Direct-entry midwife

Midwifery, direct-entry

A pregnant woman receives a visit from a midwife in her home.

A direct-entry midwife, also known as a lay midwife, is an uncertified or unlicensed midwife who gained experience through self-study or apprenticeships instead through formal education.[1] These midwives are also known for being "more natural and less intervention oriented."[2] In other words, midwives don't employ methods for childbirth that physicians in hospitals commonly use such as caesarean section, forceps and other types of equipment and drugs.

Legality of direct-entry midwifery in the United States

While direct-entry midwifery is popular and legal in many cultures around the world, it struggles to gain legality in several states in the U.S. Nurse-midwives can practice legally in all 50 states[3] however, direct-entry midwives are regulated and licensed in 23 states.[4]

23 states don’t regulate midwifery or provide an avenue for licensure.[5] Penalties for practicing direct-entry midwifery range from a misdemeanor to a Class C Felony.[6] These states include Alabama, Connecticut, the District of Columbia, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota and West Virginia.[7]

North Dakota, for instance, is one of many states that have no official laws regulating or prohibiting direct-entry midwifery. States can unintentionally encourage issues with midwifery by not providing standards or licensure opportunities to ensure the competency of midwives.[8]

Also, practicing direct-entry midwifery in these states is basically equivalent to practicing medicine without a license and has severe penalties.[2]

Some states, while they regulate the profession, make it very difficult for midwives to obtain licenses to perform. Hawaii is one of these states. While direct-entry midwifery is legal in Hawaii, licensure has been deemed too expensive and is unavailable to most, according to the Midwives Alliance of North America. Delaware is another state that, while it regulates the profession, sets up obstacles that make it difficult for midwives to practice in the state. Theoretically, Delaware midwives are able to obtain a permit to practice, but one hasn’t been issued since 2007.

The decline of midwifery in the United States

The decline of direct-entry midwifery in the United States can be contributed to a number of complex factors: the rise of the American Medical Association and the growth of hospitals in the country in the late 1800s and early 1900s shifted births from the home to the hospital.[9] The fall can also be attributed to the movement toward universities teaching gynecology and surgery as well as advancements in technology such as anesthesia and forceps. All of this led physicians to see midwives as competition instead of partners. They were also worried about what people would think about doctors if it appeared that anyone so uneducated could perform the work of a medical professional.[2] During this time period, organized medicine launched a campaign to convince the public that hospital births were the best option, while painting midwives as unintelligent, untrustworthy and criminal.[9] However, it wasn’t just physicians who joined in the campaign against midwifery – by the late nineteenth century, wealthy, pregnant women joined in because they though childbirth was less painful and safer if performed by physicians[10]

The case for legalizing direct entry midwifery

Statistics show that American women want alternatives to hospital births. 20 percent of women indicated in a study in 2006 that if they have the option to have a non-hospital delivery with readily available medical backup, they would take it.[10] The State of the World’s Midwifery report supports the profession, urging governments to recognize it as vital to maternal and newborn health services. It also urges governments to consider establishing a scope of practice, specified credentials for entering the profession and educational standards.[11] Those who argue for the legalization of direct-entry midwifery also cite its health benefits, both to the mother and the fetus.[11] Women who give birth in hospitals experience higher risks and adverse effects than women who give birth with a midwife.[12] Studies also show that the use of midwives in childbirth can decrease maternal and newborn mortality as well as stillbirths, perineal trauma, instrumental births, intrapartum analgesia and anesthesia, severe blood loss, preterm births, newborn infants with low birth weigh, hypothermia and neonatal intensive care units.[13]

There are also indications that midwife assisted childbirth is safer than birth in a hospital because there’s a lower chance of intervention.[10]

The case against legalizing direct entry midwifery

Those debating against the legalization of direct-entry midwifery usually question the competence, regulation and scope of midwives.[10] Questions regarding whether direct-entry midwives should be legally recognized as birth attendants, what their job should allow them to do, and who is responsible for their regulation surface.[10] Some in the professional healthcare profession just think homebirth is dangerous. Many hospital-based practitioners think the safest kind of birth is when it happens in a hospital.[6]

