Friday, February 20, 2009

Addendum to earlier post

In my previous post discussing the death of my friend's baby during an attempt at homebirth, I said the midwife had national credentials, I had mistakenly thought she was a CPM, she is not. There are lots of reasons why women choose not to become a CPM (Certified Professional Midwife), some political, some financial, some because it is not an easy process even for an apprentice trained midwife. To be quite honest, I do not think if she had that credential if it would have changed the outcome, she sounded like a very experienced midwife. However, if she was a CPM the family would have a process in which to ask for a Peer Review. A system would be in place to make sure the midwife's education met a certain standard, and while being a CPM does mean you have to practice a certain way, anymore than an MD does, there is a degree of accountability involved. Unfortunately, there is not a whole lot of incentive for a practicing midwife in an alegal or illegal state to become a CPM. It is only when State licensing is offered with reimbursement for Medicaid that licensure or CPM status is worth the expense or effort for some midwives. Some states like Oregon there is voluntary licensure, and for midwives who want third party reimbursement and the ability to carry certain medications for birth, they get licensed. However only about 1/3 of the midwives in Oregon choose to become licensed (last I checked the stats). CPM is the route to licensure in Oregon and in many states. In Washington, they have overcome the problems with liability insurance costs by having a state pool. They also have very stringent licensing requirements, and it is difficult for anyone not graduating from Seattle Midwifery School to become licensed. However they have very good homebirth statistics in Washington State, which is a good argument for mandatory licensure, and stricter educational requirements.

My overall position has not changed in wanting to see the profession of direct entry midwifery upgrade their standards, but I have to admit there is a bit of relief in knowing that this particular midwife was not a CPM. Of course that does not change the pain the family feels, their child is just as dead no matter what initials the midwife had after her name. If there is any good that can come from this tragedy, is a discussion about the issue, and awareness of the training of midwives, the safety of homebirth, and steps we need to take to keep this from happening to another family.


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