Midwives are so Little house on the prarie. Times have changes since then, but some people seem hell bent on going back to those times. Times were simpler but that isnt such a good thing when it comes to the life of your baby.

Even if the midwives are totally qualified there is still that one in a million chance that something could go wrong and being in a hospital right that second could make all the difference in the world.

Why would any expected mother take such a chance with the life of their baby.
Why intentionally have your baby somewhere where the advances of medicine are not readily available?

Personally I’d rather not take that chance.

Kudos to the Post Dispatch for delving into this important topic!

I absolutely agree that families should have the right to choose the maternity care provider of their choice. Women are not stupid, and are not going to hire somebody who isn’t trained.

Legalizing midwifery would just help us catch up with most of the rest of the modernized world, where midwives are a legal option. In the United Kingdom, the government is encouraging more women to have their babies at home with midwives because they have BETTER outcomes AND cost less. Who can beat great outcomes, great patient satisfaction, and low costs?!

Women care far more about the well being, health and safety of their baby than any other professional in the world. It’s *their* baby, and they want the best for their child. Why can’t we expect them to make good decisions about where and how to have a baby?

Most women choosing out of hospital birth are choosing to forgo pain relief in labor because they want what is **best for their baby** and are willing to go through extra effort to get what they think is best. Natural birth is a lot of hard work. These women deserve to have a legal caregiver who is an expert at it! CPMs are experts at natural, out-of-hospital birth.

This is fundamentally a public safety issue. The question: Is it safe to license a second class of midwife with less education and clinical training than any other midwives in the industrialized world? The answer:

1. This is NOT about having midwives in the US. We already have midwives (certified nurse midwives) who are among the best trained midwives in the world.
2. This is about creating a SECOND class of midwives with less education and training.
3. No other country has a second class of midwives.
4. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world.
5. Direct entry midwives are NOT trained for out of hospital birth, since no special training is required. The many taxi drivers, police officers and family members who deliver babies each year could tell you that. The only thing that requires training is dealing with unanticipated complications, and this is precisely what direct entry midwives lack.
6. Direct entry midwives are not “specialists” in out of hospital births. They are restricted to out of hospital births because they are considered unqualified for birth centers or hospitals.
7. Direct entry midwives are not “specialists” in normal birth. Claiming to be a specialist in normal birth makes as much sense as a meteorologist claiming to be a specialist in good weather.
8. Homebirth carries an increased risk of preventable neonatal death in the range of 1-2/1000 ABOVE the neonatal death rate for comparable risk women in the hospital.
9. To date there is not a single study that shows homebirth to be as safe as hospital birth. There are studies that claim to show that, but they do so by comparing low risk women at homebirth with high risk women in the hospital.
10. This is not about “choice”. Any woman can choose to have a homebirth. This is about licensing of health care professionals who do not have the necessary education and training.
11. The insurance industry will not write policies for homebirth or charge extraordinary premiums because their data indicate that homebirth carries an unacceptably high incidence of bad outcomes and big payouts.
12. There is no uniformity in direct entry midwifery credentials. There are many different credentials with differing education and training requirements. Direct entry midwives cannot agree among themselves what baseline training is required.
13. Direct entry midwifery credentials were created by direct entry midwives without input from medical or public health sources. These credentials are the “seal of approval” of some DEMs in regard to other DEMs. There is no independent objective basis for these credentials.
14. The Midwives Alliance of North America (MANA), the group that collected the statistics for the BMJ 2005 study, has collected statistics for the years 2001-2007 but refuses to release them to the public. They will only be released to groups that can prove they will use them for “the advancement of midwifery.” The public has a right to know these statistics.
15. There are no statistics at all for long term outcomes of homebirth with direct entry midwives. We have no idea (nor do they) about the incidence of brain damage, oxygen deprivation or birth injuries.

The bottom line is that we already have well educated, well trained, highly competent midwives in the US. We are being asked to license a SECOND class of midwives with less education and less training than any other midwives in the industrialized world.

Once again, we are being overly paternal in a situation where THE WOMAN should decide. Look guys, in moct instances women are given much more responsibility for taking care of spawn later in life than the men who helped make the spawn are. Midwives who were not certified by a male oriented and powered society have birthed healthy humans and animals for centuries. Nothing has changed, except we now have more medical care for sick newborns, regardless of how they enter the world. Cab drivers and cops birth babies, for god’s sake. How hard can it be? LMAO Any profession wants to protect its monopoly, this is no different. I saw births by self-certified midwives way back in the 70s. Anybody remember the large community Steven’s Farm? Hundreds birthed.,..hundreds survived and thrived. All by hipster midwives and god’s grace. It’s ALL god’s grace, don’t forget that. Have a severe risk birth, get medical care, but medical care does not save many, and leaves many strapped to a machine until they painfully pass too. Bottom line, all the official certs in the world don’t make a safe doc. Witness the malpracticing thousands who retain their licenses after repeated butchery. It all goes back to the woman’s right to choose where she drops that flesh of her loins. All else is bull crappie paternalistic stuff. RIP Martin and Coretta…it’s almost here!

I am an educated homebirth mom who cares about outcomes for mothers and babies. I will choose homebirth, despite the availability of midwives, for my healthy pregnancies. People may post what they will; There are just as many fancy paragraphs of studies supporting homebirth and midwifery, but I will not post them.

I believe in my right to birth choice. Missouri is absolutely archaic with midwifery law. Is that what Missouri should be? I don’t think so.

