Licensing, registering and certifying midwives–at what cost?

Many things are said to entice midwives into becoming part of the medical/government/pharmaceutical system. Some compelling arguments that I have been presented with include:

1. Midwives can feminize and change the system from within. We’ll take our herbs, homeopathics and loving care into the hospitals and everyone will see the healing power of midwifery.

2. If we become licensed/regulated, etc., we can work for the very poor who are now unable to access midwifery care.

3. We will be equal colleagues with physicians and will gain their respect. Then, if we need their services, our clients will be treated better and have continuity of midwifery care. We will also be more respected in the community.

These are lofty and tempting goals, especially for women who have chosen a career that is marginalized and abused in Western society. The problem is that these enticements have never been shown to actually come to fruition even years after legalization in government-funded or endorsed practice schemes.

Here in Canada, midwifery has been brought under a government umbrella in four provinces in the last 15 years. What we have seen is:

1. Instead of midwifery softening the “system,” the system has hardened midwives. One example of this regards elective induction.
Prior to regulation, midwives were an alternative for women who were threatened with induction of the birth process at 42 weeks gestation. Immediately after regulation in January, 1998, in the province of British Columbia (BC), midwives began stripping the membranes of homebirth clients at 41 weeks gestational age. The midwives were under threat that their clients would lose the opportunity to have a homebirth. Why? Physicians let midwives know that if they didn’t do things the same way as the doctors, they would not maintain their hospital privileges. When the midwives became regulated, they were told by the government that they would be “autonomous.” However, written into the regulatory legislation is a clause that requires midwifery clients to be seen by a physician before three months of pregnancy.


In addition, each midwife is required to have hospital privileges. Who gives out hospital privileges? Physicians, of course . It was a case of the whale swallowing the minnow. Midwifery can never be autonomous when midwives need doctors to survive and doctors don’t need midwives for their survival. Believing otherwise is simply wishful thinking.

From 1998 to 2005, women in BC were stripped, induced and pushed into the birth process by their registered midwives because the scientific evidence (Cochrane database) showed that was the best management. This aggressive treatment had not been seen previous to 1998 when BC midwives were working independently and underground. Then, in 2002, Dr. Philip Hall of Manitoba published new evidence in the British Journal of Obstetrics and Gynecology regarding the induction of birth at 41 weeks gestational age. The article, entitled “Nonsensus Consensus,” revealed flaws in the large study that was published in 1992 upon which the induction epidemic was based. Midwives in the province of BC had been inducing women with all the horrible results of that (including one homebirth death after membrane stripping) based on erroneous “scientific evidence.”

 

Government funded midwives in B.C. were no longer thinking for themselves. They were no longer doing what women have done to and for others back to the beginning of time. Even now, with the evidence overturned, the policy of the BC College of Midwives is to “offer” induction at 41 weeks gestational age but not “push” it until 43 weeks. This demonstrates how insidious the medical pressure is on government regulated midwives.

2. Midwifery is accessed by women who are smart and economically secure, not poor women. Poor women, for the most part, don’t seem to find out that they could have had a midwife until it’s too late in their pregnancies to obtain one of the limited number of placements. Regulated midwives, few in number, are all booked and the number of clients they can take on is capped (government-mandated), so they do little or no outreach to promote their services to marginalized groups.

3. Although midwives in Canada were enticed by the notion that the abusive patriarchy of big medicine would begin to treat them nicely if they did everything by the medical book, this has not happened. The relationship between doctors and midwives is analogous to a family that has an abusive father and many daughters. Some of the daughters will try to get nearer to Dad in the hope that he will change one day and appreciate all their efforts. Other daughters will move as far away from Dad as possible in order to escape the tyranny. For the ones who stay close, the game is endless and Dad never changes. The abuse may take on different forms and come in new disguises but it is always there because, ultimately, the lie is that the daughters’ job is to somehow parent the insane parent.


With midwifery and “big medicine,” the lie is that obstetrics is scientific, sane and humane. Remember, modern North American obstetrics wiped out breastfeeding, cut episiotomies routinely for 50 years, uses ultrasound routinely, invented the epidural, started the induction and cesarean epidemics, damaged babies with thalidomide and DES, etc., etc., etc. The role of “big medicine” is to get babies out of women’s bodies efficiently, timely and with as large an economic return as possible. Childbirth does not fit nicely into this context. Birth requires a great deal of time and patience to unfold in a healthy way. This dichotomy of structure is the big flaw that permeates the medical birth system. To think that midwifery can change this from within is to relegate midwives to a life of endless frustration.

Outlaw Midwives

We can draw an analogy by comparing the medical birth system to the government education system. The lie in the education system is that a seven-year-old is a broken eight-year-old who needs to be fixed. A real educator in that system will never be able to do his/her work. He/she will have to create an alternative school or support home-schoolers in order to get any job satisfaction and make a difference in the world. Within a system based on a false premise, one can only become frustrated and bitter. This is what has happened to midwives in the province of BC. Midwives are reluctant to apply to work here in B.C. Many registered midwives are continually in-fighting and changing partners and others are off on stress leave and complain of burn-out.

When the medical birth patriarchy is criticized, midwives are quick to point out the existence of very woman-friendly doctors and nurses who do a wonderful job within the existing system. This is well and good but doesn’t take away from the fact that the entire system is flawed and failing. The classic measure of how well an obstetric system is working is the cesarean rate. That rate is constantly creeping higher despite all the good intentions of the “good guys” in the system. That creeping cesarean rate is the “canary in the coal mine,” letting all practitioners know that the end cannot justify the means any longer.

