unattended birth–which is not what we want either for most women.

  6. Concerned in Michigan

    It does mention it! “In Indiana only certified nurse midwives may legally attend homebirths. These midwives are advanced practice nurses who specialize in obstetrics.

    The bill to legalize certified professional midwives has been filed in the Indiana legislature for the past 17 years but has never been heard by both chambers.”

    Does anyone wonder why lay midwives don’t go to school, get their CNM and become legal? Why in 17 years the legislators of Indiana haven’t seen fit to license the CPM’s?? The CPM does not have the same rigorous training and requirements as the college-educated CNM, who is first a registered nurse. The only other requirements to become a CPM are a high school education and CPR and neonatal resuscitation. You can become a CPM via the apprenticeship route, which means, whatever your teacher knows, doesn’t know or needs to know, but doesn’t, will be passed on to you, leaving large and dangerous gaps in your CPM education. A CNM is trained to the same standards as his or her fellow students across the country, ensuring a true baseline of beginning knowledge and competency for the new CNM. There is no such standard in the CPM credential, and as it can be obtained through various methods including online and distance learning, and has no fail-safes for ascertaining the solid foundation in science and medical knowledge, it becomes dangerous to assume that ALL CPM’s are competent to attend women in the childbearing year. Until the standards are raised and the educational requirements are standardized and stricter, caveat emptor to the childbearing couple hiring a CPM!

    • I’m sorry, but you have no idea what training CPM’sgo through to practice their calling! The thing you have said may have been true years ago but now that we are Certified Professional Midwives, we do have to meet a high standard of education and practice. If you do research on the safety of CPM births you will find that our safety record is quite impressive.
      The training may not be formal, college classroom education, but it is complete and extensive.
      I would much rather place my trust in a woman’s ability to labor and birth where she is the most comfortable – both physically and emotionally – than to rob her of all her instincts, place her in a position that is not conducive to good birthing, surround her with strangers who have a long list of rules and machines and who expect her to have problems that will make them feel needed!
      I have been an out of hospital midwife for 34 years. I’ve attended many births, including the births of my 5 grandchildren. I’ve seen women become stronger for having had a natural birth, unhindered by machines or interference. There are times when I am very glad we have doctors and hospitals for the very small percentage of women who need that intervention, but the vast majority of women are quite able to safely work through labor and birth and feel very satisfied in doing so.
      It is interesting that post partum depression is a rarity among women who birth with CPMs. Perhaps that is because they feel much more satisfied with their outcome and experience no separation from their babies.

    • Kim

      The association has both a practical and written entrance exam which are very detailed. This is designed to “catch” any gaps.

      ~~~~~~~~~~~~~~~~~
      “CPMs must have 1,350 clinical contact hours with pregnant women, mothers, and babies, as well as the knowledge and the skills to pass a 4-hour skills exam and an 8-hour written exam.

      “Our certification insures that midwives meet core competencies for knowledge and experience,” Pulley said. “NARM requires both didactic training and clinical internship and passage of the national exam for certification.”

      The average length of training to become a certified professional midwife three to five years, according to Pulley.

      “The required number of births, prenatals, and postpartum visits that family practice doctors, certified nurse midwives, and certified professional midwives need is virtually the same,” said Mary Ann Griffin, president of the Indiana Midwives Association.”

    • Linda

      Concerned in Michigan,
      It is clear how little time you have spent with our Indiana CPMs. Perhaps you should talk to one of the many Indiana CNMs who have befriended, respect, and often seek guidance from these knowledgeable, trained, and experienced women. And please don’t spend your time worrying about us, the families whom choose to work with CPMs. We would prefer you and others learn to live and let live. Or at least educate yourselves before jumping up with your opinion and insisting on controlling the lives of others equally as intelligent and capable of making our own decisions. Thanks.

    • Marla

      Concerned In Michigan,
      Please allow me to share with you a bit of my experience as a CPM. I have been involved in midwifery for 35 years and have attended well over a thousand home births with perinatal, neonatal, and maternal mortality rates of zero for the births that I have attended. Not one client in my practice has delivered prior to 36 weeks, and only seven clients have given birth between 36 and 37 weeks (all in hospital except for one woman who refused transport). This is not about luck. This is about appropriate risk screening and management, and there are a multitude of published studies over a thirty-year span that demonstrate that results such as these have been duplicated.

      The process leading to the CPM credential of the North American Registry of Midwives is certified by the National Credential for Certifying Agencies of the Institute for Credentialing Excellence (formerly the National Organization for Competency Assurance). This is the same agency that oversees the American Midwifery Certification Board for CNMs and the American Nurses Credentialing Center, a highly respected provider of specialty certification for registered nurses and advanced practice RNs. The ANCC also credentials qualifying hospitals as ANCC Centers of Excellence. So is ICE certification–that ultimately validates YOUR nurse-midwifery certification process–worth anything or nothing? You absolutely cannot make that argument in both directions.

      I am one of two executive directors of a busy residential direct-entry midwifery education program in California. We educate students who become licensed, certified professional midwives. In California, non-nurse midwives are licensed by the Medical Board. Our midwifery education program is nationally accredited by the Midwifery Education Accreditation Council (MEAC), a United States Department of Education approved accrediting agency. It has been throughly vetted and granted full approval by the Medical Board of California and the California Bureau for Private Postsecondary Education. Our primary textbooks include Varney’s Midwifery, along with several U.S. and British nursing and midwifery texts that you would immediately recognize. The scope of practice of licensed midwives in California is very similar to that of CNMs. We are licensed to practice in every setting: homes, birth centers, hospitals, physician practices, and clinics. Faculty at our school include LM/CPMs, MDs, CNMs, DOs, a CM, and science instructors with advanced degrees (M.S. and Ph.D).

      In 2009 at the national convention of the Midwives Alliance of North America, I was present at a meeting of the Bridge Club, an informal organization comprised of CNMs and direct-entry midwives from across the United States. The ACNM had sent two representatives to this meeting for the specific purpose of justifying the reasons behind the ACNM’s stratagem to torpedo federal recognition of the CPM credential. (For one prominent CNM’s view on the ACNM’s role in this political matter, see http://mana.org/response.html.) Both of the ACNM representatives stated very clearly during the Bridge Club meeting that the ACNM’s sole objection to the CPM credential is that NARM continues to support apprenticeship as one route to certification rather than requiring universal formal higher education for certification as the ACNM does. They said that the ACNM “is fine” with CPMs who graduate from formal MEAC-accredited education programs. However, they maintain their position that CPMs who do not graduate from MEAC-accredited programs “are not fit to practice.” At that point I could take it no longer. I stood, cited my credentials and experience and said, “So the ACNM feels that I am not fit to practice midwifery clinically but that I am qualified to write curricula, direct a MEAC-accredited program, and teach midwifery students? Can you please explain to me how that makes *any* sense at all?” One of the ACNM reps looked down at the floor while the other stared at me and shrugged one shoulder as if to say, “Sorry you’ve got that problem.”

