PA: A push to stop lay midwives

  1. from philadelphia inquirer, posted on mon, feb. 05, 2007

    a push to stop midwives

    pennsylvania argues that lay midwifery is illegal, that practitioners must be licensed nurses. the fear of losing the tradition troubles the amish and other plain people.


    goslin and her supporters say a new attorney for the medical board is bent on ending lay midwifery and home births, something they say contrasts strongly with gov. rendell's recent alternative-focused health plan. ennis says the state has no such agenda.

    for her part, goslin says she answers to a power higher than the state. "as a wife, mother, midwife and teacher, i believe god has given me a calling in the time-honored tradition of serving women in one of their greatest times of need," she says.

    she's worried that prohibiting lay midwifery will force the amish to turn to untrained birth attendants, such as family members.

    "i think more people will go underground," she says. "i don't think we're going to see the plain people start flooding to the hospital."

    if the medical board rules against her, goslin says she will give up her practice to teach midwifery.
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  2. 10 Comments

  3. by   Quickbeam
    My opinion...and I come from a plain background...there comes a time when credentialing is a good idea. I think this is such a time. Once upon a time everyone used a lay midwife. And lawyers apprenticed rather than going to school...the list is endless. I believe requiring a nursing background is an excellent idea. There are terrific Mennonite colleges.
  4. by   morte
    it really isnt new......actually very old....trying to medicalize birth has been going on for at least 150 years........actually, to me nurse and midwife are two separate things.....
  5. by   CHATSDALE
    this is not to make a pregnant woman feel like she is sick and needs care it is about assessing a woman for the good of her and for the good of the infant
    preeclapsia, gest diabetes m. fetal distress..there are many times when a trained eye is important
  6. by   morte
    freq. the term "lay" midwife is a misnomer.....it only means they arent docs or nurses....doesnt necessarily mean they are untrained....
  7. by   Altra
    Quote from morte
    freq. the term "lay" midwife is a misnomer.....it only means they arent docs or nurses....doesnt necessarily mean they are untrained....
    The term lay midwife refers to an individual not certified as a nurse-midwife (CNM). These are licensed RNs with additional education in midwifery.
  8. by   PANurseRN1
    Quote from Quickbeam
    My opinion...and I come from a plain background...there comes a time when credentialing is a good idea. I think this is such a time. Once upon a time everyone used a lay midwife. And lawyers apprenticed rather than going to school...the list is endless. I believe requiring a nursing background is an excellent idea. There are terrific Mennonite colleges.
    She already believes that she has a superior education to a nurse (acording to a quote from another paper). I'm sure she presents herself that way to her clients.

    The community is too strong here for this woman to suffer any consequences. It was bedlam in Harrisburg during the hearing. There is no way there will be a ruling against her. And she has the perfect clientele; even if she has a negative outcome due to lack of training or expertise, her clients aren't going to sue.
    Last edit by PANurseRN1 on Feb 5, '07
  9. by   Crocuta
    Quote from Quickbeam
    My opinion...and I come from a plain background...there comes a time when credentialing is a good idea. I think this is such a time. Once upon a time everyone used a lay midwife. And lawyers apprenticed rather than going to school...the list is endless. I believe requiring a nursing background is an excellent idea. There are terrific Mennonite colleges.
    Credentialing is a great idea, when it's done by the private sector and not forced on people by the state. There are plenty of certification organizations that could provide people with peace of mind that the person delivering their children is qualified to be doing so. But, if the person delivering wants to use a non-credentialed caregiver, that should be their right as well.
  10. by   nizhoni
    pennsylvania would well be advised to enter the 21st century where direct-entry midwifery is concerned. about half of the states in the u.s. now license midwives; generally, they accept the north american registry of midwives' certified professional midwife credential as the standard for entry-level midwifery care.

    i have attended about 900 homebirths over the last 30 years and am a registered nurse certified in perinatal nursing. i am licensed as a midwife by the medical board of california (but i am not a certified nurse-midwife).