Wanting to be respected and admired is only human. As midwifery strengthens its professional framework, this respect will naturally emerge. Midwifery needs strong, outspoken, autonomous women to articulate a vision of birth with dignity for all women. Unfortunately, such voices tend to belong to women who are “outside the system.” Once women are in a legalized system, they are silenced. They can be coerced to give unnecessary pharmaceuticals to women and babies (oxytocin, erythromicin, vitamin K) and they become good corporate citizens. The real respect and admiration that comes from knowing that you are true to yourself is missing. This can be a terrible price to pay for a piece of paper and a guaranteed pay cheque.

Midwifery is growing and expanding and, as medicine gets worse, more families are opting out of the hospital birth illusion. We see more and more families choosing to give birth unassisted by medical professionals. We’re seeing more celebrities choosing homebirth. The research studies show overwhelmingly that homebirth is safer, more satisfying and less painful than hospital birth. One need not look far for the evidence that midwifery care produces less trauma to mother and baby than physician care.

Since women can give birth by themselves, the right of each woman to choose where, when and with whom she gives birth is the fundamental principle on which any healthy midwifery model is built. Thwarting the growth of the midwifery movement by making it more and more difficult for new midwives to get training and to launch their practices is ridiculous. Instead of constantly knocking the woman off the ladder on the rung below us, we need to reach down and give her a hand up. Training of the new generation is one of the strong suits of the medical profession and midwives would be wise to emulate that desire to multiply colleagues. The future of midwifery rests in the young women who are now working as doulas. This educated group of women is emerging as the midwives of tomorrow and they need all the support and nurturing that practicing midwives can give them so they can be ready to take up the challenge. When midwives focus their time and energy on training the next generation and quit trying to join the dinosaurs that are on their way to extinction, we will find power, respect and joy in our work.

Gloria Lemay was the 2002 Recipient of the Women’s Voice Award, the 2004 Recipient of Waterbirth International’s “Mothers and Midwives” Award, an Advisory Board Member of the International Cesarean Awareness Network (ICAN) and a Contributing Editor for Midwifery Today Magazine.

For more reading on the politics of licensing/registering midwives see:
http://www.compleatmother.com/articles2/gloria_lemay.htm

About gloria

I live and work in Vancouver BC Canada. I've been in the childbirth business for 30 years. I teach midwifery and doula courses both online and in person.
This entry was posted in Homebirth. Bookmark the permalink.

51 Responses to Licensing, registering and certifying midwives–at what cost?

  1. Eydis says:

    Yes, yes, yes! ove that one Gloria!
    You know what, every time I have a chat with midwifery students, they all say the same thing: How shocking and so far away from their dream the work is. They wanted to be with women! Is that to much to ask?

    Fortunately, I’m a doula/cbe.

  2. gloria says:

    When the Ontario midwives regulated, they immediately started using dopplers at every birth. We had not seen that with midwives before. I was talking to a registered m.w. friend in Toronto and said to her “Would you want to have a doppler used on your baby if you were birthing?” She said “Oh, Gloria, if I was having a baby I wouldn’t have an Ontario registered midwife within 500 miles of me.”

    That’s the part I find hard to imagine. Giving my control over to an entity that I wouldn’t be pleased to use myself.

    • Carly says:

      My birthing center in San Diego, CA had that policy, and I had no idea until I was heavily into labor that they are required to take readings every half hour with the doppler. It was difficult to get Anna’s readings with the position that she was in, so I was not allowed to stay in the tub for my excruciating back labor (it was too hard to get the readings as often as required). When I asked if we could just stop taking the constant readings so that I could labor in the water, I was told no, and that it was either get out or be transferred to the hospital.

      I WENT to that birthing center because a homebirth would have been extremely expensive and completely out of pocket, but a certified birthing center was insurance-friendly… Now I see why.

  3. Joyce Vanselow says:

    As a 50 year old doula and midwifery student… I thank you for your words, Gloria. They ring true for me. You always say the things that make me say, “YES!” Keep stirring. Much appreciated.

  4. Marissa Dean says:

    I feel glad as a doula that I have decided not to certify, because this is what I was feeling. That i needed to conform to a system of beliefs that didn’t fit with what I know is safe for women. If a woman chooses to birth at home without a midwife or care giver, and wants a doula, I think I should be there for her. Keep it up Gloria.

  5. Carla HartleyI remember NOT being excited when Canadian midwives were becoming licensed in Florida and my friends calling me later saying” You were right…we created a monstor…we can’t practice for women any more. and when my Canadian friends were becoming “official” and them not liking my predictions…. the outcome would be what it is. Everyone know how I feel about licensing and de-runging and The Big Push…..but nobody articulates it better than Gloria!
    Why why why does anyone think we can offer more women a better service by emulating a profession whose philosophy does not value women or babies or birth and whose intention is to redefine a NORMAL process as a medical one so they can own it.
    I have never for one second understood the rationale of licensing midwives for it is THE TROJAN HORSE. If we buy into the idea that midwives need to be regulated or licensed we not only are saying that midwives can be dangerous and SOMEBODY (guess who?) needs to watch them…..BUT WE ARE SAYING THAT BIRTH IS DANGEROUS AND THAT SOMEBODY OTHER THAN THE MOTHER NEEDS TO BE IN CHARGE!
    It is not midwives’ rights or titles or credentials that really matter…..It is parents’ rights to choose to have anyone or no one. Now I am fired up and will get that Why I am not Pushing blurb up on my blog!

    • Skylark says:

      The truth has been spoken here. This is exactly what regulation is all about:
      Taking choice from women because, yes, they are indeed saying “birth is dangerous and that somebody other than the mother needs to be in charge”

      It is my deepest regret that I did not see how the registered midwife would capitulate to every suggestion made by an OB in hospital and disregard my wishes, my birth plan and my dreams because “she had to, she had no choice, she had to practice within the law…” Well, that is what she tells herself……..