      The program that I teach and administer is residential. Yet I must point out that one of your arguments against the CPM credential is that “it can be obtained through various methods including online and distance learning . . . .” It is ironic to argue that distance education for CPMs is “less than” since the American College of Nurse-Midwives has six nurse-midwifery education programs that are delivered entirely by distance education and sixteen that are partially distance ed!

      Interestingly, acceptance of the CPM credential appears to be to some degree a function of where one lives in the United States. Six months ago we were invited with one of the graduates of our school (now a busy LM/CPM in a populous southern California county) to deliver a grand rounds presentation on the subject of the education and scope of practice of licensed midwives in the State of California. It was great to feel the tenor of that meeting change from skepticism to curiosity to respect, even if the majority of us ultimately “agreed to disagree” specifically about the matter of home birth. The obstetricians at the meeting were quick to acknowledge that (1) parents are not going to stop having home births, (2) it is in the public interest to have trained LM/CPMs providing care to home birth parents, and (3) it is desirable for midwives and obstetric specialists to work together to support excellence in maternal-newborn outcomes. It was a privilege to have such a reasoned discussion and I believe it is safe to say that many CPMs in this country would enjoy duplicating that experience, if only they were invited to do so.

      A few weeks ago, the graduate who presented with us at the medical center’s grand rounds had occasion to transport a laboring woman to another hospital in the county. On the Women’s Unit one of the OBs from the grand rounds presentation recognized her and said, “Hey, I know you! What brings you here?” The midwife gave report about her patient to the OB, and then she and the doctor worked together in the room to provide care to the laboring woman, along with a perinatologist present to assist if needed. Outcomes for mother and baby were excellent and the professional environment was collegial for both the midwife and the two specialists. It makes a world of difference for midwives to anticipate transporting to that sort of situation as opposed to one in which they may be arrested for the act of attending a woman in labor at home. I know this first-hand, having witnessed quite a few changes in American midwifery over the last 35 years.

      I have had a long, happy, and very successful career as a home birth midwife. I also have clear memories of a time in which nurse-midwifery and nurse practitioner programs in the U.S. were quite often “certificate basic” programs–not graduate degree programs. Over the years, though, we have seen a predictable progression in these educational requirements that reflect our society’s love affair with degrees–which do not necessarily translate to education! And just as predictably, it’s official: the Master of Science in Nursing for nurse practitioners is being eliminated as the entry to practice, to be replaced by the Doctor of Nursing Practice (DNP). Every advanced practice nursing specialty in the country has adopted the DNP as the minimum standard for entry-level practice with one notable exception: the American College of Nurse-Midwives. In their position statement on the subject, the ACNM states, “Decades of research support the high quality care provided by CNMs, educated primarily now at the master’s level. Without evidence to the contrary, we remain concerned about requiring this degree with the added costs and year of study.”

      So the ACNM disagrees with every other advanced nurse practice certification organization regarding the necessity for doctoral preparation for entry-level practice? Well, “without evidence to the contrary,” quite a number of direct-entry midwives and the families they serve disagree with the ACNM’s unwavering position that formal, standardized educational programs are the *sole* acceptable methodology for the provision of direct-entry midwifery education. And whether or not you like it, the highly regarded Institute for Credentialing Excellence that oversees both our certifying organizations actually supports this position.

      Will these families delay childbearing until the ACNM and other organizations and individuals give their “blessing” to direct-entry midwives who didn’t learn midwifery in a formal accredited program? I submit that many of these families consider the ACNM’s position on the matter to be astonishingly irrelevant.

      • “The process leading to the CPM credential of the North American Registry of Midwives is certified by the National Credential for Certifying Agencies of the Institute for Credentialing Excellence (formerly the National Organization for Competency Assurance).”

        The key word is “process.” The NCCA certifies licensing exams. The NCCA does NOT evaluate the validity of the credential, whether that is the CPM or a license to operate a crane. It merely evaluates the credentialing process to ensure that it is impartial, properly administered, and includes relevant requirements.

        So far no one has addressed the two most important issues:

        1. If the CPM lacks the education and training to qualify for licensing in any other country in the first world, why should it be acceptable here?

        2. Even MANA knows that homebirth with a CPM dramatically increases the risk of neonatal death. They have 24,000 planned homebirths in their database and they won’t tell us how many babies died at the hands of those midwives.

        The CPM is a scam. It is a pretend credential designed to trick lay people and legislators into believing that birth junkies who can’t even obtain a high school diploma have education and training.

        No one has presented anything that contradicts these points.

        • Barbara Parker

          And we all know that the only way to learn anything, any “real” education is to attend college. Bullshit.

          • Actually, college IS the only way to get a professional level education; the only people who believe otherwise are those who don’t have college degrees and therefore have no idea what a college degree involves.

            The CPM is designed specifically to trick laypeople and legislators by obscuring the fact that CPMs are nothing more than birth junkies who couldn’t even be bothered to get a high school diploma.

            Perhaps homebirth advocates don’t care that homebirth midwives are grossly undereducated and grossly undertrained, but the rest of the public cares very much. Licensing puts the imprimatur of the state on the training of those who are licensed. Therefore, the state has not only the right, but the responsibility, to insist on minimal standards of education, training and competence. Insurance companies also have the right and the responsibility to demand minimal standards of education, training and competence before allowing midwives to receive insurance reimbursement.

            I suspect that it’s going to turn out that the biggest mistake CPMs ever made was trying to get insurance reimbursement and state licensing. States, insurance companies, and the average lay person care very much indeed that people who represent themselves as health professionals have the same level of education and training as health professionals in the US and as midwives in all other first world countries.

            Licensing PROTECTS choice by informing ALL people of the real (lack of) education and training of CPMs. Don’t other people deserve to know the truth?

  7. Shay

    They think they are making it safe to take a CPM out of the homebirth choice, but most are just going to birth at home by themselves now. I for one – would not EVER plan a hospital birth unless medically necessary.

  8. Sam

    I agree with Griffen this is an issue of justice for women. I live in IL where CPM’s are also not legally allowed to practice. I have had one homebirth with a CPM and am currently planning my second homebirth also with a CPM. There are no legal homebirth providers in my area, no free-standing birth centers, and the closest CNMs are 2 hours away and practice basically the same as OBs. No one can force me to birth in a hospital. If I didn’t have access to brave CPMs willing to continue practcing in IL and IN despite the legal risks I am sure I would join a growing number of women giving birth unassisted.

  9. S.Goyet

    I m a French midwife. I would like to understand the differences between a certified professional midwife and a registered nurse midwife. Thanks

  10. This piece is filled with multiple inaccuracies. Let’s start with an easy one.

    The CPM is a fabricated “credential” designed to trick the American public into believing that lay midwives are “educated.” In EVERY other country in the first world, the MINIMUM requirement for midwifery is a college level midwifery degree. CPMs are ineligible to practice in the UK, the Netherlands, Australia, etc. Canada used to recognize the CPM but they abolished it on the grounds that the education and training is insufficient.

    The majority of CPMs have never attended any school of any kind. Indeed, CPMs are not even required to have a high school diploma.

    Most importantly, the Midwives Alliance of North America (MANA) has collected statistics on 24,000 homebirths and REFUSES to release the death rates. It doesn’t take a rocket scientist to figure out why; the death rates are appalling.

