10 Truths Your Midwife Won't Tell You

Disclaimer: This is an article addressing the shortcomings and pitfalls of the current American midwifery system- most notably, laypersons such as Direct Entry Midwives (DEMs) and Certified Professional Midwives (CPMs). I fully support women who dedicate themselves to TRUE education and birth safety like CNMs (Certified Nurse Midwives).

I'm not required to obtain any education- not even a GED.

All I have to do is find a preceptor, observe 20 births, 20 initial prenatal visits, 20 newborn exams, 55 other prenatal exams, and 40 postpartum exams- which is why I typically start my career as a doula- I can get paid to observe while I intern! I also have to pass a written skills test to obtain my license. After I pass, I am considered to have achieved an "education" equal to the Midwifery Education Accredited Council training. I'm all for less work and the equal priviledges!

I do not have to carry malpractice insurance, even though it is available.

Malpractice insurance is expensive! And although it only takes one phone call to find an insurance company who offers to accept midwives, if state law doesn't require me to have it, I ain't gonna pay for it! Plus, it really benefits ME not to have malpractice insurance. Good luck finding a lawyer who will accept your malpractice case against a care provider who has no malpractice insurance!

I am an independent care provider- I have NO legal requirements for physician backup or oversight.

That emergency plan we have in case of a need to transfer from the home to the hospital? Yea, it's really just to make you feel better and to protect myself. There is no physician back up for you whatsoever- save the OB who is already on call at the hospital. The hospital is really just my dumping ground. Our emergency plan is just to get you there.

I could be lying about my emergency transfer and cesearean rate and you would not know the difference.

When interviewed by clients, I'm always asked about the transfer rate. Eh, "about 10%," is typically my response. But really, I'm not required to keep track. I can submit data to MANA, but only if the expecting couple sign a consent form. Otherwise, no one else is keeping track of me!

I don't have to complete any form of continuing education in midwifery.

Not surprising, considering I'm not required any formal education in the first place. It's birth- what could possibly change when I have no access to technology outside of a fetoscope or doppler anyway?

I typically don't have access to sterilizing equipment such as an autoclave for my birth instruments, so don't think my instruments are clean.

I like to boil things, bleach them, bake them- but don't ask me to spend the money and time on an autoclave. Bloodborne pathogens and OSHA got nothin' on me!

I do not have to adhere to HIPAA guidelines or the Privacy Act.

Only health care providers who "transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard," are considered covered entities. So don't be surprised when I tell all my other clients that you pooped while pushing! Or if you happen to file a complaint against me, I can rally my troops against you!

I can still practice midwifery if someone has filed a complaint against my license- even while I'm being investigated by the state.

Yep- it's great for me, because it's possible that after the investigation is completed, I may lose my license. But being able to still practice while being investigated- that investigation can take years! Sounds like a retirement plan to me!

The state will only investigate a homebirth loss or injury if a complaint is filed.

And I make sure to maintain the ultimate friendship with my clients. Since I'm not required to have insurance- I make my relationship with my clients my insurance! Typically, they harbor so much guilt, they don't think of ruffling too many feathers. It's great to work in a field where there are social networking sites that ostracize birth loss mothers for not trusting their bodies enough. Mrs. Birth Without Fear is GREAT insurance- if you keep the blame on mothers, DORA can't scrutinize my actions- after all, it's the mother who wanted a homebirth in the first place!

I can still practice midwifery with blood on my hands.

I may have contributed to a few deaths, but hey- death is a part of life and birth is as safe as life, right?