  6. eeks that did not work right….not canadian midwives becoming licensed in Florida….

  7. janet says:

    Oh Gloria I’m weeping because I know what you’re saying is true and I’m watching women and midwives walking into the jaws of the beast here right now and calling it “babysteps”. 10 years ago in Australia midwives had insurance, visiting rights, relative autonomy of practice. Governments have stripped midwives of this and are handing back carefully sculpted crumbs which cause choking upon swallowing and yet so many of us are choking them down with the arsenic chaser and crying “It’s ok to sacrifice the homebirthers! Homebirth isn’t lost, we’ll even have insurance and be registered woohoo!” Meanwhile those of us who aren’t scared to look misogyny in the face can see what’s really happening and how women are being sold out for the false promise of respectability for some handpicked medwives. If only I could explain what that respectability really costs. Maybe your blog entry will help. Much love from Downunder. J x

  8. Dear Gloria,
    I read your anti-licensure blog after seeing a link from the Citizens for Midwifery blogspot. Having read it, I must respectfully disagree with your assessment. You are writing about regulation from the perspective of the midwife, which is really the wrong end of the lens. The reason why midwives should be licensed and certified is because consumers deserve to have access to midwives who are licensed, certified, and regulated. Consumers deserve something better than a black market underground market when they seek a midwife. Consumers should be able to find a midwife in the yellow pages, if that’s what they want, not because they “know someone” to learn who and where a midwife is by word of mouth. A woman shouldn’t have to be afraid that her midwife will be arrested or shut down by a cease and desist order a couple of weeks before she gives birth. A woman shouldn’t have to worry that she will be called to testify for or against her midwife in a trial or be subjected to investigators’ questions or being reported to the child welfare authorities for using an unlicensed provider to give birth.
    In no other profession does one see this innately selfish view of licensure — no one questions that docs or nurses or chiropractors or lawyers or plumbers or manicurists should be licensed and regulated by the state. The primary reason for licensure in each of these professions is to protect the consumer. There is no intrinsic reason why midwives should be exempt.
    I am a member, Gloria, of the Canadian Maternity Care Discussion Group. From everything I have read on that list, and from the two recent studies published about midwife-attended births in, respectively, British Columbia and Ontario, midwives and their clients are functioning pretty well within the system and Canadian physicians are far more collegial than US docs. Midwife clients in Canada appear to have more options, as well.
    Those who read this blog should be aware that Citizens for Midwifery is one of the national association members of the Big Push for Midwives and fully supports licensure of CPMs. Obviously, principles of free speech support making blogspots available to those with dissenting views. But make no mistake, in the U.S. we are progressing toward licensure of CPMs in every state.
    Those midwives who choose to operate outside the law are no worse off and, in most cases, are actually much better off, in a state where midwives are licensed. That’s because unlicensed midwives in states without licensure are subject to arrest and prosecution for the unlawful practice of medicine or nursing, whereas unlicensed midwives in a state where midwives ARE licensed are seldom bothered. If they do come to the attention of the midwifery board, our experience in the US has been that they are not charged criminally and the penalties are light.
    We invite everyone who reads this blog to come visit the Big Push for Midwives website and find out the latest exciting news about midwifery in the US.

    • paule says:

      This is very interesting. I haven’t really read any compelling comment defending the licensing of midwives in your post in regards to the WOMEN. First off, perhaps a definition of “license” would be appropriate (i should look in my black law dictionary, but for the ease of your reading, i will use wikipedia, which is accessible to all):

      The verb license or grant licence means to give permission. The noun license (American English) or licence (British English) refers to that permission as well as to the document recording that permission.
      A license may be granted by a party (“licensor”) to another party (“licensee”) as an element of an agreement between those parties. A shorthand definition of a license is “an authorization (by the licensor) to use the licensed material (by the licensee).”
      In particular a license may be issued by authorities, to allow an activity that would otherwise be forbidden. It may require paying a fee and/or proving a capability. The requirement may also serve to keep the authorities informed on a type of activity, and to give them the opportunity to set conditions and limitations.

      Do you see the problem yet? A license is a CONTRACT between an entity (a corporate government, in this case) and a LEGAL FICTION (name of a flesh and blood in ALL CAPS). (Yikes. I probably went over your head here. Apologies) Where is the woman in all this? And who sees to her interest? Is a license insuring the STATE (or PROVINCE)’s interests ~ or the parents and child?

      My main concern, as a mother, would be that my midwife can serve me in MY terms, and is loyal to ME, not to a third party (the STATE or an insurance company). Not a third party to creates UNSAFE regulations (use of ultrasound and doppler) and negates my RIGHT to birth in freedom.

      Now, is this selfish? It feels to me that “A woman shouldn’t have to be afraid that her midwife will be arrested or shut down by a cease and desist order a couple of weeks before she gives birth. A woman shouldn’t have to worry that she will be called to testify for or against her midwife in a trial or be subjected to investigators’ questions or being reported to the child welfare authorities for using an unlicensed provider to give birth.” No one has EVER forced a mother to worry about her midwife. The truth is some women who are REALLY informed and are aware of the impacts of licensure on midwifery are CHOOSING this path. Because this is what freedom is: CHOOSING WHOM i will birth with ~ including the option of having NO ONE.

      “no one questions that docs or nurses or chiropractors or lawyers or plumbers or manicurists should be licensed and regulated by the state.” FALSE. if no one else, i do.

