[HeartsOpenWide]

I know of an excellent lay midwife who use to work in the NICU as an RN when she was younger. I plan on using her for the birth of my children and would chose her over an OB and hospital birth except for rare circumstances. Although I relies that there are many lay-midwives out there that give all midwives a bad name and that comparison to "hippies" not all are bad, in fact many are very good.

[J'sGirl82]

http://www.texasmidwives.com/SafetyStats.htm


Mind you this is for Texas, not any other state, just to play Devil's Advocate here.

he following table lists the infant mortality rate of midwives, CMNs, MDs and DOs for 1990 - 2000.

Infant Mortality Rate by Attendant Type 3
Rate per 1,000 live births

Year
Midwife
CNM
MD
DO
1990
3.0
3.0
7.6
7.7
1991
3.0
2.1
7.3
7.6
1992
2.3
2.8
7.5
7.7
1993
1.8
3.3
7.3
6.1
1994
1.7
4.5
6.8
6.4
1995
2.1
2.5
6.5
4.7
1996
1.1
3.1
6.3
4.0
1997
2.8
2.6
6.1
5.0
1998
1.7
2.4
5.7
6.5
1999
1.2
3.6
6.0
5.9
2000
0.3
1.9
5.5
4.7

As one can clearly tell, except for 1991, midwives in Texas have had the lowest infant mortality rate of any attendant type from 1990 - 2000. The source table for this information also indicates that midwives in Texas had lower cesarean rates than all other provider types, with rates typically under 2/1,000. Cesarean rates for both MDs and DOs were consistently higher than 200/1,000 from 1991-2000.3

Regulation of midwives and detailed rules for practice in the Midwifery Act does not account for the comparably lower infant mortality rate. In fact, all levels of infant mortality decreased some since 1990 and maternal mortality rates remained at 0.1/1000.2

Documentation and identification records of midwives from The Texas Department of Health Midwifery Programs do, however, indicate that the numbers of legally practicing midwives have steadily decreased since the passage of the 1989 Lay Midwifery Act. In 1989, there were 604 identified midwives practicing in Texas,5 14,474 births attended by midwives and others, with almost 9000 of these births taking place outside of the hospital.4 (Bureau of Vital Statistics {BVS} Table 2 report for "Resident Births by Attendant and Place of Delivery Texas, 1966-2000" does not differentiate between midwives and all other non-physician attended birth or between home births and all other forms of out-of-hospital birth sites. BVS statistics from 1990-2000 are broken down by attendant: Medical Doctor, DO, CNM, Midwife, Other and Unknown.) In 1993 when new education and restriction laws took effect, the number of midwives fell to 262,5 with 12,682 births attended by midwives or others and 5,871 of these births occurred outside of the hospital.4 In 1997 when the most recent changes took effect, there were 217 licensed midwives,5 3,549 midwife assisted births,4 and 3,825 births were listed as out-of-hospital.3 The last available tabulated year for birth and death statistics from the BVS is 2000 and indicates that the 182 licensed midwives5 assisted in 3,910 births3 and 3,360 births took place outside a hospital setting.4

Home birth and midwife-assisted births in Texas are typical of safety results documented across the world. Medical research for over a decade has concluded that home birth safety statistics are at least as good, if not better than hospital birth statistics. These statistics are true even when some studies looked at midwife-attended, out-of-hospital births which could be classified more high risk than current midwifery standards allow and those births which include unplanned out-of-hospital births.6, 7, 8

Current educational requirements for new midwives in Texas includes both academic study from a variety of medical, midwifery and other authoritative sources and clinical, hands-on, apprentice-modeled training. Certification in both CPR and Neonatal Resuscitation (NNR) are also required in order to practice legally. Standards for education and midwifery practice are consistent with those contained in the MANA Core Competencies.9 Continued documentation as a midwife requires annual continuing education hours, current CPR and NNR certification, and annual application with fees submitted to the Texas Department of Health Midwifery Program. The Midwifery Program is overseen by The Texas Midwifery Board.

[demetria]

Originally Posted by matchstickxx

I think there needs to be some way to regulate midwives. Not all people who present themselves as midwives are competent. Of course, not every poor homebirth outcome is a result of using a midwife. Hospital deliveries can have devestating outcomes too.
Aside from word of mouth, how's a mom to know if a midwife is competent or if they just been lucky that nothing bad has happened yet. A friend of mine had a home birth with an unlicensed midwife. The midwife had an "apprentice" with her who would be a midwife after she accompanied/ assisted her trainer on 100 deliveries. This was many years ago before I was even in nursing school. At the time I thought 100 deliveries sounded like a lot, but now I realize it really isn't that many.

Each state is different, but anyone can do the work and take the CPM test, www.mana.org and www.narm.org

[demetria]

Originally Posted by fergus51

I'm fine with midwives who take a recognized program and are licensed. I am not ok with lay midwives who have little to no formal training. I think they are dangerous and I wouldn't risk using one.