    It is grossly unethical for MANA and homebirth supporters to try to pretend that CPMs are anything other than birth junkies who can’t be bothered to get a real midwifery degree or aren’t qualified to enter a real midwifery program.

    Midwives in the US should be required to meet the SAME educational and training requirements of all other midwives in the first world. There is no possible excuse for anything less.

    • Theresa

      I just had a baby boy five weeks ago. He was delivered at home in the water by a CPM. I completely trust her 100%. The labor and delivery were absolutely amazing. I’ve given birth to two babies in the hospital prior to this baby and I trust my midwife more then I ever trusted my ob/gyn!! It’s probably because the outcome of my home birth was SO much better then the outcome of my hospital birth. If I happen to have any more babies home is where I’ll be giving birth, with a CPM!!

    • Natalie

      I’m not sure why it’s anyone’s business who assists me with the birth of my child or what their credentials are or what their level of education is. I’ll go ahead and make the decisions about whom to involve and what I expect of them. I’m anticipating that you’ll try to counter this with the “think of the unborn child!” argument, as if women who choose home births attended by midwives care more about being able to share a flashy/trendy/competitively-crunchy birth story over a positive birth outcome and a healthy baby. I’ve seen that tired argument paraded around the internet. Anyone who makes it doesn’t understand human mothers or any of the other concerns surrounding this topic. And not that this matters at all, but I feel this way as someone who has twice given birth in hospital and would choose a hospital birth in the future. It’s nobody’s business.

      • You already haev the right to give birth wherever you want, attended by whomever you want.

        The issue is that those who attend you don’t have the right to call themselves midwives, and most importantly, don’t have the right to charge you for attending you. That’s known as practicing without a license and that’s illegal.

        • Natalie B.

          I’m pretty sure that I’m capable of understanding the difference between a CPM and a CNM. The point is, a woman who wants a home birth can choose what credentials she wants her provider to have – if any. Giving birth entails risks, but it is not a medical event.

          (PS. That’s me above, but I noticed that there’s another Natalie below.)

        • Theresa

          With all due respect Dr. Tuteur, I’ve read your blog and to me the way you condemn women, CPM’s, and home birth is completely uncalled for. Awful things happen in hospitals as well. You write and speak as if nothing bad ever happens at the hospital. Giving birth is a natural wonderful experience. I’ve done it both ways, medicated and 100% naturally. I loved my natural birth so much I would never do it any other way. Your opinion of home birth and CPM’s is not what bothers me, it’s the way you condemn women and their choice to birth at home that bothers me. I think women deserve respect regardless of the way that they choose to birth their baby.

      • Linda

        WELL PUT, Natalie. “…being able to share a flashy/trendy/competitively-crunchy birth story over a positive birth outcome and a healthy baby…doesn’t understand human mothers…” Love it! I will use your words in the future!

    • Earth

      Dr. Amy’s email comes off bitter & full of rage. When dealing with pregnancy, birth & babies care providers must have an open heart full of understanding & love. The energy from Dr. Amy’s comments leave me felling deeply concerned for her inner well-being, she is obviously very far from feeling a sense of peace in her life, both professionally & personally. It is crucial for the health & safety of all mothers & new babies that spiteful care providers whose foundation of care is rooted in fear be removed from our maternity care system. It is obvious that the current system of childbirth management is broken, devoid of love & peace. Being trained in emergencies & having surgical skills does not automatically make you worthy of being an integral part of a newborn’s first imprint of life. MDs really need to check themselves, they need to check their intentions, their motivations, & yes do I dare say they need to check their training…why are they OK with a 33% C-sec. rate….We know why…they fear or possibly despise what is natural, they lack trust in the biological process of birth, what a shame & how dangerous for mamas & babies to have Birth Attendants who believe in cutting mamas open & supplying then with drugs as a model of safe birth. California, Vermont, Oregon have it right LONG LIVE c.p. MIDWIVES!!

    • I notice that no one seems to be able to explain why women who would not be eligible to be midwives in ANY other first world country because of lack of education and training, should be eligible to be midwives here.

      Perhaps you hadn’t realized that the CPM is a made up credential that doesn’t meet the most basic education and training requirements of all other first world countries.

    • Wendy

      Back up your statement “The majority of CPMs have never attended any school of any kind. Indeed, CPMs are not even required to have a high school diploma.” Twenty six states have legalized the use of a CPM – as such they have set their minimum criteria which include minimum educational standards, apprenticeships, curriculum requirements, testing, number of hours in practice – all must be met satisfactorily before a license is allowed. As in any profession – be it doctor, nurse, educator – licensing requirements will vary from state to state – the credentials are not the same across the US for these professions – why CPM’s? We are ‘Unites States’ – so each state is going to have to decide it’s criteria to allow a CPM to practice. There still are many other countries that allow midwives and have rigorous training, apprenticeship, and testing requirments – but not equivalent to an RN but rather unique to midwifery.

      Each state will have to decide on this matter but for me and mine, a CPM and homebirth is just fine.

      Your comments are unsupported by fact and full of venom.

      • NARM is changing the CPM requirements as of September 2012 to require a high school diploma or its equivalent. Up until now, there has no requirement for a high school degree.

        You can read about it on the NARM website:

        http://narm.org/req-updates/

        I suspect that most supporters of CPMs have no idea that they haven’t even been required to have high school diplomas.

        • MC

          And why is a high school diploma the be-all end-all of midwifery licensing requirements? I know plenty of high school graduates that I wouldn’t trust with my cat, let alone my baby’s life. I also know many homeschooled teens who I would happily ask to babysit. High school means nothing. I would ask under whom my midwife apprenticed and for how long, as well as her personal statistics and philosophies. When I chose my midwife – a CNM – I went in with a list of questions two pages long. It’s called being an educated consumer. That said, why am I not surprised that Dr. Amy is all over this story with nasty comments and misrepresentations of facts?

        • Robyn

          Hmmm…It is irrelevant if my CPM had a high school diploma or not…WHY? Because she did not learn how to assist in the delivery of babies in high school anyways…duh!

        • Aaron

          You have claimed in other comments that this is not financially driven? Of course it is! My wife has been a nurse in a critical care unit of a top 5 hospital in the US for 17 years. What do they do out in the hall shortly after a failed code while the family is in the room mourning? Tallying up the supplies used that tried to save them that didn’t work.

          Of course it’s about money. That 1% is a hell of A LOT of money. I myself have four degrees, a HS, BS, and two PhDs. If a HS diploma is what you are worried about then I assume you’ll be fine with me delivering babies over a highly experienced midwife with no HS degree right? After all, I learned a lot about delivering babies in that World Civ class that some midwives missed out on….

          Oh, and one more thing, If you want to talk about safety, then maybe you shouldn’t be dropping the ball since based on purely statistics it seems that our current hospitalization method is failing mothers a much higher rates than other first world countries. Stop failing us Amy.

          • Kemi

            Oh Aaron!!! FANTASTIC response…reading Dr Amy’s stuff makes my heart thump. She’s so incredibly bitter and spiteful. It’s so wonderful to read informed comments rather than her power crazed, misogynistic rants.