      When you write: “The primary reason for licensure in each of these professions is to protect the consumer. There is no intrinsic reason why midwives should be exempt” it is a great example of where midwifery licensure has FAILED: there are very bad licensed midwives and very good unlicensed midwives. And as Gloria explains so well, the only individuals that licensure has protected is the midwives themselves. For midwives, yes, licensure has the convenience of not being bothered by the law; of doing things according to the directions of a corporate government who loves to get more money and control the chattel. Now, tell me: who is selfish?

      Women have served women in freedom for thousands of year, and as a mother, I know deep down that they will continue to do so ~ regardless of your need for licensure.

      • Gwen Posey says:

        Ummmm WOW… Well said. I especially like the part where it becomes clear the a Licensed midwife serves the state and not the woman.

        I have been “on the fence” about getting my CPM for many yrs. I have 83 births under my belt. Only 10 count towards my NARMS. I am getting frustrated. I have been studying off and on for 8 yrs and have made very little progress towards pleasing the powers that be…

        I fear the law. I also wonder how a Lay midwife gets clients.

        I have children and I don’t want to be put in prison for the rest of my life. But I am very clear the a CPM doesn’t protect me from that, it may even put a target on my head.

        I am interested in this debate. Please comment.

        Gwen

  9. gloria says:

    Thanks for commenting, Susan. We do have diametrically opposing views on licensing. I gag when I hear “protection of the public”. Professional bodies do not protect the public, they protect the professionals. If they did protect the public, midwives wouldn’t be injecting every baby with Vitamin K and doctors wouldn’t be mutilating the genitals of 50 percent of the baby boys in the U.S.A. Let’s not be completely ridiculous. Licensing is giving money over to a protection racket and, if you want to hear it from a physician’s point of view, buy a copy of Medical Mafia by Guylaine Lanctot, M.D.

    Thanks for calling me selfish, too. That’s the big boogey-man word for professional caregivers—someone might call them selfish and that is the worst sin of all. Well, not in my world. A far greater sin in my estimation is doing to another woman what I wouldn’t do to my own daughter.

  10. Laureen says:

    Heya!

    Frankly, I don’t trust the government, right along with not trusting a lot of midwives either. I don’t think licensure will protect anyone, any more than I think that access to a midwife will (having been sold down the river to a cesarean by a team of MedWives).

    But I agree with Susan; women need to be able to find providers without having to be in the network or in the know. And *that* is precisely why I am doing everything I can to get them online. I live for the day that a birthing woman can hop on Google and find every single care provider in her neighborhood, and be able to really, truly choose, without having to navigate some kind of bizarre social hazing maneuver led either by the insurance companies or the insular and xenophobic birth community.

    The Internet provides the closest thing we’re ever going to have to true autonomy in choice.

  11. Susan Jenkins seems to think the mere ACT of regulating and certifying anything guarantees a desired outcome. Reminds me of my parents’ and grandparents’ generation, who believed that a medical doctor could do no wrong, let alone walk on water. If that guarantee were true, there wouldn’t be such a word as iatrogenesis, nor thalidomide babies. (http://en.wikipedia.org/wiki/Iatrogenesis). There also wouldn’t be a pharmaceutical lobby that has a stranglehold on the medical model, financially, politically and spiritually. Ms Jenkins also implies that some one put in jail is automatically guilty. Tell that to Steven Truscott, Nelson Mandela, Betty Krawczyk, Harriet Nahanee, to name a few. Ms Jenkins, with all respect, seems to fear ‘unregulated’ midwives. This is part of a belief system that sees the world through a microscope and believes life is a science and everything can be controlled. Pass the forceps, nurse please. The certified and regulated attending doctor told my mother women don’t have enough milk for twins, so she shouldn’t even think about breastfeeding. The tragedy, more than the male lies promulgated about breast feeding, was that women didn’t feel they had the authority to question the ‘certified and regulated’, which seems to be true for Ms Jenkins. I am SURE she means well, I am, but her clients and their babies would do a lot better if she did her homework around the myriad of certified and regulated medically sanctioned interferences a birthing woman must deal with in a hospital, rather than missplacing her loyalities with a professional body and its belief system, which reek of selfishness, myopia, both of which perhaps conceal a fear that life just may be an art, and not a science. Regulate and certify all you want Ms Jenkins, but don’t buy into the medical model that simply does not understand the nature of childbirth. see: http://www.youtube.com/watch?v=siLbqthiTWo

  12. janet says:

    “The reason why midwives should be licensed and certified is because consumers deserve to have access to midwives who are licensed, certified, and regulated. Consumers deserve something better than a black market underground market when they seek a midwife. Consumers should be able to find a midwife in the yellow pages, if that’s what they want, not because they “know someone” to learn who and where a midwife is by word of mouth. A woman shouldn’t have to be afraid that her midwife will be arrested or shut down by a cease and desist order a couple of weeks before she gives birth. A woman shouldn’t have to worry that she will be called to testify for or against her midwife in a trial or be subjected to investigators’ questions or being reported to the child welfare authorities for using an unlicensed provider to give birth.”

    You seem to be wildly misinformed about what regulation of midwifery by obstetric rules means. I’m a consumer, I want a midwife who does what I say and not what the licensing body says. In Australia, the more licensing bodies get a foothold the more women are dumped by midwives for not meeting the “guidelines” set by the licensing bodies and it’s justified as keeping women safe from themselves. More women are reported to social services by those midwives and by hospital staff because they beliee themselves to be empowered so to do by the sort of rubbish you’re suggesting. What tosh.

    Regulation serves medicalised careproviders, not women, how can you not see that?

