Thirteen years ago, when I first had the inklings that I wanted to become a midwife, I was gung-ho about getting my Certified Professional Midwife (CPM) certificate, papering up with a license and simply catching babies. Oh how young and idealistic I was back then.
Then, a few years later, while I was working under an amazing midwife as an apprentice, my ideals started to change. I started to notice that licensure was limiting so many options for families. Women were getting squeezed out of the regulated realm of “normal, low-risk pregnancy and birth”, simply for gestating longer than average, having a scar on her uterus, or being considered too old, too fat or having had too many babies. This put me against licensure altogether. Vehemently.
I became one of those women that was affected by midwifery rules, regulations, statutes, and laws. My 5th baby was born, in hospital via emergency c-section, after transferring for a serious complication, but that’s a story for another blog post.
When I became pregnant with my 6th baby, my world of options changed. Drastically. Because I now had a scarred uterus, I was not allowed a homebirth with a licensed midwife. Never mind that I had birthed vaginally 4 times prior with no complications. I was now in a place of having to either choose to VBAC in the hospital, finding and hiring an unlicensed Traditional Midwife, or going unassisted. The traditional midwives, while I loved the two that I knew of in the state I was in, had their own protocols for VBAC, which was fine, but not all of them I wanted to undergo.
Going unassisted, while a very viable choice for many, was not something I was quite comfortable with. I really wanted a supporting amazing team to surround me and lift me in love while I birthed my baby. I wanted women there, who knew what they were about and trusted birth. For myself and my Mate. He was understandably gun-shy about going unassisted.
Long story short, we moved states, I found a wonderful friend that was a Traditional Midwife in my new state, and went on to have a beautiful home water birth. A VBAC.
In the state we moved to, midwifery licensure was voluntary. Licensed midwives had their rules and regulations to adhere to, and those that were risked out of licensed midwifery care HAD OPTIONS. Choose an OB or hospital based midwife and birth in the hospital, choose a Traditional Midwife and continue with plans to birth at home, or choose to birth unassisted and birth at home. OPTIONS!!
In 2015, that traditional midwife option was close to being lost. Thankfully, it wasn’t lost, but the new rules and regulations governing Midwifery in Oregon made it harder for families to find Traditional Midwives. The new laws that Oregon passed, made midwifery licensure mandatory, with an exception for traditional midwives. In Oregon, Traditional Midwives can file birth certificates. What they cannot do is:
*Advertise, which includes any kind of website or listing that includes their skills, services, and educational qualifications.
*Carry Legend Drugs and Devices, which includes antihemorrhagic medications, lidocaine for suturing perineal, vulvar, and vaginal tears or lacerations, or oxygen.
*Traditional Midwives are also required to give an “informed consent and transport plans” form to each of her clients. One that was prepared and approved of by the state. (Front and back of form below)
As you can see, this required form has some fearmongering going on, and requires Traditiinal Midwives to virtually advertise for licensed midwives.
Now for the meat and bones of this post…
I. Am. Not. Against. Midwifery. Licensure! What I am against, is mandatory midwifery licensure. I am vehemently against limiting the options of families to choose where, how, and with whom to birth. Period!
WHAT!!! You may ask? How is this Traditional Midwife for licensure??!!
I am for OPTIONS!
Some women want that piece of paper that states that her midwife has been evaluated by the state. Some women want to birth in the hospital with all the bells and whistles. Some women want an elective cesarean section. Some women want to birth with a traditional midwife, and some women to birth with no one present but their families, if anyone at all.
All of these options are relevant, and all of these options should be available to the families who choose them.
I want to see ALL maternity care providers to realize that we are really on the same team. Serving women who are birthing babies.
It’s not a competition. It’s not about who does better than whom. IT IS ABOUT THE FAMILIES THAT ARE WELCOMING A NEW BABY!
Imagine how amazing maternity care could be if all of the various styles of providers were able and willing to collaborate with each other!
Imagine the ease of necessary transfers.
Imagine being able to have hassle free consults with other providers.
Across the board, all variations of midwives and OBs have one very strong commonality- we are in it to see healthy mothers and babies.
Instead, we see divisiveness. One trying to get rid of the other. Hospital based doctors against midwives, midwives against doctors, and midwives against midwives… No wonder we have such a maternity care crisis in the US.
Mandatory midwifery licensure, and the costs that are incurred, decreases access to care. Not lack of insurance.
Mandatory midwifery licensure ensures that only those with the ability to pay for “approved educational programs” will become licensed midwives. This decreases access to People of Color, people of low income and other marginalized groups of people to become midwives and serve their communities.
This in turn decreases access of midwifery care, and increases cost for everyone. If the cost of the education, the certification fees, the costs of Continued Education Units, the licensure fees, the malpractice insurance some states require for licensed midwives is high, which it is; these costs are passed down to the clients that midwives serve. This decreases access to care.
Insurance companies, who often refuse to pay midwives, unless the care given fits the rules and regulations (also known as the ever narrowing window of “normal, low risk pregnancy and birth”), will not pay your midwife, and even then, they pay less than what her fee is, leaving the remainder to be paid by the client. Many of these insurance companies (state insurance included) won’t even cover services provided by a Traditional Midwife. This decreases access to care.
Mandatory Midwifery Licensure decreases access to care.
Mandatory Midwifery Licensure, historically, has decreased not only access to care, but also decreases midwives available for families to choose from.
This is the one that boggles my mind.
The history of midwifery in the US, is a tale of woe. Midwives were all but wiped out in the US. By the 1960’s the only midwives readily available were few and far between and hard to find, if not impossible in some areas of the Nation. Why is that, you may ask?
Because mandatory licensure of the immigrant and Granny midwives in the early 1900’s through 1930’s, rounded up all of those midwives that were fooled into believing that it was going to increase access to care, better educational and training opportunities, and eliminated their ability to serve families. By making them illegal.
This is the mind-boggling part. Mandatory licensure all but wiped out community based midwifery care in the US!
So why is the big push for licensure happening? How is a group of such intelligent, amazing, educated people being fooled into this, AGAIN? I know that the history of midwifery is required for all midwifery education programs, so why are we seeing history repeat itself? Why are we seeing more and more and more midwives jumping on the mandatory licensure bandwagon?
Sadly this is not something that is going to be changed in the midwifery community. As more and more midwives seek professional validation, we are going to see a repeat of history.
It is up to those that hire midwives to attend them. It is up to the families to rally and make this change. Even those that wouldn’t choose a home or freestanding birth center birth. Even those that choose to birth unassisted, even those that choose an elective cesarean. I ask those people, what if the tables were turned? What if you were FORCED to birth in a way that was not what you chose? What if you were forced to birth at home with a midwife and only able to see a doctor after a referral for a complication? What if you were denied your elective c-section because you just didn’t have enough complicating factors to warrant one?
Mandatory licensure, historically, and now, is a slippery slope to removing choices, options in care and access to maternity care.
It is time for women and their families to stand up and say: “We are intelligent and responsible enough to choose whatever care provider works best with my needs and wishes regarding MY birth!”
This needs to start happening now, even if you dont feel like it will effect you. It will pour down upon your daughters and nieces and younger sisters and granddaughters.
Sister to Sister Birth 