            Thank you x

    • ES

      I laughed when I saw who this reply was by. Oh, dear. You are one special woman. You must really fear something if you spend all your waking time bashing it (and not even doing a very good job of it either).

      Thanks for the laugh, Amy Tuteur, I appreciate it.

  11. Mama Eva

    “….the vast majority of births take place in the hospital. Fewer than 2 percent of American women choose to have their babies at home….”

    Why is “the man” spending taxpayer money on picking on 2% of half of the population?!?!

    “It’s the Law…” he says? Time to change that outdated law. 😛

  12. Natalie

    I find it ironic someone who hasn’t practiced medicine in over a decade would pass herself off as informed especially when her tactics involve making gross generalizations about an entire profession of women. Bottom line is this, it is the right of all women to make informed decisions with respect to her body and her medical care and lawmakers and medical associations have no place dictating to women where and how she gives birth. It’s appalling that in 2012 in a country that values freedoms that a women has no autonomy over her own body. I can’t think of any other aspect of medical care where people are not given the right to make their own medical decisions.

  13. Lynda

    Wow, Amy, you are a totally ignorant, uneducated idiot. What exactly happened to you in your life that causes you to hate women so much? I would think that a “doctor” like you would at least have your facts straight. The inaccurate stream of lies that you posted here is just sad–it exposes how completely ignorant and terrified you are. I can see that you have no interest in truth, so I won’t bother arguing the facts with you. You are too consumed with your hatred to see the reality of CPM attended homebirth in this country. Anyone can easily research and find real CPM statistics, so you have no doubt seen them and refuse to believe the truth: that CPM attended homebirth is as safe as or safer than hospital birth.

  14. Earth

    Dr. Amy’s email comes off bitter & full of rage. When dealing with pregnancy, birth & babies care providers must have an open heart full of understanding & love. The energy from Dr. Amy’s comments leave me felling deeply concerned for her inner well-being, she is obviously very far from feeling a sense of peace in her life, both professionally & personally. It is crucial for the health & safety of all mothers & new babies that spiteful care providers whose foundation of care is rooted in fear be removed from our maternity care system. It is obvious that the current system of childbirth management is broken, devoid of love & peace. Being trained in emergencies & having surgical skills does not automatically make you worthy of being an integral part of a newborn’s first imprint of life. MDs really need to check themselves, they need to check their intentions, their motivations, & yes do I dare say they need to check their training…why are they OK with a 33% C-sec. rate….We know why…they fear or possibly despise what is natural, they lack trust in the biological process of birth, what a shame & how dangerous for mamas & babies to have Birth Attendants who believe in cutting mamas open & supplying then with drugs as a model of safe birth. California, Vermont, Oregon have it right LONG LIVE c.p. MIDWIVES!!

  15. Steph

    Regarding Ireena’s LPN license (which is, largely, irrelevant): Newspaper reporters are going from the Indiana licensing database:

    https://mylicense.in.gov/eVerification/

    It says the LPN license is “expired.” I’m not saying it’s right, just pointing out where reporters have gotten that information.

  16. nicolette hall

    This law is awful! I feel very blessed that I live in a state where home birth is not looked on as a crime. I just had a baby and he was delivered by emergency c-section, so I am grateful for the medical intervention that kept me and my son safe. I do not believe that my situation should be considered at all normal or used to help justify taking away women’s choices. Pregnancy and childbirth are not diseases and it’s frustrating when our medical industry portrays it as such and when states criminalize the midwives who assist in making the process happy and safe.

  17. b2manatees

    Last night I said the medical community is against home birth just for financial reasons, but that’s not 100% true. Even in states with open access to midwives don’t top a 5% home birth rate. Let’s be honest. Doctors are professionally jealous. Their c-section rate is now at 33%. A planned home birth with a CPM has a transfer rate of 12.1% with an overall c-section rate of 3.9%. Hmmmm. Mortality statistics are the same with some studies showing a better mortality for planned attended home births. Instead of fighting to suppress midwifery, why isn’t the medical community embracing the model and trying to discover why midwives, quite frankly, have better outcomes. The reason is simple – low-risk moms who are educated about the process, who are under care the entire labor, and who are not interfered with (i.e. everyone knows the cascade of interventions often stem from impatience and desire to control the process and end in “saving” the baby via a major abdominal surgery.

    Oh, and “dr” Amy, don’t bother to respond. You might have a med school degree, but you are NOT a physician who cares about patients or medical proof or anything of the sort. I won’t get in a fight with you until you accept the many challenges of fellow doctors who you chose to ignore.. Your head is too far up your own jackass reality to even bother with you. I swear, if somehow 1 plus 1 equalling 2 supported home birth you would do you best to prove that it equals 3.

    • Financial reasons? Surely you are joking.

      First, there is a shortage of obstetricians in the US. Every obstetrician has a full practice and cannot accommodate alll the patients that want their services.

      Second, homebirth with a CPM makes up 1/2 of 1% of births in the US. Therefore, it represents a potential loss of income of only one half of 1% for obstetricians. On the other hand, it represents 100% of income of homebirth midwives. You tell me who has a greater financial incentive to lie about the safety of homebirth.

      And please address why it is acceptable for CPMs to lack the education and training of ALL other midwives in the first world.

      • Grace

        Dr. Amy,

        Thought I’d help you out here with those points you’d like addressed.

        CPMs do not lack the education and training of ALL the other midwives in the “first world” which I assume translates as “industrial nations”. Where midwifery care is available, there are varying levels of midwifery programs and care, just as there are many varying levels of eduction and training for all health professionals, including doctors. However, there is ONE area of training that those countries you refer to require for those in the medical field, that the US lacks, yet is a pivotal point in this discussion, where natural birth is concerned: there is not a requirement of nurses, interns, residents or doctors to witness a relative number of natural childbirth here in the US. This is not true for UK, Sweden, Germany, Isreal, France…we could go on here.

        So I ask you, Dr. Tuteur, when you were attending medical school at Boston University School of Medicine, how many natural births were you required to witness? Was there a requirement of, say 20 natural, spontaneous, completely unmedicated births? This natural physiological process that mammals experience, was this a part of your training?

        This is the crux of the issue. As one who is trained, educated, as well as the a former clinical instructor at Harvard Medical School, you know this where the medical system fails. This is where midwifery care steps into the scenerio.

        It is the responsibility of the instructors to best prepare their students for the natrual process, not only via a textbook, but by attending women in a natural setting. Most medical schools do not teach this. However, midwivery programs in colleges, birthing centers, and through apprenticeships do.

        As someone who has degrees, credentialing, yada yada, I don’t agree with your previous statement:

        “Actually, college IS the only way to get a professional level education; the only people who believe otherwise are those who don’t have college degrees and therefore have no idea what a college degree involves.”

        College is not the only way to get a professional level of education. Rattling off a list will not change your perception of this, but the key here is that the profeesional level of education serving pregnant and birthing women are not required to actually witness natural birth. (Michel Odent understood this, and has apprenticed midwives of varying levels of education.) So, in this small area of low-risk pregnant women, midwives have the advantage. They work in a narrow scope of practice, but they have better outcomes when paired against doctors and hospitals stats of low-risk women.