Common routes for licensure

Many direct-entry midwives also support regulation and licensure because they believe limitations on a legalized profession would outweigh having to operation under the threat of prosecution in states where the profession is illegal.[2] For instance, to qualify for licensure in California, a midwife must complete a three-year postsecondary midwifery education program and pass a licensing examination.[2] In Minnesota, licensed midwives are required to screen potential clients, and only accept those who are expected to have a “normal” delivery. In 1994, the North American Registry of Midwives (NARM) formed, as it recognized a need for direct-entry midwives to obtain national certification. State regulation of direct-entry midwifery was varied, and the professional associated realized the professional needed certification standards. As of 1994, direct-entry midwives can receive certification through NARM and be designed as certified professional midwives (CPMs). Now, for states that regulate the profession, most of them require midwifery candidates to take the NARM exam and complete NARM certification before receiving a license from the state,[14] however certification and licensure is only recognized in states that legalize and recognize midwifery.” In order to be recognized as a CPM by NARM, a midwife must meet three criteria: meet all education requirements and pass a certification exam; meet minimum experience requirements; document proficiency in all midwifery skills (Stover, 2011, p. 325). This can take anywhere between three and five years. This certification also must be renewed every three years.

References

  1. ↑ "Midwives". American Pregnancy. Retrieved 9 November 2014.
  2. 1 2 3 4 5 Rausch, Christopher (2008). "The Midwife and the Forceps;The Wild Terrain of Midwifery Law in the United States and Where North Dakota is Heading in the Birthing Debate". North Dakota Law Review. 84 (I): 219–255.
  3. ↑ "Legal Status of U.S. Midwives". mana.org. Retrieved 5 November 2014.
  4. ↑ Elton, Catherine. "American Women: Birthing Babies at Home". time.com. Retrieved 5 November 2014.
  5. ↑ Elton, Catherine. "American Women: Birthing Babies at Home". Time.com. Retrieved 5 November 2014.
  6. 1 2 Cheyney, Melissa; Everson, Courtney; Burcher, Paul (March 2014). "Homebirth Transfers in the United States: Narratives of Risk, Fear, and Mutual Accommodation" (PDF). Qualitative Health Research. 443 (24).
  7. ↑ [(http://mana.org/about-midwives/state-by-state.) "State By State"] Check |url= value (help). mana.org. Retrieved 5 November 2014.
  8. ↑ Rausch, Christopher (2008). "The Midwife and The Forceps: The Wild Terrain of Midwifery Law in the United States and Where North Dakota is Heading in the Birthing Debate". North Dakota Law Review. 84 (1): 219–255.
  9. 1 2 Crilley, Claire (July 2014). ""The midwife must be abolished!": The Fall of Midwifery in Mid-Twentieth Century New Orleans". Newcomb College Institute Research on Women, Gender, & Feminism. 1 (2): 14–20.
  10. 1 2 3 4 5 Stover, Sarah Anne (2011). "Born by the Woman, Caught by the Midwife: The Case for Legalizing Direct-entry Midwifery in all 50 States". Health Matrix: Journal of Law-Medicine. 21 (1): 307–351.
  11. 1 2 Sandall, Jane (December 2012). "Every Woman Needs a Midwife, and Some Women Need a Doctor Too". Birth: Issues in Perinatal Care. 39 (4): 323–326. doi:10.1111/birt.12010.
  12. ↑ Sakala, Carol; Corry, Maureen (October 2008). "Evidence-Based Maternity Care: What It Is and What It Can Achieve". Childbirth Connection.
  13. ↑ ten Hoope-Bender, Petra (2014). "Improvement of maternal and newborn health through midwifery". Lancet. 384: 1226–1235. doi:10.1016/s0140-6736(14)60930-2.
  14. ↑ Stover, Sarah (2011). "Born by the Woman, Caught by the Midwife: The Case for Legalizing Direct-Entry Midwifery in All Fifty States". Health Matrix: Journal of Law-Medicine. 21 (1): 307–351.
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