    When we regulate midwifery practice we immediately remove the right of women to oversee their own healthcare. We put in place paternalistic rules to override women’s own rights to _basic autonomy_ and we privilege the rights of careproviders of all kinds over the rights of women to freely choose who they want attending them in birth. No way will most Australian women be able to access state-run homebirth. Have you seen the rules?? Apart from totally removing the right of women to choose for ourselves, a pretty basic right, these rules also open the way to the personhood of the foetus as staff are instructed to treat woman and in utero foetus as separate beings and staff are empowered thus to force women into hospitals, surgeries, deny them care, remove the baby once it’s born, vaccinate or otherwise interfere with the baby despite the wishes of the parents.

    This is what regulation brings, not some fluffy lovely world. I don’t need to be protected, thanks, I can ask a midwife what skills and qualifications she has for myself. I can ask her for the names of other clients, how many years she’s worked, what articles she’s written, her attitudes to pointy issues in birth to see if they match up with MINE not a faceless regulatory institution. If I wanted a faceless institution I’d birth in hospital! My desire for MY birth means I and I alone make the decisions about MY body, thanks very much. I don’t need some paternalistic regulatory body stacked with surgeons interfering in my birth, my relationship with my careprovider, or anything else in my life.

    Only women would be expected to roll over and be good when state-run authorities started dictating the terms under which we’re allowed to use our bodies. We have lobby groups in Australia who labour under this misconception too and it’s a tribute to the power of patriarchy and the surgical discourse that you all have such an astonishingly limited notion of women’s human rights. With friends like this we may as well lie down and submit to the nice doctors without a second thought.

    No one makes decisions about my body, my birth or my babies but me. End of story.

  13. Marissa Dean says:

    I haven’t read all the comments, so I am not sure if this has been said or not. Alberta midwives were funded in April of this year, and somethings have changed since it happened. One thing that scares me is that they no longer can accept patients who are having twins. They used to share the responsiblity with a doctor, but now that the province is funding them, they won’t pay for 2 care providers for 1 patient. I think that is just the begginning. I don’t even know what else is changing.

  14. janet says:

    http://www.homebirth.net.au/2009/09/australian-college-of-midwives-draft.html The draft statement from our college of midwives in Australia. Truly appalling. Nothing woman-centred about this at all just a lot of arse covering and surgeon worship.

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  17. Diane says:

    Wow. Just wow.

    I agree with Gloria. And it chaps my hide every time I get forwarded an email from MAMA or the Big Push or whoever about how they are working for “federal recognition” here in the states.

    I am a certified professional midwife and I am licensed in the state of Texas. My CPM means more to me than my license. My CPM is certification by NARM that verifies that I have completed a course of study and passed a thorough exam. This gives the consumer confidence that I have at the very least been thoroughly trained. Does it guarantee that I am a good midwife who practices safely? Of course not.

    My license, on the other hand, only duplicates what NARM has already verified, and allows the state to charge me a $250 “occupation” tax each year to practice as a midwife. La-ti-frickin-da.

    I don’t want to be federally recognized, thank you very much. And I have been told that I should support federal recognition of midwives for those midwives who have birth centers and/or who want medicaid and insurance companies to reimburse them for their services. I should do it to help my “sister midwives.”

    Nope. You said it right, Gloria: “the end cannot justify the means…”

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  19. janel says:

    What about the baby? While all of this fighting goes on?

  20. gloria says:

    Well, Janet, we do our best to engage the baby in the fight by wacking the cord off, drying vigorously with rough towels, shining bright lights in the eyes, poking things up the nose and down the throat, etc. but the little bleeders won’t fight back so we wrap them like a burrito and stick them in the hot box. Thanks for asking.

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  22. Amy says:

    Midwives are licensed and publicly funded in Manitoba. When I got pregnant with my son (my first) I knew I wanted to give birth at home. I ‘applied’ for midwifery care (gotta’ love that – public health care makes it ‘fair’ for everyone, right? Makes health care ‘accessible’ for everyone, right?) when I was 5 weeks pregnant (from LMP, so I’d known for all of a week since I have a long cycle). I was promptly turned down. After a lot of pressure from me I was given a few reasons:

    1) I was a primip – I hadn’t ‘proved’ I could birth, even though I was ‘low risk’ (27 years old, healthy, average weight/build, no pre-existing health conditions, etc). I love this one because it’s like they’re saying, “No, no, honey. You have to have at least one really bad, over-managed hospital birth FIRST and then, if you and your baby manage to make it through that relatively unscathed (i.e. by some miracle of fate, you end up still having a vaginal birth) then – and only then – will we consider you a viable candidate for midwifery care. That’s how the system works, dear, and we’re all just working within the system.”

    2) I didn’t classify as ‘low-income’ (to meet this you have to live below the poverty line) or as a ‘minority group’ – midwives in Manitoba must have FIFTY PERCENT of their clientele come from these groups, despite the fact that the service is PUBLICLY FUNDED.

    3) And this is the real bottom line, too. The month was already full. Yep, I call in within a week of seeing that little plus sign on a stick and the period coming nearly 10 months later was already booked up for all the midwives. Again, good thing we have publicly funded midwifery care so it can be fair for everyone (I certainly hope everyone’s noticing the sarcasm dripping from those words – I haven’t had much faith in our system since I watched my mother spend months and months getting weaker and weaker, nearly bleeding to death while she sat on the waiting list for an emergency hysterectomy, though). It was at this time that the gal on the phone whispered that it was pretty much impossible to get midwifery care in Manitoba unless you were of the aforementioned groups or “knew someone” who could “get you in”. She consoled me by saying the rooms at the hospital were ‘homey’ and that she would send me a little card in the mail that I could send to the Minister of Health, saying we need more midwives in Manitoba (postage paid, of course).

