Midwives and Nursing Education

January 25th, 2008 by admin

There is a battle going on in parts of the U. S. over non-traditional medicine providers and those on the side of more traditional providers of care. The primary issue at hand involves non-licensed midwives in rural communities across the nation.

This article about a Missouri midwife outlines the key issues behind the problem.

While about half of the States provide for licensing of midwives following some degree of formal training, the rest either prohibit the practice of midwifery outside of other formal training (i.e. nurse-midwife) or have no regulations at all.

Advocates for use of traditional midwives argue that they put the power over childbirth decisions back in the hands of the woman having the baby. They argue that because childbirth is a natural process, it can safely be monitored outside of official health care circles, and that neo-natal resuscitation guidelines are able to be performed in the field with minimal training until EMS can arrive and transport to a hospital facility.

Representatives from the anti-midwife groups argue about the lack of oversight, lack of formal training, and unsafe practices unsupported by science and research. The challenge is that many women have come to distrust hospital births because they believe the facilities and physicians are driven to performing expensive, unnecessary procedures out of fear of lawsuits and covering the bottom line.

What do you think? Let us know using the comment link below or email us here at comments@nursingshow.com

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3 responses about “Midwives and Nursing Education”

podmedic said:
January 27th, 2008 at 5:36 am
Listener Marlene had this comment:

“I started out in the nursing field intending to get my CNM, but the more I learned about CNM’s the less I wanted to be one. I have several friends that went that route. I cannot. It is handy to have a nursing background, but I use my midwifery skills in my nursing job a lot more than I ever need to use my nursing skills in midwifery. If a nursing background is to be considered prerequisit for midwifery. I would say a midwifery background should be prerequsit for a nursing degree!

All my friend’s who are CNM’s entered the field to do homebirths, none of them are currently able to do so. This is indeed sad, that the education they so dearly paid for, was still not good enough, to achieve their goal. I am glad I didn’t waste my money on all that extra schooling.

I instead went the CPM route, which wasn’t easy either. It has high standards one must meet in order to get their CPM. NOCA has given the NARM CPM process a very high rating, it doesn’t come in cereal boxes! It is the only US midwifery training that specializes in out of hospital births.

CNM’s (and doctors as well) can graduate and start a practice without ever seeing a totally natural birth! This is apalling! CPM’s must prove competancy in normal birth as well as knowing when medical care is needed and homebirth should be r/o or abandoned.

The CPM is the best training for homebirths and the CNM is best training for hospital births. And Ob’s are best trained for surgical births.

Why can’t we all see that and work together instead of each accusing the others of being unsafe? Truth is, none of us catagorically are unsafe, though individual unsafe practioners exist in each catagory.”

Thanks for the input for the discussion!
podmedic said:
January 27th, 2008 at 5:39 am
Listener Stacey had this comment to add:

“I know this is a hot topic and I won’t even get into all the reasons CPM’s should be supported. This is the comment I find interesting:

‘Representatives from the anti-midwife groups argue about the lack of oversight, lack of formal training, and unsafe practices unsupported by science and research.’

The CPM in my area has 7 years of formal training. After obtaining her bachelors degree, she entered a 3 year midwifery program in Oregon. Since home birth is the norm up there, the programs are very thorough. She is as educated as a CNM. To become a CPM, midwives have to go through a very extensive testing process, much like CNMs. It’s through NARM, National American Registry of Midwives. This includes a day of written testing as well as hands one tests. Sounds just like most other certification processes, doesn’t it?

Finally, the part about the quoted comment that really strikes me is the part about unsupported by science and research. The irony is, obstetrics is the least evidence based specialty in existence. The only thing continuous fetal monitoring has done is increase c-section rates. It has not been shown to save babies at all. Yet, we still do it.

We still strap moms down to beds, increasing her risk for stalled labor and eventually c-section. Cytotec has been shown to be an incredibly dangerous medication to use for induction, yet it’s still used extensively. Recent guideline changes by the CDC regarding protocol for +GBS have not been widely adopted, increasing hospital stays for millions of moms and babies.

Dr. Tom Brewer, an obstetrician conducted studies that showed a high protein diet can prevent PIH/preeclampsia (www.blueribbonbaby.org). This is such a simple, simple thing to do - ask moms at risk to increase their protein intake. Even if an OB doesn’t believe the research here, it can’t hurt to try. It’s non-interventive and only beneficial to both mom and baby to have a protein rich diet. Yet, OB’s laugh at the idea that it could help. Ignoring the evidence.

How many years did it take for OB’s to stop cutting episiotomy, despite the extensive evidence that it can be harmful, and rarely actually needed? How high does our nations c-section rate have to get, while morbidity and mortality also continue to climb, before folks wake up and start actually looking at the evidence?

I have to admit, after nearly a decade working in labor and delivery, that I feel much safer in the hands of an illegal home birth midwife, who IS using evidence based practice.”

Stacey R. RN

More great input!
More on Midwives - The Nursing Show - For Nurses by Nurses said:
January 30th, 2008 at 9:19 am
[...] got a lot of feedback on the article I posted on unlicensed midwives in some states facing uncertain futures as state opted to outlaw their practices rather than giving them licensure [...]