On July 16, 2013 Philosopher Joe (AKA Joe Campbell, Professor of Philosophy at Washington State University) interviewed Rose Huskey (a well voiced equality activist living in Moscow, Idaho) on the subject of Midwifery in Idaho.
writing to you as a concerned layperson. I am not affiliated with
any political organization, lobbying interest, or health care entity.
In 2014 legislation regarding Idaho direct entry (DEM) aka certified
professional midwives (CPM) will be reviewed and, it is to be hoped,
allowed to sunset. The current classification of midwives, due to
confusing and frankly misleading titles, makes it difficult to understand
the credentials of each category and to identify which midwives would be
affected by changes in Idaho law, although, in your case I am sure that
you are aware of the differences. If you wish to share this
email, please do so. I have learned that very few laypeople
understand the classification of or issues surrounding midwifes in Idaho.
The table below briefly summarizes and clarifies the required statutory
training and education of each group. I have furnished internet links
throughout this letter for independent verification of my statements.
the risky practice of licensing self-educated women will have absolutely
no effect on the work or careers of Certified Nurse Midwives. A
certified nurse midwife (CNM) has earned a B.S. in nursing from a
regionally accredited college or university. She has successfully
passed a nationally administered exam to qualify as a registered nurse.
The BSN degree encompasses hundreds of hours of academic and clinical
training under the supervision of competent professionals. Post-graduate
education in midwifery prepares BSN graduates to provide routine maternity
care for low risk clients and physician collaboration for complex
pregnancies and deliveries. Most states require at least a
master’s level degree to license a CNM. Nurse midwives are
rightfully eligible for privileges in Idaho hospitals and enjoy
cooperative and collegial relationships with other health care providers.
CNM education and training stands in sharp contrast to the growing number
of certified professional midwives (CPM), a fancy, designer-style
name that obscures their lack of formal education and creditable training.
Licensed midwives (LM) who practiced prior to the adoption of any
midwife educational criteria in Idaho are grandfathered to continue their
midwife work despite the fact that there were no academic or clinical
requirements for their practice.
began researching the “credentials” of certified professional midwives
I was stunned. CPMs self-educate in obstetrics and apprentice to other
CPMs for clinical experience. In lieu of an academically accredited
program they prepare and submit a portfolio describing their experiences
for review by their credentialing organization the North
American Registry of Midwives.
Six out of seven members of the Board are CPMs.
Their professional organization, Midwife
Alliance of North American,
reflects a similar lack of academic and/or intellectual diversity.
Sixty-one percent of the nine member MANA executive board are CPMs.
Similarly, eight of the nine members of Idaho Midwifery Council Board of
Directors (the ninth is a “birth assistant”) are CPMs. By
statute, three of the five board members of the Idaho
Board of Midwives are CPMs.
) Because the leadership of MANA, the Idaho Midwifery Council, and
the Idaho Board of Midwives, has overwhelming chosen and endorsed a career
that requires no accredited academic preparation and celebrates the
organization’s position that “endorses
diversity in educational backgrounds and practice styles”
there is little reason to believe that more stringent requirements
will ever be implemented.
professions in Idaho respect their clients (and their profession) enough
to insist on a more rigorous approach to education and training. I
randomly selected three licensed professions with extracts from the
educational requirements and training as a comparison to the minimal
educational requirements for CPMs. The hyperlink leads to the statute.
Denturists who fit and manufacture dentures are required to successfully complete two years of college in “an educational institution accredited by a national or regional accrediting agency recognized by the Idaho state board of higher education, with a curriculum of which includes courses in oral pathology, physiology, head and oral anatomy, clinical microbiology, clinical jurisprudence, asepsis, and first aid for minor office emergencies”
from and completion of a two thousand (2,000) hour course of instruction
in a school of cosmetology, or a four thousand (4,000) hour course of
instruction as an apprentice covering all phases of the practice of
(d) Successful passage of an examination for cosmetologist conducted by or acceptable to the board.
completed and received credit for at least sixty (60) semester hours' or
ninety (90) quarter-hours' instruction in a duly accredited college or
university and has obtained at least a C grade average for all courses of
instruction; provided, however, at least three-fourths (3/4) of all of
such credits must be for courses in the fields of liberal arts, business
or science as defined and specified by the board of morticians.
successfully completed a course in an embalming school accredited by the
American board of funeral service education, inc., or such other embalming
school as approved by the board of morticians.