    I told my husband I intended to have our baby in the comfort of my own home, regardless of what some stupid bureaucrats had devised. I started researching and didn’t stop until my son was born. When I got that stupid card in the mail I took a big red sharpie and wrote over the form letter on the back of it, “I intend to give birth at home – alone – without a medical professional, because the system I pay into cannot provide me with the care I deserve. If something should go amiss I will hold the public health care system solely responsible for leaving me no choice in my birth.” My son was born on the mattress we sleep on still, at home, into his father’s hands, with no one there but his father and me, unassisted.

    Though I feel unassisted birth was the right path for us and will do it again if/when I am blessed with another child, I wouldn’t have even considered it had I not been turned down for publicly funded and regulated midwifery care. Licensing and government control always (yes, ALWAYS) lead to more trouble than good in my opinion. I don’t care what the intentions of the proposals are, the outcomes are what counts. Government involvement in birth does no good and HURTS WOMEN.

    My right to birth how and where I desire is just that, a RIGHT. I am entitled to personal autonomy and public health care, in particular, has blurred those lines, to say the least.

  23. Catherine says:

    Amy has eloquently expressed the dilemma of the consumer under the new regimented-midwifery system, and I think she has thoroughly refuted Susan’s position. I just want to add my 2c worth regarding my perspective on the Ontario history.

    I had 3 home births with unregistered midwives in Ontario between 1980 and 1989. The first one was overseen by a doctor, and as a primipara I was required to have an ultrasound “to check pelvic size”. For all the good that did (actually, the child’s evident extreme discomfort with the procedure did do some good, by encouraging me not to have any more if at all possible!). Shortly after our third child was born, midwifery was legalized and regulated. Suddenly I found that I was no longer a candidate for homebirth, as an “elderly” 35 year old – because “the midwives would lose their hospital privileges if they allowed it”. To say I felt betrayed would be putting it mildly.

    In the end, it was a moot point as I went into perimenopause prematurely and never had another full-term pregnancy. Although deeply disappointed, I was also somewhat relieved at not having to get into a struggle with the medical system. Another struggle. I feel that my “pioneer” homebirths were personally rewarding, but politically pointless.

    • Diana says:

      I have been to a couple of births with new Midwives, my role models being Gloria Lemay and Ina May Gaskin, all I can say is this new model should be called “MED Wives “.

  24. darkdaughta says:

    Thank you for this post. It highlights, in really plain english, the problems with certification. My only difficulty is in this next quoted passage that I wanted to draw to your attention: “Midwifery is accessed by women who are smart and economically secure, not poor women.”

    For me it reads like: Wimmin who are economically secure are smart and wimmin who are poor cannot also be smart.

    Wimmin who are well off financially might have access to more or better education but this does not make them smarter. In fact, some might actually say the reverse, that the more they are formally educated, the more they lose touch with their inner wisdom.

    In any case I’m sure you didn’t mean to position these two groupings of wimmin in this way and it in no way changes the veracity of your statement about who access midwifery before certification and who gets to access it more often now.

    Thank you for existing and for resisting. You are a beacon and an example. Be well.

  25. gloria says:

    Oh, thanks for pointing out how that lands, I didn’t intend that interpretation. I was thinking more of the economically secure women who dutifully follow their obstetrician right down cesarean road and then, after say “How could I have been so dumb!” I need to make that qualifier, too, that all women can make some pretty dumb moves but it doesn’t mean we don’t have intelligence. We simply make mistakes, trust something that’s untrustworthy, do better when we know better, etc, etc.

    When a woman is under severe economic stress in pregnancy, worried about the rent and putting groceries on the table, often it’s a low priority to be taking steps to design a really satisfying, beautiful birth experience with a midwife.

    I agree with you that my choice of words could be better since the “smart” part of it was actually pertaining more to “being adept at working the system”. Thanks. Gloria

  26. Melissa says:

    “This is what regulation brings, not some fluffy lovely world. I don’t need to be protected, thanks, I can ask a midwife what skills and qualifications she has for myself. I can ask her for the names of other clients, how many years she’s worked, what articles she’s written, her attitudes to pointy issues in birth to see if they match up with MINE not a faceless regulatory institution. If I wanted a faceless institution I’d birth in hospital!”

    YES, YES, YES!! Women are NOT stupid. I’d prefer to decide for myself whether or not someone is qualified to be MY midwife…I could give two shits about what the state says. I don’t know a single licensed midwife in my state who I’d choose to be at the birth of my children…and I know some lovely midwives! But once they sign that piece of paper, their hands are tied, and the state then gets its nasty little hands on the bodies of women and babies.

    I see first hand what my state does to licensed midwives. It feeds them a bunch of bullshit laws and scares the crap out of them, forcing them to refuse care to normal, healthy women simply because the “risk factor” is too high to receive midwifery care. Midwives, also, are NOT stupid. I don’t know a single midwife (licensed or not) who would willingly risk a life if indeed a mother was not healthy enough for midwifery care…”risk factors” do nothing but prevent otherwise healthy women from receiving truly mother-baby-centered care.

    Gloria, we have the same “natural induction” issue going on here in my state, too. It’s absolutely sickening.

    And you are right about one thing, Susan…consumers should be able to find midwives listed in the phone book. ALL midwives: licensed, regulated, and the “black market underground” midwife. I strongly believe in women’s choice, and that includes the choice to have WHOEVER they want at their birth–not only those whom are “allowed” by the state to practice.

    As for me? I’ll take a black market underground midwife with 30+ years experience who trusts the birth process over a bushy-tailed, bright-eyed, fresh MEAC graduate with a shiny piece of paper whom the state has scared shitless.