        I think you can stop asking someone to address this for you.

        You’re Welcome.

        • The only people who don’t seem to understand that every obstetrician has witnessed hundreds of uncomplicated, unmedicated births are homebirth advocates? Why? Well it certainly isn’t because they are familiar with the professional training and experience of obstetricians. It’s because other homebirth advocates made it up.

          One thing that consistently surprises me about homebirth advocates is that they appeared to be mired in the 1950’s. It seems to have escaped them that more than half of all obstetricians ARE women, and most have given birth. It is this direct PERSONAL experience that informs their attitude toward homebirth and natural childbirth.

          Women obstetricians like myself KNOW that the claims of homebirth and NCB advocates are fabrications that are only believed by other homebirth and NCB advocates. They have no basis in reality.

          I have given birth to four children, two without pain medication, so please don’t presume to lecture me or any other woman obstetrician about what birth is “really” like.

          And you still haven’t explained why 1) American women should settle for self proclaimed midwives who don’t meet the education and training standards of any other country and 2) why those self proclaimed midwives shouldn’t be required to have the same level of training as midwives in the UK, the Netherlands, Denmark, Norway, France, Germany, Australia, New Zealand, etc., etc., etc.

      • Siri

        I find it very revealing that none of these commenters is able to come up with a single rational argument against your comments – every single one has to resort to invective and personal insults, thus showing themselves up as ignorant, bad-mannered and self-righteous. Keep up the good work, Amy – the backlash against CPM/natural childbirth dogma will happen, or perhaps it is already happening – you can fool ignorant people most of the time, but sooner or later the truth will out. There is nothing bitter, misogynistic or venomous about your statements; on the contrary, your commitment to the safety of women and babies stems from a compassionate (and passionate) nature, while your anger is fuelled by the very real harm that CPMs do to their victims – sorry, clients. Your perseverance in the face of endless insults and spite is truly impressive.

  18. Rene

    I live in the Pacific Northwest in an area where people tend to be much more open minded about midwives and home births. I knew that some Americans weren’t as open minded, but I’m actually shocked to find out that midwives are treated as criminals in some states. Thanks for opening my eyes.

  19. It’s ludicrous that the specialty which has put America at the BOTTOM of industrialized nations in maternal mortality holds itself up as the gold standard of maternity care! I think it’s significant that the World Health Organization’s solution to meeting Millenium Development Goals 4 (reducing child deaths) and 5 (improving maternal health) is the training and retention of more MIDWIVES–not obstetricians and not nurse-midwives specifically (though they are needed as well).

    To quote the WHO: “It is basic midwifery care which makes the difference to the health outcome of mothers and newborn babies. In the face of repeated complications, the tendency is to strengthen skills to handle the abnormal, occasionally at the detriment of the basic skills.”

    If “basic” midwifery care is enough to address the horrific maternal and neonatal mortality rates in developing countries where HIV, malaria, poor nutrition and unsafe drinking water are daily obstacles to overcome, how much more so in a country where food and clean water are plentiful? Where access to a higher-level of obstetric care–when necessary–SHOULD just mean a seamless transfer of care from homebirth midwife to hospital-based obstetrician?

    In the US we have the ingredients to have the best maternity care in the developed world. Instead, we have the worst. Instead, we waste time and money prosecuting midwives, the experts in attending and safeguarding low-risk birth. What a shame….what a short-sighted, dangerous shame!

  20. Lisa

    A CPM from the U.S. would not be able to practice in Europe or Australia where a minimum of a Bachelors degree is required to serve women in this way. And the requirements are very different from that of a CNM. A CPM only needs to be present at a total of 55 births before being able to practice. She only has to be the primary care provider for 25 of these. While I’m sure most CPM’s see more births than this, a credential is only as good as its minimum requirement.

  21. Julia

    I come from one of those states where CPMs are regulated & licensed. We have to go to school through an approved program, WITH our high school diploma (CPMs still can take an unaccredited program, just like lawyers still can in some states…. the only difference in these programs??? The PRICE to attend. So many offended practicing health care personnel are unhappy at the “unfairness” of this, that it will change in the future-I am sure. Accredited schools only.), attend many births & clock many clinical hours. We take the same neonatal resuscitation classes the OB’s do & CPR. We take in some CEU classes with the OB’s as well. Every birth is attended with the necessary life-saving equipment needed if any adverse situation unexpectedly arises. It is legal to carry pitocin in this state. Much time & care is taken in making sure each client is low-risk. Many issues are addressed– iron/feretin levels, prenatal profile, GBS status, 28 wk. glucose challenge, protein etc. in urine, collaborative care with the Drs. in our area to address any concerns, reasonably priced ultrasounds with our OB doc., paps, STD testing, careful newborn exams checking femoral pulses etc. & recommendation to visit the pediatrician ASAP to cover all bases. This is just a brief synopsis of what a CPM is in a regulated state. There are laws constraining any delivery outside the hospital if the baby is not vertex (head down). VBAC delivery has to be within a certain distance of the hospital & lots of risk assessment/paper work follows.
    I take issue with the fact that CPMs are not well-trained. It is a lie. In the past, there were some CPMs who were grand-mothered into certification for the many years of excellent care they had been giving already. I myself attended some births with a midwife of 2,000+ births. The back-up doctors had very high respect for her. Just because someone is a doctor, doesn’t mean they give good care. There are horror stories gleaned from many mothers sharing their birth stories. These were deliveries attended by a physician. I hear of people every day who had a friend deliver their baby or there is someone who now call themselves a midwife, they have no experience (these are the birth junkies), things go wrong because they do not have enough knowledge to see a problem in the making, wait too long to get to advanced care, & bring major train wrecks to the ER. It is irresponsible. Most of the time the parents think they know a lot, but are ignorant of all the emergency situations they could find themselves in & do not have a professional there to handle these situations well. CNMs are just fine, I have nothing against them accept some feel they are more qualified because of their nursing degree. But then, the family-practice docs & OBs have the same issues between themselves as well. In summary, if you do not know what you are attacking, give it up. NARM/MANA will not give out their GOOD statistics to just anyone. I know they have nothing to hide. In this country where everyone sues or uses lawyers to make suits and go any given direction, I wouldn’t just hand out information either.

  22. Melissa A.

    This is an endless discussion that will continue to go in circles. There will always be the disagreement and those such as Dr. Amy will make it their full time job to make their opinions known. You have that right madam. However, the arguments does not change the situation. I recommend that those who are home birth put money and time into legislative and educational efforts. Every credential was made up by someone, let’s put some standards behind it legally, because, quite frankly, a majority of CPMs are qualified. Arguing pro-homebirth and anti-lay midwife is like arguing religion. Stand your ground, let your truth be heard and get the hell out of everyone else’s way so that they can follow their path. Otherwise, we’ll have witchhunts, which is basically what is going on in Indiana. If I remember correctly, OBs have been around for less than 150 years and someone had to have made up that credential and there was a movement to promote standards of education and practice to to make it a valid profession.