Commenter 3, this isn’t about the US. It is about Missouri. Missourians have extremely limited access to midwives because of the law. In California, I was able to make a good choice care providers because I could interview more than 25 midwives just by looking in a phone book. That is birth choice. That is informed decision-making. Missourians who choose homebirth are at a disadvantage.

Yes, midwifery should be legal in Missouri. No one cares more about birth outcome than birthing mothers. Women are smart and will make safe birth choices if the choice is given to them.

As an ob nurse, I know that safe and satisfying births can happen in a hospital. As a mother who has birthed twice in a hospital (one with an OB/GYN, once with a Certified Nurse Midwife) and who has birthed at home twice with a Certified Professional Midwife, I know that for some families, home births with a professional midwife are SAFER and better for mothers and babies.

Women have birthed at home since the beginning of time, and will continue to do so, despite whether or not it is “legalized.” As it stands now, CNMs can be present for homebirths–but there are not enough doctors who are willing to risk ridicule from their colleagues and possible termination of hospital privileges for backing homebirth midwives.

The safety issue continues to be bantered about–so let’s look at the fact that because women will continue to birth at home with midwives, let’s ensure that those midwives are competent by legalizing midwifery. As it stands now, anyone can call themselves a “midwife” and catch babies at home. Legalizing midwifery in Missouri, along with requiring a minimum standard of education and skill, will help ensure that families who choose to birth at home with a midwife will have a better chance of having a skilled and safe birth practitioner.

Laura
in Northwest Missouri

If its a choice the parents have then they should also take responsibility if that choice results in the death or permanant damage to their child.

I would ask each of you to research this. the statistics have been there over and over that midwives have just as good of out comes as the hospital births. As far as the quality of care I have had both a hospital birth and 3 home births. the care that my babies and I received was far personalized and specific to our needs than in the hospital. My midwives knew exactly what was going on with us and gave us options and care appropriate for each situation. They are specifically trained to care for a mother and baby not a wide variety of illnesses so they are able to know more about the care of mother and baby. I am tired of the government telling me that I’m not smart enough to choose quality care for myself and my baby. I want to be free to choose the best care for myself and baby not be forced to be strapped to a table while other people tell me how to labor, when to labor and if I’m capable of giving birth. I support midwives and the women’s right to choose.

Dr. Amy touts the CNMs as wonderfully trained midwives, the answer to the need for homebirth providers.
CNMs are great. She’s right about that. They have great outcomes, and many women are very grateful for them. What Dr. Amy doesn’t mention is that there is ONE nurse midwife with a legal homebirth practice in the state - Count that; one person to serve the approx. 1,000 babies born at home each year in Missouri??
That just doesn’t work.
One midwife isn’t enough to go around for the entire state, which leaves people who desperately want a homebirth to find an underground midwife (who may or may not be certified, and have verified her education through a national accrediting body) or to do it by themselves, with no one there who knows how to stop a hemorrhage or resuscitate a baby.

Certified Nurse Midwives receive their training almost exclusively in hospitals and often are not comfortable delivering in a home setting.
Certified Professional Midwives are REQUIRED to have out of hospital training to ensure that they know what to do without the OR down the hall, or a blood transfusion near at hand. They are experts at home birth.

Both the CPM and CNM credential are accredited by the National Commission for Certifying Agencies (NCCA) that is considered the “gold standard” for certification - used by nurses, nurse practitioners, midwives, nurse anesthetists, EMTs, etc, etc.

Bravo for the two wonderful articles on midwives. It is so refreshing to see the beauty of a homebirth discussed in an open and honest way.

I have to strongly disagree with some of the negative comments posted here by opponents of direct entry midwives, along with the continued use of fear in trying to keep midwives from taking their rightful place in the care of women with low-risk pregnancies. I had one child with Certified Nurse Midwives in a hospital, where the care was still very technical and interventionist. These midwives still have to adhere to the rather stringent rules of the hospital. I then had one beautiful homebirth with a direct entry midwife in Missouri,and am now expecting my third child with a direct entry midwife in Germany, where direct entry midwifery is legal (and birth outcome statistics are much better than in the US).

I have learned so much more about birth and prenatal care from direct entry midwives than I ever did from the obstetricians in whose care I began. I also feel that I am heard much better by my midwives. They take the time to listen to and address concerns. They have a wealth of knowledge about how to treat standard pregnancy issues that one obstetrician had no clue about. There is no question that obstetricians play an important role in birth for mothers with higher risk pregnancies. They are taught how to handle the exceptions in medical school, and how to intervene in every step. They are not taught, however, how to support and handle a normal, natural birth without trying to intervene. In fact, I lived next door to two SLU medical students who never witnessed a natural birth without the use of pitocen in their entire obstetrician rotation. This is where midwives play a critical role. Their training covers how to empower the women, give her strength, and help her to have the birth that she wants. Their training is both rigorous and covers the exact situations that obstetricians do not learn. I have only ever encountered an atmosphere of fear and intimidation when dealing with obstetricians, as their natural focus is on the birth exceptions due to their training.

On the one hand, I am grateful for the obstetricians who are there for the mothers who need them. Many of us, however, want to birth our babies in a relaxed, unpressured environment, where we control our birth experience. If we need an obstetrician, then that is when the obstetrician should take on the case. Direct entry midwives and obstetricians are not enemies. They should work together to give women the birth experiences and options that they are looking for. I feel that obstetricians could learn an incredible amount from the direct entry midwives, if they would take the time to really look at the midwife model of care.