This post is coming to you as I have had several days to think about the amazing reactions I’ve had to my most recent post My Thoughts on Home Births. The thing about midwifery is that there are way too many distinctions of different kinds of midwives. Just a few: Lay, Direct Entry, Certified Professional Midwife and Certified Nurse Midwife….the only thing you need to know is that a CNM is the ONLY type of midwife with a clinical degree in nursing. That means she (or he in some places!) has a high school diploma, bachelors in nursing, masters in nursing and nurse midwifery certifications and degrees. I’m taking a rather slow and easy road to midwifery, but if one is on the normal track to becoming a midwife straight out of high school, then she will have been in school for at least 6 years, if not more in some cases. She also must take continuing education in basic life support, neonatal resuscitation, suturing, etc. CPMs, Lay, and Direct Entry midwives may have some pre recs to take before entering a program and in less than 3 years they could be on their own catching babies, mostly at home. Those midwives are not certified to work in a hospital or in some birthing centers. All this to say…education makes a huge difference and as I said in the last post about home birth, I am a HUGE advocate for education, both of the provider and the patient.
I say this because, despite my not being a fan of home birth, our country still needs
good great home birth midwives. People who want to give birth at home, educated or not, are going to give birth at home and they should do so with a great midwife. The most ideal home birth midwife would be a CNM. I know a few CNMs who actually attend births at home. This area gets sticky depending on different state regs, but in Colorado, it is allowable. Now, does she carry liability insurance? Probably not because it is too expensive to do so. Would I hire a midwife to attend my birth without liability insurance? No, because that also means that my insurance is most likely not going to cover a dime. Regardless, we need to accept that, while home birth is not the safest place to have a baby, that it’s still going to happen and they need to be attended by great home birth midwives.
What does a great home birth midwife look like? In a perfect world, she is a CNM and has experience working in a hospital setting. She has a relationship with the local hospital in which transferring is not looked at with such negativity and she carries liability insurance. She carries a post-patrum hemorrhage kit with her, along with a tank of O2, an IV kit with plenty of fluids and oxytocin. She has THREE assistants..not just one or two. These are also CNMs who have just as much experience and understanding in labor, birth, and newborn care. She also only takes on truly low-risk moms. In a perfect world, right? For now, our focus should be on having the same standard of midwifery care at home as we do in the hospital. That scope needs to include the same amount of schooling and continuing education that is required of CNMs today. If you know anything about education, you also know that those standards change constantly and in my experience, become more thorough and strict. That is great! Midwifery is a profession just like any other and you wouldn’t hire someone who was not fully educated to take care of you and your baby, right?
The reason we need great home birth midwives is because we need to lessen the number of neonatal deaths. Since families are going to make that choice whether I agree with them or not, we still need to have educated, great midwives attending those births. We need to continue to hold midwives accountable who have had deaths or complications made because of their lack of education or preparedness.
Remember, we don’t want to bury our babies twice, or even once if we can! #notburiedtwice