  27. Lisa says:

    I’ve wanted for years to be a midwife. The complete lack of ways to train here in Alberta has had me stymied for years, but the requirements to be registered made me give up entirely. I’ve studied birth for nearly 9 years & I feel now like it’s a complete waste. Yeah, I could just call myself a TBA & start attending births, but I know I need experience…which I can’t get now.

  28. Pingback: Midwifery Politics « Musings of a Modern Doula

  29. Rachel J says:

    Thank you Gloria. I SO appreciate how outspoken you are about this. I would never choose a licensed midwife, how could I possibly become what I refuse to use?

  30. Gloria, I need to meet you in person!!! I just wrote a post on why I don’t certify as a doula with DONA or register with the DSA. I think Power To Push is an impressive movement because it is working towards improving birth on a hospital level… for women who are planning hospital births for whatever reason, Power To Push is a good resource. However, I still think midwives and out-of-hospital are best and what we really need to be educating women about. And totally agree about the “hardening” of midwives…. I’ve been back and forth on applying to UBC’s midwifery program, but hestitating deeply because I don’t feel aligned with their training or practice model…. way to medical! Ay.

    Love your posts!

  31. Angie E says:

    Love this and feel so blessed to have stumbled into Trust Birth with Carla Hartley and you and so many other wise women in ’08! All this “licenses protect the women” rhetoric implies that women are not intelligent enough to make an educated decision about with whom (or not) to birth.
    PS – i wish all women and birth workers would go to the Trust Birth conference in Nashville TN, April 2012!

  32. Chloe says:

    I love your quote Gloria …”Since women can give birth by themselves, the right of each woman to choose where, when and with whom she gives birth is the fundamental principle on which any healthy midwifery model is built.”

    I am saddened by the news of countries or states where midwifery regulation is overly restrictive and has reduced choices for mothers, or curtailed a midwife’s autonomy or scope of practice. In every location, supporters of normal birth should work towards a situation where midwives can be truly autonomous and practice the full scope of their profession (according to their training and experience), and where consumers can have access to midwives in their preferred birth setting. Maybe for some regions, it is necessary to work towards improving or abolishing current regulations that are too onerous; maybe for other areas, it is necessary to work towards creating regulations where midwifery can thrive and meet the needs of their clients.

    I birthed my first child in Alabama where my midwife attended my birth illegally. After she was prosecuted, she moved her practice to Tennessee where she was able to get a midwifery license. I birthed my second child in a rental house just over the Tennessee state line, one of many Alabama families making the “run for the border” to receive midwifery care. I then went on to apprentice with her for four years to become a midwife myself. Unlike your situation in Canada, we found the Tennessee regulations were not a barrier to autonomy or scope of practice. As Diane mentioned above, it was annoying for my midwife to have to pay a licensing fee to be legal, but she did have better reception during hospital transports and also some of her clients’ insurance policies even paid for a portion of their bill.

    As long as midwives can be prosecuted just for attending a home birth, midwifery as a profession cannot grow and meets the needs of our families. To gain licensure for CPMs in Alabama would result in expanding birth options for Alabama families. I am thankful for groups like the Big Push that offer support for our efforts while still respecting the autonomy of local consumers and midwives in charting the best course to meet our needs.

  33. I lived in BC when I was pregnant with my first son, 11 years ago. This was at the time when BC had just instituted registered midwifery, and I was so thrilled that I could get a midwife for free, covered under the BC medical system. Yay! I quickly realized after a couple of meetings with my registered midwife, that something was wrong: She hadn’t “heard” me, when I told her that under no circumstances would I be having an ultrasound, and she demurred when I told her I would not be induced–not at 42 weeks, and not ever. It occurred to me that she was not working for me, but for the college of physicians and surgeons (or the newly formed college of midwifery). So I politely fired her, and hired the best Traditional Birth Attendant (Traditional midwife) *in the world*. Despite having been repeatedly harassed by the BC college of midwives for the duration of that pregnancy (phone calls, threats, and admonishments that my baby would probably end up dead), I had the *perfect* home waterbirth, and I went on to give birth at home on three subsequent occasions, the last two of which were unassisted, and entirely blissful. I am now pregnant with my fifth child, who will also be born at home, unassisted. THANK YOU GLORIA! xoxoxoxoxo

    • Skylark says:

      http://www.birthtakesavillage.com/no-have-to-in-childbirth/

      I honestly believe that the key to normalizing childbirth is the education of women and girls. I thought the above article by Jessica Austin says it all. Why do women believe they “have to”? Why do we believe it’s up to someone else to make decisions for us? The only real reason is FEAR. Fear that is sold to us, marketed to us, propagated at every turn in media and by the medical field in general.

      Here’s to what women want and have a right to, and what they have a right to know about themselves, their bodies and birth.

