Why is that? “It's the question of the ages,” Ms. Holzer said in an interview. “The doctors all say it's a legal liability. They don't believe [home birth] is safe. But there are lots of studies out there that show that it is safe. I don't think that safety is the question if you take a look at the data out there. A lot of physicians have told us that their insurance companies have actually come out and said that if they back up out-of-hospital practitioners, they will be dropped.”
Physicians tend to be more accepting of nurse-midwives than of those without nursing degrees, Dr. Phelan said, adding that she has worked alongside nurse-midwives for 30 years, has helped train them, and is highly supportive of the use of nurse-midwives in birthing centers and hospitals. Some physicians may have the impression that someone can call herself a midwife after attending a 2-day workshop and participating in a handful of births. In reality, the requirements are more stringent. (See box, previous page.)
Despite the malpractice crisis that is causing many physicians to move away from obstetrics, the number of home births nationwide appears to be holding steady, Ms. Holzer said. “Birth is a natural process, and doesn't need to be interfered with to the extent that it has become in this country,” she added.
“I understand the reason why some women want home births,” Dr. Phelan said. “There is the perception of the rigidity of hospital settings, the unwillingness to have family in attendance, [the concern that] we're going to cut episiotomies, the higher rate of C-section, all of those kinds of things. But I think much of that has changed. … I think more and more hospitals are trying to have a more homelike birth experience with the ability to still provide the current technology and safety.”
ELSEVIER GLOBAL MEDICAL NEWS
Midwife Classifications Defined
A Certified Midwife (CM) is an individual educated in the discipline of midwifery who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. This term also is used in certain states as a designation of certification by the state or midwifery organization.
A Certified Professional Midwife (CPM) is a knowledgeable, skilled, and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings. CMs and CNMs typically practice in hospitals or clinics.
A Certified Nurse-Midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. Unlike CMs or CPMs, CNMs are licensed in all 50 states.
A Direct-Entry Midwife (DEM) is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife typically provides care to healthy women and newborns throughout the childbearing cycle, primarily in out-of-hospital settings.
The term Lay Midwife is used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife, and independent midwife.
A Licensed Midwife (LM) is a midwife who is licensed to practice in a particular jurisdiction (usually a state or province).
Sources: Midwives Alliance of North America; American College of Nurse-Midwives
Licensing Requirements in New Mexico
To be licensed as a direct-entry midwife in New Mexico, an applicant must complete 12 months of theoretical and clinical education at an accredited midwifery school, pass a licensing exam, and show evidence of the following clinical experience:
▸ Observing and managing 40 labors.
▸ Delivering 25 newborns and placentas.
▸ Completing 25 well-women health assessments.
▸ Making 100 prenatal visits with at least 15 different women.
▸ Starting one successful intravenous line.
▸ Performing 30 newborn examinations.
▸ Administering 15 uses of prophylactic eye medications.
▸ Making 30 postpartum visits with mothers and babies within 36 hours of deliveries.
▸ Collecting blood from 15 newborns for metabolic screening.
▸ Performing 15 6-week postpartum and/or yearly physical exams and Pap smears.
▸ Making 30 family planning visits, consultations, and/or referrals.
▸ Observing one neonatal-intensive-care nursery.
▸ Observing one high-risk obstetric-care case.