  23. Penny

    I just want to thank those midwives who continue to practice under such unnecessary, horrible legal conditions. We need more of them, who are supported by law, reimbursed by insurers, and appreciated by those whose birth experiences they enhance. We also need to trust women to make the choices that work for them. Midwives actually model what that trust looks like, as they make decisions WITH their clients, rather than FOR them. I had one hospital birth, one birth in a birthing center with a nurse midwife, and a home birth with a CPM. I have to say, there was no comparison. The CPM was by far the most knowledgeable, the most supportive, the most resourceful, and the most loving.

  24. I just don’t understand why the same doctors that advocate killing babies that “fail” a prenatal test are so darn concerned with where I birth my less than perfect baby??? And are you kidding me? How does a doctor protest the credentials of any midwife? They should be spending all their time working to lower their own surgical birth rates! High school diploma? There are actually doctors that don’t have their high school diploma. Seriously….anyone can continue their education without earning a diploma. And don’t let this “dr” fool you….there are noncredentialed midwives practicing all over the world. She is beating a dead horse. Plleeeeeeaaaaassssseeeee Dr. Amy – go pick on someone in your own association….there is plenty of picking to be done there. Maybe you could begin by investigating all the babies that were given skull fractures at birth due to improper use of forceps or doctors that butcher women so they are unable to stand, sit or lay down without pain for months after birth.

  25. AP

    My issue with CNMs is that they practice more like OBs and my reasons for hiring a mifwife and having a homebirth in the first places is to AVOID said practices of OBs. CNMs are more likely to medicalize birth like it is in hospitals and are trained to do so. In many places, CNMs have to be under an OB, which places restrictions on their care that would otherwise be safely available. OBs in the US are the only medical doctors that routinely practice non-evidence based medicine. CNMs, being trained as OB nurses first, are fare more likely to be the same. I don’t birth in hospitals because birth is not a medical event and I don’t want a care provider, at a hospital or home, that treats it as though it is and is more likely to push unnecessary medical interventions.

    • Natalie B.

      I agree with your assessment that CNM’s practice more like OBs. I saw a CNM at my clinic for prenatal visits with both of my children and CNM’s delivered both of them. They don’t act that much different than the doctors in the clinic/hospital. When my second was breech at 34 weeks, C-section was mentioned in the conversation. That really riled me up, because I felt like there was still time for the baby to turn or that we might discuss a breech delivery before we went to the C-section conversation. I gave birth at the hospital that I did because of my insurance, and I will, in all likelihood give birth there if I have more children, but make no mistake, the CNM’s I know are hospital oriented thinkers.

  26. Patty Allen

    Oh, Dr. Amy! Are you a masochist or what? No one agrees with your thought process, and we are women of all ages and experiences. I do have to wonder if you would condemn the fact that I used cloth diapers on my children…and please tell me you are NOT a mother!

    • I agree with Amy! And I am a midwife, health visitor, breastfeeding supporter, mother of five, and someone who has had a homebirth. To my mind, Amy is a true heroine – a passionate campaigner for the safety and welfare of pregnant women and their (born AND unborn) babies. Not bitter, not venomous, not women-hating, just very, very angry at the injustices that have been perpetrated in the name of ‘women’s choice’, leading to an increasing death toll of tiny, defenceless babies. Healthy term babies who should be alive and thriving, not buried in tiny coffins due to the ignorant and harmful practices of some CPMs. There are CPMs with several infant deaths to their name – of all my midwifery colleagues, NO ONE has lost ANY healthy term baby! In hospitals, the unexpected loss of even one single baby would lead to a full investigation, and the midwife in question would be subject to the closest possible scrutiny; even if she were found not to be at fault, she would carry that feeling of guilt and failure with her to the day she dies. Some CPMs have two, three, four, even more dead babies in their past, and they carry on practicing regardless! Just shrug their shoulders, say, ‘Some babies aren’t meant to live’, and keep charging women for their (expensive) services. How is it that none of these commenters care about all these dead babies? Are you really that callous? All these mothers with empty arms; and yet you accuse Amy of hating women. She doesn’t. She wants EVERY woman to keep her precious baby if humanly possible, and the anger she feels is shared by many, many others. Including me. And I have had a homebirth. I am a midwife. I have never presided over a baby’s death.

  27. Cindy

    Licensure does not equal competence. Licensure creates a contract that allows the state to monitor and control midwifery. A midwife who has a contract with the state is no longer working ONLY for the mother, but now for the state as well. Given the choice between serving mothers in a safe but illegal (due to her license restrictions) way or losing her license, a midwife will choose her license every time. Licensure creates a situation that is bad for mothers, bad for midwives. Licensure is NOT the answer.

    Only when we recognize and demand that mothers own their births and therefore it is NOT up to the state to regulate the attendants they choose will we have true autonomy over our bodies and our reproductive choices.

    • Valerie Runes

      Licensure requires a minimum standard of competence for entry into practice. I don’t believe that is a bad thing.

      A “situation that is bad for mothers, bad for midwives” occurs when midwives are subject to criminal prosecution for simply practicing midwifery, and that is what is occurring in states like Indiana, where midwives may be prosecuted for practicing medicine or nursing without a license. You express concern about midwives choosing their license over “serving mothers.” What sort of care do you think midwives can provide when they accompany a hospital transport as a “sister” or “doula” because their illegal status leads them to fear criminal prosecution?

      In fact, the state does have the right to regulate those who provide midwifery care (as it does physicians, nurses, nail technicians, embalmers, and a host of other professionals), and no declarations to the contrary are going to change that.

  28. >>>While I’m sure most CPM’s see more births than this, a credential is only as good as its minimum requirement.<<<

    Really? A tale of two doctors: One graduated from medical school and went no further. Another graduated from medical school then completed eight more years of residency to become a neurosurgeon. Since both graduated from medical school, both are MDs….but which would you want operating on your brain?

    I don't think it's fair to say the MD credential of a neurosurgeon is only as good as that of a new med school graduate! Credentialing shows a set minimum educational and skill level has been met to practice competently. It doesn't matter if the credentialing is in medicine, nursing, midwifery, or heating and cooling! I can't think of anyone I know–in any profession–who believes receiving credentials is the end of their education, least of all midwives!

    I'm just not comfortable with the statement that a credential is only as good as its minimum requirement. Whether a consumer is hiring a midwife, doctor, or contractor, it's important for them to find out what training and experience their potential hire has *beyond* credentialing. State licensure of midwives would only help this process.

  29. Erin

    This is just funny. I’ve heard of the “evil doctor Amy who isn’t a real doctor” for a long time, but I’ve never actually seen her in action on a message board about home birth. It makes the story soooo much more interesting; every good story must have a villain! Amy, maybe you should meet with us (educated homebirth moms) for coffee and discuss this out the old fashioned way. Do you live in Indiana? How is your life affected by this law here in Indiana? The most amazing, powerful, educated, and passionate women I know are having home births… and we are sharing our stories. Care to hear mine?

    I make decisions about my body even if that necessitates challenging the status quo and state regulations that make these decisions difficult. I believe there is a fundamental right for me and all women to choose where we want to deliver our babies.

