Clarification about midwifery

Dear Editor,

This letter is in response to the July 10, 2008 article “Local Family To Be Featured on WXII,” written by News Editor, Leslie Evans. After discussing the article, she and I agree that because there was no delineation or distinction in the article regarding the different levels of “midwife,” it lends itself to confusion and misrepresentation. We both felt it would be important to clarify.

The term “midwife” in and of itself holds connotations that confuse the American public. In the U.S. today, there are several pathways into the legal midwifery profession - the Certified Nurse Midwife (CNM), Licensed Midwife (LM), and Certified Professional Midwife (CPM). The “lay midwife” is not a legally accepted professional.

The only level of midwifery recognized as legal in all 50 states is the Certified Nurse Midwife. In North Carolina, the only legally accepted “midwife” is the Certified Nurse Midwife. Nurse midwives always work in consultation and collaboration with obstetrician-gynecologists. It is legal in North Carolina for Certified Nurse Midwives to attend home births.

Certified Nurse Midwives are additionally educated to provide complete well-woman care, including family planning/contraception care, gynecological services, and menopausal care. The Certified Nurse Midwife is the only level of midwifery that must pass a nationally recognized examination and meet and maintain stringent guidelines of competency and accountability. In North Carolina, it is the only level that enjoys and has advantage of physician support.

All this is not to say that CNN’s are the only competent midwives. Quite the contrary, CNN’s learn a tremendous amount from “traditional” midwives. It is to say, however, that there are “midwives” practicing in this area who are practicing unsafely and unwisely, and there have been some very poor outcomes (i.e. neonatal deaths) due to poor judgment and unsafe choices. Expectant parents are urged to select their midwife carefully.

The article of July 10 erroneously stated that “nurse midwives cannot deliver babies.” Nurse midwives can legally attend in and out-of-hospital births. Ms. Evans was totally accurate in stating “it is very difficult for Certified Nurse Midwives to obtain physician back-up for home births.” “Almost impossible” would probably be more correct!

The article states that “caesarian birth rates are lower with home births attended by midwives.” In actually, the research substantiates that caesarian rates are lower with all levels of midwifery care (CNM/s, LM’s, CPM’s) whether in or out of hospital births, in addition to fewer premature and underweight babies. This superb record of safety only applies to healthy, low-risk women.

Home birth is a beautiful, peaceful experience as long as everything goes well. Even perfectly healthy low-risk women can experience life-threatening complications in the birth process that are totally unpredictable. It is not a decision to be made lightly or glibly. The Creeches have obviously completed an enormous amount of research and made heartfelt decisions. They have been blessed with repeated normal births.

Home births are more than a “hip and groovy” experience. The birth process has been medicalized beyond recognition. Women have truly been robbed of the natural process, trust in their bodies to birth their babies, and are active participants in the decision making process.

A more viable option might be for someone to have the courage to open an out-of-hospital birthing center in our area. High Point was a beautiful option and a great loss. The Chapel Hill facility is perfect and outstanding, staffed and owned by Certified Nurse Midwives with decades of experience. But, many parents are worried about traveling over an hour to birth their baby.

There is a beautiful quote from a 16th century text