greenmidwife | Indy Week

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Re: “Midwives seek autonomy in N.C.

I just bumped into this article and read most of your posts. Dr. Tuteur, I am a colleague of the president of MANA and have forwarded her the link to this discussion. For the advancement of direct-entry midwifery in the US, I am almost positive that she would have NO reason to withhold any information from anyone seeking to know the data collected from the CPM2000 study. The US is one of the only developed countries where direct-entry midwives are considered and quoted as "incompetent, inferior and second class" citizens by physicians. This quote is Maybe I missed the statistic that according to the CDC (and 2003 was the last time reported) the maternal mortality rate was 12.1 deaths per 100,000 births in the US. If midwives in the US are attending less that 1% of these births, what piece are we missing? What is happening in the maternity care system to create one of the highest maternal mortality rates amongst developed countries? Please tell me, I want to know.

What people like you (Dr. Tuteur) and me have to do is start having conversations about the varying differences in our practices. The US COULD aim to be like the UK and New Zealand and Holland where midwives, direct-entry and nurse midwives, attend 70-72% of the births working in collaboration with OB's, Physicians and other maternity professionals. THEY HAVE CONVERSATIONS rather than continuously beat each other down. It takes work, yes and it's possible.

I am an educated direct-entry midwife and a homebirth midwife. As an educated direct-entry midwife, I do agree that advocates should gain insight and report information that comes from places other than Mothering Magazine. The editors do a good job of making sure articles are accurate, however we must look to other databases if we are going to be reporting statistics that can make a difference in our advancement. All the midwives I trained with were highly educated and I think you are missing some major pieces in regards to our education. I attended a required 100 NORMAL births as a student, over three years of didactic and clinical work. It is not UNCOMMON for midwives fresh out of school to have attended between 75-150 normal births. I completed near 2000 hours of clinical and birth work, which includes prenatal, postpartum, preconception, GYN and well-woman care (as these are legal statutes in the states I trained). We were required to write a thesis research paper that was presented for CEU credits to the midwifery community. Some of these papers will potentially become published. My classmates graduated as valedictorians from schools such as Smith College and UC Berkley with majors in neuroscience and biology. Overall, with my preceptors, I had 16 transports from rural settings 10 of which resulted in vaginal births and 6 had necessary cesareans. I was part of a neonatal death, as a student. We do see complications and WE ARE EFFECTIVELY TRAINED to recognize these complications immediately. We were trained by Perinatologists, Obstetricians, Dieticians, Physicians, PhDs and psychiatrists and this happened at a direct-entry midwifery school. I know some schools have Chinese Medicine Doctors, Naturopaths, DOs and other medical professionals who teach courses, as well. So to say we are uneducated and voicing this freely is using half truths, mistruths and outright deceptions. It is an essential part of my practice to give good informed choice/consent on every test or medical event physicians offer their patients (in and out of labor), and then also add recent evidence from the Cochrane Database, JAMA, ACOG, AAP and MANA. You are right to say some midwives have unsafe practices. However, unsafe practices happen in hospital settings routinely and these statistics go unreported, chart notes become lost or misplaced. It is a tenet of the midwifery model of care for midwives, as a profession, to do our best in peer review to talk to these women/men and look at the ways their practices impact the childbearing population and our profession.

We as the maternity care profession are all at fault for the statistics in the US being so poor. As a collaborative we must accept that responsibility. We are ALL too pigheaded in our autonomy to cooperate, to work together, and to strive to create a unified maternity care system that solely devotes its energy to improving the health and awareness of maternal and neonatal outcomes. We are all too high on our soapboxes to come down, shake each others hands and create a system that could be an example to other countries. Midwives, in current society, are highly trained and I want for you Dr. Tuteur to call Geradine Simkins, president of MANA, and discuss your concerns about these midwifery statistics that are not being released unless they "are for the advancement of midwifery." Your voice is very strong and passionate, and you can continue to operate in the archaic mindset that midwives are stupid and untrained and unsafe to birth with or you can really talk to a midwife and find out the truth. Go outside of your state, call midwives in Oregon, Washington, Vermont, Texas, Montana, Colorado and ask them about their work and their education and their statistics.

One day, I believe the US will have a unified system and we'll get over our egos as maternity care providers because in the end the choices childbearing men and women make is not up to the providers and we will not be able to hold them back from where they choose to birth.

My final question to you Dr. Tuteur, if you read this, is to ask you what made you detest the home birth, out-of-hospital, direct-entry, licensed, certified professional midwife the way that you do? What have we done wrong to you and who taught you what you know about us? What have we taken from you?

I hope NC sees the CPM to a legal status. Keep doing your work Carolinians and if you need support from the rest of the CPM community please call upon those of us that can help from around the country that are legal and attending small (3-5% of my community population) but significant numbers of births in our community and have healthy, collaborative relationships with the hospital community.


Posted by greenmidwife on 08/07/2008 at 3:17 PM

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