    Collaborative care does not exist for women in Indiana despite evidence-based data proving it is a safe option for healthy women. The data is clear, and if the % of women having c-sections and the maternal death rate and infant morbidity continue to rise… more and more women will choose home birth. They will realize that home birth is just as safe as hospital birth for low risk women but with much lower rates of interventions such as cesarean sections and inductions than in similar births in hospitals.

    I was old enough when my mother had my two youngest sisters to remember the “hospital experience” and as I remember it, medical interventions got in the way of a more peaceful child birthing experience for my mom and for my sisters.

    Determined to find another way for me and for my children, my husband and I visited both hospitals and birthing centers and ultimately determined a midwife was more likely to give me and my children the birthing experience I was looking for. My daughter was born the birthing center. My son was born at home with the same midwife almost 4 years later. Both of my babies were born into warm water.

    Both my children and I were unmedicated, and were able to bond and recover in the comfort of our own home surrounded by loving and attentive family members. Through the expertise of the midwife, the use of water to birth in, and being able to freely move into a great position for birthing I required no stitches either time and was able to walk around the next day if needed.

    My choice to birth in the way I wanted was a very personal decision, a decision many women do not realize is an option….yet.

    The norm in our culture is for woman to give their bodies over to medical “experts” rather than embracing the opportunity to master their own birthing experiences. This will shift. More and more families in Indiana are having homebirths, and I am confident this number will continue to rise. More legal options for women and a shift away from normal birthing being treated like a medical illness will allow all women more safety and support in their births.

    Good will conquer, and the villain will be vanquished… one birth at a time.

    • ‘Good will conquer, and the villain will be vanquished… one birth at a time.’

      Indeed it will, although the ‘good’ is the justice for all mothers for which Dr Amy fights so valiantly, and the ‘villain’ is the callous evil of dangerous birth junkies who sacrifice healthy babies (and their mothers’ wombs, sometimes) to their own selfish interests. Those killer midwives WILL be vanquished… one birth at a time. Truer words were never spoken…

  30. Freiderike

    Trying to understand. What is the difference between a CPM and a certified nurse midwife( CNM)? Is the second a nurse that also has a midwife training? The article sounds like if the CPM s are not certified( what I don’t agree with)then there is nobody to attend homebirth. But I sounded that CNMs are allowed to do it. Are there not enough of them or are not willing to do ti? Just trying to understand better. Sorry for my ignorance. Homebirth is the best thing I ever experienced and I had a 12 pound baby at home.

  31. Barbara A. Case

    I am extremely fed-up with women being treated as if they can’t make intelligent, informed decisions for themselves. All of the midwives I know are well educated, intelligent women. The best interest and safety of their clients is their primary concern. If they see any indication of any type of possible problem they take appropriate action to insure the client and their child are taken care of properly. The propensity of the medical profession to resort to cesarean surgery is grossly out of proportion to what is truly necessary.

    The real problem is doctors apparently have a problem with what they perceive as infringement on their exclusive territory. I see this as the basic reason that Indiana has no licensure for midwives.
    People that are elected to represent the public should listen to the public instead of thinking they know whats best for us because we can’t think for ourselves.

  32. Marti

    Friederike, a CNM has had a university education in nursing and midwifery. Graduates are highly trained, and only the best of the best candidates can get into CNM programs.

    The CPM certification is new. It has relatively (by comparison to the CNM) lax requirements. There is no formal education in midwifery required, only apprenticeship, passing a written exam and attendance at a certain number of births (about half of which you are only required to be present, you needn’t be a caregiver). You might call these midwives “traditional” in that they consciously avoid using technology of any kind.

  33. Danita

    Wow this really upsets me some of the comments.. why dont you all that are not well educated take a look around and research stuff before its said. You should really check out the movie called Business of being born….its a great movie. it explains alot..

  34. c

    this is our country taking one more giant leap towords communism! Ill happily have my babys at home with whom ever I choose to be there licensed or not!!!!!!

  35. Eve

    35 years ago my mother wanted a home delivery after two unpleasant hospital births. She couldn’t find a midwife willing to attend so she read everything she could find and delivered at home twice with just her mom,a friend and my dad catching the baby. (no medical experience there at all btw). If either of her hospital birth experiences had been positive at all she probably wouldn’t have done the home route, but I know she doesn’t regret it.

  36. Jill

    As a OOH CNM, I fear that if women do not have a choice or a competent provider, they will choose unassisted birth. That is not the answer. I have read with interest Dr Amy and her absolute unyielding attitude. She would better serve her felllow woman by getting her facts straight about midwives and their roles. She could also use all this energy she has by coming up with POSITIVE ways to improve care delivery in the OOH arena. Perhaps she could volunteer to be a preceptor for midwives and offer to serve on one of MANAs many committees to improve this system that she thinks is so flawed. I can think of many ways this MD could serve the midwives she so fears. She could turn this horrible anti OOH birth/anti CPM stance to something wonderful. Dr Amy, be a help not a hinderance. I am sure you have so much to offer. Turn your negativism into something lovely. That is my suggestion. Oh by the way, do you know how many births ACNM requires before a CNM student graduates ?? That is the question of the day?

    • Leaving aside the fact that your threat is based on the unproven assumption that homebirth midwives are responsible for fewer preventable deaths than unassisted births, this threat (for it is a threat) is remarkably cold blooded. It’s essentially a hostage claim: yes, CPMs are responsible for preventable neonatal deaths, but if they’re not allowed to let hostages die, then less professional hostage takers (parents) will take over and even more hostages will die.

      CPMs express no remorse for the preventable deaths of babies. They refuse to take any responsibility for these deaths. Indeed, MANA is desperately hiding the number of babies who die at the hands of CPMs. But homebirth advocates know that the rest of us care. So homebirth advocates threaten that if CPMs are not allowed to practice without meeting the minimal standards of midwives everywhere else, even more babies will die.

      I have a better idea: force MANA to disclose the death rates among their own members, restrict the title “midwife” to those who can meet the minimum standards required in all other industrialized countries, and fine those birth junkies who insist of practicing without the requisite education and training.

  37. Everte Farnell

    The mistake by the midwives is to continue practicing. They should all “go on strike” until and unless the people of IN force the legislators to change the law.

    As long as the people have access to home births, with no risk to themselves, why would they get riled up? To handle this the midwives must temporarily take away to people’s choice in order to ensure the midwives safety. Once people no longer have a choice, you’d be stunned how quickly they’ll move to change the law!

  38. Yeah, yeah

    I’m sorry, but I had to laugh at the comment that the only way to ensure a professional education is through college.

