Monday, July 18, 2005

The Double Edged Sword of Licensed Midwifery

Right now there are changes going on in laws regulating the practice of midwifery around the US, changes that will impact the future of home-birth in this country. One of the ones that is always on my mind is the move for state and national licensing and certification of midwives.

When you think of the term “licensed midwife”, it sounds good. It sounds like it means “safe”, “well-trained”, “qualified”, “accountable”, “responsible” midwife. But, in my journey into midwifery I am starting to wonder how true that is.

On the positive side, maybe licensing will bring a certain respectability to midwifery. Maybe people will see that we have something to offer the community on a wider level. There are countries where lay-midwives even have hospital privileges if they are licensed. And, maybe if Doctors saw that we had worked to gain the knowledge we have and we had some title to prove it they would listen to us if we had to transfer a patient, much like they would listen to another Doctor giving over a patient to their care. But, would gaining respect in a more mainstream system require assimilating yourself into it?

I think that the real crux of the issue lies in regulating midwives more then licensing them… And the two things go hand in hand. When a state decides to license midwives, they also hand them a set of rules and guidelines to follow in order to keep that license. This becomes a problem for moms like me, mom’s who have more than one c-section in their history and know their best chance at having a normal birth is with a midwife at home. Or, a mom carrying twins. Or a mom past the magic 42 weeks gestation. But, the midwife operating within the confines of her license is sometimes forced to turn away these mothers whether she feels able to help them on their path to a normal pregnancy and birth or not.

So, the midwives with the most freedom to exercise their judgment end up being those in areas where midwifery remains un-regulated. And, assuming that they are in a state where midwifery is not illegal… I would say these midwives might be in a pretty good situation. “But, without a license how will I know she is a competent midwife?” mothers may ask. Talk to her and ask as many questions as you can. Do your homework. Talk to her clients. Look into public record and see if there is anything about her. Ask other midwives in your area their opinion. Be an informed consumer. And I hope if you have to be referred to a physician at any point during your care you will check his credentials the same way.

When I first started researching midwifery I thought that I would want to be licensed, and that I would never practice unless I was. Now, I am starting to feel differently. I don’t think a license will make me a better midwife. And I don’t think that passing an exam to get licensed will teach me anything more than how to pass the exam and get licensed. I am not interested in that. I will do it if I feel it is the right choice, but I am no longer locked into the idea that it will help me or protect me to have a license.

You come to a point when you are learning about midwifery that you realize midwives are really sticking their necks out no matter what their license status is. There is no way to prevent it. And I hope everyone sees that a license is not a guarantee that you are choosing the right midwife. I know that some people are soothed by the license. They feel like it is a way to reassure themselves that the midwife they have chosen is capable. And, there may be some truth to the idea that licensing could weed out some under-qualified midwives… But it might also keep some really great ones from doing things they know are right.

I guess in the end if I get a license (and I just might) I will try to remember that it is only a piece of paper and I am only doing it to get midwifery out there in the mainstream. But, I will not let it dictate my practice. I will not let the fear of losing it keep me from doing what I know is right. And I will remember that some of the organizations making these licenses are still living in the past and using antiquated information to form their standards most of the time.

So, next time you hear a midwife tell you she is not licensed, remember this and ask her why.


Anonymous said...

Salaams: How does insurance work if you're not licensed? I assume you still have to carry it? -- UZ

UmmLayla said...

It depends on the state and if insurance is even available to you. I know that the states that license midwives sometimes also have insurance available to them. And of course Nurse midwives have malpractice insurance... But here in Wyoming that wouldn't help them in a home-birth situation.

I guess the answer is it goes case by case. But, the one thing I have heard strongly recommended is to have a relationship with an attorney who has some experience in the area of home-birth. There is a book about it that I have been saying I was going to get, From Calling to Courtroom.

The sad thing is I have know very well covered and competent midwives who still get sued and still have to pay the bills for the case. The problem is that many times even in states where they do licensing and all that the midwife gets called up on charges of practicing medicine without a license. If you’re lucky it gets thrown out, but it is stressful anyway. I knew a certified nurse midwife who was licensed and registered in CA and also had a PhD and various other unusual qualifications who got sued by a family who she transferred to hospital due to complications and charged by the state with practicing medicine without a license. That's what I mean when I say midwives are pretty much sticking their necks out no matter what.

Anonymous said...

Salaam 'Alaikum

The situation totally sucks and is really frustrating, esp. when you look at how (a) cost effective midwifery is for a healthy pregnancy and (b)... I mean, the whole woman connection thing (ok maybe I'm a little more Earth Mother-y than others). I don't really read parenting / pregnancy type magazines anymore, but I've noticed an increase in features on midwifery. Still, people do look at you like you've got a third head if you're going to a CNM, much less a DEM. -- Umm Zaid

Anonymous said...

Hello Ummlayla

I am glad I found your blog. I am moving to Laramie, WY in 2 months. I am now 1 month pregnant. So far, I was lucky because I thought I would give birth in Maryland (where there is a midwife-managed birth center). But, now that birthing will take place in Laramie, I am concerned about the possibility of finding a midwife and being able to have a homebirth.
If you could guide me with names and contacts of midwives as well as more clearer information on how illegal is the status of midwifery practice in WY, I would greatly appreciate it!! In some websites, midwifery practice is posted as legal in WY as long as they don't conduct prenatal or postpartum care....and according to others it is illegal or is left to interpretation.
Any help will be invaluable!
Please reply to

Iman said...

As Salaamu Alaikoum

I saw you know a lot about midwifes, mashaAllah. I would like to ask you do you know where I could get any info about getting a Muslim midwife for delivery of my baby in Philadelphia area. Does there exist some kind of directory of Muslim midwifes in USA. I would be so happy if you could help me out. I really want my baby to be delivered by Muslim inshaAllah.

Thank you so much and may Allah bless you inshaAllah

Salaam, Iman

Iman said...

again me can u please reply to

thank you