  34. (This was originally a response to a criticism of Gloria’s article above, after I posted the article on fb) Many women feel that birth is emphatically NOT a medical event, but rather a NORMAL biological process. It is only extremely recently that medicalized, hospital birth has become a “standard”. And this shift away from women attending women during birth occurred NOT because so many babies and mothers were dying during childbirth (yes, of course this did happen, and continues to happen in the hospital and at home, and will continue to happen until the end of time) but because the medical community saw an untapped opportunity for income and control. The word midwifery means, simply “with woman”. Unregulated midwifery is the world’s oldest profession, and we, as a species, have successfully replicated without medical help for orders of magnitude longer than the North America hospital birth model has been standard. While regulation is a great idea when it comes to banks, Traditional Midwifery has an inherently successful internal regulatory system: Women talk to one another. I have lived in BC and New Brunswick, and within the natural birthing communities in these provinces (and everywhere else) there is a high degree of detailed communication between women (and now thanks to the internet and social networking, this is even more the case). Any traditional midwife who is lacking skills, knowledge, or integrity will quickly find herself without clients. I cannot imagine why anyone would find the implications of Gloria Lemay ‘s article insulting. I find registration and legislation of midwifery *highly* insulting for the following reason: forced regulation, by criminalizing lay midwifery, implies that women are not intelligent or knowledgeable or responsible enough to choose the birth attendant of their choice. Every pregnant woman cares *deeply* about her unborn child: this is part of our biological makeup as mammals. Most pregnant women, however, decide to go to the hospital to give birth, and may not give the issue much more thought than this (despite the fact that much of what happens to birthing women and babies in the hospital is dangerous and risky and harmful). On the other hand, women who choose to give birth at home with an alternative care provider, *agonize* over the decsion of whom to hire to attend their births, in order to make sure that they have chosen someone who will be able to offer them the kind of care that they want and need. That said, in my own case, I would *never* assume that anyone–no doctor, no nurse, no midwife, registered, or not–bears the responsibility for my life, or the life of my baby. This is my job, as a mother. Eleven years ago, when I was pregnant with my first child, regulated midwifery, in BC, had just been passed. I had decided before that, that I definitely did NOT want to be in the hospital to give birth, so I thought, “yay! the medical system will pay for my midwife! fabulous!” and I hired a registered midwife. It quickly became clear that this midwife did NOT work for me, but rather for the BC college of physicians and surgeons. Because of the detailed stipulations around how she had to practice if she wanted to retain her license, she was forced to push the same diagnostic testing procedures on her clients, that are used at the hospital. Finally, after she attempted on several occasions to bully me into having an ultrasound, and to agreeing to an induction if my pregnancy continued beyond 41 weeks, I fired her, and hired a non-registered traditional midwife. I paid this wonderful woman what amounted to a lot of money (to me), and it was the best decision I ever made. I ended up giving birth at 42 weeks of pregnancy, after a 20 hour birth process, and it was absolutely perfect, peaceful, wonderful and enlightening in every way. I believe strongly that every woman should have the right to give birth where and with whom she feels most comfortable. For those women who want a medical birth, there are ample resources and opportunities for them to get what they want. For women who want an intervention-free homebirth, hiring a registered midwife may end up being highly disappointing.

  35. Viviana says:

    Hear, hear sister… it is so true.

    When I got pregnant I expected my experience of birth to be amazing as I chose to do so with a midwife.

    As my pregnancy went on and I was talking about my home birth plans, my midwife student during an early visit persuaded me to do a scan to check for abnormalities in the heart etc. The scan ended up showing a placenta that was both Fundal and low lying….

    I was told I have no choice but to go in for another scan to verify the findings. Despite the fact that my main midwife clearly believes this finding to be false. I have no signs that my placenta is anywhere but high. Not to mention I have told them several times now that my scan probably was picking up the two polyps I have lying at the opening of my uterus. …. so frustrating as I had thought midwives would be more supportive of natural care and less intervention. I had wanted no scans for this pregnancy and now am having to have 2.

    But alas the medical world has invaded the midwifery one and I am sitting in better care than I would if I was with a doctor but not the midwifery care I had hoped to sign up for…..

    I wonder how many people will opt for a more dangerous unassisted home birth if midwifery continues to become more medical?

  36. Jill says:

    Yo Gloria… I got a vagina … I dare the state or anyone else say how and when I can use my equipment….

    ILY and I have watched your fight fot 15 + years…

    Yes, I have watched and I am stronger because of you and of Carla – I was speaking the truth long before I knew it was not just MY truth… for that I am despised… its okay when you ain’t got nothin’ you ain’t got nothin to lose…

  37. Holly says:

    Hi Gloria! I have a question!!! Hoping you can help me find a midwife who WILL take me on!
    The trouble I am having is that in Ontario Canada it appears midwives are not allowed to care for a high risk pregnancy….. My pregnancies are not high risk themselves but it is my pre-existing medical conditions that place them at high risk. I am a type 1 insulin dependant diabetic with 2 previous c sections who wishes to have an au natural vaginal birthing experience-no fetal monitoring, or at least not continuous and no epidural as I need to be able to walk off or move around when needed.
    There are 2 local midwifery services in my area and both have denied taking me on due to my health history-I AM HEALTHY-diabetes is in very good control, I am in good shape, I am active and I see no reason why I should have to face a joke of a trail labour in hospital only to go on to be cut yet again-Please help!
    Thank you!
    H

  38. Trina Fournier says:

    Amen! Wonderful article. Thank you.

  39. Stephanie says:

    I saw this firsthand in Alberta. I had one of those “good”, hands off doctors who let me skip anything routine, but had to move 13 days before my due date. By some miracle i got into the shared care maternity program in Spruce Grove, even without a ton of documentation from my doctor. Had a wonderful, 15 min LeBoyer birth, quiet, in the dim light and my first waterbirth (my fifth child). Two years later i was pg again, but was told (by the same midwife) that there were no exceptions, i would have to jump through all the same hoops i had tried to avoid (due to a previous traumatic birth). Peeing in a cup, weighing, the regular schedule of visits (bringing my 9,7,5,3, and 1 yo for the 45 min one way drive to their town). Everything was exactly the same as a regular doctor.
    After the beautiful waterbirth, she had said “you could have done that at home!” We chose to believe her, and went without midwifery or doctor care ( there were no doctors in my isolated rural village who would deliver a baby, but that’s another issue), and delivered our sixth baby in water, in our living room next to the wood stove. And our seventh baby, and our eighth baby.
    We live on one income, and i have given up on being able to afford the 5000$ for a traditional midwife, but regulating it meant only that i could now “afford” something else i didn’t want :( .

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