I 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 and educational requirements to meet.

One of the most passionate and well referenced responses came from listener/reader Ashley, an RN and Certified Nurse Midwife in training. Here is her email to me (used with permission).

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Hello at Nursing Show,

I am writing to express my disappointment with yesterday’s blog post entitled, “Midwives and Nursing Education.” The entire post was misleading and inaccurate.

The post fell short with the suggestion that non-nurse midwives are poorly trained and practice unsafe care. The assertion is not only very far from the truth, it is exactly the kind of divisiveness that prevents access to competent, safe, out-of-hospital midwifery care for women and their families.

As a nurse working in a free-standing birth center, I know first-hand that 98% of all low-risk pregnant women can safely give birth in an out-of-hospital setting and as a student nurse-midwife I value maternity care practices that are proven and evidenced-based.

The practice of Certified Professional Midwives (CPM) in planned home births has been repeatedly proven safe, most noteably in the British Journal of Medicine in a prospective study in North America in 2000.

The author of yesterday’s post failed to include any information about the Certified Professional Midwife credential. While some CPMs are trained as nurses, they are not CNMs, who often do a fair amount of their clinical training in a hospital setting.

CPMs are skilled at caring for women experiencing low-risk pregnancies and normal births. The training that CPMs receive is rigorous, including clinical and didactic hours, and they are required to sit for a national credentialing examination to test both their knowledge and skill.

CPMs are trained in complications of pregnancy and birth, and know when it is unsafe to continue care of the patient in an out-of-hospital setting. Contrary to the author’s assertion “that neo-natal resuscitation guidelines are able to be performed in the field with minimal training until EMS can arrive” is yet another example of how misinformed many are on the subject of non-nurse midwives. CPMs are trained in neonatal resuscitation and carry equipment required in an emergency situation.

This issue is one that hits close to home as I plan on attending women in birth at home upon completion of my CNM studies. Most importantly however, I am a mother to four children, all born at home into the skilled hands of a Certified Professional Midwife.

I know first-hand that the information you presented in yesterday’s post was disingenuous and completely opposite from what I experienced under the care of my midwife. As a fellow nursing colleague, I trust that the author values evidenced-based practice as much as I do and will post a prompt follow-up detailing the truth about the proven safety and efficacy of Certified Professional Midwives.

Sincerely,
Ashley M., RN, SNM

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Here is another piece of input I received from Elizabeth, an MD who also was in favor of home births:

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I am a family physician who attends births at home and in a free-standing birth center.  I have worked with CNM’s and CPM’s in many settings over 20 years.  I have reviewed the scientific literature evaluating the safety of home birth and midwifery care.

I trained in hospitals with obstetricians and family physicians.  After a careful review of all of this, when it was my time to give birth, I chose home with a midwife for SAFETY reasons.

Home birth with a midwife is evidence-based care. It is endorsed by the World Health Organization and the American Public Health Association.  It is cost-effective, saving the State of Washington millions of dollars every year.

It is woman-centered, focusing on what the woman (and her baby) need and want, even if it is inconvenient or uncomfortable for the midwife.  It supports breastfeeding.  It may prevent prematurity and low birth weight.

Every woman in the US should have access to a qualified, local midwife.

Elizabeth A., MD

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A thank-you to both Ashely and Elizabeth for sending in their comments.

You can read other comments from listeners and readers of the Nursing Show attached to the original article here.