The evidence though states otherwise. Very few people are going to practice midwifery without being qualified. You know the old joke.. what do you call a doctor who got Ds in med school.... DR.
You will always have a crappy fringe of practicioners, they are the minority, especially in midwifery.

I think apprenticeship is an amazing way to learn and study. Many of the worlds best midwives were trained this way. Midwifery is still the primay mode of birth care throughout Europe. We have an awful birth record as a nation and I believe that all types of midwives should be embraced. Yes training is essential, so we could have the CPM as a national standard, allowing the general to see what their midwife had to do and test through to become a midwife.

[KellNY]

Where did it say anything about the family suing?

Looks like the state is persuing this, not the family.

Helping a family deliver a baby is not practicing medicine without a license. *Unless* she cut an episiotomy, gave stadol, performed a c/s, etc. But telling a mother when to push, when to breath, suctioning mucus out of a baby's mouth...that's not medicine.

And "midwife2b" yes, I do know people who have went the UC (unassisted childbirth) route. My next child will be a homebirth, very likely UC. Though I may have a midwife on call in case something goes wrong.

Kelly

[allthingsbright]

Originally Posted by topamicha

What is your opinion on them? Are they qualified to be delivering babies (certified professional midwives)? Should they be able to recieve licensure? What are the pros/cons of a CPM as opposed to a CNM? What are the dangers of using a CPM?

I was talking to someone yesterday and this came up...I'm curious what your opinions are on this.

In Florida I seriously considered lay midwifery, applied to a program and started precepting w/ a local certified lay midwife. She was quite competent and had a thriving practice (despite being kind of "wierd" ).

Um, she and other lay midwives in the area were really into "bending the rules" (one being that they would attempt to deliver/deliver breech babies, which is against the law in Florida). What I saw from a short term experience scared the crap out of me (every lay midwife I met was being sued for something) so I got back into my old nursing program (had to move back to my old state) and am shooting for CNM at some point.

Lay midwifery has its value, but the liability is just crazy! ARG! It is almost more of a lifestyle choice, IMHO--if that makes any sense? I dont know how else to explain that...

[fergus51]

Originally Posted by demetria

The evidence though states otherwise. Very few people are going to practice midwifery without being qualified. You know the old joke.. what do you call a doctor who got Ds in med school.... DR.
You will always have a crappy fringe of practicioners, they are the minority, especially in midwifery.

I think apprenticeship is an amazing way to learn and study. Many of the worlds best midwives were trained this way. Midwifery is still the primay mode of birth care throughout Europe. We have an awful birth record as a nation and I believe that all types of midwives should be embraced. Yes training is essential, so we could have the CPM as a national standard, allowing the general to see what their midwife had to do and test through to become a midwife.

I think apprenticeship WITH formal study is a great way to learn. Midwifery is the primary model of birthing care in Europe and their midwives take formal courses. My countless positive experiences with UK midwives is the main reason that I am extremely pro-midwife in general.

BTW, For the poster who posted just the number of deaths.... that's almost meaningless without looking at the type of patients and controlling for that. Midwives look after the lowest risk patients.

[CNM-to-be]

All 4 of my childrens births were attended by a CPM at home. I had wonderful experiences each time despite a tricky case of shoulder dystocia, a slow to start baby, and uterine atony d/t a 10# baby. In each case my mw was extremely professional and always held our safety in the highest regard. I think that CPM standards for non-nurse midwives are excellent...the certifying exam is not a cake walk by any means.

[Elvish]

Ina May Gaskin is a CPM and, if I'm not mistaken, teaches OB at a med school in the Ivy League. I personally feel better about having a CNM as opposed to a CPM but I live in NC where the laws about home birthing are very tricky for everybody.

[tntrn]

Originally Posted by fergus51

BTW, For the poster who posted just the number of deaths.... that's almost meaningless without looking at the type of patients and controlling for that. Midwives look after the lowest risk patients.

Also because there's no way to know which of the botched home deliveries were transported and then successfully or unsuccessfully delivered at a hospital. When I lived Northern CA, we had a lot of lay midwives, who when everything was working perfectly, had successful deliveries and very happy clients. But I think their judgments were very bad. They didn't know when to call it and head for more help.

In one instance, the midwife and couple appear,after 6 hours of pushing, no descent and then proceed to tell me that "we don't want an IV or PIT." um, okay, then exactly why are you here? If you don't want me to anything that might help, then perhaps you should just go back home, where you can also not do anything to help AND it won't cost you or the taxpayers a dime.

In another instance, we had a very compromised (color grey) baby finally and the midwife kept insisting that the mom "needed" breast feed and bond. This is while two NICU nurses and a neonatologist were furiously working just to keep the kid alive. After ignoring her first several comments, I finally told her that if she wanted to bond with a dead baby to keep it up, otherwise, she had to shut up and let the staff do their jobs. That seemed to get her attention. I seriously don't think she had a CLUE of the gravity of the situation.

So competent, maybe in the ideal world. But the judgments when the stuff started to hit the fan, was very questionable in my mind. I worked there in the 70's and 80's so maybe it's all better now.