When midwives put on their legislative-policy-changing hats, they often encounter statements that call into question the qualifications and competency of direct-entry midwives. I recently penned a response to patently false information that was being circulated in my home state of Oklahoma, surrounding a new licensing law for CPMs and CMs. I was deeply saddened to see harmful, crowdsourced, misinformation being spread around, and believe we must hold policy makers accountable for securing and reporting accurate information about our scope and credentials. 

I have attempted to adapt my statements, below, into thoughts for any policy-changing-midwife, anywhere, to use:

 Regarding references to:

“The intent of the law” – It is important to understand the legislative intent of the law in your state so that you can speak to it in your communications. In Oklahoma, the expressed legislative intent, per the authors of the law, is to provide an oversight and accountability process for CMs and CPMs without removing any birthing options and without limiting consumer autonomy. Knowing the legislative intent of your law is especially helpful when addressing groups or individuals who want to assign it their own wishes and values. 

“Lay midwives” –  A Lay midwife is a midwife who has received no formal training,  and usually serves her immediate community in a traditional way. Neither CPMs nor CMs are “lay midwives” and it is intentionally pejorative to refer to them as such. Both CPMs and CMs are meticulously trained in all the skills and competencies required to provide expert midwifery care and must complete a formal process to demonstrate their education. A member of a professional community or policy-maker using “lay midwife” should be immediately, and repeatedly, corrected. 

“High risk” – High risk is a valueless term that should be left out of policy-making, as it was intentionally left out of Oklahoma law, because it has no clear definition. There is no accepted threshold for what makes something “high risk” so it can be applied to any situation where there is increased risk. This is unhelpful in determining appropriateness for midwifery care. “Normal” is the term intentionally used in the Oklahoma law, and it is defined as “circumstances under which a Licensed Midwife has determined that a Client does not have a condition that requires medical intervention.” There are well established professional standards that guide these determinations, and we can rely on our licensed midwives, as we rely on other practitioners, to make these judgements. 

“ACOG guidelines” – Midwives are not admitted to, certified by, nor governed by, the American College of Obstetrics and Gynecology, and have their own guidelines set forth by their own professional organizations. Guidelines made without all stakeholders at the table are not universally applicable. While ACOG guidelines are important resources to consider they are based on the medical practice of obstetrics. Direct-entry midwives practice midwifery, and their guidelines and rules of practice, appropriately, take into consideration the unique practice settings and the Midwifery Model of Care.

“VBAC, Multiples, and Breech” - Any efforts within the law or rules to prohibit these practices run afoul of established ethical standards, as well as any statutory protections, which protect consumer autonomy.

“Formulary vs. Prescriptive Authority” – The intent of a formulary is to provide a list of medications that a licensed midwife may obtain, transport, and administer when providing midwifery services. Generally, these medications directly impact the safety of community birth and their appropriate use is covered by all routes of education available to CPM’s and CMs.  A formulary does not grant prescriptive authority. 

“No evidence of training” – This may be the most troubling accusation direct-entry midwives face, as it speaks directly to biases that seek to discredit both the profession of midwifery and the families who prefer midwifery care. The evidence of training, as with other professions, is the credential, itself. Both the CM and CPM are accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE). This is the same accrediting body that accredits many healthcare credentials, including the Certified Nurse-Midwife (CNM). Furthermore, the educational guidelines of CPMs and CMs are easily accessible through a cursory internet search and clearly outline that both credentials require explicit academic knowledge, and clinical mastery, of established midwifery competencies. 

Sadly, the intentional undermining of community midwives in Oklahoma is already actively harming families by fostering mistrust within the medical community, and reducing access to needed consultation and collaboration. This is the likely result of any attempt to cast doubt on the intentions and/or qualifications of direct-entry midwives, and is concretely contrary to the stated goals of all parties involved, to protect the health and wellbeing of babies and families. 

Considering that our unified intent is to protect those we serve from harm, I feel confident that all professionals serving birthing families can find common ground working together toward improving outcomes, regardless of intended provider type or birth space. There is not one of us who serves in a profession that has no room for improvement, and our concerted efforts should be finding solutions that don’t involve an us vs. them mentality. Obviously, the answer to finding a flaw in community birth is not eliminating community births anymore than the answer to finding a flaw in hospital birth is razing the building! Only working together, affirmatively,  can we make both community and hospital birth as safe as it can be. Let that be our battle cry.

Respectfully,

Sarah Foster, LM, CPM

MA Maternal-Child Health Systems

President, National Association of Certified Professional Midwives, Oklahoma Chapter

Director of Organizational Development, Midwives Alliance of North America