    i have instructed direct-entry midwives (who are primarily non-nurses) for several years in a program that takes them from being complete "greenies" to practitioners who must function at the same level as other mid-level providers, though (in most states) without prescriptive privileges. i absolutely guarantee you that non-nurses can be educated to function quite capably in the midwifery role. even the american college of nurse-midwives recognizes this fact, since they have an accredited university-based program for non-nurses leading to a credential recognized in two states, the certified midwife (cm).

    remember, we were once "non-nurses" also.

    thanks to "morte" for the clarification re: "lay" midwives. old terminology. licensed midwives are members of the health care team and are finally being recognized as such. the statistics for homebirth in the u.s. and other countries have historically been excellent, provided the patient and her baby are low-risk and attended by a competent midwife. in the u.s., where 98% of all births are attended in-hospital, the statistics related to maternal and infant death are less than stellar. this is rather ironic given the fact that we spend more money on obstetrics than any other nation. and lest we excuse ourselves with the traditional argument that "you can't compare low-risk homebirths to mixed-risk hospital births," i will mention that there are well-constructed, published studies comparing low-risk hospital births to low-risk homebirths . . . and homebirth still presents very favorably.

    there's a lot to be said for keeping your hands off a normal process. midwives--including direct-entry midwives--are educated to support the normal process and to recognize deviations from the norm and obtain consultation or transfer care as necessary. that's what we're best at. u.s. statistics will not improve until we learn that lesson and utilize more midwifery care, including out-of-hospital midwifery care. presently the u.s. ranks just below cuba and just above romania in terms of perinatal outcomes. women in this country have difficulty negotiating access to the obstetrical system and the average length of a prenatal visit with an ob in this country is 7 minutes (as opposed to 45-60 minutes average with licensed midwives). staffing ratios in l&d continue to be a problem and we can't resist "tweaking" the normal process once women are admitted. it's no wonder that our statistics need significant improvement.

    this pennsylvania situation <really> irritates me. if the powers-that-be care as much as they will allege that they do about maternal-infant outcomes in the inevitable firefight over ms. goslin's right to practice, they will decriminalize direct-entry midwifery practice and make it easier to practice midwifery and educate future midwives. my experience with women from other populations who prefer to birth at home is that they do not "go easily into that good night" when the state says they must deliver in the hospital. they just take homebirth underground.
  11. by   fmwf
    nizhoni, powerful,patient and eloquent. i am praying for such patience to teach the uninformed (please forgive me all).

    midwives are the optimal care-givers for normal births. even for women who are vulnerable. "the evidence bears this out." like to know more? this evidence is online:evidence basis for the ten steps of mother-friendly care published as a supplement to the winter issue of the journal of perinatal education is available to download via the cims and ingenta websites. log onto www.motherfriendly. org and click on the appropriate icons or log onto [color=#003399]http://www.ingentac onnect.com/ content/lamaze/ jpe and click on volume 16, supplement i, winter 2007.

    new york states has a highly successful culture of cms. they practice "safely" and do not identify with "extra" nursing training. they have degrees and professional status.

    come everybody, learn a little more. you might be surprised what you find.
  12. by   mstigerlily
    as an ob nurse, i support the idea of cnms as care providers. i'm not sure about other forms of midwifery. but as a mother and a woman, i do agree that normal birth is not a disease state that needs to be managed. yes, things can go wrong but i believe that in many cases the cascade of interventions contributes to some of the things that go wrong. it's the woman's body, she should give birth how she wants but she needs to accept the risks along with the benefits in the case of a bad outcome.

    Quote from nrskarenrn
    from philadelphia inquirer, posted on mon, feb. 05, 2007

    a push to stop midwives

    pennsylvania argues that lay midwifery is illegal, that practitioners must be licensed nurses. the fear of losing the tradition troubles the amish and other plain people.

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