Idaho are not required to have formal, accredited education in biology,
medical terminology, anatomy, physiology, pharmacology, human
reproduction, fetal development, or obstetrics. There are no
requirements for post high school education. Despite these abysmal
statues permit certified professional midwives
to administer oxytocin,
suture/repair 1st and 2nd degree
lacerations associated with childbirth, and to perform a vaginal delivery
after a previous Caesarean Section. Idaho statutes are silent on the
practice of placing
placental tissue in the new mother’s mouth
to control post partum hemorrhage (please scroll down to the bottom
of the page and select Birth Story #4), I’m not. This New Age –
read that magical thinking – approach to what can quickly develop into a
life threatening situation is both scientifically ludicrous and
esthetically disgusting. Despite an extensive literature search I
found no evidence in juried publications addressing the purported value of
certified professional midwives deliver infants in the client’s home,
others own/are employed by a free-standing “birth center.”
Obstetrical and neonate emergencies require immediate, professionally
staffed, well equipped facilities to effectively manage a medical crisis.
Certified professional midwives are ill equipped to meet those challenges
and indeed may exacerbate them by failing to recognize and promptly act in
a deteriorating situation. Their desire to be perceived as an
authority figure, despite the objective truth that they are ill-educated
and ill-trained, in the drama and excitement of a birth trumps the welfare
of mother and baby. Direct entry midwives rely on the fact that most
labors and deliveries proceed in a relatively straight forward fashion.
And yet, those of us with a passing knowledge of the history of
medicine (or who enjoy strolling through old cemeteries) understand that
risks associated with pregnancy, labor, and delivery are always present.
There are actuarial reasons that malpractice insurance rates for
obstetricians are among the highest in the medical profession. This
is not an issue of concern for direct entry midwives. They carry no
published studies of morbidity and other risks associated with direct
entry midwife care emphasize the increased fetal death and maternal death.
The following studies in juried publications address these issues.
A., McCullough, L., Sapra, K., Brent, R., Levene, M., Arabin, B.,
Cherenak, F. (June 23, 2013). Apgar Score of Zero at Five Minutes
and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to
Birth Setting. American Journal of Obstetrics M& Gynecology.
Click here for abstract.
from the article and sourced here is the following text.
is an identifiable pattern in these data for the outcomes of singleton
term births: home birth is associated with a significantly increased risk
of 5-minute Apgar score of 0 and neonatal seizures or serious neurologic
dysfunction compared to hospital birth. When it comes to home birth versus
hospital birth, setting is strongly associated with worse outcomes. The
increased rate of adverse outcomes of home births exists despite the
reported lower risk profile of home birth. The pattern for free-standing
birth centers is also identifiable: this setting is associated with
increased risk compared to hospital delivery, though not as high risk as
home birth. When it comes to freestanding birth center versus hospital,
setting is strongly associated with worse outcomes.
is essential to note significantly increased risks of adverse outcomes
from the setting of home and from the setting of free-standing birth
centers reported here may be serious underestimations of clinical
Y., Snowden, J., King, T., Caughey, A., (June 20, 2013). “Selected
perinatal outcomes associated with planned home births in the United
States” American Journal of Obstetrics & Gynecology. Click here for abstract.
Watterberg Kristi, Lead author, Policy Statement, COMMITTEE ON FETUS AND NEWBORN “Planned Home Births,” Pediatrics, Official Journal of the American Academy of Pediatrics, on-line publication April 29, 2013. . Click here for full paper
concurs with the recent position statement of the ACOG, affirming that
hospitals and birthing centers are the safest settings for birth in the
United States, while respecting the right of women to make a medically
informed decision about delivery. 7 In addition, the AAP in
concert with the ACOG does not support the provision of care by lay
midwives or other midwives who are not certified by the American
Midwifery Certification Board.
note: The American Midwifery Certification Board does
Certified Professional Midwives or Licensed Midwifes since both are lay
midwifes by definition.