    I hope you don’t use electricians for anything. Most of them are trained through apprenticeships. They have to pass a test administered by the state to become licensed, but in general, there is no four year degree involved for that. Given that the installation of faulty electrical services could cause a house fire, you’d better stay away from hiring an electrician to do his job since he didn’t go to college. 😉

  39. Brandie Roberts

    I just want to say that I have had the experience of 2 home births and 1 hospital birth – all natural and all healthy. I believe that it SHOULD be a woman’s choice and that people should be educated and informed to help them make an appropriate decision. After all – everyone has the same goal in the end… healthy mom, healthy baby, personal experience. If a woman feels she can have that in a hospital; fine – if she is healthy and decides to have that child at home – the experience is extremely personal and beautiful. I would have to say that I have never heard of an M.D. spend more than 15 minutes with someone for a pre-natal visit; and that sometimes the mother doesn’t even MEET the doctor who will be delivering. For me – that was a cold experience. My pre-natals were AT LEAST 45 minutes long with my midwives – and all of my births (even my hospital birth) were without medication and they all went very well. It is such a personal issue – but, at the end of the day – I do think it should be legalized, and I do believe women should have the right to that option. I will always be grateful to my midwives – and my kids – now 12, 14, and 19 are all healthy, happy (and quite intelligent, kind people, I might add). I think if it were legalized and there were standards – there would not be folks taking a break from Jerry Springer to catch a baby – and most of the women attending home births currently already HAVE gone through the certification and licensing processes and are quite capable. It is about making informed and intelligent decisions so that women can feel empowered about their bodies, about their babies and about their birth choices. Not everyone WANTS to have a home birth – and that is okay!! To those who block any women from making a sensible choice – whether it be militant home birth folks or the medical community who tries to frighten women into pain medication and induction – I do not support that line of thought. For women who feel that a hospital birth is more appropriate to help them feel confident and comfortable – I support you in your choice. But for women who are committed to this, who have educated themselves, and to those who support them and assist them – I support you and know in my heart that had I had a chance to do all 3 births over – I would choose home birth for ALL my children. It was a lovely experience and I would not trade that for anything in the world.

  40. Jessica K.

    I’ve had all three of my children at home assisted by a CPM, after receiving excellent, thorough, pre-natal care from a CPM. Many of my friends have had hospital births, and while the outcome has been good (healthy baby), the whole experience never seems to go as planned. The hospital is unwilling to let things happen in their own time, pushes induction, or tries to speed up natural labor, then ends up “saving” the situation with an emergency c-section. I as so grateful for CPMs who risk everything to give families a choice. My midwife charges a fraction of what others do, because she believes that anyone should have the option of home-birth. I whole-heartedly thank her.

  41. Linda A-M, RN

    WOW… Do people still have their heads in the sand !! Birth is a natural process…. Sorry it was ever made a Medical Emergency!! I think that all started, about the same time Money became #1. The midwives I know and work with, are educated, trained, and have more experience than most MD’s. Their is more to life than just the Medical way…Open your eyes and look around!! All of us should be allowed to make our own choices in our own lifes. Politics… Makes me ANGRY sometimes!!

    • anonymouse

      Birth is a natural process

      So is death. And, in “nature” they often go together. My baby and I would have died of obstructed labor if “nature” had been allowed to take its course. No doubt you would have shrugged and said, “Some babies aren’t meant to live and if you can’t deliver naturally it’s better for the species if you die”, but I’m glad others took a different view.

  42. Heidi

    I am not sure where to even start after reading all this. I have found it all interesting and it brings up a lot for me personally. My baby died at the hands of a CPM. There aren’t words to describe that kind of pain. I am not sure where I am at in all of this but do think I have a unique perspective that most here do not have or have even considered let alone addressed.

    I have never been a person who has looked at those with degrees as superior even though I do have more than one myself. I believe that education is acquired in a multitude of ways. I believed I was making an educated decision even though I know there are others who saw it as irresponsible. There will always be people who see this issue from different ways based on there perspective. I accept that and respect others choices even if I don’t agree or see it as uneducated, wrong, wreckless, etc..

    I have come to a conclusion that most people come to their point of view based on common things. Having a bad hospital experience, not having a bad hospital experience, being affected by another’s experience, personal family history and what was done by other family members, etc, etc. We live in a country where we get to choose even if it means making certain decisions may mean we have to work harder at getting to whatever our goal is.

    Accountability is far more of what should be discussed here. What does or will provide that? My CPM has her certification from NARM, she was training two other midwives during most of my pregnancy, she was a member of a local state association for a few months at the end of my pregnancy, she claimed 16 years of experience. I could go on and on. But where the rubber meets the road is she killed my baby by making so many bad decisions that I only learned later about.

    I was induced with pitocin in my home by IV, I was prescribed hormones and she was able to do this because she let a pharmacy believe she was a nurse practitioner. I can’t go into all the details of my labor, subsequent emergency csection and ultimate death of my baby that we longed for for over 20 years but my babies death I learned was not her first.

    I totally get both sides of the issue. What bothers me is what comes across to me as a lack of accountability. Like how does giving licensure to midwives(by the way not all want it) give me a mother in my situation justice? What my midwife did is criminal and we are still waiting for others to move on keeping not only the public safe but also from this midwife from ever practicing again.

    Do know we have filed and are waiting but because of all the political stuff around this issue those who normally could do something have their hands tied because of a lack of licensure and what appears to us as an unwillingness to use the law as it is written.

    There is no doubt I would have my baby in my arms if it wasn’t for the rogue midwife we had who really believes she is doing a huge service to women by practicing the way she does.

    I am not for or against midwives or hospitals and ob’s. I am for women being able to have the kind of care they want and having available the medical services and interventions when needed and or desired. It should be that simple but it isn’t and until both sides come together for the best interests of the mother and child there will be horror stories on both sides.

    My babies death is not going to be for nothing and I will not let either side use it to further their cause. Change is needed on both sides and I believe accountability is key, not the only thing but crucial.

    No one warned me of the things this midwife was doing or her reputation among other midwives. The other woman who losses her baby due to this same midwife didn’t do anything in the way of filing etc either and while I understand her loss I also want other women to think of other women and their babies too. This grief I continue to walk through is the hardest thing I have ever dealt with so I know. But I can’t just let it go knowing that it is only a matter of time before another mother and baby will face what I have if she isn’t stopped. I nearly lost my life and uterus.

  43. Warning about

    Just in case anyone was wondering, “Dr” Amy Tuteur is quack and highly disregarded by the medical community. She will jump to the gun to argue with non-healthcare professionals, but the second an OB says anything, she shuts her mouth. Oh and she is no longer licensed as a physician. The Commonwealth of Massachusetts Board of Registration in Medicine reports that her license expired in 2003 and she has not practiced in about 2 decades. She has also lost 2 jobs in the past several years as a guest writer at salon.com and Science Based Medicine due to her writing about things she knows nothing about. She is against homebirths and natural births because it gives women options. She dislikes women, otherwise she wouldn’t be opposed to them having a choice. Bottom line, she’s an individual with NO authority to speak on anything birth related and has deceived people by throwing around her “Harvard educated, Ob-Gyn” background and making them believe her words are actually valid and legitimate.

    • On the contrary, Dr Amy is a very highly regarded professional; as a practicing OB/GYN she was a competent, compassionate, respected (and respectful) practitioner, and in her current role she is a widely admired, tireless campaigner for the safety and welfare of pregnant women and their babies. Her authority and experience are firmly established, and all her statements are backed up with real data. She is extremely knowledgeable in her chosen field, and her perseverance in the face of anonymous insults, name-calling, slander and invective is truly inspirational. It is interesting to note that not one of her detractors is able to come up with a single real argument against her statements; they invariably resort to the sort of pathetic name-calling employed by ‘Warning about’.

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